H.861 AN ACT RELATED TO HEALTH CARE

AFFORDABILITY FOR VERMONTERS COMPARISON

 

As Passed the House

As Passed Senate

Conference Report

Chronic Care Initiatives – Substantially similar

  • Focus on statewide chronic care initiatives to ensure Vermonters receive the appropriate care at the appropriate time.
    • Blueprint for Health – develop the initiative and move to statewide implementation

Medicaid, the Vermont Health Access Plan and Dr. Dynasaur – contract out services and chronic care management

Catamount Health

  • Method of administration – self-insured w/ discretion on reinsurance

 

 

 

  • Benefit package – based on state employees

 

 

 

  • Who can purchase – uninsured Vermont resident; sliding scale premiums up to 350% of FPL ($34,300 annually for 1 person); full price over that income

 

 

 

 

 

 

 

 

 

 

 

  • Payment levels – Medicare + 10%

Catamount Health

  •  Method of administration – option of fully insured product or self-insured with mandatory reinsurance

 

 

  • Benefit package – based on Blue Cross Blue Shield plan (12% less)

 

 

 

  • Who can purchase – uninsured Vermont resident; sliding scale premiums up to 300% of FPL ($29,400 annually for 1 person); full price over that income.
    • Any Vermont resident may receive minimum preventive care (immunizations)
    • Excludes adults who are claimed as a dependent on an out-of-state resident’s tax return

 

  • Adds enrollment limitation or cap provision

 

  • Payment levels: Medicare + 10% for health care professionals; cost + 10% for hospitals

Catamount Health

  • Method of administration – fully insured product; legislative review of final program – both insurance product and assistance program April 1, 2007
  • Benefit package – similar to Senate proposal – PPO, $250 individual deductible; specifies family deductibles and out-of-pocket maximums
  • Who can purchase – Same as Senate proposal; sliding scale premiums established through Catamount Health Assistance
    • Immunizations administered by department of health

 

 

 

 

 

 

·        Enrollment cap required if board determines appropriation is not sufficient to support enrollment

  • Same as Senate

 

 

  • BISHCA may mandate participation by Blue Cross Blue Shield and nonprofit HMOs

 

 

Catamount Health Assistance

  • Premium and cost-sharing assistance for individuals under 300% of FPL
  • Covers deductibles and cost-sharing for chronic care services
  • Enrollment cap required if board determines appropriation is not sufficient to support enrollment

 

 

Commission on Health Care Reform

  • Codifies oversight functions of the commission (expires in 2011)
  • BISHCA may mandate participation by certain insurers if none participate voluntarily
  • Review of Catamount Health market for cost-effectiveness on or after October 1, 2009
  • Establishes fall-back process to issue a request for proposals if the program as a whole is not cost-effective

 

Medicaid Reimbursement

  • Increases Medicaid reimbursement for primary care services to Medicare levels in FY 2007

Medicaid Reimbursement

  • Increases Medicaid reimbursements more broadly
  • Adds a hospital reimbursement increase

Medicaid Reimbursement

  • Clarifications in hospital reimbursements
  • Removes incentive payments for participation in the Blueprint, because Blueprint has funding to provide these; Sec. 10 added to indicate this

Premium Assistance Program; Employer-Sponsored Insurance

Information gathered about individual’s availability to purchase employer-sponsored plans

Premium Assistance Program; Employer-Sponsored Insurance

  • Individuals enrolled or eligible for VHAP and Catamount Health will participate in certain employer-sponsored insurance plans, if available, with premium assistance to offset the cost
  • Employer plans must be substantially similar to Catamount Health

Premium Assistance Program; Employer-Sponsored Insurance

Senate version except:

  • Allows more flexibility on what employer plans may be approved for individuals in VHAP, but provides protection for individuals by wrapping benefits and cost-sharing
  • For individuals with income over VHAP amounts and under 300% of FPL, ensures the employer plans will be substantially similar to Catamount Health, but allows time for chronic care programs to improve to Catamount Health level
  • Enrollment cap required if board determines appropriation is not sufficient to support enrollment

 

Hospital Uncompensated Care Policies

  • Recommends uniform statewide policy
    • May recommend deviations or set of policies
  • Recommends reporting changes to ensure fair and thorough method of reporting uncompensated care
    • Method of calculating
    • Information about patients using policy

