Journal of the House

________________

FRIDAY, MARCH 3, 2006

Rep. Carolyn Partridge in Chair.

At nine o'clock in the forenoon the Speaker called the House to order.

Devotional Exercises

Devotional exercises were conducted by the Speaker .

Memorial Service

The Speaker placed before the House the following name of a member of past sessions of the Vermont General Assembly who had passed away recently:

Louis Lavin of Barre Town          Sessions: 1955, 1957, 1959 & 1961

Thereupon, the members of the House rose for a moment of prayer in memory of the deceased member.  The Clerk was thereupon directed to send a copy of the House Journal to the bereaved family.

Bill Referred to Committee on Ways and Means

H. 872

     House bill, entitled

     An act relating to pass-through of a portion of the federal credit for energy-efficient homes;

     Appearing on the Calendar, affecting the revenue of the state, under the rule, was referred to the committee on Ways and Means.

Bills Referred to Committee on Appropriations

House bills of the following titles, appearing on the Calendar, carrying appropriations, under the rule, were referred to the committee on Appropriations:

H. 708

House bill, entitled

An act relating to providing that junkyards shall be regulated by the secretary of natural resources instead of the agency of transportation;

H. 791

House bill, entitled

An act relating to allocation of funds from the solid waste management assistance account of the waste management assistance fund to the environmental contingency fund;

H. 869

House bill, entitled

An act relating to state’s transportation program.

Committee Bill Introduced

H. 874

Rep. Lippert of Hinesburg, for the committee on Judiciary, introduced a bill, entitled

An act relating to sentencing for first and second degree murder;

Which was read the first time and, under the rule, placed on the Calendar for notice tomorrow.

House Bill Introduced

H. 875

Rep. Rusten of Halifax introduced a bill, entitled

An act relating to approval of amendments to the charter of the village of Jacksonville;

Which was read the first time and referred to the committee on Government Operations.

Committee Bill Introduced

H. 876

Rep. Adams of Hartland, for the committee on Fish,  Wildlife and Water Resources, introduced a bill, entitled

An act relating to management of exposure to mercury;

Which was read the first time and, under the rule, placed on the Calendar for notice tomorrow.

Senate Bills Referred

Senate bills of the following titles were severally taken up, read the first time and referred as follows:

S. 51

Senate bill, entitled

An act relating to disability retirement benefits for state employees;

To the committee on Government Operations.

S. 188

Senate bill, entitled

An act relating to financial literacy and asset building of low income Vermonters;

To the committee on Human Services.

S. 194

Senate bill, entitled

An act relating to sealing juvenile records relating to a delinquent act;

To the committee on Judiciary.

S. 218

Senate bill, entitled

An act relating to motor vehicle retail installment sales contracts;

To the committee on Commerce.

Joint Resolution Referred to Committee

J.R.H. 63

Reps. Chen of Mendon, Clarkson of Woodstock, Fallar of Tinmouth, Hosford of Waitsfield, Hube of Londonderry, Johnson of South Hero, Komline of Dorset, Marron of Stowe, Nitka of Ludlow, O'Donnell of Vernon, Orr of Charlotte, Peterson of Williston, Pugh of S. Burlington, Reese of Pomfret, Rusten of Halifax and Shand of Weathersfield offered a joint resolution, entitled

Joint resolution relating to the integrity of the education and general funds;

Whereas, in 2005, over 150 municipal legislative bodies, including both selectboards and city councils, adopted the Grafton Resolution opposing any use of the education fund that is outside Act 60’s original intent to “make payments to school districts and supervisory unions for the support of education,” and

Whereas, since its inception in 1919, the teachers’ retirement fund has been funded by the state from general revenue and, historically, it has been

underfunded, and

Whereas, the idea of drawing on the state education fund to help support the retirement system is contrary to long-established practice and to the original intent incorporated into Act 60 that the newly established education fund was created for the purpose of supporting local school systems, and

Whereas, a new percent of purchase and use tax revenue was created as part of Act 60 to support education via the education fund, and

Whereas, when Act 68 was enacted, another one percent of the purchase and use tax was allocated to support education and directed to the education fund, and simultaneously, $11.1 million of gasoline tax that had been assigned to the education fund under Act 60 was returned to the transportation fund, and

Whereas, it is possible to imagine that the education fund might be considered as one source for meeting federal matching requirements, and

Whereas, the appropriation of money from the education fund for purposes other than local education operational expenses could result in individual communities increasing local education property tax rates, and

Whereas, these examples of the legislature appropriating dollars from funds that had been designed for other specific purposes sends a worrisome message to those concerned with protecting the education fund’s integrity, now therefore be it

Resolved by the Senate and House of Representatives:

     That the General Assembly opposes any use of the state education fund for purposes that are outside Act 60’s original intent, and be it further

Resolved:  That existing general fund obligations should not be transferred to the education fund, and be it further

Resolved:  That the current level of periodic general fund transfers to the education fund should not be reduced, and be it further

Resolved:  That the secretary of state be directed to send a copy of this resolution to Governor James Douglas; Steven Jeffrey, the executive director of the Vermont League of Cities and Towns; and John Nelson, the executive director of the Vermont School Boards Association.

Which was read and, in the Speaker’s discretion, treated as a bill and referred to the committee on Appropriations.

 

 

Joint Resolution Adopted in Concurrence

J.R.S. 58

Joint resolution, entitled

Joint resolution providing for a Joint Assembly to vote on the retention of two Superior Judges;

Was taken up read and adopted in concurrence.

Bill Amended; Third Reading Ordered;

Rules Suspended; Bill Placed on all Remaining Stages of Passage;

Bill Read the Third Time and Passed

H. 766

Rep. Marcotte of Coventry, for the committee on Commerce, to which had been referred House bill, entitled

An act relating to real estate transfer pursuant to strict foreclosure not voidable as fraudulent conveyance;

Reported in favor of its passage when amended by striking all after the enacting clause and inserting in lieu thereof the following:

Sec. 1.  9 V.S.A. § 2292(e) is amended to read:

(e)  A transfer is not voidable under subdivision (a)(2) of section 2288 2288(a)(2) or section 2289 of this title if the transfer results from:

(1)  termination of a lease upon default by the debtor when the termination is pursuant to the lease and applicable law; or

(2)  enforcement of a security interest in compliance with Article 9 of Title 9A; or

(3)  foreclosure of a mortgage in compliance with subchapter 6 of chapter 163 of Title 12.

Sec. 2.  12 V.S.A. § 4524 is amended to read:

§ 4524.  SUPPLEMENTAL JUDGMENT JOINING PARTIES; RECORDING

At any time, without further notice or service on the purchaser, or mortgage or lien holder, lienholder whose interest in the property being foreclosed first arose after the filing of the complaint in the town clerk’s office, and upon filing certified copies of the deed, mortgage, or attachment with the clerk of the court by the plaintiff in the foreclosure action, any superior judge may sign a supplemental judgment specifically naming that party.  Reference to the deed, mortgage, or lien and the supplemental judgment may be filed in the town clerk’s office for record, and it shall have the same force and effect as though that person had been made a party defendant in the original action.

Sec. 3.  12 V.S.A. § 4528 is amended to read:

§ 4528.  DECREE FORECLOSING EQUITY OF REDEMPTION; WRIT OF

  POSSESSION

(a)  If a decree is made foreclosing the right of redemption, the time of redemption shall be established by the court before which the foreclosure is proceeding and shall not be less than three business days nor more than six months from the date of the decree unless a shorter time is orderedThe court shall fix the period of redemption taking into consideration whether there is substantial value in the property in excess of the mortgage debt and debt owed to junior lienholders, any assessed but unpaid property taxes, the condition of the property, the mortgagor’s efforts and capacity to preserve its value, and any other equities. 

(b)  If the premises are not redeemed agreeably to the decree, the clerk of the court may shall issue a writ of possession at the plaintiff’s request.  Such writ shall have the same force and effect and be executed in the same manner as similar writs issued after judgment by a court of law in ejectment proceedings.  Where the premises are occupied by a residential tenant, the writ shall be served on the tenant, and no sooner than 30 days after the writ is served, the plaintiff shall be placed in possession of the property without further proceedings.  No decree of strict foreclosure shall be issued absent a finding by the court based on competent evidence presented by the party seeking such decree that there is no substantial value in the property in excess of the mortgage debt found by the court to be due to the plaintiff, plus assessed but unpaid property taxes due on the property.

(c)  For the purposes of this section, “value” is defined as fair market value less all reasonable expenses that would be incurred in selling the property.

Sec. 4.  12 V.S.A. § 4530 is amended to read:

§ 4530.  REDEMPTION IF COPY NOT RECORDED

(a)  Such foreclosure The expiration of the right of redemption under the decree shall not transfer the title to such lands as against foreclose the interest of subsequent purchasers, mortgagees, or attaching creditors whose interest in the property being foreclosed first arose after the filing of the complaint for foreclosure in the land records as provided in section 4523 of this chapter, unless such copy of record or such decree or copy thereof is thus left for record the plaintiff complies with section 4529 of this title or records in the land records a certified copy of the judgment, or is afterwards and prior to the acquiring of any interest in or lien on the lands by a purchaser, mortgagee, or attaching creditor, left for record in like manner.  If not thus left for record, such lands shall be subject to redemption by subsequent purchasers, mortgagees or attaching creditors, as though the time of redemption had not expired.

(b)  If the certified copy of the judgment is not recorded within the time period specified in section 4529 of this chapter or prior to the acquisition of an interest in the lands being foreclosed, upon motion by a plaintiff or a party intervening in the action to assert a right of redemption as a result of the late recording of the certified copy of the judgment, the court before which the foreclosure is proceeding may establish a right of redemption for the party asserting a right under this subsection.  No party whose right to redeem has expired under the terms of the judgment shall be granted an additional right to redeem, nor shall any previously expired right of redemption be reinstated in a proceeding under this section.

Sec. 5.  12 V.S.A. § 4531 is amended to read:

§ 4531.  STRICT FORECLOSURE EXCEPTION

(a)  All liens and mortgages affecting real property may, on the written motion of any party to any suit for foreclosure of such liens or mortgages, or at the discretion of the court before which the foreclosure proceedings are pending, be foreclosed by a judicial foreclosure sale, even if the mortgage does not contain a sale provision instead of a strict foreclosure.

(b)  In an action for foreclosure, if a lien or interest in such realty is held by any person or federal agency which may not be foreclosed by strict foreclosure pursuant to federal law, a decree may be entered providing for such period of redemption as the court may determine, and providing for a sale of the mortgaged premises at the conclusion of such period if said premises are not redeemed, and for the time, manner, and notice of sale, if required, and the application of the proceeds therefrom.

The bill, having appeared on the Calendar one day for notice, was taken up and read the second time.

Pending the question, Shall the House amend the bill as recommended by the committee on Commerce? Rep. Kainen of Hartford moved to amend the report of the committee on Commerce as follows:

     In Sec. 3 by striking 12 V.S.A. § 4528(a) and inserting a new subsection (a) to read as follows:

(a)  If a decree is made foreclosing the right of redemption, the time of redemption shall be six months from the date of the decree unless a shorter time is ordered.  The court shall fix the period of redemption taking into consideration whether there is value in the property in excess of the mortgage debt and debt owed to junior lienholders, any assessed but unpaid property taxes, the condition of the property, and any other equities. 

Which was agreed to.

Thereupon, the recommendation of amendment offered by the committee on Commerce, as amended, was agreed to and third reading ordered.

On motion of Rep. Young of Orwell, the rules were suspended and the bill placed on all remaining stages of passage.  The bill was read the third time and passed.

Senate Proposal of Amendment Concurred in

H. 248

     The Senate proposed to the House to amend House bill, entitled

     An act relating to registration of lobbyists;

By striking all after the enacting clause and inserting in lieu thereof the following

Sec. 1.  2 V.S.A. § 261 is amended to read:

§ 261.  DEFINITIONS

As used in this chapter,

* * *

(4)  “Employer” means any person, other than a lobbying firm, who engages the services of a lobbyist for compensation for the purpose of lobbying.  A lobbyist who employs another lobbyist shall be required to register and report both as an employer and a lobbyist.

* * *

(6)(A)  “Gift” means political contributions, contributions or tickets to political fundraising events and anything of value, tangible or intangible, that is bestowed for less than adequate consideration including travel expenses such as travel fare, room and board and other expenses associated with such travel and including meals and alcoholic beverages whether given as part of a general or open invitation or not.  “Gift” does not include anything given between immediate family members:

(i)  a political contribution;

(ii)  anything of value, tangible or intangible, that is bestowed for less than adequate consideration, including travel expenses such as travel fare, room and board, and other expenses associated with travel;

(iii)  a meal or alcoholic beverage;

(iv)  a ticket, fee, or expenses for, or to, any sporting, recreational, or entertainment events;

(v)  a speaking fee or honorarium, except actual and reasonable travel expenses;

(vi)  a loan made on terms more favorable than those made generally available to the public in the normal course of business.

(B)  “Gift” does not mean:

(i)  anything given between immediate family members;

(ii)  printed educational material such as books, reports, pamphlets, or periodicals;

(iii)  a gift which is not used and which, within 30 days after

receipt, is returned to the donor or for which the donor is reimbursed for its fair market value; and

(iv)  a devise or inheritance.

* * *

(10)  “Lobbyist” means a person who engages in lobbying for compensation of more than $500.00 or expends more than $500.00 lobbying in any calendar year a person who receives or is entitled to receive, either by employment or contract, $500.00 or more in monetary or in-kind compensation in any calendar year for engaging in lobbying, either personally or through his or her agents, or a person who expends more than $500.00 on lobbying in any calendar year.

* * *

(12)  “Lobbying firm” means a sole proprietorship, partnership, corporation, limited liability corporation, or unincorporated association which receives or is entitled to receive $500.00 or more in monetary or in-kind compensation for engaging in lobbying, either personally or through its agents, in any calendar year.

(13)  “Immediate family” means a person’s spouse or civil union partner, parent, sibling, child, or in-law, including a parent, sibling, or child of a spouse or civil union partner.

