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NO. 14. AN ACT RELATING TO FINANCING OF HEALTH CARE.

(H.159)

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1. PURPOSE

Consistent with the goal of assuring universal access to health care benefits for all Vermonters, it is the purpose of this act to finance health care benefits for uninsured or underinsured low income Vermonters. To the extent permitted by appropriations, the revenues generated by this act will finance the existing Medicaid program and will increase the number of low income Vermonters with health benefits coverage, integrate certain publicly-funded beneficiaries into mainstream medical care, bring Medicaid beneficiaries into managed care plans, extend pharmaceutical benefits to low income elderly and disabled individuals, increase residential care, home and community based Medicaid waiver services, and enhance access to health care benefits paid under the Medicaid program by increasing reimbursement levels for physicians and other providers.

Sec. 2. 33 V.S.A. 1953(a) is amended to read:

(a) For the fiscal *[years]* year beginning *[July 1, 1993 and 1994]* July 1, 1994, each hospital's assessment shall be *[two]* 4.02 percent of its audited gross inpatient revenues for services to patients as reported by the hospital to the hospital data council or to the commissioner under subsection (e) of this section. The commissioner may for good cause exempt any mental hospital or psychiatric facility from assessment under this subchapter if the Secretary of the United States Department of Health and Human Services grants a waiver for such exemption, pursuant to section 1903(w)(3)(E)(ii) of the Social Security Act (42 U.S.C. 1396b(w)(3)(E)(ii)).

Sec. 3. 33 V.S.A. 1954(a) is amended to read:

(a) For the fiscal *[years]* year beginning *[July 1, 1993 and 1994]* July 1, 1994, each nursing home's annual assessment shall be *[$725.00]* $800.00 per bed licensed pursuant to section 7105 of this title on June 30 of the immediately preceding fiscal year*[, unless a waiver can be obtained from the Secretary of the United States Department of Health and Human Services, pursuant to section 1903(w)(3)(E)(ii) of the Social Security Act (42U.S.C. 1396b(w)(3)(E)(ii)) for a graduated tax, in which case the assessment shall be $675.00 per bed on the first 50 beds, $775.00 on the fifty-first to one hundredth bed, and $875.00 on all licensed beds more than 100]*. Beginning July 1, 1995, the annual assessment shall be $1,000.00 per bed. If federal approval of the home and community based demonstration project is not granted by January 1, 1996, the funds shall be held in escrow in the fund, and may be applied to a program with the same purpose of expanding community residential care.

Sec. 4. 33 V.S.A. 1956(a) and (b) are amended to read:

(a) The health care trust fund is hereby established in the state treasury. All assessments, including late-payment assessments, from health care providers under this subchapter shall be deposited in the fund. The proceeds of other taxes designated by law and donations may also be deposited in the fund. Interest earned on the fund and any remaining balance shall be retained in the fund for the purposes of this subchapter. The department shall maintain records showing the amount of money in the fund at any time.

(b) All monies received from or generated to the fund shall be used for the state portion of Medicaid expenditures and for administration of the provisions of this subchapter under subsection 1952(c) of this title. The net revenues generated by the $200.00 per bed increase in the annual assessment on nursing homes effective July 1, 1995, shall be used for residential care and home and community based Medicaid waiver services with half of the funding to be used for home and community based waiver slots to be developed within a demonstration project that is limited to licensed residential care homes.

Sec. 5. 32 V.S.A. chapter 230 is added to read:

CHAPTER 230. TAX ON TRANSFERORS OF NURSING HOMES

9530. DEFINITIONS

The following definitions shall apply throughout this chapter unless the context requires otherwise:

(1) "Beds" means the maximum number of beds for which a nursing home isrequired to be licensed under 33 V.S.A. 7103.

(2) "Commissioner" means the commissioner of social welfare.

(3) "Division" means the division of rate setting.

(4) "Nursing home" means an institution required to be licensed pursuant to 33 V.S.A. 7103.

(5) "Owner" means any natural person, association, trust, or corporation with an ownership interest in a nursing home.

(6) "Secretary" means the secretary of human services.

(7) "Transfer" means every sale or change of ownership of a Vermont nursing home whether effected by the transfer of stock, shares or assets, and after which the home will continue in operation.

(8) "Transferor" means the owner of a nursing home who by the transfer has been divested of an ownership interest in the home.

