H.861 AN ACT RELATED TO HEALTH CARE

AFFORDABILITY FOR VERMONTERS

 

SECTION-BY-SECTION SUMMARY

BILL AS PASSED THE HOUSE

 

Sec. 1.  Health Care Reform Principles

Adopts guidelines modeled after the Coalition 21 principles

Sec. 2.  Legislative Purpose And Intent

  • Legislative intent that all Vermonters receive affordable and appropriate health care at the appropriate time and that health care costs be contained over time.
    • First steps:
      • Prevention and management of chronic disease
      • Coverage of uninsured through catamount health
  • Legislative intent to ensure that any reduction in the cost shift is returned to consumers by slowing the rate of growth in insurance premiums. Raising Medicaid payment rates and reducing the number of uninsured will reduce the cost shift

Sec. 3.  Health Care System Reform - Coordination

  • Establishes the secretary of administration with general assembly as responsible for the coordination of health care system reform
  • Defines reform initiatives as:
    • Blueprint for Health (chronic care infrastructure, disease prevention, and management)
    • Information technology initiatives
      • Vermont health information technology project (VITL)
      • Multi-payer data collection project
      • Common claims administration project
      • Consumer price and quality information system
    • Public health initiatives
    • Medicaid, VHAP, Dr. Dynasaur, VPharm, and Vermont Rx
    • Catamount health
  • Requires a report, including five-year strategic plan, by secretary to commission on health care reform, health access oversight, house health care, senate health and welfare, and governor by December 1, 2006
  • Provides for annual report starting January 15, 2007

Chronic Care Infrastructure and Prevention

Sec. 4.  Blueprint for Health

  • Endorses and builds on Blueprint for Health, chronic care and disease prevention initiative
  • Requests revised strategic plan by October 1, 2006
  • Requires fully designed model for patient registry by January 1, 2007

Sec. 5.  Chronic Care Infrastructure and Prevention

  • 701.  Definitions
    • chronic care
    • chronic care management
    • health risk assessment
  • 702.  Blueprint for Health; Strategic Plan
    • requires the department of health to create a five-year strategic plan
    • establishes an executive committee to advise the commissioner
    • provides criteria to be included in the strategic plan:
      • description of the Blueprint, including standard elements to used statewide
      • description of prevention programs
      • plan to develop and implement reimbursement systems aligned with chronic disease management
      • involvement of public and private parties
      • alignment of information technology needs
      • use and development of outcome measures and reporting requirements
      • target timelines
      • strategy for ensuring statewide participation no later than January 1, 2009
    • reviews the plan biennially and report of amendments to general assembly
    • reports by the department quarterly
    • recommendations in January 2009 if statewide participation is not achieved
  • 703.  Request for Proposals
    • requires secretary of administration to issue an RFP no later than January 1, 2007 for:
      • individuals with chronic disease in Medicaid, VHAP, and Dr. Dynasaur
      • individuals enrolled in catamount health
    • allows secretary to target chronic care management to certain groups to ensure successful implementation and quality of services and to maximize cost savings
      • includes all individuals in catamount health upon enrollment
      • allows time period of phased-in implementation for current individuals in Medicaid, VHAP, and Dr. Dynasaur
      • directs secretary to apply for Medicare waiver to include dual eligibles
    • provides for broad range of chronic conditions to be included
    • requires proposals to include:
      • methods for identifying patients
      • processes for coordinating care
      • methods of increasing communication among health care professionals and patients
      • protocols and tools for educational, wellness, and clinical management
      • process and outcome measures
      • payment methodologies creating financial incentives to improve disease management
      • payment to the care management organization which guarantees savings or risks its fee
    • requires the commission on health care to review RFP before it is issued

Sec. 6.  Chronic Disease Prevention and Care Management; Agency of Human Services

  • Establishes an implementation plan for compliance with Blueprint and RFP by January 1, 2007
  • Allows agency to provide additional care coordination services (Medicaid top 1% initiative)
  • Ensures payment methods are aligned with Blueprint and RFP
  • Establishes only annual recertifications in existing health care programs

Sec. 7.  Chronic Disease Prevention and Care Management; State Employees

  • Requires human resources to seek information on chronic care management and Blueprint participation in RFP for state employees’ health benefit plan
  • Provides that human resources and VSEA work with the secretary of administration on how to be included in the Blueprint

Medicaid Initiatives

Sec. 8.  Medicaid Reimbursement

  • Increases Medicaid reimbursement for primary care services to Medicare levels in FY 2007
  • Provides intent to link future increase in reimbursements to Blueprint standards

Sec. 9.  Hospital Service Area Pilot Projects

  • Provides for an RFP by OVHA and DOH in two hospital service areas
  • Establishes goal of pilots to integrate and improve collaboration among health care professionals and community partners
  • Provides incentive grants of $100,000