Sec. 2.  2 V.S.A. § 262(2) is amended to read:

(2)  a duly-elected or appointed official or employee of the United States, the state of Vermont, or of any instrumentality, agency, or governmental subdivision of the foregoing, when acting solely in connection with matters relating to the person’s office or public dutiesHowever, if one of the foregoing individuals or entities contracts with a lobbyist, that person or entity, as well as that lobbyist, shall comply with the provisions of this chapter;

Sec. 3.  2 V.S.A. § 263 is amended to read:

§ 263.  REGISTRATION OF LOBBYISTS AND EMPLOYERS; FEES

(a)  On forms provided by the secretary of state, every lobbyist shall register with the secretary of state before, or within 48 hours of, commencing lobbying activities. A lobbyist shall file a separate registration statement for each of the lobbyist’s employers.  Each lobbying firm shall submit a list of the names of each lobbyist who is a partner, owner, officer, employee, or agent of the lobbying firm.  Each lobbying firm shall file a supplemental list within 48 hours of any changes that have occurred.

* * *

(d)  A registration statement filed by an employer shall be signed by the employer and shall contain the following information:

* * *

(5)  The name and mailing address of each lobbyist employed engaged by the employer and date of employment or contract for the biennium.

* * *

Sec. 4.  2 V.S.A. § 264 is amended to read:

§ 264.  REPORTS OF EXPENDITURES

(a)  Every employer and every lobbyist registered or required to be registered under this chapter shall file disclosure reports with the secretary of state as follows:

(1)  on or before March April 25, for the preceding period beginning on January 1 and ending with the month of February March;

* * *

(b)  An employer shall disclose for the period of the report the following information:

(1)  a A total of all lobbying expenditures, to the nearest $200.00, made by the employer; in each of the following categories:

(A)  advertising, including television, radio, print, and electronic media;

(B)  expenses incurred for telemarketing, polling, or similar activities if the activities are intended, designed, or calculated, directly or indirectly, to influence legislative or administrative action.  The report shall specify the amount, the person to whom the amount was paid, and a brief description of the activity;

(C)  contractual agreements in excess of $100.00 per year or direct business relationships that are in existence or were entered into within the previous 12 months between the employer and:

(i)  a legislator or administrator;

(ii)  a legislator’s or administrator’s spouse or civil union partner; or

(iii)  a legislator’s or administrator’s dependent household member;

(D)  the total amount of any other lobbying expenditures.

(2) the The total amount of compensation, to the nearest $200.00, paid to lobbyists for lobbying, provided the report need not identify the lobbyists to whom compensation was paid and it.  The employer shall report the name and address of each lobbyist to which the employer pays compensation.  It shall be sufficient to include a prorated amount based on the value of the time devoted to lobbying where compensation is to be included for a person lobbyist whose activities under this chapter are incidental to regular employment; and or other responsibilities to the employer.

(3)  an An itemized list of every gift, whether or not made in connection with lobbying, the value of which is greater than $5.00, made by or on behalf of the employer to or at the request of one or more legislators or administrative officials, and with respect to each such gift, the date made, the nature of the gift, the value of the gift, the identity of any legislators or administrative officials who requested the gift, and the identity of any recipients of the gift the value of which is greater than $15.00, made by or on behalf of the employer to or at the request of one or more legislators or administrative officials or a member of a legislator’s or administrative official’s immediate family.  With respect to each gift, the employer shall report the date the gift was made, the nature of the gift, the value of the gift, the identity of any legislators or administrative officials who requested the gift, and the identity of any recipients of the gift.  Monetary gifts, other than political contributions, shall be prohibited.

(c)  A lobbyist shall disclose for the period of the report the following information:

(1)  a A total of all lobbying expenditures, to the nearest $200.00, made by the lobbyist; and in each of the following categories:

(A)  advertising, including television, radio, print, and electronic media;

(B)  expenses incurred for telemarketing, polling, or similar activities if the activities are intended, designed, or calculated, directly or indirectly, to influence legislative or administrative action.  The report shall specify the amount, the person to whom the amount was paid, and a brief description of the activity;

(C)  contractual agreements in excess of $100.00 per year or direct business relationships that are in existence or were entered into within the previous 12 months between the employer and:

(i)  a legislator or administrator;

(ii)  a legislator’s or administrator’s spouse or civil union partner; or

(iii)  a legislator’s or administrator’s dependent household member;

(D)  the total amount of any other lobbying expenditures.

(2)  an itemized list of every gift, whether or not made in connection with lobbying, the value of which is greater than $5.00, made by or on behalf of a lobbyist to or at the request of one or more legislators or administrative officials, and with respect to each gift, the date made, the nature of the gift, the value of the gift, the identity of any legislators or administrative officials who requested the gift and the identity of any recipients of the gift, except gifts reported by an employer The total amount of compensation paid to a lobbyist for lobbying, including the name and address of each registered employer who engaged the services of the lobbyist reporting.  It shall be sufficient to include a prorated amount based on the value of the time devoted to lobbying where compensation is to be included for a lobbyist whose activities under this chapter are incidental to other responsibilities to the employer.

(3)  An itemized list of every gift, the value of which is greater than $15.00, made by or on behalf of a lobbyist to or at the request of one or more legislators or administrative officials or a member of the legislator’s or administrative official’s immediate family.  With respect to each gift, the lobbyist shall report the date the gift was made, the nature of the gift, the value of the gift, the identity of any legislators or administrative officials who requested the gift, and the identity of any recipients of the gift.  Monetary gifts, other than political contributions, shall be prohibited.

* * *

(f)  If an unsolicited gift is given to a legislator or administrative official by a lobbyist or employer and the recipient does not use it and returns it to the donor within 30 days or the donor is reimbursed for its fair market value, it shall not be considered a “gift” and shall not be required to be reported as such by the donor to the secretary of state.  If the item has already been reported as a gift, the lobbyist or employer shall file an amended report with the secretary of state.

(g)  Within 15 days after the date disclosure reports are to be filed under this section, the secretary shall file a compilation of the disclosure reports with the legislative council.  Compilations of disclosure reports received during the legislative session shall be published in the calendars of the house and senate.

(g)(h)  Disclosure reports shall be made on forms published by the secretary of state and shall be signed by the employer or lobbyist.  The secretary of state shall mail those forms to registered employers and lobbyists not later than 30 days before the end of each reporting period each filing deadline.

(h)(i)  A person lobbyist or employer who fails to file a disclosure report on time shall pay a late reporting fee of $25.00 plus $10.00 for each day the disclosure report is late, not to exceed $175.00.

(i)(j)  A gift from a member of an interest group to, or for the benefit of, a legislator or administrative official, which is made in connection with lobbying as defined in 2 V.S.A. § subdivision 261(9)(D) of this title, shall be deemed to be made on behalf of the employer or lobbyist who sponsored the activity and shall be reported and itemized.

Sec. 5.  2 V.S.A. § 267a is amended to read:

§ 267a.  INVESTIGATIONS

The attorney general may shall investigate, as the attorney general finds necessary, to determine whether a person has violated this chapter on his or her own initiative or in response to a complaint filed in writing with the attorney general, whether a violation of this chapter has occurred.  The attorney general may administer oaths, require filing of a statement under oath, take evidence and require the production, by subpoena or otherwise, of financial records, books, papers, correspondence and other documents and records the attorney general considers to be relevant and material to the investigation.  The attorney general shall make a determination of each complaint filed and, at the time of resolution of a complaint which is found to have merit, shall post on the website of the office of the attorney general a brief summary of the complaint and resolution.

Sec. 6.  2 V.S.A. § 268(b)(3) is amended to read:

(3)  order reimbursement from any person who caused governmental expenditures for the enforcement of the provisions lobbyist or employer found to be in violation of this chapter;

Sec. 7.  REPEAL

2 V.S.A. § 264a (tax on expenditures of lobbyists) is repealed.

Sec. 8.  EFFECTIVE DATE

This act shall take effect on January 1, 2007.

     Which proposal of amendment was considered and concurred in.

Bill Amended, Read Third Time and Passed

H. 701

House bill, entitled

An act relating to ancient roads to be known as identified corridors;

Was taken up and pending third reading of the bill, Rep. Young of Orwell moved to amend the bill as follows:

     In Sec. 1 by adding 19 V.S.A. § 302(a)(6)(H) to read as follows:

(H)  An unidentified corridor shall not create a subdivision with respect to zoning, tax, and septic issues.  If the unidentified corridor is reclassified as a class 1, 2, 3, or 4 highway or as a trail, the then highway or trail shall be recognized as any other highway or trail for the purpose of creating a subdivision with respect to zoning, tax, and septic issues. 

Which was agreed to.  Thereupon, the bill was read the third time and passed.

Favorable Report; Third Reading Ordered;

Rules Suspended; Bill Placed on all Remaining Stages of Passage;

Bill Read the Third Time and Passed; Rules Suspended;

Bill Ordered Messaged to the Senate Forthwith

S. 311

Rep. Hunt of Essex, for the committee on Appropriations, to which had been referred House bill, entitled

An act relating to an appropriation to continue Vermont National Guard family support and counseling services;

Reported in favor of its passage.  The bill, having appeared on the Calendar one day for notice, was taken up, read the second time and third reading ordered.

On motion of Rep. Sunderland of Rutland Town, the rules were suspended and the bill placed on all remaining stages of passage.  The bill was read the third time and passed in concurrence and, on motion of Rep. Sunderland of Rutland Town the rules were suspended and the bill was ordered messaged to the Senate forthwith.

Bill Amended; Third Reading Ordered

H. 630

Rep. Jerman of Essex, for the committee on Education, to which had been referred House bill, entitled

An act relating to teaching about signs of and responses to depression and risk of suicide in public schools;

Reported in favor of its passage when amended by striking all after the enacting clause and inserting in lieu thereof the following:

Sec. 1.  FINDINGS

(a)  The general assembly finds that:

(1)  Depression leading to serious health consequences and risk of suicide is a common problem in Vermont and nationally. 

(2)  Harassment and bullying are leading contributors to lowered

self-esteem and high-risk behavior. 

(3)  The findings of the annual Vermont youth risk behavior survey and the annual safe and healthy schools report from the Vermont department of education contain information and statistics that are compelling indicators of the need for suicide prevention education.

(b)  Therefore, the general assembly concludes that teaching about signs of and appropriate responses to depression and risk of suicide is critical to promoting a safe and healthy school environment for all children.

Sec. 2.  16 V.S.A. § 131 is amended to read:

§ 131.  DEFINITIONS

For the purposes of this subchapter:

“Comprehensive health education” means a systematic and extensive elementary and secondary educational program designed to provide a variety of learning experiences based upon knowledge of the human organism as it functions within its environment.  The term includes, but is not limited to, a study of:

* * *

(5)  Family health and mental health, including instruction which promotes the development of responsible personal behavior involving decision making about sexual activity including abstinence; skills which strengthen existing family ties involving communication, cooperation, and interaction between parents and students; and instruction to aid in the establishment of strong family life in the future, thereby contributing to the enrichment of the community; and which promotes an understanding of depression and the signs of suicide risk in a family member or fellow student that includes how to respond appropriately and seek help and provides an awareness of the available school and community resources such as the local suicide crisis hotline;

* * *

The bill, having appeared on the Calendar one day for notice, was taken up, read the second time, report of the committee on Education agreed to and third reading ordered.

Favorable Report; Third Reading Ordered

H. 710

Rep. Kilmartin of Newport City, for the committee on Education, to which had been referred House bill, entitled

     An act relating to organization of supervisory districts;

Reported in favor of its passage.  The bill, having appeared on the Calendar one day for notice, was taken up, read the second time and third reading ordered.

Favorable Report; Third Reading Ordered

H. 717

Rep. Houston of Ferrisburgh, for the committee on Commerce, to which had been referred House bill, entitled

     An act relating to direct sellers and unemployment insurance;

Reported in favor of its passage.  The bill, having appeared on the Calendar one day for notice, was taken up, read the second time and third reading ordered.

Bill Amended, Consideration Interrupted by Recess

H. 861

House bill, entitled

An act relating to health care affordability for Vermonters;

Was taken up and pending third reading of the bill, Rep. Parent of St. Albans City moved to amend the bill as follows:

* * * Chronic Care Infrastructure and Prevention * * *

Sec. 1.  BLUEPRINT FOR HEALTH

(a)  The general assembly endorses the “blueprint for health” prevention and chronic care management initiative as a foundation which it intends to strengthen by broadening its scope and coordinating the initiative with other public and private chronic care coordination and management programs.

(b)  The charge and strategic plan for the blueprint for health are codified as chapter 13 of Title 18. 

(c)  The department of health shall revise the current strategic plan for the blueprint for health and provide the revised plan to the commission on health care reform, the health access oversight committee, the house committee on health care, and the senate committee on health and welfare no later than October 1, 2006.  The revised strategic plan shall provide that a model for the patient registry under the blueprint for health is fully designed no later than January 1, 2007.

Sec. 2.  18 V.S.A. chapter 13 is added to read:

Chapter 13.  CHRONIC CARE INFRASTRUCTURE

AND PREVENTION

§ 701.  DEFINITIONS

For the purposes of this chapter:

(1)  “Blueprint for health” means the state’s chronic care infrastructure, disease prevention, and case management program.

(2)  “Chronic care” means health services provided by a health care professional for an established disease that is expected to last a year or more and that requires ongoing clinical management attempting to restore the individual to highest function, minimize the negative effects of the disease, and prevent disease-related complications.  Examples of chronic disease include diabetes, hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental illness, and hyperlipidemia.

(3)  “Chronic care management” means a system of coordinated health care interventions and communications for individuals with chronic disease, including significant patient self-care efforts, systemic supports for the physician and patient relationship, and a plan of care emphasizing prevention of complications utilizing evidence-based practice guidelines, patient empowerment strategies, and evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.

(4)  “Health care professional” means an individual, partnership, corporation, facility, or institution licensed or certified or authorized by law to provide professional health care services.

(5)  “Health risk assessment” means screening by a health care professional for the purpose of assessing an individual’s health, including tests or physical exams and a survey or other tool used to gather information about an individual’s health, medical history, and health risk factors during a health screening.

(6)  “Patient registry” means the electronic database developed under the blueprint for health.

§ 702.  BLUEPRINT FOR HEALTH; STRATEGIC PLAN

(a)  In coordination with the secretary of administration under section 2222a of Title 3, the commissioner of health shall be responsible for the development and implementation of the blueprint for health, including the five-year strategic plan.