9531. TAX ON TRANSFEROR OF A NURSING HOME

A tax is hereby imposed upon the transferor of any nursing home located in this state. The tax shall be $500.00 for each bed required to be licensed as of the date of the transfer.

9532. EXEMPTIONS

The exemptions enumerated in section 9603 of this title relating to the property transfer tax, with the exception of subdivision (19), shall apply to the transferor tax, unless the commissioner finds that a significant reason for the structure of the transaction is to avoid the transferor tax. The exemption under section 9603(19) shall apply only if the transfer is made or is decreed by the court to be made without consideration. No reference to low income or affordable housing in section 9603 shall be construed to refer to nursing homes for purposes of the transferor tax.

9533. TAX LIABILITY, PAYMENT, AND ACKNOWLEDGEMENT

(a) The tax imposed by this chapter is the sole liability of the transferor and shall conclusively be presumed to have been paid by the transferor only.

(b) The tax shall be paid by the transferor to the department of social welfare within10 days after the date of the transfer, accompanied by the nursing home transferor tax form prescribed by the commissioner.

(c) A nursing home transferor tax return filing shall not be required for transferors exempted from the tax by section 9532 of this chapter.

(d) Notwithstanding anything to the contrary in 1 V.S.A. 317 and 32 V.S.A. 3102, tax return filings made pursuant to this chapter shall be public information, subject to disclosure pursuant to 1 V.S.A. 316.

(e) Upon the receipt of the full amount of the tax, the commissioner shall deposit receipts from the transferor tax in the health care trust fund established pursuant to 33 V.S.A. 1956 and shall send a certificate of payment to the transferor, the transferee, and the division showing the date when the tax was received.

9534. IMPLEMENTING RULES

The secretary may adopt rules necessary to implement the provisions of this chapter.

9535. REVIEW AND APPEALS

(a) At any time before, or within ten days after the date of a transfer of a nursing home, a transferor may request from the commissioner a determination of the transferor's liability to pay or the amount of the nursing home transfer tax due. The commissioner shall render a decision within 30 days of the receipt of all information that the commissioner deems necessary to make a determination.

(b) Within 30 days of the date of issuance of the commissioner's determination, a transferor aggrieved by that determination may request review by the secretary or the secretary's designee. This review shall not be subject to the provisions of 3 V.S.A. chapter 25.

Sec. 6. 32 V.S.A. 7771 is amended to read:

7771. RATE OF TAX

A tax is imposed on all cigarettes held in this state by any person for sale, such tax to be at the rate of *[ten]* 22 mills for each cigarette and the payment thereof to be evidenced by the affixing of stamps to the packages containing the cigarettes, as hereinafterprovided. Any cigarette on which the tax imposed by this chapter has been paid, such payment being evidenced by the affixing of such stamp, shall not be subject to a further tax under this chapter. Nothing contained in this chapter shall be construed to impose a tax on any transaction the taxation of which by this state is prohibited by the constitution of the United States. The amount of taxes advanced and paid by a licensed wholesale dealer or a retail dealer as herein provided shall be added to and collected as part of the retail sale price on the cigarettes. All taxes upon cigarettes under this chapter are declared to be a direct tax upon the consumer at retail and shall conclusively be presumed to be precollected for the purpose of convenience and facility only.

Sec. 7. 32 V.S.A. 7811 is amended to read:

7811. IMPOSITION OF TOBACCO PRODUCTS TAX

There is hereby imposed and shall be paid a tax on all tobacco products possessed in the state of Vermont by any person for sale on and after July 1, 1959 which were imported into the state or manufactured in the state after said date, except that no tax shall be imposed on tobacco products sold under such circumstances that this state is without power to impose such tax, or sold to the United States, or sold to or by a voluntary unincorporated organization of the armed forces of the United States operating a place for the sale of goods pursuant to regulations promulgated by the appropriate executive agency of the United States. Such tax on tobacco products shall be at the rate of *[twenty]* 41 percent of the wholesale price and is intended to be imposed only once upon any tobacco product. Provided, however, that upon payment of the tax within ten days, the distributor or dealer may deduct from the tax two percent of the tax due. It shall be presumed that all tobacco products within the state are subject to tax until the contrary is established and the burden of proof that any tobacco products are not taxable hereunder shall be upon the person in possession thereof. *[The net proceeds, as determined by the commissioner of taxes, of the tax on tobacco products imposed by this act shall be applied first to the general fund deficit as of June 30, 1959.]*

Sec. 8. 32 V.S.A. 7823 is added to read:

7823. TRANSFER OF REVENUE

The net revenue generated by the additional 12 mills of the tax on cigarettes and by the additional 21 percent of the rate of the tax on the wholesale price of tobacco products, determined by allowing for any decline in purchases of such products resulting from such tax increases, shall be transferred monthly to the Vermont health access fund established by subchapter 3 of chapter 19 of Title 33.

