S.310 - COMMON SENSE INITIATIVES -

SIDE BY SIDE COMPARISON OF THE VERSIONS

“AS PASSED BY SENATE” AND

AMENDMENTS PROPOSED BY

THE HOUSE HEALTH CARE COMMITTEE AND THE HOUSE APPROPRIATIONS COMMITTEE

 

Section

As Passed the Senate

House Health Care and House Appropriations Committee Amendment Changes   

 

 

WELLNESS INITIATIVES

Secs. 1–5.

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

·        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%

Secs. 6–7.

Community Grants

·      Department of Health (DOH) initiative CHAMPPS (coordinated healthy activity, motivation, and prevention programs) shall be the foundation

·      Human Services will compile an inventory of existing programs or initiatives that fund or promote health, recreation, wellness, or like efforts, including funding sources and conditions, and file the inventory with the legislature by 12/15/06

·      DOH shall establish a community health and wellness grant program

·      Successful grant recipient communities must have a comprehensive approach which promotes wellness across community and lifespan, is consistent with blueprint and community goals, uses demonstrated effective methods, and allows evaluation and monitoring

·      DOH will provide assistance with technical aspects, research findings, and accessing and maximizing funding from all sources (private funds can be accepted by the grant communities and DOH)

·      Commissioner will create grant committee with legislative and designated agency and community members

·      Grant committee will design grant application and award parameters, which shall encourage private participation, such as funding

·      A subcommittee (without legislators) will review grants and recommend awards to the commissioner

·      Commissioner can adopt rules and shall report to the general assembly

·      For fiscal year 2007 only, DOH can use $200,000.00 of funding for existing commitments in the blueprint and other departmental community grants and $50,000.00 as continued support for a chief nutritionist position

  • Corrects word in name of “champps” to read “coalition for” rather than “coordinated”
  • Expresses intent of legislature to fund community wellness grants beginning July 1, 2007, using (a) the base funding from the Healthy Aging program, (b) the base funding from the Fit and Healthy Kids program, (c) the base funding for community grants in the blueprint for health program, (d) $500,000 of the federal grant money for substance abuse and mental health services, and (e) possible funds from other health programs to be identified when AHS compiles the inventory of state health programs
  • Commissioner will assist community projects by providing access to “best and promising practices” rather than “applicable research findings”
  • A member of the Governor’s Commission on Healthy Aging is added to the grant committee
  • No legislative members are appointed to the grant committee  

 

MEDICAL EVENT and HOSPITAL INFECTION RATE REPORTING

Secs. 8–11.  Medical Event Reporting

·      Requires DOH to establish a program for the purpose of improving patient safety, eliminating adverse events in hospitals, and supporting hospital quality improvement efforts

·      Hospital compliance is required as part of licensure

·      Defines near miss, adverse event, and reportable adverse event

·      Rulemaking will define events hospitals must report to DOH, which must include the National Quality Forum 27 “never events,” for which hospitals must also provide causal analysis reports to DOH

·      Hospitals must develop internal policies and procedures to track and report events and conduct causal analyses

·      Hospitals must disclose to patients adverse events that cause death or serious bodily injury

·      Hospitals must give DOH access to records, including patient records and peer review records, for DOH to evaluate compliance

·      For adverse event or near miss that results from a criminal act, a purposefully unsafe act, alcohol or substance abuse, or patient abuse, the hospital must timely notify DOH, and DOH shall notify licensing and law enforcement authorities

·      Patient confidentiality and peer review protections are maintained; information to DOH is not public record

·      Commissioner of health, in consultation with others, will recommend to BISHCA which patient safety data should be included in hospital community reports

·      DOH is given enforcement authority, including hospital licensing sanctions and civil penalties of $10,000.00, and $100,000.00 or 1/10 of gross annual revenues for continuing violations 

·      Commissioner shall report to the general assembly and appropriate committees on 1/15/2008 and on 1/15/2009

  • The definition of “intentional unsafe act” is moved to the definition section.  The provision concerning reporting of intentional unsafe acts is reworked without any substantive impact 
  • DOH shall adopt rules that encourage anonymous in-hospital reporting of adverse events and near misses, when possible
  • Requires reporting to an immediate family member of the deceased patient when an adverse event results in a patient’s death
  • Revised subsection (g) concerning disclosure and protection of information provided to DOH to limit the prohibition against obtaining access to information by subpoena, through discovery, or via other disclosure, to requests for information in cases brought against a provider.   Likewise, the prohibition on DOH staff from testifying about information received through the reporting system is confined to cases against a provider
  • DOH commissioner must make  recommendations to BISHCA as to what hospital medical error data should be added to the hospital community reports within 18 months after patient safety system is set up