(b)  The commissioner shall establish an executive committee to advise the commissioner on creating and implementing a strategic plan for the development of the statewide system of chronic care as described under this section.  The executive committee shall engage a broad range of health care professionals who provide services under section 2024 of Title 33, health insurance plans, professional organizations, community and nonprofit groups, consumers, businesses, school districts, and state and local government in developing and implementing a five-year strategic plan. 

(c)(1)  The strategic plan shall include:

(A)  a description of the Vermont blueprint for health chronic care model, which includes general, standard elements established in section 703 of this title to be used uniformly statewide by private insurers, third party administrators, and public programs;

(B)  a description of prevention programs and how these programs are integrated into communities and with chronic care management;

(C)  a plan to develop and implement reimbursement systems aligned with the goal of managing the care for individuals with or at risk for chronic disease in order to improve outcomes and the quality of care;

(D)  the involvement of public and private groups, health care professionals, insurers, third party administrators, associations, and firms to facilitate and assure the sustainability of a new system of care;

(E)  alignment of any information technology needs with other health care information technology initiatives;

(F)  the use and development of outcome measures and reporting requirements, aligned with existing outcome measures within the agency of human services, to assess and evaluate the system of care;

(G)  target timelines for inclusion of specific chronic diseases to be included in the chronic care infrastructure and for statewide implementation of the blueprint for health; and

(H)  a strategy for ensuring statewide participation no later than January 1, 2009, in the chronic care management plan, including common outcome measures, best practices and protocols, data reporting requirements, payment methodologies, and other standards.

(2)  The strategic plan shall be reviewed biennially and amended as necessary to reflect changes in priorities.  Amendments to the plan shall be reported to the general assembly in the report established under subsection (d) of this section.

(d)(1)  The commissioner of health shall report quarterly on the status of implementation of the Vermont blueprint for health to the house committee on health care, the senate committee on health and welfare, and the health access oversight committee.  The quarterly report shall include the number of participating insurers, health care professionals, and patients, the progress for achieving statewide participation in the chronic care management plan, including the measures established under subsection (c) of this section, the expenditures and savings for the period, and other information as requested by the committees.  At least annually, the commissioner shall report the results of health care professional and patient satisfaction surveys. The surveys shall be developed in collaboration with the executive committee established under subdivision (b) of this section.

(2)  If statewide participation is not achieved by January 1, 2009, the commissioner shall recommend to the general assembly statutory changes to create alternative measures to ensure statewide participation by health insurers, third party administrators, and health care professionals.

§ 703.  CHRONIC DISEASE PREVENTION AND CARE  MANAGEMENT; REQUEST FOR PROPOSALS

(a)(1)  The secretary of administration or designee shall issue a request for proposals no later than January 1, 2007 for health services for individuals with chronic disease who are enrolled in Medicaid, and the Vermont health access plan, or Dr. Dynasaur. 

(2)  With the goal of including all individuals, the secretary may initially target the chronic care management program to certain groups of individuals to ensure successful implementation and quality of services and to maximize cost savings.  Individuals with chronic disease who are enrolled in catamount health shall be included in the chronic care management program upon enrollment.  In the request for proposals, the secretary may provide a time period for implementing chronic care management to individuals currently enrolled in Medicaid, the Vermont health access plan, or Dr. Dynasaur in order to allow sufficient time for health care professionals and the entity administering the proposal to identify and enroll these individuals.

(3)  The secretary or designee shall apply for a waiver or other approval from the Centers for Medicare and Medicaid Services to include individuals who are dually eligible for Medicare and Medicaid.   

(b)  The secretary shall include in the request for proposal a broad range of chronic diseases for chronic care management.

(c)  The request for proposals shall stipulate that responses include:

(1)  a method involving the health care professional in identifying eligible patients, including the use of the patient registry, an enrollment process which provides incentives and strategies for maximum patient participation, and a standard statewide health risk assessment for each individual;

(2)  the process for coordinating care among health care professionals;

(3)  the methods of increasing communication among health care professionals and patients, including patient education, self-management, and follow‑up plans;

(4)  the educational, wellness, and clinical management protocols and tools used by the care management organization, including management guideline materials for health care professionals to assist in patient-specific recommendations;

(5)  process and outcome measures to provide performance feedback for health care professionals and information on the quality of care, including patient satisfaction and health status outcomes;

(6)  payment methodologies which create financial incentives and rewards for health care professionals to improve disease management and the quality of care, including case management fees or pay for performance; and

(7)  payment to the care management organization which would guarantee net savings to the state or put the care management organization’s fee at risk if the management is not successful in reducing costs to the state.

(d)  The secretary shall review the request for proposals with the commission on health care reform prior to issuance.  The issuance of the requests for proposals is conditioned on the approval of the commission in order to ensure that the request meets the intent of this section and section 702 of this title.

(e)  The secretary shall ensure that the responses to the requests for proposals, including future requests, shall comply with the Vermont blueprint for health.

Sec. 3.  CHRONIC DISEASE PREVENTION AND CARE

             MANAGEMENT; AGENCY OF HUMAN SERVICES;

             IMPLEMENTATION PLAN

(a)  No later than January 1, 2007, the agency of human services shall develop an implementation plan for chronic disease prevention and care management which at minimum meets the criteria and requirements of chapter 13 of Title 18.  The agency’s implementation plan shall be revised periodically to reflect changes to the chronic care infrastructure, disease prevention, and management strategic plan.  In addition to the chronic care management provided under section 703 of Title 18, the agency may provide additional care coordination services to appropriate individuals as specified in its strategic plan.  The agency shall ensure that Medicaid, Medicaid waiver programs, and Dr. Dynasaur change the payment methodologies in order to comply with the recommendation of the strategic plan and the request for proposals developed under chapter 13 of Title 18.  The agency shall analyze and include a recommendation as to any waivers or waiver modifications needed to implement a chronic care management program.

(b)  The agency shall require recertification or reapplication for Medicaid, the Vermont health access plan, and Dr. Dynasaur only once a year.

Sec. 4.  CHRONIC DISEASE PREVENTION AND CARE MANAGEMENT;

             STATE EMPLOYEES

The commissioner of human resources shall include in any request for proposals for the administration of the state employees health benefit plans a request for a description of any chronic care management program provided by the entity and how the program aligns with the Vermont blueprint for health developed under section 702 of Title 18.  The commissioner shall also work with the secretary of administration or designee, and the Vermont state employees’ association on how and when to align the state employees’ health benefit plan with the goals and statewide standards developed by the Vermont blueprint for health in section 702 of Title 18.

***  The Consumer Health Care Options, Choice and Empowerment Act or “CHOICE”***

Sec. 5.  8 V.S.A. chapter 107 subchapter 9 is added to read:

Subchapter 9.  Consumer Health Care Options, Improvement,

Choice, and Empowerment Act

§ 4100n.  DEFINITIONS

For the purposes of this subchapter:

(1)  “Commissioner” means the commissioner of banking, insurance, securities, and health care administration.

(2)  “Out-of-state insurer” means a company offering health insurance policies that is domiciled in another state of the United States.

§ 4100o.  OUT-OF-STATE INSURERS

An insurer may not offer a health insurance policy to a resident of the state of Vermont unless it is issued a “certification of insurer” by the commissioner.  The certification shall assure that the following qualifications have been met:

(1)  The out-of-state insurer holds a valid certificate of authority to market individual health insurance in the state of its domicile.

(2)  Any policy for individual health insurance offered for sale in Vermont by an out-of-state insurer domiciled in another state of the United States complies with the applicable individual health insurance laws in the state of its domicile, and the policy is actively marketed in that state.

(3)  The insurance policy offered to Vermont residents is currently being actively marketed in the state of the out-of-state insurer’s domicile.

(4)  The out-of-state insurer maintains minimum capital and surplus requirements and maintains reserves as required by the commissioner.

(5)  The out-of-state insurer meets the commissioner’s requirements of reporting plan information with respect to individual health plans offered for sale in Vermont and discloses to prospective enrollees how the health plans differ from individual health plans offered by domestic insurers in a format approved by the commissioner.  Health plan policies and applications for coverage must contain the following disclosure statement or a substantially similar statement:

“This policy is issued by an out-of-state insurer and is governed by the laws and regulations of the State of (out-of-state insurer’s state of domicile).  This policy may not be subject to all the insurance laws and rules of the State of Vermont, including coverage of certain health care services or benefits mandated by Vermont law.  Before purchasing this policy, you should carefully review the terms and conditions of coverage under this policy, including any exclusions or limitations of coverage.”

(6)  Grievance procedures.  The out-of-state insurer meets the requirements of the state of Vermont grievance procedures with respect to health plans offered for sale in this state.

(7)  Unfair (insurance) trade practices.  Vermont’s provisions apply to the out-of-state insurer.

(8)  Premium taxes.  The out-of-state insurer is subject to applicable premium taxes imposed on insurers marketing individual health insurance in Vermont.

(9)  The out-of-state insurer participates in an insurance insolvency guaranty association to which a Vermont insurer that markets individual health insurance is required to belong in accordance with this title.  An insurance producer may not act as an agent of an out-of-state insurer certified to market individual health insurance pursuant to this bill, unless the producer holds a valid producer license from the state domicile of the out-of-state insurer.

§ 4100p.  VERMONT INSURERS

Notwithstanding any other provision of this title, except as expressly provided, a domestic insurer may offer for sale in this state an individual health plan duly authorized for sale in another state by a parent or subsidiary of the domestic insurer if:

(1)  The parent or subsidiary of the Vermont insurer holds a valid certificate of authority to market individual health insurance in the state of its domicile.

(2)  Any policy, contract or certificate of individual health insurance offered for sale in this state by a Vermont insurer complies with the applicable individual health insurance laws in the state or country of domicile of the parent or subsidiary, and the policy is actively marketed in that state.

(3)  The Vermont insurer meets the requirements for reporting plan information with respect to individual health plans offered for sale in this state and discloses to prospective enrollees how the individual health plans of the parent or subsidiary differ from individual health plans offered by domestic insurers in a format approved by the commissioner within 90 days of the effective date of this section.  Health plan policies and applications for coverage must contain the following disclosure statement or a substantially similar statement:

“This policy is issued by a Vermont Insurer but is governed by the laws and rules of the State of (state of domicile of parent or subsidiary of domestic), which is the state of domicile of the parent or subsidiary of the domestic insurer or health maintenance organization.  This policy might not be subject to all the insurance laws and rules of the State of Vermont, including coverage of certain health care services or benefits mandated by Vermont law.  Before purchasing this policy, you should carefully review the terms and conditions of coverage under this policy, including any exclusions or limitations of coverage.”

(4)  The Vermont insurer meets the requirements for grievance procedures with respect to health plans offered for sale in this state.

Sec. 6.  EFFECTIVE DATE AND APPLICABILITY

(a)  This act shall apply to out-of-state insurers and Vermont insurers notwithstanding any other provision of law to the contrary in Title 8 of the Vermont Statutes or otherwise, except where it expressly so provides.

(b)  This act shall take effect July 1, 2006.  The commissioner’s requirements of reporting plan information with respect to individual health plans offered for sale in Vermont and disclosure to prospective enrollees on differences from individual health plans offered by domestic insurers shall be prepared and approved by the commissioner within 90 days of the effective date of this act.

Pending the question, Shall the House amend the bill as recommended by Rep. Parent of St. Albans City? Rep. Tracy of Burlington demanded the Yeas and Nays, which demand was sustained by the Constitutional number.  The Clerk proceeded to call the roll and the question, Shall the House amend the bill as recommended by Rep. Parent of St. Albans City?  was decided in the negative.  Yeas, 52.  Nays, 85.

Those who voted in the affirmative are:


Acinapura of Brandon

Adams of Hartland

Allaire of Rutland City

Allard of St. Albans Town

Bartlett of Dover

Bostic of St. Johnsbury

Branagan of Georgia

Canfield of Fair Haven

Clark of Vergennes

Dates of Shelburne

DePoy of Rutland City

Donaghy of Poultney

Donahue of Northfield

Dowland of Holland

Dunsmore of Georgia

Endres of Milton

Errecart of Shelburne

Helm of Castleton

Houston of Ferrisburgh

Howrigan of Fairfield

Hube of Londonderry

Hudson of Lyndon

Johnson of Canaan

Kainen of Hartford

Kennedy of Chelsea

Kilmartin of Newport City

Krawczyk of Bennington

Larocque of Barnet

Larrabee of Danville

Lawrence of Lyndon

Livingston of Manchester

Marcotte of Coventry

Marron of Stowe

McAllister of Highgate

Miller of Elmore

Morley of Barton

Morrissey of Bennington

Myers of Essex

Niquette of Colchester

O'Donnell of Vernon

Otterman of Topsham

Parent of St. Albans City

Peaslee of Guildhall

Shaw of Derby

Smith of New Haven

Sunderland of Rutland Town

Turner of Milton

Valliere of Barre City

Westman of Cambridge

Winters of Swanton

Winters of Williamstown

Wright of Burlington


Those who voted in the negative are:


Ancel of Calais

Aswad of Burlington

Atkins of Winooski

Audette of S. Burlington

Baker of West Rutland

Bohi of Hartford

Botzow of Pownal

Brennan of Colchester

Brooks of Montpelier

Chen of Mendon

Clarkson of Woodstock

Condon of Colchester

Copeland-Hanzas of Bradford

Corcoran of Bennington

Cross of Winooski

Darrow of Dummerston

Deen of Westminster

Donovan of Burlington

Dostis of Waterbury

Edwards of Brattleboro

Emmons of Springfield

Evans of Essex

Fallar of Tinmouth

Fisher of Lincoln

Frank of Underhill

French of Randolph

Gervais of Enosburg

Grad of Moretown

Green of Berlin

Haas of Rochester

Head of S. Burlington

Heath of Westford

Hosford of Waitsfield

Howard of Rutland City

Hunt of Essex

Hutchinson of Randolph

Jerman of Essex

Jewett of Ripton

Johnson of South Hero

Keenan of St. Albans City

Keogh of Burlington

Kiss of Burlington

Kitzmiller of Montpelier

Klein of East Montpelier

Kupersmith of S. Burlington

Larson of Burlington

Leriche of Hardwick

Lippert of Hinesburg

Lorber of Burlington

Louras of Rutland City

Maier of Middlebury

Marek of Newfane

Martin of Wolcott

Masland of Thetford

McCullough of Williston

McFaun of Barre Town

McLaughlin of Royalton

Milkey of Brattleboro

Miller of Shaftsbury

Minter of Waterbury

Molloy of Arlington

Mook of Bennington

Nease of Johnson

Nitka of Ludlow

Nuovo of Middlebury

Obuchowski of Rockingham

Orr of Charlotte

Partridge of Windham

Pellett of Chester

Perry of Richford

Peterson of Williston

Pillsbury of Brattleboro

Potter of Clarendon

Pugh of S. Burlington

Randall of Troy

Reese of Pomfret

Rusten of Halifax

Seibert of Norwich

Shand of Weathersfield

Sharpe of Bristol

Smith of Morristown

Sweaney of Windsor

Tracy of Burlington

Trombley of Grand Isle

Zuckerman of Burlington


Those members absent with leave of the House and not voting are:


Barnard of Richmond

Clark of St. Johnsbury

Flory of Pittsford

Koch of Barre Town

Komline of Dorset

LaVoie of Swanton

Malcolm of Pawlet

Martin of Springfield

Monti of Barre City

Rodgers of Glover

Severance of Colchester

Young of Orwell


 

     Pending third reading of the bill, Rep. O’Donnell of Vernon moved to amend the bill as follows:

In Sec. 14, by adding § 2028 to read:

§ 2028.  PREMIUM ASSISTANCE PROGRAM

(a)  As used in this section:

(1)  “Approved employer‑sponsored insurance plan” means a health insurance plan offered to an eligible individual or to his or her dependent, which when combined with the assistance offered under the program established by this section satisfies the criteria adopted by the office for a comprehensive, affordable health insurance plan that includes appropriate coverage of chronic care.  The office shall consult with the department of banking, insurance, securities, and health care administration in developing criteria under this subdivision.  An approved employer‑sponsored health insurance plan shall conform to the standards established for secretary‑approved coverage under the Global Commitment waiver.

(2)  “Eligible individual” means an individual who:

(A)(i)  Is enrolled in VHAP on January 1, 2007, and the individual or his or her dependents have access to an approved employer‑sponsored insurance plan;

(ii)  Applies for enrollment in Medicaid on and after January 1, 2007, and the individual or his or her dependents have access to an approved employer‑sponsored insurance plan; or

(iii)  Applies for enrollment in the premium assistance program on and after January 1, 2007, has household income greater than 150 percent of the federal poverty level, and has household income equal to or less than 300 percent of the federal poverty level, and the individual or his or her dependents have access to an approved employer‑sponsored insurance plan; and

(I)  Has been a resident of this state for at least 12 months immediately preceding the individual’s application for assistance;

(II)  Is not eligible for any other state or federal public health insurance program; and

(III)  Has not been insured under a private market health insurance plan that provides major medical coverage during the 12 months prior to the application.  The office may adopt rules permitting the waiver of the provisions of this subdivision because of unusual or mitigating circumstances, including but not limited to the loss of employer‑sponsored coverage, the loss of coverage by an institution of higher education, and the very low income of the individual.

(3)  “Global Commitment waiver” means the Medicaid Global Commitment to Health Demonstration waiver entered into between the agency of human services and the federal Centers for Medicare and Medicaid Services.

(4)  “Office” means the office of Vermont health access.

(5)  “VHAP” means the program that extends publicly sponsored coverage to low income, uninsured adults, previously under the Vermont health access plan, subsequently replaced by the Global Commitment waiver.  VHAP includes coverage for adults with household income up to 150 percent of the federal poverty level as well as parent-caretaker coverage for individuals with household income between 150 percent and 185 percent of the federal poverty level.  

(b)  The office shall request federal approval for the premium assistance program authorized by this section and shall adopt such rules as are necessary to carry out the purposes of this section.

(c)  For eligible individuals under subdivision (a)(2)(A)(i) of this section, the premium assistance program shall offer financial assistance to enable eligible individuals to participate in an approved employer‑sponsored insurance plan.  The rules of the premium assistance program with respect to eligible individuals under subdivision (a)(2)(A)(i) of this section shall include the following:

(1)  A subsidy of premiums or cost‑sharing amounts based on the household income of the eligible individual, with greater amounts of financial assistance provided to eligible individuals with lower household income and lesser amounts of assistance provided to eligible individuals with higher household income.

(2)  A requirement that eligible individuals under subdivision (a)(2)(A)(i) of this section enroll in an approved employer‑sponsored insurance plan as a condition of continued public assistance under this section or under any other benefit program offered or administered by the office.

(3)  Standards to ensure that eligible individuals under subdivision (a)(2)(A)(i) of this section on an annual basis are obligated to make out‑of‑pocket expenditures for premiums and cost‑sharing amounts which are substantially equivalent to or less than their premium and cost‑sharing obligations under VHAP.

(4)  Standards to ensure that eligible individuals under subdivision (a)(2)(A)(i) of this section have health insurance coverage of services which meet a minimum level of coverage as specified by the office.  The office may offer supplemental benefit coverage to such individuals.

(d)  For eligible individuals under subdivision (a)(2)(A)(ii) of this section, the premium assistance program shall offer financial assistance to enable eligible individuals to participate in an approved employer‑sponsored insurance plan offered to the individual.  The rules of the premium assistance program with respect to eligible individuals under subdivision (a)(2)(A)(ii) of this section shall include the following:

(1)  A subsidy of premiums or cost‑sharing amounts based on the household income of the eligible individual, with greater amounts of financial assistance provided to eligible individuals with lower household income and lesser amounts of assistance provided to individuals with higher household income.

(2)  A requirement that eligible individuals under subdivision (a)(2)(A)(ii) of this section enroll in an approved employer‑sponsored insurance plan as a condition of continued public assistance under this section or under any other benefit program offered or administered by the office.

(3)  The office may offer supplemental benefit coverage to such individuals.

(e)  For eligible individuals under subdivision (a)(2)(A)(iii) of this section, the premium assistance program shall offer financial assistance to enable eligible individuals to participate in an approved employer‑sponsored insurance plan offered to the individual.  The rules of the premium assistance program with respect to eligible individuals under subdivision (a)(2)(A)(iii) of this section shall include a subsidy of premiums or cost‑sharing amounts based on the household income of the eligible individual, with greater amounts of financial assistance provided to eligible individuals with lower household income and lesser amounts of assistance provided to eligible individuals with higher household income.

(f)  Except as provided by this section, eligible individuals may be offered assistance as otherwise provided in this subchapter under catamount health.

(g)  In the event that the office determines that appropriations for the premium assistance program for eligible individuals under subdivision (a)(2)(A)(iii) of this section are insufficient to meet the projected costs of enrolling new program participants, the office may suspend or terminate new enrollment for such eligible participants in the program or restrict enrollment to lower income eligible individuals.

(f)  With the approval of the joint fiscal committee and upon a demonstration by the office that expansion of the premium assistance program will result in financial savings to the Medicaid program without adversely affecting access to affordable health insurance and to quality health care for the affected individuals, the office may require additional categories of individuals who would otherwise be eligible for enrollment in Medicaid, the State Children’s Health Insurance Program (“SCHIP”), or VHAP but who have access to an approved employer‑sponsored insurance plan to participate in the premium assistance program as a condition of public financial assistance.

Pending the question, Shall the House amend the bill as recommended by Rep. O’Donnell of Vernon? Rep. Sunderland of Rutland Town demanded the Yeas and Nays, which demand was sustained by the Constitutional number.  The Clerk proceeded to call the roll and the question, Shall the House amend the bill as recommended by Rep. O’Donnell of Vernon?  was decided in the negative.  Yeas, 55.  Nays, 82.

Those who voted in the affirmative are:


Acinapura of Brandon

Adams of Hartland

Allaire of Rutland City

Allard of St. Albans Town

Baker of West Rutland

Bartlett of Dover

Bostic of St. Johnsbury

Branagan of Georgia

Brennan of Colchester

Canfield of Fair Haven

Clark of Vergennes

Dates of Shelburne

DePoy of Rutland City

Donaghy of Poultney

Donahue of Northfield

Dowland of Holland

Dunsmore of Georgia

Endres of Milton

Errecart of Shelburne

Helm of Castleton

Houston of Ferrisburgh

Howrigan of Fairfield

Hube of Londonderry

Hudson of Lyndon

Johnson of Canaan

Kainen of Hartford

Kennedy of Chelsea

Kilmartin of Newport City

Koch of Barre Town

Krawczyk of Bennington

Larocque of Barnet

Larrabee of Danville

Lawrence of Lyndon

Livingston of Manchester

Marcotte of Coventry

Marron of Stowe

McAllister of Highgate

Miller of Elmore

Morley of Barton

Morrissey of Bennington

Myers of Essex

Niquette of Colchester

O'Donnell of Vernon

Parent of St. Albans City

Peaslee of Guildhall

Shaw of Derby

Smith of New Haven

Sunderland of Rutland Town

Turner of Milton

Valliere of Barre City

Westman of Cambridge

Winters of Swanton

Winters of Williamstown

Wright of Burlington

Young of Orwell


Those who voted in the negative are:


Ancel of Calais

Atkins of Winooski

Bohi of Hartford

Botzow of Pownal

Brooks of Montpelier

Chen of Mendon

Clarkson of Woodstock

Condon of Colchester

Copeland-Hanzas of Bradford

Corcoran of Bennington

Cross of Winooski

Darrow of Dummerston

Deen of Westminster

Donovan of Burlington

Dostis of Waterbury

Edwards of Brattleboro

Emmons of Springfield

Evans of Essex

Fallar of Tinmouth

Fisher of Lincoln

Frank of Underhill

French of Randolph

Gervais of Enosburg

Grad of Moretown

Green of Berlin

Haas of Rochester

Head of S. Burlington

Heath of Westford

Hosford of Waitsfield

Howard of Rutland City

Hunt of Essex

Hutchinson of Randolph

Jerman of Essex

Jewett of Ripton

Johnson of South Hero

Keenan of St. Albans City

Keogh of Burlington

Kiss of Burlington

Kitzmiller of Montpelier

Klein of East Montpelier

Kupersmith of S. Burlington

Larson of Burlington

Leriche of Hardwick

Lippert of Hinesburg

Lorber of Burlington

Louras of Rutland City

Maier of Middlebury

Marek of Newfane

Martin of Wolcott

Masland of Thetford

McCullough of Williston

McFaun of Barre Town

McLaughlin of Royalton

Milkey of Brattleboro

Miller of Shaftsbury

Minter of Waterbury

Molloy of Arlington

Mook of Bennington

Nease of Johnson

Nitka of Ludlow

Nuovo of Middlebury

Obuchowski of Rockingham

Orr of Charlotte

Otterman of Topsham

Partridge of Windham

Pellett of Chester

Perry of Richford

Peterson of Williston

Pillsbury of Brattleboro

Potter of Clarendon

Pugh of S. Burlington

Randall of Troy

Reese of Pomfret

Rusten of Halifax

Seibert of Norwich

Shand of Weathersfield

Sharpe of Bristol

Smith of Morristown

Sweaney of Windsor

Tracy of Burlington

Trombley of Grand Isle

Zuckerman of Burlington


Those members absent with leave of the House and not voting are:


Aswad of Burlington

Audette of S. Burlington

Barnard of Richmond

Clark of St. Johnsbury

Flory of Pittsford

Komline of Dorset

LaVoie of Swanton

Malcolm of Pawlet

Martin of Springfield

Monti of Barre City

Rodgers of Glover

Severance of Colchester


 

     Pending third reading of the bill, Rep. Marcotte of Coventry moved to amend the bill as follows:

     In Sec. 17c by striking “July 25” wherever it appears and inserting in lieu thereof “August 25

     Which was agreed to.

     Pending third reading of the bill, Rep. Donahue of Northfield moved to amend the bill as follows:

First:  By striking Secs. 1 through 22 and inserting in lieu thereof the following:

Sec. 1.  HEALTH CARE REFORM PRINCIPLES

The general assembly adopts the following guidelines, modeled after the Coalition 21 principles, as a framework for reforming health care in Vermont:

(1)  It is the policy of the state of Vermont to ensure universal access to and coverage for essential health care services for all Vermonters. 

(2)  Health care coverage needs to be comprehensive and continuous. 

(3)  Vermont’s health delivery system must model continuous improvement of health care quality and safety. 

(4)  The financing of health care in Vermont must be sufficient, equitable, fair, and sustainable. 

(5)  Built-in accountability for quality, cost, access, and participation must be the hallmark of Vermont’s health care system.

(6)  Vermonters must be engaged, to the best of their ability, to pursue healthy lifestyles, to focus on preventive care and wellness efforts, and to make informed use of all health care services throughout their lives.

Sec. 2.  LEGISLATIVE PURPOSE AND INTENT

(a)  It is the intent of the general assembly that all Vermonters receive affordable and appropriate health care at the appropriate time and that health care costs be contained over time.  The general assembly finds that effective first steps to achieving this purpose are the prevention and management of chronic disease and coverage of the uninsured through catamount health, a self-insured, comprehensive benefit plan with sliding-scale premiums.  The general assembly finds that chronic care management is one tool to contain health care costs and ensure that Vermont’s health care system becomes sustainable.

(b)  It is also the intent of the general assembly to ensure that any reduction in the “cost shift” is returned to consumers by slowing the rate of growth in insurance premiums.  The cost shift results when the costs of health services are inadequately paid for by public health care programs and when individuals are unable to pay for services.  Raising Medicaid payment rates and reducing the number of uninsured will reduce the cost shift. 

Sec. 3.  3 V.S.A. § 2222a is added to read:

§ 2222a.  HEALTH CARE SYSTEM REFORM; QUALITY AND

               AFFORDABILITY

(a)  The secretary of administration, working in collaboration with the general assembly, shall be responsible for the coordination of health care system reform among executive branch agencies, departments, and offices.

(b)  The secretary shall ensure that those executive branch agencies, departments, and offices responsible for the development, improvement, and implementation of Vermont’s health care system reform do so in a timely manner.