Sec. 9. 33 V.S.A. chapter 19, subchapter 3 is added to read:

Subchapter 3. Vermont Health Access Trust Fund

1971. DEFINITIONS

As used in this subchapter,

(1) "Agency" means the agency of human services.

(2) "Secretary" means the secretary of human services.

(3) "Office of health access" means the division of Medicaid within the agency of human services.

1972. VERMONT HEALTH ACCESS TRUST FUND ESTABLISHED

(a) The Vermont health access trust fund is hereby established in the state treasury for the purpose of establishing a health access program to finance health care coverage for uninsured or underinsured low income Vermonters pursuant to statutes or rules that expand medical assistance programs through a federal waiver or otherwise. Further purposes of this fund and the health access program are to increase the number of low income residents with health benefits coverage, integrate certain publicly-funded beneficiaries into mainstream medical care, bring Medicaid beneficiaries into managed care plans, extend pharmaceutical benefits to low income elderly and disabled individuals, enhance access to health care benefits paid under the Medicaid program by increasing reimbursement levels for physicians and other providers, and replace unanticipated reductions in federal Medicaid receipts resulting from federal action.

(b) The proceeds from grants, donations, contributions, and taxes and other sourcesof revenue as may be provided by statute or by rule may also be deposited in the fund. Interest earned on the fund and any remaining balance shall be retained in the fund. The department shall maintain records indicating the amount of money in the fund at any time.

(c) All monies received by or generated to the fund shall be used for the administration and delivery of the health access program and the medical assistance program.

(d) Consistent with the purposes for which the fund may be used, the general assembly shall appropriate funds from the fund to the agency of human services and its constituent departments, divisions, or offices, and to the health care authority.

(e) In the event the waiver is not granted by January 1, 1996, the increase in the rate of reimbursement to providers established on July 1, 1995, as provided in this act, shall continue, and commencing on January 1, 1996 payments under the pharmaceutical assistance program established under chapter 6 of Title 18 shall be set at a fifty percent subsidy.

Sec. 10. 32 V.S.A. 7814 is amended to read:

7814. FLOOR *[STOCKS]* STOCK TAX

*[A floor stocks tax is hereby imposed upon every wholesale dealer in this state, at the rate of twenty percent of the wholesale price of each tobacco product in his possession or under his control at 12:01 A.M. o'clock on July 1, 1959. Each wholesale dealer, on or before August 20, 1959, shall file a report to the commissioner in such form as the commissioner may prescribe showing the tobacco products on hand at 12:01 A.M. o'clock on July 1, 1959 and the amount of tax due thereon. The tax imposed by this section shall be due and payable on or before August 20, 1959 and thereafter shall bear interest at the rate of one percent per month. Provided, however, that upon payment of the tax within the time specified by this section, the distributor or dealer may deduct from the tax two percent of the tax due. Any tobacco product with respect to which a floor stocks tax has once been imposed and paid under this subchapter shall not again besubject to tax hereunder.]*

(a) Tobacco products. A floor stock tax is hereby imposed upon every retailer of tobacco products in this state at the rate of 21 percent of the wholesale price of each tobacco product. The tax shall apply to tobacco products in the possession or control of the retailer at 12:01 a.m. o'clock on July 1, 1995, but shall not apply to retailers who hold less than $500.00 in wholesale value of such tobacco products. Each retailer subject to the tax shall, on or before July 25, 1995, file a report to the commissioner in such form as the commissioner may prescribe showing the tobacco products on hand at 12:01 a.m. o'clock on July 1, 1995, and the amount of tax due thereon. The tax imposed by this section shall be due and payable on or before July 25, 1995, and thereafter shall bear interest at the rate established under section 3108 of this title. In case of timely payment of the tax, the retailer may deduct from the tax due two percent of the tax. Any tobacco product with respect to which a floor stock tax has been imposed and paid under this section shall not again be subject to tax under section 7811 of this title.

