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Introduced by Senator Rivers of Windsor County

Referred to Committee on


Subject: Health; health policy council

Statement of purpose: This bill proposes to reestablish the health policy council to conduct public hearings and make recommendations to the commissioner of banking, insurance, securities, and health care administration in connection with the development of the state health plan, and in connection with certificate of need and hospital budget review proceedings.


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

Sec. 1. 18 V.S.A. § 9402(11) is amended to read:

(11) "*[Public oversight commission]* Health policy council" means the *[commission]* council established in section 9407 of this title.

Sec. 2. 18 V.S.A. § 9407 is amended to read:

§ 9407. *[Public oversight commission]* Health policy

council; technical panel

(a) *[With the advice and consent of the senate, the governor shall appoint a public oversight commission to be composed of 13 members who shall reflect in the broadest sense the various health care needs and the demographic and geographic diversity of the state of Vermont. Nine members shall be sitting members, and four members shall be designated alternates to be assigned to create a quorum or to replace any sitting member who has a conflict of interest. The governor shall appoint a chair. Members of the commission shall be appointed for staggered terms of three years and shall serve no more than two consecutive terms. The commission shall review hospital budgets and certificate of need applications and make recommendations thereon to the commissioner. ]*

(1) There is created a health policy council. The council shall be a part of the department and shall serve in an advisory capacity to the commissioner. The council shall consist of 26 members who shall be residents of the state of Vermont. Eighteen members shall be appointed by the governor. Members appointed by the governor, except at-large members, shall be appointed from a list of three nominees for each membership category submitted in accordance with the provisions of subdivision (6) of this subsection. Prior to making an appointment, the governor may, in his or her discretion, request a new list of nominees for any category. Nominations by the council and appointment by the governor shall be made in a manner designed to ensure representation from all geographic areas of the state.

(2) The governor shall appoint one provider member from each of the following categories: physicians, hospitals, nurses, dentists, the allied health professions, third party payers, providers of mental health services, long-term health care facilities, and providers of community health services.

(3) The governor shall appoint one public member from each of the following categories: low income Vermonters, the elderly, the handicapped, labor, and environmental health; two public members representing major purchasers of health care from the private sector; and two at-large members.

(4) Four members shall be members of the general assembly. Two shall be senators appointed by the committee on committees of the senate; two shall be representatives appointed by the speaker of the house of representatives.

(5) Of the remaining four members, three shall be the secretary of human services, the dean of the college of medicine at the University of Vermont, and a representative of the department of health, or their designees; the fourth member shall be the director of the Veterans’ Administration center in Vermont, or his or her designee, who shall be a nonvoting member.

(6) A council membership committee shall be established for purposes of initiating the selection of representatives from categories enumerated in subdivisions (2) and (3) of this subsection. For the purpose of convening the initial nomination meeting, the council membership committee shall notify organizations of which it is aware in each category and shall, through notices published in the manner prescribed in section 839 of Title 3, invite additional organizations to participate. The council membership committee shall decline to accept an organization whose stated purposes do not coincide with the interests of the designated constituency, but no organization shall be excluded for any other reason. A grievance procedure for organizations excluded under this section shall be established by council rule. The council membership committee shall also adopt temporary rules for the organizational meetings of nominating committees. Thereafter, the nominating committees may adopt their own rules of procedure, provided that all matters to be decided by a nominating committee shall be decided by a majority vote of individuals present at a duly warned and convened meeting, and not by a majority of organizations represented, and provided that nominees shall be limited to members of categories to be represented.

(7) Members who are members of the general assembly shall be appointed for two years or until their successors are appointed, beginning February 15 in the first year of each biennium. The other members shall be appointed for three years or until their successors are appointed, beginning February 15 in the year in which the appointments are made. No member may serve for more than six years, whether or not consecutive.

(8) In the event of a vacancy occurring in the membership of the council, the vacancy shall be filled in the same manner as the original appointment with a person whose appointment shall terminate on the date on

which the original appointment would have terminated if the vacancy had not occurred.

(b)(1) The council shall elect a chair and vice chair from its membership who shall serve for one year or until their successors are elected.

(2) A majority of the members of the council shall constitute a quorum, provided that seven of the members present are public members. The council shall act only by vote of a majority of its members present and voting at a meeting called upon adequate notice to all its members and at which a quorum is in attendance.

(3) Members of the council, except for legislative members while the general assembly is in session, shall be entitled to a per diem in the amount provided in section 1010 of Title 32 and their necessary and actual expenses.

(c) The council shall:

(1) Advise the commissioner on matters relating to the commissioner’s responsibilities.

(2) Carry out special studies or projects related to health care or the duties of the commissioner as requested by the commissioner, including the assessment of the need for and appropriate distribution of services and technologies.

(3) On or before January 15, 2002, and every third year thereafter, recommend a state health plan to the secretary of human services, in accordance with section 9405 of this title. The plan shall identify the health care, facility, and human resource needs in Vermont, the resources available to meet those needs, and priorities for addressing those needs on a statewide basis.

(A) The plan shall include:

(i) A statement of principles used in the allocation of resources and in establishing priorities for health services.

(ii) Identification of the current supply and distribution of hospital, nursing home, and other inpatient services; home health and mental health services; treatment services for alcohol and drug abuse; emergency care; ambulatory care services, including primary care resources; human resources; major medical equipment; and health screening and early intervention services.