(c)  Vermont’s health care system reform initiatives include:

(1)  The state’s chronic care infrastructure, disease prevention, and management program contained in the “blueprint for health” established by chapter 13 of Title 18, the goal of which is to achieve a unified, comprehensive, statewide system of care that improves the lives of Vermonters with or at risk for chronic disease.

(2)  The Vermont health information technology project.

(3)  The multi-payer data collection project.

(4)  The common claims administration project.

(5)  The consumer price and quality information system.

(6)  The public health promotion programs of the department of health and the department of disabilities, aging, and independent living.

(7)  Medicaid, the Vermont health access plan, Dr. Dynasaur, VPharm, and Vermont Rx, established in chapter 19 of Title 33, which contain programs to provide health care coverage to elderly, disabled, and low to middle income Vermonters.

(d)  The secretary shall report to the commission on health care reform, the health access oversight committee, the house committee on health care, the senate committee on health and welfare, and the governor on or before December 1, 2006 with a five-year strategic plan for implementing Vermont’s health care system reform initiatives, together with any administrative or legislative recommendations.  Annually, beginning January 15, 2007, the secretary shall report to the general assembly on the progress of the reform initiatives.

(e)  The secretary of administration or designee shall provide information and testimony on the activities included in this section to any legislative committee upon request and during adjournment to the health access oversight committee and the commission on health care reform.

* * * Chronic Care Infrastructure and Prevention * * *

Sec. 4.  BLUEPRINT FOR HEALTH

(a)  The general assembly endorses the “blueprint for health” prevention and chronic care management initiative as a foundation which it intends to strengthen by broadening its scope and coordinating the initiative with other public and private chronic care coordination and management programs.

(b)  The charge and strategic plan for the blueprint for health are codified as chapter 13 of Title 18. 

(c)  The department of health shall revise the current strategic plan for the blueprint for health and provide the revised plan to the commission on health care reform, the health access oversight committee, the house committee on health care, and the senate committee on health and welfare no later than October 1, 2006.  The revised strategic plan shall provide that a model for the patient registry under the blueprint for health is fully designed no later than January 1, 2007.

Sec. 5.  18 V.S.A. chapter 13 is added to read:

Chapter 13.  CHRONIC CARE INFRASTRUCTURE

AND PREVENTION

§ 701.  DEFINITIONS

For the purposes of this chapter:

(1)  “Blueprint for health” means the state’s chronic care infrastructure, disease prevention, and case management program.

(2)  “Chronic care” means health services provided by a health care professional for an established disease that is expected to last a year or more and that requires ongoing clinical management attempting to restore the individual to highest function, minimize the negative effects of the disease, and prevent disease-related complications.  Examples of chronic disease include diabetes, hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental illness, and hyperlipidemia.

(3)  “Chronic care management” means a system of coordinated health care interventions and communications for individuals with chronic disease, including significant patient self-care efforts, systemic supports for the physician and patient relationship, and a plan of care emphasizing prevention of complications utilizing evidence-based practice guidelines, patient empowerment strategies, and evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.

(4)  “Health care professional” means an individual, partnership, corporation, facility, or institution licensed or certified or authorized by law to provide professional health care services.

(5)  “Health risk assessment” means screening by a health care professional for the purpose of assessing an individual’s health, including tests or physical exams and a survey or other tool used to gather information about an individual’s health, medical history, and health risk factors during a health screening.

(6)  “Patient registry” means the electronic database developed under the blueprint for health.

§ 702.  BLUEPRINT FOR HEALTH; STRATEGIC PLAN

(a)  In coordination with the secretary of administration under section 2222a of Title 3, the commissioner of health shall be responsible for the development and implementation of the blueprint for health, including the five-year strategic plan.

(b)  The commissioner shall establish an executive committee to advise the commissioner on creating and implementing a strategic plan for the development of the statewide system of chronic care as described under this section.  The executive committee shall engage a broad range of health care professionals who provide services under section 2024 of Title 33, health insurance plans, professional organizations, community and nonprofit groups, consumers, businesses, school districts, and state and local government in developing and implementing a five-year strategic plan. 

(c)(1)  The strategic plan shall include:

(A)  a description of the Vermont blueprint for health chronic care model, which includes general, standard elements established in section 703 of this title to be used uniformly statewide by private insurers, third party administrators, and public programs;

(B)  a description of prevention programs and how these programs are integrated into communities and with chronic care management;

(C)  a plan to develop and implement reimbursement systems aligned with the goal of managing the care for individuals with or at risk for chronic disease in order to improve outcomes and the quality of care;

(D)  the involvement of public and private groups, health care professionals, insurers, third party administrators, associations, and firms to facilitate and assure the sustainability of a new system of care;

(E)  alignment of any information technology needs with other health care information technology initiatives;

(F)  the use and development of outcome measures and reporting requirements, aligned with existing outcome measures within the agency of human services, to assess and evaluate the system of care;

(G)  target timelines for inclusion of specific chronic diseases to be included in the chronic care infrastructure and for statewide implementation of the blueprint for health; and

(H)  a strategy for ensuring statewide participation no later than January 1, 2009, in the chronic care management plan, including common outcome measures, best practices and protocols, data reporting requirements, payment methodologies, and other standards.

(2)  The strategic plan shall be reviewed biennially and amended as necessary to reflect changes in priorities.  Amendments to the plan shall be reported to the general assembly in the report established under subsection (d) of this section.

(d)(1)  The commissioner of health shall report quarterly on the status of implementation of the Vermont blueprint for health to the house committee on health care, the senate committee on health and welfare, and the health access oversight committee.  The quarterly report shall include the number of participating insurers, health care professionals, and patients, the progress for achieving statewide participation in the chronic care management plan, including the measures established under subsection (c) of this section, the expenditures and savings for the period, and other information as requested by the committees.  At least annually, the commissioner shall report the results of health care professional and patient satisfaction surveys.  The surveys shall be developed in collaboration with the executive committee established under subdivision (b) of this section.

(2)  If statewide participation is not achieved by January 1, 2009, the commissioner shall recommend to the general assembly statutory changes to create alternative measures to ensure statewide participation by health insurers, third party administrators, and health care professionals.

§ 703.  CHRONIC DISEASE PREVENTION AND CARE

             MANAGEMENT; CATAMOUNT HEALTH; REQUEST FOR

            PROPOSALS

(a)(1)  The secretary of administration or designee shall issue a request for proposals no later than January 1, 2007 for health services for individuals with chronic disease who are enrolled in Medicaid, the Vermont health access plan, or Dr. Dynasaur. 

(2)  With the goal of including all individuals, the secretary may initially target the chronic care management program to certain groups of individuals to ensure successful implementation and quality of services and to maximize cost savings.  Individuals with chronic disease who are enrolled in catamount health shall be included in the chronic care management program upon enrollment.  In the request for proposals, the secretary may provide a time period for implementing chronic care management to individuals currently enrolled in Medicaid, the Vermont health access plan, or Dr. Dynasaur in order to allow sufficient time for health care professionals and the entity administering the proposal to identify and enroll these individuals.

(3)  The secretary or designee shall apply for a waiver or other approval from the Centers for Medicare and Medicaid Services to include individuals who are dually eligible for Medicare and Medicaid.   

(b)  The secretary shall include in the request for proposal a broad range of chronic diseases for chronic care management.

(c)  The request for proposals shall stipulate that responses include:

(1)  a method involving the health care professional in identifying eligible patients, including the use of the patient registry, an enrollment process which provides incentives and strategies for maximum patient participation, and a standard statewide health risk assessment for each individual;

(2)  the process for coordinating care among health care professionals;

(3)  the methods of increasing communication among health care professionals and patients, including patient education, self-management, and follow‑up plans;

(4)  the educational, wellness, and clinical management protocols and tools used by the care management organization, including management guideline materials for health care professionals to assist in patient-specific recommendations;

(5)  process and outcome measures to provide performance feedback for health care professionals and information on the quality of care, including patient satisfaction and health status outcomes;

(6)  payment methodologies which create financial incentives and rewards for health care professionals to improve disease management and the quality of care, including case management fees or pay for performance; and

(7)  payment to the care management organization which would guarantee net savings to the state or put the care management organization’s fee at risk if the management is not successful in reducing costs to the state.

(d)  The secretary shall review the request for proposals with the commission on health care reform prior to issuance.  The issuance of the requests for proposals is conditioned on the approval of the commission in order to ensure that the request meets the intent of this section and section 702 of this title.

(e)  The secretary shall ensure that the responses to the requests for proposals, including future requests, shall comply with the Vermont blueprint for health.

Sec. 6.  CHRONIC DISEASE PREVENTION AND CARE

             MANAGEMENT; AGENCY OF HUMAN SERVICES;

             IMPLEMENTATION PLAN

(a)  No later than January 1, 2007, the agency of human services shall develop an implementation plan for chronic disease prevention and care management which at minimum meets the criteria and requirements of chapter 13 of Title 18.  The agency’s implementation plan shall be revised periodically to reflect changes to the chronic care infrastructure, disease prevention, and management strategic plan.  In addition to the chronic care management provided under section 703 of Title 18, the agency may provide additional care coordination services to appropriate individuals as specified in its strategic plan.  The agency shall ensure that Medicaid, Medicaid waiver programs, and Dr. Dynasaur change the payment methodologies in order to comply with the recommendation of the strategic plan and the request for proposals developed under chapter 13 of Title 18.  The agency shall analyze and include a recommendation as to any waivers or waiver modifications needed to implement a chronic care management program.

(b)  The agency shall require recertification or reapplication for Medicaid, the Vermont health access plan, and Dr. Dynasaur only once a year.

Sec. 7.  CHRONIC DISEASE PREVENTION AND CARE MANAGEMENT;

             STATE EMPLOYEES

The commissioner of human resources shall include in any request for proposals for the administration of the state employees health benefit plans a request for a description of any chronic care management program provided by the entity and how the program aligns with the Vermont blueprint for health developed under section 702 of Title 18.  The commissioner shall also work with the secretary of administration or designee, and the Vermont state employees’ association on how and when to align the state employees’ health benefit plan with the goals and statewide standards developed by the Vermont blueprint for health in section 702 of Title 18.

* * * Medicaid Reimbursement * * *

Sec. 8.  MEDICAID REIMBURSEMENT

(a)  For fiscal year 2007, the office of Vermont health access shall increase Medicaid reimbursement for evaluation and management procedure codes to enhance payment for primary care services under Medicaid and the Vermont health access plan to a level equivalent to rates in the Medicare program.  Starting in fiscal year 2008, the office shall also align Medicaid rates to reflect the changes in reimbursement for the chronic disease prevention and care management program provided for in chapter 13 of Title 18.

(b)  In fiscal years subsequent to 2007, Medicaid reimbursement increases to health care professionals and hospitals under Medicaid, the Vermont health access plan, and Dr. Dynasaur should be tied to the standards developed under the chronic disease prevention and care management program established in section 702 of Title 18, quality or performance measures.  Prior to implementation, these standards shall be approved by the general assembly through the appropriations process.

Sec. 9.  HOSPITAL SERVICE AREA PILOT PROJECTS

(a)  The office of Vermont health access, in consultation with the department of health, shall issue requests for proposals for community pilot projects in two separate hospital service areas.  The goal of the project shall be to increase integration and collaboration among health care professionals and community partners to coordinate the delivery of quality health care services in an efficient manner for implementation of the blueprint for health and catamount health.

(b)  The responses shall include:

(1)  a comprehensive evaluation process that would establish test measures to monitor improvements and changes in access, clinical outcomes, quality, and cost‑containment;

(2)  parameters for evaluating sharing the financial risk and any savings; and

(3)  developing payment methodologies which include cost containment and realignment of incentives.

(c)  The office shall negotiate with the applicants to determine the scope and duration of the project.  The office shall provide incentive grants of $100,000.00 to successful applicants to be used to coordinate and enhance the effectiveness of the pilot. 

Sec. 10.  VHAP PREMIUM ADJUSTMENTS

Sec. 147(d) of No. 66 of the Acts of 2003, as amended by Sec. 129 of No. 122 of the Acts of the 2003 Adj. Sess. (2004) and Sec. 279 of No. 71 of the Acts of 2005, is further amended to read:

(d)  VHAP, premium-based.

* * *

(2)  The agency shall establish per individual premiums for the VHAP Uninsured program for the following brackets of income for the VHAP group as a percentage of federal poverty level (FPL):

(A)  Income greater than 50 percent and less than or equal to 75 percent of FPL:  $11.00 $7.00 per month.

(B)  Income greater than 75 percent and less than or equal to 100 percent of FPL:  $39.00 $25.00 per month.

(C)  Income greater than 100 percent and less than or equal to 150 percent of FPL:  $50.00 $33.00 per month.

(D)  Income greater than 150 percent and less than or equal to 185 percent of FPL:  $75.00 $49.00 per month.

Sec. 11.  DR. DYNASAUR AND SCHIP PREMIUM ADJUSTMENTS 

Sec. 147(f) of No. 66 of the Acts of 2003, as amended by Sec. 280 of No. 71 of the Acts of 2005, is amended to read:

(f)  Dr. Dynasaur and SCHIP premium changes.

(1)  The agency is authorized to amend the rules for individuals eligible for Dr. Dynasaur under the federal Medicaid and SCHIP programs to require beneficiary households to pay a monthly premium based on the following:

(A)  for individuals living in households whose incomes are greater than 225 percent of FPL and less than or equal to 300 percent of FPL, and who have no other insurance coverage:  $80.00 $40.00 per household per month.

(B)  for individuals living in households whose incomes are greater than 225 percent of FPL and less than or equal to 300 percent of FPL, and who have other insurance coverage:  $40.00 $20.00 per household per month.

(C)  for individuals living in households whose incomes are greater than 185 percent of FPL and less than or equal to 225 percent of FPL:  $30.00 $15.00 per household per month.

* * *

* * * Private Insurance Cost Shift Reviews* * *

Sec. 12.  8 V.S.A. § 4062d is added to read:

§ 4062d.  COST SHIFT REVIEW OF HEALTH INSURANCE PREMIUMS

In connection with insurers’ rate filings made pursuant to sections 4062, 4062b, 4515a, 4587, and 5104 of this title and any other applicable provisions of law, the commissioner shall ensure that health insurers appropriately account for reductions in hospital and provider charges attributable to any increase in Medicaid or other public insurance program reimbursements for health care providers or facilities and to a reduction in bad debt or charity care.

