Sen. James Leddy, Co-Chair, Rep. John Patrick Tracy, Co-Chair, Rep. Janet Ancel, Sen. Ann Cummings, Sen. M. Jane Kitchel, Rep. Steven Maier, Rep. Francis “Topper” McFaun, Sen. Kevin Mullin, John  Bloomer, Jr., Walter Freed

MEMBERS ABSENT:

None

Also Present:

Legislative and Joint Fiscal staff, Members of the Administration, the press, and the public

Meeting Recorded:

CD No. 06-1-3

Documents Distributed:

Overview of Coordination Across Vermont’s Chronic Care Management Initiatives, 9/26/06 – Susan Besio, Director of Health Care Reform Implementation

1)         Convene 

           Senator Leddy and Representative Tracy convened the meeting at 9:30 a.m. in Room 11 at the Statehouse, Montpelier, Vermont.

2)                  Update on national interest in Catamount

Sen. Leddy updated the members of the committee regarding a conference he attended in Chicago of public pension trustees and managers for a major California State Employees Group.  Dr. Ken Thorpe was a keynote speaker and he outlined areas that need to be included in any plan that will address areas in healthcare. 

Overall, there were a lot questions and interest in what Vermont has done.  Ms. Susan Besio will be providing an update on the meeting with Representatives of the Robert Wood Johnson and the Academy Health Foundation.  Several Vermont legislators attended the meeting.   

In conclusion, because Vermont is getting a lot of attention, Sen. Leddy thought we might get some help and assistance in moving forward with implementation.

3)                  Implementation

a)         BISHCA Update – Christine Oliver, Deputy Commissioner, Health Care Administration

ü                  Catamount Rules - There was one objection raised in which the rule was modified.  The rule was based on the voluntary/involuntary loss of employment.  Once the rule was modified, LCAR withdrew the objections and adopted the rule as modified.  It was filed on September 8, 2006.  BISHCA expects the letters of intent from the carriers by October 9, 2006. 

ü                 Pilot Program, Sorry Works! - The statute called for rules by October 1, 2006.  Only one hospital is interested in the program as designed in the Act, but the hospital’s insurance carrier has not agreed to allow the hospital to participate.  Since participation cannot be mandated by BISHCA under the Act, BISHCA is working with hospitals to determine whether they would be interested if the program were to be modified.  BISHCA will come back to the legislature next session with ideas to foster participation.    

b)         General Update– Susan Besio, Director of Health Care Reform Implementation

ü                  Date for Community Health Grants RFP - On September 20, 2006, the RFP was posted on the state RFP website and the Vermont Business Registry website (www.vermontbusinessregistry.com.) Responses are requested by October 20,  2006. 

ü                CMS Amendment Waiver Request - The waiver amendment request was submitted to CMS on September 11, 2006, there is a 90-day period for CMS to respond with questions, a formal response, or both.  Ms. Besio said that the State will be in contact with CMS in the next week or two about the status of the document.  

ü                Employer Contributions Rules – Ms. Besio passed out a revised timeline which identifies where the rules are posted.  The rules were filed with ICAR on September 14, 2006.  The published rules will be September 28, 2006 and October 5, 2006.  The meetings will be open to the public.  The Department of Labor will be sending out a notice.

ü                  Common Claims Work Plan – The Act requires the Common Claims Work Group to report to the House Health Care and Sen. Health and Welfare Committees by September 1, 2006 with a two year work plan and budget.  The report was submitted on time and includes a specific list of tasks to be addressed over the next two years.  Additional funds will be needed to help conduct focus groups.  

ü                  Robert Wood Johnson Foundation State Coverage Initiatives – There was a recent meeting with Alice Burton of the Academy Health State Coverage Initiatives Program and the Robert Wood Johnson Foundation.  Sen. Mullin, Rep. Tracy and Sen. Kitchel and Catherine Benham attended the meeting. Some of the ideas for possible funding that were discussed were:

ü                  employer sponsored insurance (ESI) database and how to develop the program and the cost effectiveness test 

ü                  how to work with the carriers to see if the state can get access to employer health plan information. 

ü                  develop an overpayment recovery design and cost effectiveness evaluation for Catamount

ü                  coordinated outreach and education strategy re: the various insurance products and premium assistance options.

Rep. Maier would like an update on the components of the CHAMP program next month. Ms. Besio said that Barbara Cimaglio is the lead and she will ask her to come to the next meeting.

 c)       Premium Assistance Design – Betsy Forrest, OVHA – Currently OVHA is doing a survey of VHAP beneficiaries to determine how many have access to ESI.  The results should be completed by the end of the first week in October.  Then an analysis has to be done that estimates how many ESI plans are going to be cost-effective, any savings that can be achieved by moving people into the ESI program,  and the budgetary impact for fiscal year 2008.

            OVHA has proposed delaying its analysis of whether children should be included in the ESI programs.  It would be beneficial to implement the program for adults first.  A delay in the analysis would not be detrimental for any child, because the children at issue are now eligible for Dr. Dynosaur.  Also, delaying the analysis on children would allow OVHA to do more thorough work.  The analysis is hoped to be completed by January 2007.