(b) Cigarettes. Notwithstanding the prohibition against further tax on stamped cigarettes under section 7771 of this title, a floor stock tax is hereby imposed upon every dealer of cigarettes in this state who is either a wholesaler, or a retailer who at 12:01 a.m. o'clock on July 1, 1995, has more than 10,000 cigarettes for retail sale in his or her possession or control. The rate of tax shall be 12 mills for each cigarette in the possession or control of the wholesaler or retailer at 12:01 a.m. o'clock on July 1, 1995, and on which cigarette stamps have been affixed before July 1, 1995. A floor stock tax is also imposed on each Vermont cigarette stamp in the possession or control of the wholesaler at 12:01 a.m. o'clock on July 1, 1995, and not yet affixed to a cigarette package, and the tax shall be at the rate of 24 cents per stamp. Each wholesaler and retailer subject to the tax shall, on or before July 25, 1995, file a report to the commissioner in such form as the commissioner may prescribe showing the cigarettes and stamps on hand at 12:01 a.m. o'clock on July 1, 1995, and the amount of tax due thereon. The tax imposed by this section shall be due and payable on or before July 25,1995, and thereafter shall bear interest at the rate established under section 3108 of this title. In case of timely payment of the tax, the wholesaler or retailer may deduct from the tax due two and three-tenths of one percent of the tax. Any cigarettes with respect to which a floor stock tax has been imposed under this section shall not again be subject to tax under section 7771 of this title.

Sec. 11. Sec. 4 of No. 56 of the Acts of 1993 is amended to read:

Sec. 4. EFFECTIVE DATE; REPEAL

(a) This act shall take effect from passage *[and shall terminate June 30, 1995]*.

(b) 33 V.S.A. 1953 (hospital assessment) and 1954 (nursing home assessment) are repealed effective July 1, 1997.

Sec. 12. TRANSITIONAL PROVISION

The secretary of human services is authorized to adopt rules to implement the amendments to the provider tax in Secs. 2, 3 and 4, the tax on transferors of nursing homes in Sec. 5, and the Vermont Health Access Trust Fund in Sec. 9 of this act. The secretary shall adopt a rule requiring that each individual who is eligible for enrollment in the health access program and is 18 years of age or older to pay an enrollment fee, not to exceed $20.00, at the time of each enrollment. All fees collected by the Vermont health access office for enrollment in the health access program shall be deposited in the Vermont Health Access Trust Fund.

Sec. 13. HEALTH ACCESS OVERSIGHT COMMITTEE; CREATION

(a) A legislative health access oversight committee is created to monitor the development, implementation, and ongoing operation of the health access program. The committee shall consist of ten members, five representatives, who shall not all be from the same party, and five senators, who shall not all be from the same party. The speaker of the house shall appoint the chair and two other members from the committee on health and welfare; one member from the committee on ways and means; and one member from the committee on appropriations. The committee on committees shall appoint the chair and two other members from the committee on health and welfare; one member from thecommittee on finance; and one member from the committee on appropriations.

(b) The committee shall elect a chair, vice-chair and clerk and may adopt rules to carry out its duties. The legislative council shall provide primary professional and administrative support to the committee, and additional assistance shall be provided by the department of banking, insurance, and securities, the agency of human services, and the Vermont health care authority.

(c) The committee shall meet at least once a month until July 1, 1996. For attendance at meetings which are held when the general assembly is not in session, the members of the committee shall be entitled to the same per diem compensation and reimbursement for necessary expenses as provided to members of standing committees under 2 V.S.A. 406.

(d) In order to fulfill its duties to monitor the development, implementation, and ongoing operation of the health access program, the committee shall consult with the following:

(1) Consumers regarding their satisfaction and complaints.

(2) Providers regarding their satisfaction and complaints.

(3) The Vermont health care authority.

(4) The department of banking, insurance, and securities.

(5) The agency of human services.

(6) The attorney general.

(7) The Vermont commission on public health care values and priorities.

(8) The Vermont program for quality in health care.

(9) Any other appropriate person.

(e) The office of Vermont health access shall submit to the committee monthly progress reports that shall include revenue and expenditures from the health access trust fund for the prior month, enrollment and projected enrollment, projected expenditures related to enrollment for the fiscal year, and the geographic and provider capacity of health plans to enroll beneficiaries.