Sec. 13.  COST SHIFT TASK FORCE

The department of banking, insurance, securities, and health care administration shall convene a task force of health care professionals, insurers, hospitals, and other interested parties to determine how to ensure that reductions in hospital and provider charges are reflected in a slower rate of growth in health insurance premiums.  The task force shall make written recommendations on statutory or administrative changes needed to ensure that a reduction in the cost shift is reflected in health insurance premiums to the commission on health care reform no later than December 1, 2006.

Sec. 14.  ENROLLMENT INITIATIVES

The secretary of administration or designee and the director of the office of Vermont health access shall engage interested groups and parties in assisting with outreach and informational initiatives to ensure Vermonters have information about health care coverage options provided by Medicaid, the Vermont health access plan, and Dr. Dynasaur.  

Sec. 15.  COMMISSION ON HEALTH CARE REFORM

Any reports required by this act shall be provided to the commission on health care reform established by Sec. 277c of No. 71 of the Acts of 2005 until the time that the commission dissolves.

Sec. 16.  APPROPRIATIONS

(a)  For fiscal year 2007, the sum of $2,900,000.00 is appropriated from the Global Commitment fund for the increase in Medicaid rates under Sec. 8 of this act.

(b)  For fiscal year 2007, the sum of $200,000.00 is appropriated from the general fund for the incentive grants for the hospital service area payment pilot projects under Sec. 9 of this act.

Sec. 17.  EFFECTIVE AND IMPLEMENTATION DATES

This act shall take effect upon passage, except that Secs. 8 (Medicaid reimbursement) and 12 (cost shift review) shall take effect July 1, 2006, and Secs. 10 (VhHAP premiums) and 11 (Dr. Dynasaur premiums) shall take effect July 1, 2007.

Second:  By adding a new Sec. 18 to read:

Sec. 18.  STUDY OF CATAMOUNT HEALTH; ECONOMIC AND

               FINANCIAL STUDIES

(a)  On or before January 15, 2007, in order to assess more fully the benefits and costs and to prepare and plan for the implementation of full and universal access to health care in Vermont, the commission on health care reform, in consultation with the department of banking, insurance, securities, and health care administration, shall direct that the following economic impact and  financing studies be undertaken.  The commission shall direct its staff or contract for one or more consultants to undertake the economic impact and financing studies authorized by this section.

(1)  Economic impact study.  The economic impact study shall examine the impact of implementing a system of universal access to health care for Vermonters versus the effects of sustaining the current system on business and the labor force, the future growth of the economy, and the economic competitiveness of Vermont and the effects on residents and population groups and on current and potential insurers and providers of health care.

(2)  Financing options.  The financing study shall examine the financing options that most effectively achieve the goal of universal access to health care and maintaining its affordability.  The study shall include the examination of all financing options and their implications, including the income tax, a payroll tax, premiums or cost-sharing measures, consumption taxes, specific, more limited taxes to support parts of the health care system’s financial needs, and other revenue sources, including insurance risk pools and insurance assistance and incentives.

(A)  The study shall reference the fact and supporting empirical evidence that many countries have achieved universal access and more affordable health care utilizing public financing as a tool to achieve this goal.  The study shall consider the strengths and weaknesses of such public financing systems with respect to fairness and adequacy of funding and access to and quality of services.

(B)  The study shall examine how implementation of any public financing options will be offset in corresponding reductions in premiums, other taxes, and individual cost-sharing contributions.

(C)  The study shall examine how any proposed changes in financing or delivery of health care could affect benefits Vermonters currently receive through Vermont employers.

(D)  The study shall address issues involved with federal law and taxation, including ERISA and other areas of preemption; technical proposals to exempt nonresident employees of Vermont businesses; a provision to ensure a soft landing for affected businesses and a recommendation as to the appropriate amount needed in a soft‑landing provision to mitigate negative effects on business; recommendations on the best method for unemployed individuals to contribute to the financing; a simplified structure based on employee numbers, employer payroll, or a combination for ease of administration and clarity; and the recommendations of the department of taxes. 

(E)  The study shall analyze methods for recapturing insurance premiums as a result of any reductions in uncompensated care, such as the Dirigo model enacted in the state of Maine, or any reductions in insurance premiums resulting from public financing and for ensuring that all Vermonters contribute to the financing of health care’s fixed costs.

(3)  The commission on health care reform shall include in its report to the general assembly its analysis and recommendations concerning:

(A)  The costs and policy considerations of providing uninsured low and moderate income Vermonters access to health insurance through a premium assistance program such as the catamount health program recommended by the house committee on health care during the 2006 Session of the Vermont general assembly.

(B)  The financial and policy advantages and disadvantages of providing premium assistance to low and moderate income uninsured Vermonters through a public health insurance program or through commercial health insurance plans.

(C)  The number of individuals enrolled in any chronic care management program which complies with the requirements in chapter 13 of Title 18, including those covered by private insurance.

(D)  Any recommendations to achieve a 98 percent rate of insured Vermonters.  In making its recommendations, the commission shall consider whether mandating participation in public health care programs and health insurance coverage is necessary to increase enrollment and whether mandating that those who choose not to have health insurance coverage should be required to pay some of the health care costs. 

(b)  The department of banking, insurance, securities, and health care administration shall complete a survey of insurance status no later than June 30, 2009, provided that an appropriation for this purpose is made by the general assembly.  The agency of administration shall make recommendations to the general assembly no later than January 15, 2010 on any changes to catamount health needed to increase enrollment to achieve a 98 percent rate of insured Vermonters.  In making its recommendations, the agency shall consider whether mandating participation in public health care programs and health insurance coverage is necessary to increase enrollment.  The agency shall include supporting information and data for the recommendation.

Pending the question, Shall the House amend the bill as recommended by Rep. Donahue of Northfield? Rep. Morrissey of Bennington demanded the Yeas and Nays, which demand was sustained by the Constitutional number.  The Clerk proceeded to call the roll and the question, Shall the House amend the bill as recommended by Rep. Donahue of Northfield?  was decided in the negative.  Yeas, 54.  Nays, 80.

Those who voted in the affirmative are:


Acinapura of Brandon

Adams of Hartland

Allaire of Rutland City

Allard of St. Albans Town

Baker of West Rutland

Bartlett of Dover

Branagan of Georgia

Brennan of Colchester

Canfield of Fair Haven

Clark of Vergennes

Dates of Shelburne

DePoy of Rutland City

Donaghy of Poultney

Donahue of Northfield

Dunsmore of Georgia

Endres of Milton

Errecart of Shelburne

Helm of Castleton

Houston of Ferrisburgh

Hube of Londonderry

Hudson of Lyndon

Johnson of Canaan

Kennedy of Chelsea

Kilmartin of Newport City

Koch of Barre Town

Krawczyk of Bennington

Larocque of Barnet

Larrabee of Danville

Lawrence of Lyndon

Livingston of Manchester

Louras of Rutland City

Marcotte of Coventry

Marron of Stowe

McAllister of Highgate

Miller of Shaftsbury

Miller of Elmore

Molloy of Arlington

Morley of Barton

Morrissey of Bennington

Myers of Essex

Niquette of Colchester

O'Donnell of Vernon

Otterman of Topsham

Peaslee of Guildhall

Shaw of Derby

Smith of New Haven

Sunderland of Rutland Town

Turner of Milton

Valliere of Barre City

Westman of Cambridge

Winters of Swanton

Winters of Williamstown

Wright of Burlington

Young of Orwell


Those who voted in the negative are:


Ancel of Calais

Aswad of Burlington

Atkins of Winooski

Audette of S. Burlington

Bohi of Hartford

Botzow of Pownal

Brooks of Montpelier

Chen of Mendon

Clarkson of Woodstock

Condon of Colchester

Copeland-Hanzas of Bradford

Corcoran of Bennington

Cross of Winooski

Darrow of Dummerston

Deen of Westminster

Donovan of Burlington

Dostis of Waterbury

Dowland of Holland

Edwards of Brattleboro

Emmons of Springfield

Evans of Essex

Fallar of Tinmouth

Fisher of Lincoln

Frank of Underhill

French of Randolph

Gervais of Enosburg

Grad of Moretown

Green of Berlin

Haas of Rochester

Head of S. Burlington

Heath of Westford

Hosford of Waitsfield

Howard of Rutland City

Howrigan of Fairfield

Hutchinson of Randolph

Jerman of Essex

Jewett of Ripton

Johnson of South Hero

Keenan of St. Albans City

Keogh of Burlington

Kiss of Burlington

Kitzmiller of Montpelier

Klein of East Montpelier

Kupersmith of S. Burlington

Larson of Burlington

Leriche of Hardwick

Lippert of Hinesburg

Lorber of Burlington

Maier of Middlebury

Marek of Newfane

Martin of Wolcott

Masland of Thetford

McCullough of Williston

McFaun of Barre Town

McLaughlin of Royalton

Milkey of Brattleboro

Minter of Waterbury

Mook of Bennington

Nease of Johnson

Nitka of Ludlow

Nuovo of Middlebury

Obuchowski of Rockingham

Orr of Charlotte

Partridge of Windham

Pellett of Chester

Perry of Richford

Peterson of Williston

Potter of Clarendon

Pugh of S. Burlington

Randall of Troy

Reese of Pomfret

Rusten of Halifax

Seibert of Norwich

Shand of Weathersfield

Sharpe of Bristol

Smith of Morristown

Sweaney of Windsor

Tracy of Burlington

Trombley of Grand Isle

Zuckerman of Burlington


Those members absent with leave of the House and not voting are:


Barnard of Richmond

Bostic of St. Johnsbury

Clark of St. Johnsbury

Flory of Pittsford

Hunt of Essex

Kainen of Hartford

Komline of Dorset

LaVoie of Swanton

Malcolm of Pawlet

Martin of Springfield

Monti of Barre City

Parent of St. Albans City

Pillsbury of Brattleboro

Rodgers of Glover

Severance of Colchester


 

Recess

At one o’clock in the afternoon, the Speaker declared a recess until one o’clock and thirty-five minutes in the afternoon.

At two o’clock and in the afternoon, the Speaker called the House to order.

Rep. Warren Kitzmiller in Chair.

 

Consideration Resumed;

Bill Amended and Third Reading Ordered

H. 861

Consideration resumed on House bill, entitled

An act relating to health care affordability for Vermonters;

     Pending third reading of the bill, Rep. Errecart of Shelburne moved to amend the bill as follows:

     By striking all after the enacting clause and inserting in lieu thereof the following:

* * * Findings and Purpose * * *

Sec. 1.  FINDINGS AND PRINCIPLES FOR HEALTH CARE REFORM

(a)  Findings.

(1)  Vermont faces twin challenges to our health care system: unsustainable health care inflation and a growing number of uninsured Vermonters.  These challenges are interrelated:  health care inflation creates difficult choices for public and private health insurance plans; as employers drop or reduce coverage, more Vermonters become uninsured; and an increase in the number of uninsured Vermonters will tend to increase the cost of uncompensated care paid for by those who are insured.

(2)  Health care spending in Vermont and the nation is increasing at an unsustainable rate.  While Vermont health care costs are still lower than national per capita costs, the gap between Vermont and the nation has been narrowing.

(3)  Chronic conditions account for more than three-quarters of the $3.3 billion Vermont spends on health care each year.  The health care needs of Vermonters with chronic conditions will be the primary driver of the demand for health care and the resulting costs for the foreseeable future.

(4)  Vermont’s health care system offers high quality care and accessible coverage to Vermonters, but health care system improvements can be made in many areas, including developing a comprehensive chronic care treatment system, building a modern health information technology system, reducing administrative costs and complexities, using a comprehensive health care claims database to improve the quality and cost‑effectiveness of care, providing consumers paying increased out‑of‑pocket expenses with good price and quality information, and establishing an adverse event reporting system.

(5)  Public health initiatives are an essential component of a comprehensive health care reform plan, with promotion of healthy behavior and disease prevention across the lifespan of the individual.

(6)  Reforms to the tort system for adjudicating medical malpractice claims will create a better environment for Vermont practitioners to focus on providing quality and affordable health care to Vermonters.

(7)  Vermont has been a leader in offering health insurance for low and moderate income Vermonters through the Medicaid program, but the Medicaid program can no longer be used as the primary mechanism to lower costs and expand access to health insurance because, even with the Global Commitment waiver, significant cost containment activities must be engaged in to avoid a substantial deficit in the Medicaid program in future years and because the low level of Medicaid reimbursements results in a Medicaid cost shift that is paid for by Vermonters covered by employer‑sponsored insurance.

(8)  The health care reform plan established by this act offers universal access to health insurance for all Vermonters by distinguishing between the different groups of uninsured Vermonters and by creating targeted strategies for insuring each group according to its needs and circumstances.

(A)  The largest group of uninsured Vermonters (about 45 percent) is potentially eligible for Medicaid, based on household income, but has not enrolled in the Medicaid program.  For this group of uninsured Vermonters, health insurance coverage could be offered under the existing Medicaid program.

(B)  About 34 percent of uninsured Vermonters have household income between 150 percent and 300 percent of the federal poverty level.  These Vermonters are ineligible for a Medicaid program and, because of their income, might have difficulty affording commercial health insurance coverage.

(C)  A third group of uninsured Vermonters (about 21 percent) has household income over 300 percent of the federal poverty level.  These individuals and households most likely could afford to purchase health insurance, especially if a basic, affordable health insurance policy were offered.

(b)  The goals and principles of health care reform for Vermont should be:

(1)  Universal access to affordable health insurance for all Vermonters.

(2)  Improved quality and affordability through health care system reform.

(3)  The promotion of healthy behavior and disease prevention across the lifespan of individual Vermonters.

(4)  Reduced demand for health care expenditures through improved health outcomes.

(5)  Personal responsibility and consumer choice, with the patient at the center of decision‑making.

(6)  A competitive private health insurance market and cost-effective public programs.

(7)  Compatibility with and support for economic growth and prosperity.

