- Blueprint for Health – Chronic Disease Prevention &
Care Management Initiative
- Build on the House proposal by specifying governance
structure
- Catamount Health (Oct. 1, 2007)
- A self-insured health care benefit for uninsured
Vermonters
- For uninsured Vermonters without access to employer
sponsored insurance, a benefit package equivalent to that of the average
commercially insured Vermonter
- Sliding-scale premiums for individuals with incomes under
350% of federal poverty level ($70,000 for a family of 4)
- Benefit available at full cost for the uninsured with
incomes over 350% FPL
- Reinsured with a private carrier to protect the state
against catastrophic costs
- Reimbursement to hospitals at 110% of costs in first
year; cost containment by limiting increases to Medicare economic index
- Operated by a private third-party administrator
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- Sliding scale premium assistance for individuals with
incomes under 350% of FPL who have access to employer-sponsored coverage
that is comparable to Catamount Health
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- A focus on chronic disease prevention and care management;
- Universal access to a limited number of diagnostic or
other services (for example, immunizations; pap smears)
- Premium Relief for the Individual or Nongroup
Insurance Market
- Reinsurance or other assistance offered to insurers with
products in the individual market to reduce premium cost for individuals
- Cost Shift Reduction
- Reduce amount of bad debt and charity care through
covering the uninsured through Catamount Health and other existing
programs
- Enhance BISHCA’s authority to review rates to ensure
reductions in the cost shift are passed through to consumers
- Hospital Default Insurance
- Establish minimum criteria for hospital uncompensated
care programs to ensure statewide uniformity
- Create an uncompensated care pool to pay for and track
the use and expenditures for uncompensated care
- Set aside funds from insurance premiums or payments into
the uncompensated care pool to match through Global Commitment
- Use premium assessed on employers who do not offer
insurance to fund pool
- Increase in Medicaid rates for primary care
- Vermont Health Access Plan (VHAP) – employer
sponsored insurance
- premium assistance for individuals enrolled in the
Vermont Health Access Plan (VHAP) who have access to employer-sponsored
insurance
- Everyone contributes and other financing
- Premium assessed on employers who do not offer insurance;
use for hospital default insurance pool
- Possible financing through a 60 cent increase in the
cigarette tax, tobacco settlement strategic payments, and the Global
Commitment to Health.
- Next steps:
- extend universal access to additional diagnostic or other
services
- explore methods for underinsured individuals (for
example, those whose health care costs are more than 10% of their gross
income) to access Catamount Health
- explore options for individuals in high cost markets
- in 2010, determine if a health insurance requirement is
necessary in 2011 to achieve universal coverage
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