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