(f) The committee shall report to the governor and the general assembly no later than December 1 of each year. The report shall include an evaluation of the strengths and weaknesses and successes and failures of the health access program; recommendations to improve the program; identification of out-of-pocket expenses borne by non-Medicaid eligible Medicare recipients and a detailed report on the operation of the health access program, including the number of participants enrolled, the number of participants projected, the cost of the program for each participant enrolled and projected; and a complete financial accounting of all receipts and expenditures from the health access trust fund and the Vermont Medicaid program under authority of this act.

Sec. 14. MEDICAL ASSISTANCE; VERMONT HEALTH ACCESS OFFICE;

HEALTH PLAN; REQUIREMENTS

(a) No contract of a health plan shall be approved by the office of Vermont health access unless the health plan provides the following which shall be consistent with applicable state and federal law:

(1) QUALITY ASSESSMENT AND QUALITY IMPROVEMENT PROCEDURES. A health plan shall establish criteria and implement procedures for quality assessment and quality improvement activities that evaluate, maintain, and improve the quality of the clinical services provided to covered persons. These functions shall be integrated with existing quality assessment and quality improvement procedures, internal and external, which are consistent with this plan as well as with other health plan functions, including provider credentialing, provider contracting, development of provider panels, utilization management, consumer grievances, risk management data reporting, and consumer satisfaction.

(2) GRIEVANCE PROCEDURES FOR CONSUMERS AND PROVIDERS. A health plan shall provide grievance procedures that insure timely resolution of disputes relating to the denial of services or denial of payment for benefits by a health care facility, health care provider, or health insurance carrier and that afford patients, carriers, facilities, and providers a timely opportunity to contest decisions made by the plan.Managed care enrollees shall have access to the general Medicaid fair hearing grievance procedures available to the fee-for-service consumers.

(3) CONFIDENTIALITY OF MEDICAL RECORDS. A health plan shall provide safeguards to protect the confidentiality and privacy rights of individuals.

(4) PROCEDURES TO PREVENT DISCRIMINATION. Eligible enrollees shall have access to all services offered under a health plan contract without discrimination based on disability, congenital condition, or health status, if those services are medically necessary.

(5) HEALTH CARE PROVIDER INVOLVEMENT. A health plan shall guarantee that health care providers actively participate in decisions regarding medical and financial issues related to patient care, reimbursement, and other matters that affect the quality of health care provided to patients. The plan shall insure that health care providers are fully informed regarding the parameters, limitations, criteria for referral to specialists, and patient benefits of the health plan for which they provide services and that the health care providers may serve as patient advocates.

(6) PHARMACEUTICAL BENEFITS. A health plan contract shall provide enrollees who are Medicare eligible full coverage for prescription drugs with the same copayment that categorically Medicaid eligible individuals are required to pay.

(7) PREVENTATIVE AND HEALTH MAINTENANCE SERVICES. A health plan contract shall include cost-effective health care services that will enable patients to maintain or improve their health status or prevent or reduce their need for medical care. The plan shall also provide consumers with forms for organ donation, living will, and durable power of attorney for health care and information about the advantages and benefits of executing such documents.

(8) FRAUD AND ABUSE CONTROL. A plan shall require its employees, contractors, and grantees which provide goods or services for the plan to furnish upon reasonable request to the office of health access and the attorney general any record, document, or other information necessary for a review, audit, or investigation of programfraud or abuse and shall establish a procedure to report all suspected fraud and abuse to the office of health access and the attorney general.

(9) ECONOMIC INCENTIVES AND DISINCENTIVES. A health plan shall disclose to the office of Vermont health access any economic incentives and disincentives that are contained in provider reimbursement policies.

(b) The office of Vermont health access shall make available the following:

(1) CONSUMER EDUCATION. The office of Vermont health access shall assure that consumers have access to comprehensive information regarding the benefits and disadvantages of all health plans available under the health access program in order to make an informed decision about which health plan best suits that consumer's needs and requirements.

(2) INDEPENDENT OMBUDSMAN SERVICES. The office of Vermont health access shall contract to provide ombudsman services to consumers.

(3) HEALTH CARE ACCESS. The office of Vermont health access shall maintain its responsibility to assure access to health care by reviewing health plan operations, including provider reimbursement policies since adequate provider reimbursement levels are one of the essential variables in achieving access to health care. The office shall involve health care providers, consumers, and their representatives in the review.

(c) For the purposes of this section, "health plan" means an insurance company, non-profit hospital and medical service corporation, health maintenance organization, or any other similar entity that provides health care services to a group of individuals.