 

 

Sec. 12. Hospital Infection Rate Reporting

·      Adds infection rate reporting to hospital community reports, using comparisons to industry benchmarks

·      Adds members of the public representing patient interests to the group advising BISHCA on what measures to use

·      H.258 as passed the house

 

ADMINISTRATIVE SIMPLIFICATION

Sec. 13.  Common Forms and Procedures

·      A common claims and procedures work group shall form and elect its own chair, with representation from providers, insurers, OVHA, DOH, business groups, consumers, and BISHCA

·      Group will make recommendations for simplifying the claims administration process for consumers, providers, and others, and for lowering costs

·      Group will make a final report to the governor and general assembly by 1/15/08 concerning work agreed on and recommended future actions; the report will state any cost savings achieved from actions implemented and expected future savings

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

  • Commissioner of BISHCA is required to amend the rule concerning use of a common claims form if, in his or her discretion, it is necessary to implement the work group’s recommendations
  • Chair of the work group will be responsible for coordinating the group’s meetings and work
  • Each organization represented on the work group will be asked to contribute funds for the group’s administrative costs
  • Group’s report to the legislature with a two-year work plan will also include a budget
  • Among the claims processing procedures to be reviewed by the group will be 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

 

Sec. 14.  Common Provider Credentialing

·      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

·      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  

·      Gives commissioner of BISHCA enforcement authority against insurers and hospitals for noncompliance

·      H.607 with some changes

  • Parts of this section are reworked without any substantive impact

INFORMATION TECHNOLOGY and HEALTH REFORM INITIATIVE COORDINATION

Secs. 15–18.  Coordination of Efforts

·      Consolidates authority for coordinating and supervising health reform initiatives, including government information technology efforts in the Secretary of Administration’s office

·      Directs the Agency of Human Services to ensure that IT efforts are incorporated in and comply with the statewide information technology plan established by VITL

·      Ensures that VPQHC technology efforts are incorporated in and comply with the statewide information technology plan established by VITL

·      Modifies the authority of VITL to conform to the consolidated efforts and adds the Department of Health as a member

·      Requires the statewide information technology plan to address issues relating to data ownership, governance, and confidentiality and security of patient information

·      Extends the deadline for the statewide information technology plan by 6 months, and requires that an interim report be due on 1/1/07

  • Explicit permission for the Secretary of Administration to designate a project manager for the coordination work is deleted
  • Other parts of this section are reworked without any substantive impact
  • Adds to the requirements for the health information technology plan a requirement that the plan integrate the IT components being coordinated by the Secretary of Administration, including the blueprint for health, the global clinical record and other Medicaid management information systems being developed by OVHA, any VPQHC IT work, the program to loan and grant program for physicians to develop electronic medical records systems, and any other IT initiatives
  • Requires BISHCA to establish a loan and grant program to provide for capitalization of compatible, electronic medical records systems at primary care practices.  The loan and grant program will be part of the VITL plan

 

 

 

Sec. 19.  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

·      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

Sec. 19a.

Not in this version

 

  • The Area Health Education Centers (AHEC) will convene a work group no later than 9/1/06 to 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 be composed of representatives of AHEC, VITL, providers, insurers, VPQHC, and state government agency and department representatives, including BISHCA
  •  The group will provide cost and time estimates for development and implementation of a master provider index
  • The group will develop recommendations for the governance of the index and its relationship to other state health information data systems, technologies, and records
  • The group will report and make recommendations to the legislature no later than 1/15/07, including whether an index should be created

PROVIDER INITIATIVE

Sec. 20.  Loan Repayment for Health Care Professionals

 

Authorizes awards to health care providers with outstanding loans who agree to serve patients with Medicare, Medicaid, or state health benefit coverage, with awards designed to recruit and retain providers in underserved geographical areas or specialties

  • Makes loan repayment available to health educators in addition to providers
  • Changes requirement for recipients to serve “Vermont patients” to a requirement that the individual “serve Vermont”
  • Changes requirement for recipients to accept patients with Medicaid or other public health benefit program coverage to apply only as applicable (i.e., this requirement would not bar a recipient whose services are not covered by Medicaid from receiving a loan repayment award)
  • Defines health care provider as an individual licensed, certified, or authorized to provide medical or dental services in Vermont

ADVANCED DIRECTIVES

Secs. 21–29a.