(iii) A determination of the appropriate supply and distribution of the resources and services identified in subdivision (ii) of this subdivision (A), and mechanisms which will encourage the appropriate integration of these services on a local or regional basis. To arrive at such determination, the council shall consider the following factors: the needs of the population on a statewide basis; the needs of particular geographic areas of the state; the use of Vermont facilities by out-of-state residents; the use of out-of-state facilities by Vermont residents; the needs of populations with special health care needs; the desirability of providing high quality services in an economical and efficient manner, including the appropriate use of mid-level practitioners; and the cost impact of these resource requirements on health care expenditures.

(iv) A component which addresses health promotion and disease prevention prepared by the department of health in a format established by the authority.

(B) In the preparation of the plan, the council shall conduct at least three public hearings, in different regions of the state, on the plan as proposed, and shall give interested persons an opportunity to submit their views orally and in writing. To the extent possible, the council shall arrange for hearings to be broadcast on interactive television. Not less than 30 days prior to any such hearing, the authority shall publish in the manner prescribed in section 839 of Title 3, the time and place of the hearing, the place at which interested persons may review the plan in advance of the hearing, and the place and period during which to direct written comment to the council.

(4) Review and make recommendations concerning the expenditure target or the unified health care budget proposed by the commissioner as provided in section 9406 of this title.

(5) Make recommendations to the commissioner in connection with any certificate of need application under section 9440 of this title.

(6) Make recommendations to the commissioner in connection with any hospital budget review under section 9456 of this title.


(b)]*(d)(1) The commissioner shall appoint a technical panel to be composed of nine members and shall designate a chair. The panel shall include experts in medicine, law, business, hospital administration, economics and consumer health care issues. The technical panel shall advise the public oversight commission and the commissioner on technical matters arising under this chapter relating to the unified health care budget, resource allocation, utilization review recommendations, hospital budgets, quality assurance, the state health plan, and make recommendations regarding amendments to the health resource management plan and any other matter the commissioner may deem appropriate. The commissioner may impanel additional members as needed to advise on specific technical issues, who shall not serve as permanent members.


(c)]*(2) Members of the *[public oversight commission and members of the]* technical panel shall be compensated as provided in 32 V.S.A. § 1010(b)

and (c).

(e) As used in this section:

(1) "Mid-level practitioner" includes physicians’ assistants, nurse practitioners, and certified nurse midwives.

(2) "Provider" means an individual:

(A) who is a direct provider of health care (including a physician, dentist, nurse, podiatrist, physician assistant, or ancillary personnel employed under the supervision of a physician) in that the individual’s primary current activity is the provision of health care to individuals or the administration of facilities or institutions (including hospitals, long-term care facilities, rehabilitation facilities, alcohol and drug abuse treatment facilities, outpatient facilities, and health maintenance organizations) in which such care is provided and, when required by law, the individual has received professional training in the provision of such care or in such administration and is accordingly licensed or certified; or

(B) who is an indirect provider of health care in that he or she:

(i) holds a fiduciary position with, or has a fiduciary interest in, any entity described in subdivision (II) or (IV) of subdivision (ii) of this subdivision (B), provided that this subdivision shall not apply to a board member of an entity described in Section 501(c)(3) of the Internal Revenue Code of 1954, as amended, so long as the person is not otherwise a provider;

(ii) receives either directly or through his or her spouse more than one-fifth of his or her gross annual income from any one or combination of the following:

(I) Fees or other compensation for research into or instruction in the provision of health care;

(II) Entities engaged in the provision of health care or in research or instruction in the provision of health care;

(III) Producing or supplying drugs or other articles for individuals or entities for use in the provision of or in research into or instruction in the provision of health care;

(IV) Entities engaged in producing drugs or such other articles;

(C) who is a member of the immediate family of an individual described in this subdivision; or

(D) who is engaged in issuing any policy or contract of individual or group health insurance or hospital or medical service benefits.

(3) "Public member" means an individual who represents the public and who is not a provider.

(4) "Third party payer" means any health insurer or nonprofit hospital or medical insurance corporation as defined in Title 8.

Sec. 3. 18 V.S.A. § 9433(c) is amended to read:

(c) The commissioner shall consult with hospitals, nursing homes and professional associations and societies, *[the public oversight commission]* the health policy council, the technical panel, the secretary of human services and other interested parties in matters of policy affecting the administration of this subchapter.

Sec. 4. 18 V.S.A. § 9440(c) is amended to read:

(c) The review process shall be as follows:

(1) The *[public oversight commission]* health policy council shall review the application materials provided by the applicant and the arguments raised in favor of or against the proposal, if any, and may request the technical panel's advice, recommendations and comments on the merits of the application.

(2) The *[public oversight commission]* health policy council shall hold a public hearing during the course of a review if requested by persons directly affected by the review.

(3) A review shall be completed and the commissioner shall make a decision within 120 days after the date of notification under subdivision (b)(4) of this section. Whenever it is not practicable to complete a review within 120 days, the commissioner may extend the review period up to an additional 30 days. Any review period may be extended with the written consent of all applicants.

(4) After reviewing each application and after considering the recommendations of the *[public oversight commission]* health policy council, the commissioner shall make a decision either to issue a certificate of need or to deny the application for a certificate of need. Notice of the decision shall be sent to the applicant. This notice shall state the basis of the decision.

Sec. 5. 18 V.S.A. § 9456(b)(8) and (d) are amended to read:

(b) In conjunction with budget reviews, the commissioner shall:

* * *

(8) seek the advice and recommendations of the *[public oversight commission]* health policy council.

(d) Beginning October 1, 1996, and annually thereafter, the commissioner shall consider the recommendations of the *[public oversight commission]* health policy council and*[,]* establish a budget for each hospital, and each hospital shall operate within the budget established under this section.