- S. 310 –

COMMON SENSE INITIATIVES

 

SECTION BY SECTION SUMMARY

 

Section

Description

Funding

 

 

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

None

Secs. 6–7.

Community Grants

·      DOH initiative CHAMPPS shall be the foundation

·      DOH shall establish community health and wellness grant program

·      Successful grant recipient communities must have 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 funding

·      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 will review grants and recommend awards to the commissioner

·      The commissioner can adopt rules and shall report to the general assembly

$1,003,500.00 to DOH from general funds

 

and

 

$500,000.00 from federal substance abuse grants to DOH

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

·      The 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 

The commissioner shall report to the general assembly and appropriate committees on 1/15/2008 and on 1/15/2009

 

First year:  $160,000.00 to DOH from general funds and $40,000.00 to DOH from the hospitals 

 

Second year and thereafter: 

50% general funds and 50% from hospitals

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

None

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

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

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

$400,000.00 to BISHCA for common forms and procedures, common provider credentialing, multi-payer database, and consumer price and quality information system

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 the BISHCA commissioner enforcement authority against insurers and hospitals for noncompliance

·      H.607 with some changes

See above

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

 

$500,000.00 to BISHCA from the general fund and $200,000.00 from the BISHCA special fund

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

 

$400,000.00 to BISHCA for common forms and procedures, common provider credentialing, multi-payer database, and consumer price and quality information system

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

$850,000.00 from the general funds to DOH (administered by AHEC)

Secs. 21–29.

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 its services consistent with what it believes 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 3 months the time for getting the registry developed, and by 6 months the time for developing rules and internet information about the registry and motor vehicle 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

 

$50,000.00 from general funds to DOH

APPROPRIATIONS

 

Sec. 30.  Appropriations

Funds:

·      Statewide health technology plan:  $700,000.00

·      Community wellness grants:  $1,003,500.00 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:  $850,000.00

·      Advance Directives Registry:  $50,000.00