* * * Universal Access to Health Insurance * * *

Sec. 2.  18 V.S.A. § 9413 is added to read:

§ 9413.  HEALTH INSURANCE ASSISTANCE AND REFERRAL

              SERVICE

The commissioner shall contract for the establishment of a health insurance assistance and referral service.  The service shall offer a toll-free telephone number and an internet website for individuals and businesses in Vermont to call or visit to obtain information on affordable health insurance options.  The service shall offer advice, assistance, and referral concerning both public and private health insurance options, including Medicaid, Medicare, the premium assistance program, the basic health insurance policy, nongroup private health insurance, small group and association health insurance, and other public and private health insurance options.

Sec. 3.  THE MEDICAID ENROLLMENT INITIATIVE

(a)  The governor and the general assembly find that:

(1)  Vermont is a leader in providing health insurance coverage for low and moderate income Vermonters.  Household income eligibility criteria are among the highest in the nation, providing health insurance for many working Vermonters.

(2)  As a result, Vermont’s average uninsured rate is the second lowest in the nation, and 96 percent of children are covered by public or private health insurance.

(3)  Despite Vermont’s efforts, about 45 percent of the uninsured in Vermont could be eligible for coverage under a Medicaid program based on an estimate of uninsured Vermonters’ household income, but are either unwilling or unable to enroll in a public health insurance program.

(b)  The office of Vermont health access shall identify the reasons why 28,000 Vermonters with household income below Medicaid and SCHIP household income levels are not enrolled in a public health insurance program and shall develop a strategy designed to encourage eligible individuals and families to enroll.  The office shall report annually to the governor and the general assembly on or before January 15 with an assessment of outreach and enrollment strategies, together with any administrative or legislative recommendations for improving participation and retention of eligible individuals and families.

Sec. 4.  THE MEDICAID COST SHIFT INITIATIVE

(a)  The governor and the general assembly find that the gap among hospital, doctor, and other provider reimbursements for Medicaid claims when compared with commercial health insurance claims is too great.  If the current reimbursement gap continues, Vermonters enrolled in public health insurance programs may face reduced access to the health care system because fewer health care providers may participate, and Vermonters enrolled in commercial health insurance plans will face higher premiums than would otherwise be the case because the difference between Medicaid reimbursements and commercial health insurance reimbursements is shifted to commercial health insurance plans.

(b)  The governor and the general assembly are committed to a significant appropriation in fiscal year 2007 to increase health care provider reimbursements for Medicaid, the SCHIP program, and other public insurance programs administered by the office of Vermont health access, in accordance with a methodology approved by the director.

(c)  In fiscal years subsequent to fiscal year 2007, any health care provider and hospital reimbursement increases appropriated by the general assembly for Medicaid, SCHIP, or other public health insurance programs shall be contingent upon adherence to standards adopted by the office of Vermont health access relating to quality, performance, and chronic care payment reform strategies.

Sec. 5.  8 V.S.A. § 4062d is added to read:

§ 4062d.  COST SHIFT REVIEW OF HEALTH INSURANCE PREMIUMS

In connection with insurers’ rate filings made pursuant to sections 4062, 4062b, 4515a, 4587, 5104 of this title, and any other applicable provisions of law, the commissioner shall ensure that health insurers appropriately account for reductions in hospital and provider charges attributable to any increase in Medicaid or other public insurance program reimbursements for health care providers or facilities.

Sec. 6.  33 V.S.A. chapter 19, subchapter 9 is added to read:

Subchapter 9.  Premium Assistance Program

§ 2091.  PREMIUM ASSISTANCE PROGRAM

(a)  As used in this section:

(1)  “Approved employer‑sponsored insurance plan” means a health insurance plan offered to an eligible individual or to his or her dependent, which when combined with the assistance offered under the program established by this section satisfies the criteria adopted by the office for a comprehensive, affordable health insurance plan that includes appropriate coverage of chronic care.  The office shall consult with the department of banking, insurance, securities, and health care administration in developing criteria under this subdivision.  An approved employer‑sponsored health insurance plan shall conform to the standards established for secretary‑approved coverage under the Global Commitment waiver.

(2)  “Eligible individual” means an individual who:

(A)(i)  Is enrolled in VHAP on January 1, 2007, and the individual or his or her dependents have access to an approved employer‑sponsored insurance plan;

(ii)  Applies for enrollment in Medicaid on and after January 1, 2007, and the individual or his or her dependents have access to an approved employer‑sponsored insurance plan; or

(iii)  Applies for enrollment in the premium assistance program on and after January 1, 2007, has household income greater than 150 percent of the federal poverty level, and has household income equal to or less than 300 percent of the federal poverty level, and the individual or his or her dependents have access to an approved employer‑sponsored insurance plan; and

(I)  Has been a resident of this state for at least 12 months immediately preceding the individual’s application for assistance;

(II)  Is not eligible for any other state or federal public health insurance program; and

(III)  Has not been insured under a private market health insurance plan that provides major medical coverage during the 12 months prior to the application.  The office may adopt rules permitting the waiver of the provisions of this subdivision because of unusual or mitigating circumstances, including but not limited to the loss of employer‑sponsored coverage, the loss of coverage by an institution of higher education, and the very low income of the individual.

(3)  “Global Commitment waiver” means the Medicaid Global Commitment to Health Demonstration waiver entered into between the agency of human services and the federal Centers for Medicare and Medicaid Services.

(4)  “Office” means the office of Vermont health access.

(5)  “VHAP” means the program that extends publicly sponsored coverage to low income, uninsured adults, previously under the Vermont health access plan, subsequently replaced by the Global Commitment waiver.  VHAP includes coverage for adults with household income up to 150 percent of the federal poverty level as well as parent-caretaker coverage for individuals with household income between 150 percent and 185 percent of the federal poverty level.  

(b)  The office shall request federal approval for the premium assistance program authorized by this section and shall adopt such rules as are necessary to carry out the purposes of this section.

(c)  For eligible individuals under subdivision (a)(2)(A)(i) of this section, the premium assistance program shall offer financial assistance to enable eligible individuals to participate in an approved employer‑sponsored insurance plan.  The rules of the premium assistance program with respect to eligible individuals under subdivision (a)(2)(A)(i) of this section shall include the following:

(1)  A subsidy of premiums or cost‑sharing amounts based on the household income of the eligible individual, with greater amounts of financial assistance provided to eligible individuals with lower household income and lesser amounts of assistance provided to eligible individuals with higher household income.

(2)  A requirement that eligible individuals under subdivision (a)(2)(A)(i) of this section enroll in an approved employer‑sponsored insurance plan as a condition of continued public assistance under this section or under any other benefit program offered or administered by the office.

(3)  Standards to ensure that eligible individuals under subdivision (a)(2)(A)(i) of this section on an annual basis are obligated to make out‑of‑pocket expenditures for premiums and cost‑sharing amounts which are substantially equivalent to or less than their premium and cost‑sharing obligations under VHAP.

(4)  Standards to ensure that eligible individuals under subdivision (a)(2)(A)(i) of this section have health insurance coverage of services which meet a minimum level of coverage as specified by the office.  The office may offer supplemental benefit coverage to such individuals.

(d)  For eligible individuals under subdivision (a)(2)(A)(ii) of this section, the premium assistance program shall offer financial assistance to enable eligible individuals to participate in an approved employer‑sponsored insurance plan offered to the individual.  The rules of the premium assistance program with respect to eligible individuals under subdivision (a)(2)(A)(ii) of this section shall include the following:

(1)  A subsidy of premiums or cost‑sharing amounts based on the household income of the eligible individual, with greater amounts of financial assistance provided to eligible individuals with lower household income and lesser amounts of assistance provided to individuals with higher household income.

(2)  A requirement that eligible individuals under subdivision (a)(2)(A)(ii) of this section enroll in an approved employer‑sponsored insurance plan as a condition of continued public assistance under this section or under any other benefit program offered or administered by the office.

(3)  The office may offer supplemental benefit coverage to such individuals.

(e)  For eligible individuals under subdivision (a)(2)(A)(iii) of this section, the premium assistance program shall offer financial assistance to enable eligible individuals to participate in an approved employer‑sponsored insurance plan offered to the individual.  The rules of the premium assistance program with respect to eligible individuals under subdivision (a)(2)(A)(iii) of this section shall include a subsidy of premiums or cost‑sharing amounts based on the household income of the eligible individual, with greater amounts of financial assistance provided to eligible individuals with lower household income and lesser amounts of assistance provided to eligible individuals with higher household income.

(f)  Except as provided by this section, eligible individuals may be offered assistance as otherwise provided in this subchapter under catamount health.

(g)  In the event that the office determines that appropriations for the premium assistance program for eligible individuals under subdivision (a)(2)(A)(iii) of this section are insufficient to meet the projected costs of enrolling new program participants, the office may suspend or terminate new enrollment for such eligible participants in the program or restrict enrollment to lower income eligible individuals.

(f)  With the approval of the joint fiscal committee and upon a demonstration by the office that expansion of the premium assistance program will result in financial savings to the Medicaid program without adversely affecting access to affordable health insurance and to quality health care for the affected individuals, the office may require additional categories of individuals who would otherwise be eligible for enrollment in Medicaid, the State Children’s Health Insurance Program (“SCHIP”), or VHAP but who have access to an approved employer‑sponsored insurance plan to participate in the premium assistance program as a condition of public financial assistance.

Sec. 7.  8 V.S.A. § 4080f is added to read:

§ 4080f.  BASIC HEALTH INSURANCE POLICY

(a)  As used in this section:

(1)  “Basic health insurance policy” means a health insurance policy, a nonprofit hospital or medical service corporation service contract, or a health maintenance organization health benefit plan approved by the commissioner offered or issued to an individual or to an employer who has not offered health insurance during the three years prior to application, and offering single, two‑person, and family coverage.

(2)  “Health insurer” means a health insurance company, a hospital or medical services corporation, or a health maintenance organization.

(3)  “Individual” means a person who:

(A)  Has been a resident of this state for at least 12 months immediately preceding the individual’s application to purchase a basic health insurance policy; and

(B)  Has not been insured under a public or private health insurance plan that provides major medical coverage during the 12 months prior to the individual’s application for purchase of a basic health insurance policy, and the individual or a member of the individual’s household is not eligible for coverage under a group health insurance plan that provides major medical coverage for the individual and for the individual’s dependents if applicable for which the plan sponsor contributes at least 50 percent of the cost of the applicable plan.  The commissioner may adopt rules permitting the waiver of the provisions of this subdivision because of circumstances beyond the control of the individual, including but not limited to the loss of employer‑sponsored coverage, the loss of coverage by an institution of higher education, and the very low income of the individual.

(C)  Has been insured under a basic health insurance policy issued under this section for no more than ten years.

(b)  The commissioner shall encourage health insurance companies, hospital and medical service corporations, and health maintenance organizations doing business in this state to offer basic health insurance policies to individuals.  If necessary to ensure the availability of basic health insurance policies, the commissioner may require a health insurer covering at least five percent of the lives insured in the private health insurance market in this state to offer basic health insurance policies to individuals.  The commissioner may permit one or more health insurers to enter into a joint operating agreement to consolidate the offering of basic health insurance policies to uninsured Vermonters.  In connection with a rate decision, the commissioner may make reasonable supplemental orders to a health insurer and may attach reasonable conditions and limitations to such orders as he or she finds, on the basis of competent and substantial evidence, necessary to carry out the purposes of this section. 

(c)  A basic health insurance policy shall be a policy approved by the commissioner that is consistent with the following standards:

(1)  The policy covers major medical services in accordance with the requirements of this chapter and with the requirements of chapter 221 of Title 18.

(2)  The policy covers eligible preventive care which meets the requirements of Section 223 of the Internal Revenue Code (health savings accounts), as amended, notwithstanding any deductible amount, including  services determined by the commissioner to be necessary for the treatment of chronic conditions, based on the recommendations of the commissioner of health.

(3)  The policy has annual deductible amounts no less than the deductible amounts required under a high deductible health insurance plan which meets the requirements of Section 223 of the Internal Revenue Code (health savings accounts), as amended, and no greater than an amount approved by the commissioner from time to time for the purpose of ensuring that the basic health insurance policy will offer affordable health insurance and quality health care for Vermonters.

(d)  A health insurer shall guarantee acceptance of any individual for any basic health insurance policy offered by the health insurer.  A health insurer shall also guarantee acceptance of each dependent of such individual for any basic health insurance policy it offers.

(e)  A health insurer shall comply with the preexisting condition requirements of subsection 4080b(g) of this title.

(f)(1)  Subject to approval by the commissioner, a health insurer shall use a community rating methodology that includes one or more risk classifications and such other rating and underwriting criteria as are necessary to mitigate against adverse selection into the basic health insurance policy market.

(2)  The premium charged for a basic health insurance policy shall not deviate above or below the community rate filed by the health insurer by more than 20 percent, or by more than 40 percent if the commissioner determines that the greater deviation is necessary to mitigate against adverse selection into the basic health insurance policy market.

(3)  Such rating and underwriting criteria shall not permit any medical underwriting and screening, except that the health insurer may offer rewards, premium discounts, rebates, or otherwise waive or modify applicable co‑payments, deductibles, or other cost-sharing amounts in return for adherence by the individual to programs of health promotion and disease prevention, in accordance with rules adopted by the commissioner under subdivisions 4080a(h)(2)(B) and 4080b(h)(2)(B) of this title.

* * * Health Care System Reform Initiatives * * *

Sec. 8.  18 V.S.A. § 9421 is added to read:

§ 9421.  IMPROVING QUALITY AND AFFORDABILITY THROUGH

              HEALTH CARE SYSTEM REFORM

(a)  The secretary of administration, working in collaboration with the general assembly, shall be responsible for the coordination of a common sense strategy of health care system reform among executive branch agencies, departments, and offices designed to achieve the following goals:

(1)  Improved health care quality and affordability in patient care.

(2)  Promotion of healthy behavior and disease prevention across the lifespan of individual Vermonters.

(b)  The secretary of administration shall ensure that those executive branch agencies, departments, and offices responsible for the development and implementation of Vermont’s health care system reform initiatives do so in a timely manner.  The secretary may appoint a project manager to assist the secretary in the performance of his or her health care system reform responsibilities.