Advance Directives

·      Defines “anatomical gift” and “procurement organization” as they are defined in the Vermont Uniform Anatomical Gifts Act

·      Clarifies that owner, operator, or staff of a facility cannot be an agent if the principal is residing in the facility at the time of execution (unless the principal is a family member of the agent) and adds that an individual cannot act as agent while serving the interests of a procurement organization

·      Requires a health care provider to notify the registry and submit a copy of any amendments, suspensions, and revocations about which it knows

·      Requires procurement organizations to follow advance directive and instructions of agent concerning anatomical gifts

·      Requires procurement organizations, funeral directors, crematory operators, and cemetery officials to develop systems to check the registry for an advance directive

·      Gives immunity to these entities for providing or withholding their services consistent with what they believe to be a valid advance directive

·      Adds probate court official and procurement organization to those with access to registry

·      Clarifies that advance directive can specify who can and cannot bring probate court action and that probate court will honor this

·      Extends by 4 months the time for DOH to adopt rules, including those developing the advance directives form (deadline would be July 1, 2006)

·      Extends by 6 months the time for getting the registry developed and the time for developing internet information and adopting rules about use of the registry (deadline would be September 1, 2006)

·      Extends by 6 months the time for the department of motor vehicles to provide licenses that identify that the holder has an advance directive

·      Adds to the top of the list for authorizing anatomical gifts a person identified in an advance directive as having such authority

·      Directs AG to study and make recommendations by January 15, 2007 concerning which individuals should be authorized to direct the disposition of remains and to order funeral goods and services and to establish a procedure in probate court to resolve disputes

 

  • Study on who should have the right to order funeral goods and services and direct the disposition of funeral remains is removed
  • Parts of these sections are reworked for clarity, but there are no other significant, substantive changes

 

IMPROVING ACCESS TO CARE

Sec. 29a.

FQHC Look-alikes and Uncompensated Care Pool

 

See above.  Ordered a study on authority over funeral services 

  • Funeral services study removed; see above
  • Authorizes DOH to carry forward funds appropriated last year for federally qualified health centers look-alikes (FQHCs)
  • $200,000 of general funds is appropriated in Sec. 30 for the development of uncompensated care pool funds for an income-sensitized sliding scale fee schedule for patients at FQHCs  look-alikes
  • DOH should distribute money with equal geographic distribution and ensuring a FQHC look-alike in every county as goals
  • Initial priority for FQHC look-alikes  will be given to Lamoille, Washington, Windsor/Windham, and Addison county areas
  • If appropriations exceed $200,000, additional uncompensated care pool funds will be made available to primary care practices with at least 25% of patients being individuals who are uninsured or receive Medicaid

Sec. 29b.

Medicaid Outreach            

Not in this version

  • Bi-State Primary Care Association, in consultation with the Medical [Medicaid] Care Advisory Committee, will research successful Medicaid enrollment efforts in Vermont and other states and report its findings and recommendations to the legislature and agency of human services by 11/15/06

APPROPRIATIONS

Sec. 30.  Appropriations

Funds:

·      Statewide health technology plan:  $700,000.00

·      Community wellness grants:  $973,000.00 from general funds

·      Medical Event reporting:  $160,000.00 from general funds

·      Administrative simplification, Multi-payer database and Consumer Price and Quality Information System:  $400,000.00

·      Loan Repayment program:  $880,000.00

·      Advance Directives Registry:  $50,000.00

 

  • References the $700,000 appropriated in the House appropriations bill for the statewide health technology plan
  • Funding for community wellness grants removed; intent is to fund for fiscal year 2008 (see section 6 above)
  • References the $400,000 appropriated in the House appropriations bill for multi-payer database and consumer price and quality information system; language clarifies that these funds are not for common claims and procedures work group by removing language referencing that work
  • References the $540,000 appropriated in the House appropriations bill for the health care provider loan repayment program and adds a $340,000 appropriation to keep the total funding at  $880,000.  The bill makes clear that this funding is not for the health care provider loan forgiveness program 
  • References the $80,000 appropriated in the House appropriations bill for the health care provider loan forgiveness program
  • References the $50,000 appropriated in the House appropriations bill for the advance directives registry
  • $200,000 is appropriated from the general fund to DOH for FQHC look-alike uncompensated care pool funds
  • $40,000 is appropriated to AHS for Medicaid outreach, to be expended only upon approval of the outreach plan by the Health Access Oversight Committee

 

 

TECHNICAL PROVISION

Sec. 31.

Technical Provision

Not in this version

  • Enables Legislative Council to reconcile the H.861 and S.310 versions of 3 V.S.A. § 2222a