Same as Senate

 

Nongroup Market Security Trust

Provides reinsurance for insurers in nongroup market to cover 5% of the claims cost – reduces cost of insurance

Same as Senate

Review required coverage

Review in 2010; considers mandate in 2011

Required coverage

Individual mandate in 2011 if 98% of Vermonters are not insured

Required coverage

House version; determined by the commission

Financing

  • Cigarette Tax Increase
    • Increases the cigarette tax by 60 cents
  • New Tobacco Settlement Funds
  • Global Commitment

Financing

  • Employers’ Health Care Premium Contribution

o        Assessed quarterly by department of labor on FTE uncovered employees; exemption for 3 FTEs

o        FY 2007 $91.25 per FTE per quarter

o        Uncovered employee means an employee of an employer who does not offer to pay part of health care costs; an employee who is not eligible for health care offered by employer and an uninsured employee

o        Effective January 1, 2007, payable April 30, 2007

Cigarette and Tobacco Taxes

·         Increases cigarette tax by 60 cents in 2006 and 80 cents in 2008; taxes little cigars and roll-your-own tobacco as cigarettes

·         Changes method of taxing moist snuff from 41% of the wholesale price to per ounce; increase in 2008 – 17 cents

Global Commitment – uses less than House

Financing

·         Employers’ Health Care Premium Contribution

o       Increased exemptions to 8 in first 2 years (2007 & 2008); 6 in 2009 and 4 in 2010

o       Other financing same as Senate

Healthy Lifestyles Insurance Discount

·      Changes maximum discount to 15% in nongroup and small group markets.

·      Caps sum of wellness discount/reward and existing allowable deviation from community rates at 30%

 

Healthy Lifestyles Insurance Discount

·      Authorizes small group and nongroup carriers, including Blue Cross Blue Shield and HMOs, to offer financial incentives worth up to 20% of the premium to beneficiaries who adhere to programs of health promotion and disease prevention

·      Commissioner adopts rules applicable to the discounts

Same as House

 

Common claims and procedures

·         Chair of the work group will be responsible for coordinating the group’s meetings and work

·         Group will look at procedural issues relating to the prior authorization process and reimbursement to providers for services rendered prior to being credentialed by an insurer

·         Work group must report its progress to the legislature and governor by 1/15/07

·         If necessary, rule will be amended

 

Common claims and procedures

·         Work group shall form, with providers, insurers, OVHA, VDH, business groups, consumers, and BISHCA

·         Group will make recommendations for   

     simplifying the claims administration

·         Report  to the governor and general assembly due 1/15/08 concerning work agreed on and recommended future actions and any cost savings

·         Commissioner of BISHCA may amend the common claims rule based on the recommendations

Same as House

 

Common Credentialing for Providers

·          Authorizes BISHCA to prescribe the credentialing form to be used by hospitals and insurers, which shall be the form used by the Council for Affordable Quality Health Care or a similar nationally recognized form; and enforce requirement

·         The requirement would begin 1/1/07

·         Hospitals and insurers would have to notify the provider within 30 days if the credentialing application form is incomplete and would have to notify the provider of the status of the application not later than 60 days after submission and every 30 days after that  

 

Multi‑payer Database and Consumer Price and Quality Information

·         Adds objective of improving quality and affordability of patient health care and coverage

·         Requires reporting to multi-payer database from health insurers, third party administrators, pharmacy benefit managers, and the state health plan, as well as Medicaid and Medicare, as allowed by federal law

·         Adds prices and quality of health care to what commissioner may require to be reported

·         Gives VITL and VPQHC access to data consistent with BISHCA rules

·         Requires BISHCA to develop system to use data to provide consumers transparent price and quality information, which it may do incrementally, beginning with the data consumers would find most useful and understandable  

·         Large health insurers must also file a plan for providing price and quality information to consumers

 

Master Provider Index

·         AHEC and work group will make recommendations for the creation of a master provider index which will allow identification and cross-reference of providers in the information technology work via a common set of data fields

·         Work group will have representatives of AHEC, VITL, providers, insurers, VPQHC, and BISHCA

·          The group will provide cost and time estimates

·         The group will develop recommendations for the governance of the index and its relationship to other state health information data systems

·         Report and recommendations 1/15/07

None.

Same as House