Sec. 15. REDUCTION IN MEDICAID PROGRAM; PROPORTIONAL REDUCTION

(a) The purposes of this act may not be accomplished through any reduction in eligibility or current benefit levels or services provided under the existing Vermont Medicaid program, nor shall a federal waiver or health access program established under this act be premised on such reductions. Existing eligibility, benefits, or services provided through a managed care delivery system shall not be construed to be a reductionprohibited by this section.

(b) Any reduction in federal Medicaid receipts resulting from federal action shall be fairly and proportionally distributed among:

(1) all Medicaid recipients regardless of the basis for eligibility, consistent with applicable federal laws;

(2) health care providers; and

(3) administrative costs.

Sec. 16. HEALTH ACCESS PROGRAM; LIMITATIONS; IMPLEMENTATION

(a) Enrollment in the health access program shall be limited by the amount of money available for that purpose in the Vermont Health Access Trust Fund established in Sec. 9 of this act. The office of Vermont health access shall track enrollment on a monthly basis to assure that enrollment does not exceed either appropriations or the capacity of the health plan to serve enrollees.

(b) The oversight committee shall monitor the implementation of the health access program as required in Sec. 13 of this act.

(c) The integration of Medicaid beneficiaries into managed care plans shall proceed on an earlier schedule to the extent plan capacity to serve beneficiaries expands.

Sec. 17. TRANSFER OF POSITIONS; POSITIONS AUTHORIZED

(a) Effective upon passage, the following positions shall be transferred from the health care authority to the department of social welfare:

(1) two (2) vacant positions from the Vermont health care authority, positions 527001 and 527002, to be converted to managed care program director and senior managed care administrator;

(2) one (1) position, position 527006, and the incumbent employee and an appropriation amount from personal services to support this transfer for the remainder of the fiscal year and for fiscal year 1996.

(b) In fiscal year 1996, the following positions shall be transferred and converted from areas of government to be determined by the secretary of administration to fill thefollowing roles in the department of social welfare:

(1) two (2) managed care administrators;

(2) one (1) business manager or accountant;

(3) one (1) administrative assistant;

(4) one (1) income maintenance supervisor;

(5) two (2) income maintenance specialists;

(6) one (1) clerical C.

Sec. 18. APPROPRIATION

(a) For the purpose of the health access program authorized by this act, there is appropriated to the department of social welfare for fiscal year 1996, the following amounts:

Medicaid grants $15,347,920.00

Source of funds

Federal funds $ 9,251,152.00

Special funds $ 6,096,768.00

Total $15,347,920.00

Administration

Personal services $ 457,161.00

Operating expenses $ 3,376,000.00

Total $ 3,833,161.00

Source of funds

Federal funds $ 2,154,080.00

Special funds $ 1,679,081.00

Total $ 3,833,161.00

(b) The amounts appropriated in this section for Medicaid grants, including all special and federal funds, are in addition to any amounts otherwise appropriated for Medicaid grants in fiscal year 1996. The special funds appropriated by this section are from the Vermont Health Access Fund established by 33 V.S.A. 1972.

(c) Of the funds appropriated by this section from the Vermont Health Access Fund, the following amounts shall be expended:

(1) $2,730,000.00 shall fund an increase in the Medicaid reimbursement rate for physicians;

(2) $400,000.00 shall fund an increase in the Medicaid reimbursement rate for dentists;

(3) $1,480,000.00 shall be transferred to the department of social welfare to provide additional funding to the EPSDT program as defined in 42 U.S.C. 139(a)(B)(4);

(4) $1,486,768.00 shall be expended for the Medicaid pharmacy program and for the uninsured under 100 percent of poverty program; and

(5) $1,679,081.00 shall be expended for program administration, of which $50,000.00 shall be expended for the survey on public health values and priorities.

(d) In addition to the above, the following additional amounts are appropriated annually from the Vermont Health Access Fund:

(1) $150,000.00 is appropriated to the department of health to fund the loan repayment program for the recruitment of primary care providers;

(2) $380,000.00 is appropriated to the department of social welfare to fund the pharmaceutical assistance program established in chapter 6 of Title 18.

Sec. 19. EFFECTIVE DATE

This act shall take effect from passage with the following exceptions:

(1) Sec. 6 shall apply to cigarettes held by wholesale dealers on and after July 1, 1995;

(2) Sec. 7 shall apply to tobacco products held by distributors and dealers on and after July 1, 1995; and

(3) Secs. 8 and 9 shall take effect July 1, 1995.

Approved: April 12, 1995