The administration needs to make a decision on the basic program design for the premium assistances programs by the end of this week because a premium assistance workgroup will be doing detail system design beginning in October.   

Ms Forrest stated that there have been meetings to review ESI Payment Options with JFO, groups representing employers, low income housing advocates, and representatives from BC/BS and MVP. 

The administration feels that the options that they are leaning toward are the best options for all the different groups.

The first option is for individuals enrolled in employer sponsored insurance program.  The Employee would pay his/her share of the premium directly through payroll deduction through the employer and the State would then pay the employee for the state share of the premium prospectively at the beginning of each month.   This option has been successful in most of the states.  This option doesn’t require employers to modify payroll and accounting systems.  This option also works best for beneficiaries.

Sen. Leddy asked Ms. Forrest how she would deal with the employee’s contribution being pre-taxed and then getting a subsidy.  Sen. Leddy explained, when their employee share is withheld from payroll they are not paying taxes but then they are going to receive a subsidy from the state and he presumes this would be taxable.

Ms Forrest wasn’t thinking that the subsidy from the state would be taxable, this is an issue in need of further research with the legal counsel, tax department and other states.  Mr. Forrest will provide and update to the members of the committee.

Ms. Forrest updated the members of the committee on the beneficiary share for each of the programs.  She indicated that the Act defines premiums for people on VHAP in that it says that if someone is eligible for VHAP and moving into an ESI plan, they won’t pay a premium amount any greater than what they would pay by staying on VHAP.  It also sets the beneficiary share of the Catamount Health Assistance Program Premiums.  However, it is not a directive regarding the beneficiary share of the premiums for people not eligible for VHAP but eligible for ESI premium assistance, which are those people between 150% and 300% of federal poverty level.  The administration determined the percentage of monthly income someone would pay for VHAP, ESI or Catamount Health Assistance Premium.  Ms. Forrest indicated that the administration’s conclusion was to set the ESI beneficiary shares at the same level as the Catamount health assistance premiums because this seemed the most equitable way to have the programs be comparable.   

In conclusion, Ms. Forrest looked to the members of the committee to comment on setting the ESI beneficiary shares. 

Mr. Dickey, JFO is doing an analysis of what other states are doing with the ESI program and will have a report done in October.

ü            Overview of Coordination

VITL

Susan Besio, Director of Health Care Reform Implementation, stated that they are continuing work on contracts between GE, VTIL and VDH.   They are still struggling with the relationship around “risk bearing” in each of the different contracts.  They are hoping to have an agreement by the end of this week.    

                        Chronic Care Coordination

Ms. Besio passed out a brief presentation giving a high level overview and a grid that will be part of the Blueprint strategic plan that shows some of the alignment across various programs.  The goal is to have all of the components across the state done by 2009.

Ms. Besio stated that the biggest issue is figuring out how to support providers and help them to see the benefits of the various entities.   The Vermont Department of Health will do outreach to providers to foster provider participation in the chronic care information system. 

The Blueprint Strategic Plan is due October 1, 2006 Workgroups are working on developing pieces of the plan in October thru December.  The final plan will be distributed in January 2007 and then annual and biennial reviews will take place.

OVHA RFP for Chronic Care

Mr. Donald Dicky from JFO indicated that Act 191 requires that the RFP for the Chronic Care Management Program be submitted to the HCRC for approval before the RFP is issued.  Mr. Dickey talked about the issues and the review process.  He said that the review process began with JFO and OVHA in May 2006 and identified key issues and then the RFP was completed in August and September.  The RFP went out to the providers and advocacy groups for their comment.

Mr. Dickey talked about the basic elements of the chronic care management program and he mentioned that monitoring evaluation and payment will be done by the agency with the vendor.  Mr. Dickey said that the intervention program will identify each risk group through a claims analysis and put the groups into the appropriate programs.  In conclusion, Mr. Dickey indicated that some of the key issues will be coordination with the Blueprint, measuring performance and a separate contract for health risk assessment and intervention vendors. 

Mr. Joshua Slen, Director of OVHA introduced Ms. Julie Trottier, MSA, Health Care Programs Administrator who is the project lead for the Chronic Care RFP.  OVHA’s concept is to collaborate and not put burdens on the provider communities.  Ms. Trottier stated that the legislation laid out ten program requirements, six mentioned the involvement of local providers and their roles and that an advisory board will be established that will include physician representation as well as other stakeholders.

MOTION:  Rep. Steve Maier moved to accept the Chronic Care Management Program RFP.  Sen. Kitchel seconded the motion.  The vote was 10-0-0.

MINUTES:  The minutes to the August 28, 2006 HCRC meeting were unanimously approved. 

UPCOMING MEETINGS: 

The Health Care Reform Commission Committee meetings are scheduled at the State House, Montpelier, Vermont on the following dates:

ü      Tuesday, October 24, 2006  at 9:30 a.m. in Room 11

ü      [Cancelled] Tuesday, November 21, 2006 at 9:00 a.m. in Room 10

ü      Wednesday, December 20, 2006 at 9:30 a.m. in Room 11

Minutes respectfully submitted by Lynn Hegamyer, Committee Assistant.