Sec. 10.  VHAP Premiums

Reduces current VHAP premiums by 35% to increase enrollment

Sec. 11.  Dr. Dynasaur Premiums

Reduces current Dr. Dynsaur premiums to increase enrollment

Private Insurance Cost Shift Reviews

Sec. 12.  Cost Shift Review

Requires BISHCA to ensure for appropriate reductions in cost shift due to increased Medicaid rates and reduction in bad debt or charity care

Sec. 13.  Cost Shift Task Force

Convenes a task force to determine how to ensure the cost shift is reflected in health insurance premium rates

Catamount Health

Sec. 14.  Catamount Health

  • 2021.  Policy and Purpose
  • 2022.  Definitions
    • Chronic care – same as Blueprint
    • Chronic care management – same as Blueprint
    • Preventive care
    • Primary care
    • Uninsured – same as VHAP 12‑month rule
  • 2023.  Eligibility
    • uninsured Vermont resident
    • rules to establish criteria for and proof of residency, income, and insurance status
  • 2024.  Benefits
    • actuarially equivalent to the Cigna Selectcare POS plan for state employees in 2006, except cost sharing as provided for in this chapter
    • details developed by rule
    • ensures nondiscrimination by provider type, while allowing appropriate cost-sharing to encourage use of efficacious or cost-effective services
    • establishes criteria for benefit details
  • 2025.  Administration
    • contracts out with a third party administrator
    • allows purchase of reinsurance if cost-effective and financially prudent
    • pays for services at Medicare +10%
    • provides for a single, simplified form to apply for Catamount health, Medicaid, VHAP, and Dr. Dynasaur
    • requires data collection
    • provides for annual recertification
    • requires smooth transition between current programs and Catamount health
  • 2026.  Cost Sharing
    • establishes sliding scale premiums for individuals with incomes up to 350% of FPL and for full cost buy-in by those with incomes over 350%
    • provides that co-payments, deductibles, or other cost-sharing to be proposed to general assembly, but none for chronic care management or preventive care
    • includes a late enrollment premium increase
    • allows for healthy lifestyles discounts
  • 2027.  Catamount Fund
    • establishes the Catamount fund as a special fund for revenue from strategic payments under the Master Tobacco Settlement Agreement, increase in the cigarette tax, and other appropriations if any.

Sec. 15.  Catamount Health Premiums

Establishes sliding scale premium amounts for Catamount health from $60 to $170, with full premium set at $310

Sec. 16.  Rules Process and Oversight

  • Provides for review of rules by the commission and health access oversight committee
  • Establishes oversight by health access oversight committee

Sec. 17.  Global Commitment Financing

  • Finances Catamount health through Global Commitment
    • Requires agency to seek a waiver amendment to include program in the premium
    • Allows financing as an MCO investment

Sec. 17a. Fund Transfers

Provides for up to $10 million of any balance in the Catamount fund to be transferred for Medicaid.

Sec. 17b. and 17c. Cigarette Tax Increase & Floor Stock Tax

  • Increases the cigarette tax by .60 cents
  • Provides for one-time floor stock tax to account for existing inventory; tax is calculated on July 1, 2006 & paid by August 25, 2006

Sec. 17d. – 17h. Technical Amendments to Funds

  • 17d. amends tobacco settlement statute to account for deposit of strategic payments into the Catamount fund
  • 17e. amends the state health care resources fund to reflect split in cigarette tax between this fund and Catamount fund
  • 17f. deletes obsolete reference to cigarette tax in general fund statute
  • 17g. clarifies that the one-time floor stock tax is to be deposited into the Catamount fund
  • 17h. revises revenue estimates to the emergency board to include Catamount fund and new names of Medicaid funds

Sec. 18.  Reports

  • Provides that the secretary of administration will make recommendations for changes to the program if the insured rate is not at 98% by January 15, 2009 and that the BISHCA survey of insurance status will be completed in time for this report
  • Requires report no later than January 15, 2009 on:
    • The percentage of uninsured Vermonters and the number of insured Vermonters by coverage type
    • An analysis of the trends of catamount health costs and trends in the revenue sources for catamount health
    • Feasibility of allowing additional coverage in Catamount health
    • Number of enrollees with employer sponsored insurance
    • Number of individuals in chronic care management programs
    • Removing or capping the late enrollment premium increases

Sec. 19.  Enrollment Initiatives

Provides for engagement of interested groups and parties in assisting with outreach

Sec. 20.  Commission on Health Care Reform

Provides any reports to the commission

Sec.  21. Appropriations

Medicaid Reimbursement – $2.9 M

Hospital Service Area Incentive Grants – $200,000

Sec. 22. Effective Dates

Upon passage, except:

  • June 30, 2006 for catamount fund & state health care resources fund
  • July 1, 2006 for Medicaid reimbursement, cost shift review, catamount fund transfers, and tobacco litigation fund; cigarette tax applies after this date.
  • July 1, 2007 for VHAP & Dr. Dynasaur premium changes