(c)  The secretary of administration shall report to the governor and the general assembly on or before January 15, 2007 and every two years thereafter with a five-year strategic plan for implementing Vermont’s health care system reform initiatives, together with any administrative or legislative recommendations.

(d)  Vermont’s health care system reform initiatives include:

(1)  The Vermont blueprint for health - the chronic care initiative.

(2)  The Vermont health information technology project.

(3)  The multi-payer data collection project.

(4)  The common claims administration project.

(5)  The consumer price and quality information system.

(6)  The public health promotion and disease prevention programs of the department of health and the department of disabilities, aging, and independent living.

(7)  The managed care organization activities authorized by the Medicaid Global Commitment waiver.

(e)  The commissioner of health shall be responsible for the development and implementation of the Vermont blueprint for health - the chronic care initiative.  The commissioner of health, working in collaboration with the blueprint leadership, shall:

(1)  Prepare and implement a five-year strategic plan.  The plan shall include:

(A)  Explicit timelines for achievement of the goals and objectives of the plan.

(B)  The development and implementation of measurable standards for the management and treatment of at least four chronic conditions.

(C)  A financial plan that provides adequate financial support for the blueprint.

(2)  Collaborate with the commissioner of banking, insurance, securities, and health care administration and the Vermont information technology leaders (“VITL”) to ensure that the blueprint’s chronic disease information system and VITL’s electronic medical record project are developed and coordinated in an appropriate and cost-effective manner and in a manner designed to improve the quality and affordability of patient care.

(f)  The commissioner of health, the commissioner of disabilities, aging, and independent living, the commissioner of banking, insurance, securities, and health care administration, and the director of the office of Vermont health access shall ensure that Vermont’s health care system reform initiatives, identified in subsection (d) of this section, are developed, implemented, and coordinated in an appropriate and cost-effective manner and in a manner designed to improve the quality and affordability of patient care.

Sec. 9.  18 V.S.A. § 9408 is amended to read:

§ 9408.  COMMON CLAIMS FORMS AND PROCEDURES

(a)  No later than January 15, 1993, the commissioner shall adopt by rule uniform health insurance claims forms, and uniform standards and procedures for the processing of claims, including electronic claims forms submission.

(b)  No later than January 15, 2008, the commissioner shall adopt amended rules pursuant to this section designed to lower administrative costs and improve the efficiency and effectiveness of the claims administration system.  On or before July 1, 2006, the commissioner shall convene an advisory committee to assist the commissioner in the development of amended rules, consisting of the commissioner of health, the director of the office of Vermont health access, health care providers and facilities, health insurers, individual and business consumers and payers, and other individuals or groups designated by the commissioner.  In adopting such rules, the commissioner shall consider the potential public benefit to be derived from implementation of such rules, the cost for and the capacity of health care facilities, health care providers, or health insurers to comply with the requirements of such rules, and any other relevant consideration.  The commissioner’s rules may include greater standardization or uniformity in connection with:

(1)  Claims forms, patient invoices, and explanations of benefits forms.

(2)  Payment codes.

(3)  Claims submission and processing procedures, including electronic claims processing.

(4)  Utilization review standards and procedures.

(5)  Benefit plan design.

(6)  Prescription drug formularies.

(7)  Provider credentialing.

(8)  Any other element of the claims administration system which could be made more efficient and effective through greater standardization or uniformity.

Sec. 10.  18 V.S.A. § 9410(a) and (c) are amended to read:

(a)(1)  The commissioner shall establish and maintain a unified health care data base to enable the commissioner to carry out the duties under this chapter and Title 8, including:

(1)(A)  Determining the capacity and distribution of existing resources.

(2)(B)  Identifying health care needs and informing health care policy.

(3)(C)  Evaluating the effectiveness of intervention programs on improving patient outcomes.

(4)(D)  Comparing costs between various treatment settings and approaches.

(5)(E)  Providing information to consumers and purchasers of health care.

(2)(A)  The program authorized by this section shall include a consumer health care price and quality information system designed to make available to consumers transparent health care price information, quality information, and such other information as the commissioner determines is necessary to empower individuals to make economically sound and medically appropriate decisions.

(B)  The commissioner shall convene a working group composed of the commissioner of health; the director of the office of Vermont health access; health care consumers, employers, and other payers; health care providers and facilities; the Vermont program for quality in health care; health insurers; and any other individual or group appointed by the commissioner to advise the commissioner on the development and implementation of the consumer health care price and quality information system.

(C)  The commissioner may require a health insurer covering at least 15,000 lives in this state to file with the commissioner a consumer health care price and quality information plan, in accordance with rules adopted by the commissioner.  Approved plans may include the internet publication of the prices or charges established by health care facilities and health care providers and other providers of health care services and products and the reimbursable amounts negotiated with health insurers and payable by the individual in connection with the individual’s deductible or other cost‑sharing obligations.

(D)  The commissioner shall adopt such rules as are necessary to carry out the purposes of this subdivision (2).  The commissioner’s rules may permit the gradual implementation of the consumer health care price and quality information system over time, beginning with the ten most common inpatient and outpatient procedures, products, or services.  The commissioner’s rules shall permit health insurers to use security measures designed to allow subscribers access to price and other information without disclosing trade secrets to individuals and entities who are not subscribers.

(c)  Health insurers, health care providers, health care facilities, and other providers of health care services or products, including providers of pharmaceutical products and medical equipment, and governmental agencies shall file reports, data, schedules, statistics, or other information determined by the commissioner to be necessary to carry out the purposes of this section.  Such information may include:

(1)  health insurance claims and enrollment information used by health insurers;

(2)  information relating to hospitals filed under subchapter 7 of this chapter (hospital budget reviews); and

(3)  any other information relating to health care costs, prices, quality, utilization, or resources required to be filed by the commissioner.

Sec. 11.  18 V.S.A. § 9410(i) is added to read:

(i)(1)  As used in this section, and without limiting the meaning of subdivision 9402(9) of this title, the term “health insurer” includes:

(A)  any entity defined in subdivision 9402(9) of this title;

(B)  any third party administrator, any pharmacy benefit manager, any entity conducting administrative services for business, and any other similar entity with claims data, eligibility data, provider files, and other information relating to health care provided to Vermont residents and health care provided by Vermont health care providers and facilities required to be filed by a health insurer under this section;

(C)  any health benefit plan offered or administered by or on behalf of the state of Vermont or an agency or instrumentality of the state; and

(D)  any health benefit plan offered or administered by or on behalf of the federal government with the agreement of the federal government.

(2)  The commissioner may adopt rules to carry out the provisions of this subsection, including standards and procedures requiring the registration of persons or entities not otherwise licensed or registered by the commissioner and criteria for the required filing of such claims data, eligibility data, provider files, and other information as the commissioner determines to be necessary to carry out the purposes of this section and this chapter.

* * * Public Health Initiatives * * *

Sec. 12.  18 V.S.A. § 104(j) is added to read:

(j)  The commissioner shall develop and implement public health programs designed to promote healthy behavior and disease prevention across the lifespan of individual Vermonters and to coordinate such activities with the Vermont blueprint for health - the chronic care initiative and with Vermont’s other health care system reform initiatives identified in subsection 9421(d) of this title.  Such programs may include:

(1)  The fit and healthy kids program.

(2)  The obesity prevention program.

(3)  The maternal/child health and immunization program.

(4)  Mental health and substance abuse programs.

(5)  Tobacco prevention and cessation programs.

Sec. 13.  33 V.S.A. § 504(c) is amended to read:

(c)  In addition to the powers vested in it by law, the department may:

(1)  Cooperate with appropriate federal agencies which fund programs which the department administers.

(2)  Notwithstanding the provisions of chapter 13 of Title 3, enter into an agreement with the University of Vermont and State Agricultural College to continue the rural and farm family rehabilitation program.

(3)  Develop and implement public health programs designed to promote healthy behavior and disease prevention across the lifespan of individual Vermonters and to coordinate such activities with the Vermont blueprint for health - the chronic care initiative and with Vermont’s other health care system reform initiatives identified in subsection 9421(d) of Title 18.  Such programs may include:

(A)  The healthy aging program.

(B)  The elder care clinicians program.

Sec. 14.  8 V.S.A. § 4080a(h)(2) is amended to read:

(2)(A)  The commissioner shall, by rule, adopt standards and a process for permitting registered small group carriers to use one or more risk classifications in their community rating method, provided that the premium charged shall not deviate above or below the community rate filed by the carrier by more than 20 percent (20%), and provided further that the  commissioner’s rules may not permit any medical underwriting and screening.

(B)  The commissioner’s rules may permit a carrier, including a hospital or medical service corporation, to establish rewards, premium discounts, rebates, or otherwise waive or modify applicable co-payments, deductibles, or other cost-sharing amounts in return for adherence by a member or subscriber to programs of health promotion and disease prevention.  The commissioner shall consult with the commissioner of health and the director of the office of Vermont health access in the development of health promotion and disease prevention rules.  Such rules shall:

(i)  be designed to promote good health or prevent disease for individuals in the program and not be used as a subterfuge for imposing higher costs on an individual based on a health factor;

(ii)  provide that the reward under the program is available to all similarly situated individuals; and

(iii)  provide a reasonable alternative standard to obtain the reward to any individual for whom it is unreasonably difficult due to a medical condition to satisfy the otherwise applicable standard for the discount and disclose in all plan materials that describe the discount program the availability of a reasonable alternative standard.

(C)  The commissioner’s rules shall include:

(i)  standards and procedures for health promotion and disease prevention programs based on the best scientific, evidence-based medical practices as recommended by the commissioner of health;

(ii)  standards and procedures for evaluating an individual’s adherence to programs of health promotion and disease prevention; and

(iii)  any other standards and procedures necessary or desirable to carry out the purposes of this subdivision.

Sec. 15.  8 V.S.A. § 4080b(h)(2) is amended to read:

(2)(A)  The commissioner shall, by rule, adopt standards and a process for permitting registered nongroup carriers to use one or more risk classifications in their community rating method.  After July 1, 1993, provided that the premium charged shall not deviate above or below the community rate filed by the carrier by more than 40 percent (40%) for two years, and thereafter 20 percent (20%).  Such rules may not permit, and provided further that the commissioner’s rules may not permit any medical underwriting and screening and shall give due consideration to the need for affordability and accessibility of health insurance.

(B)  The commissioner’s rules may permit a carrier, including a hospital or medical service corporation, to establish rewards, premium discounts, rebates, or otherwise waive or modify applicable co-payments, deductibles, or other cost-sharing amounts in return for adherence by a member or subscriber to programs of health promotion and disease prevention.  The commissioner shall consult with the commissioner of health and the director of the office of Vermont health access in the development of health promotion and disease prevention rules.  Such rules shall:

(i)  be designed to promote good health or prevent disease for individuals in the program and not be used as a subterfuge for imposing higher costs on an individual based on a health factor;

(ii)  provide that the reward under the program is available to all similarly situated individuals; and

(iii)  provide a reasonable alternative standard to obtain the reward to any individual for whom it is unreasonably difficult due to a medical condition to satisfy the otherwise applicable standard for the discount and disclose in all plan materials that describe the discount program the availability of a reasonable alternative standard.

(C)  The commissioner’s rules shall include:

(i)  standards and procedures for health promotion and disease prevention programs based on the best scientific, evidence-based medical practices as recommended by the commissioner of health;

(ii)  standards and procedures for evaluating an individual’s adherence to programs of health promotion and disease prevention; and

(iii)  any other standards and procedures necessary or desirable to carry out the purposes of this subdivision.

Sec. 16.  8 V.S.A. § 4516 is amended to read:

§ 4516.  ANNUAL REPORT TO COMMISSIONER

Annually, on or before March 15, a hospital service corporation shall file with the commissioner of banking, insurance, securities, and health care administration a statement sworn to by the president and treasurer of the corporation showing its condition on December 31.  The statement shall be in such form and contain such matters as the commissioner shall prescribe.  To qualify for the tax exemption set forth in section 4518 of this title, the statement shall include a certification that the hospital service corporation operates on a nonprofit basis for the purpose of providing an adequate hospital service plan to individuals of the state, both groups and nongroups, without discrimination based on age, gender, geographic area, industry, and medical history, except as allowed by subdivisions 4080a(h)(2)(B) and 4080b(h)(2)(B) of this title.

Sec. 17.  8 V.S.A. § 4588 is amended to read:

§ 4588.  ANNUAL REPORT TO COMMISSIONER

Annually, on or before March 15, a medical service corporation shall file with the commissioner of banking, insurance, securities, and health care administration a statement sworn to by the president and treasurer of the corporation showing its condition on December 31, which shall be in such form and contain such matters as the commissioner shall prescribe.  To qualify for the tax exemption set forth in section 4590 of this title, the statement shall include a certification that the medical service corporation operates on a nonprofit basis for the purpose of providing an adequate medical service plan to individuals of the state, both groups and nongroups, without discrimination based on age, gender, geographic area, industry, and medical history, except as allowed by subdivisions 4080a(h)(2)(B) and 4080b(h)(2)(B) of this title.

Sec. 18.  8 V.S.A. § 5115 is amended to read:

§ 5115.  DUTY OF NONPROFIT HEALTH MAINTENANCE

              ORGANIZATIONS 

Any nonprofit health maintenance organization subject to this chapter shall offer nongroup plans to individuals in accordance with section 4080b of this title without discrimination based on age, gender, industry, and medical history, except as allowed by subdivisions 4080a(h)(2)(B) and 4080b(h)(2)(B) of this title.

* * * Adverse Event Reporting * * *

Sec. 19.  18 V.S.A. § 9405b(a)(2) is amended to read:

(a)  The commissioner, in consultation with representatives from the public oversight commission, hospitals, and other groups of health care professionals shall adopt rules establishing a standard format for community reports, as well as the contents, which shall include:

* * *

(2)  measures of patient safety that are valid, reliable, and useful, including comparisons to appropriate industry benchmarks for safety, including adverse event reporting;

Sec. 20.  18 V.S.A. § 1905(19) is added to read:

(19)  All hospitals shall comply with the rules adopted by the commissioner of health pursuant to section 1912 of this title.  License applications shall document compliance with the rules without providing protected health information.

Sec. 21.  18 V.S.A. § 1912 is added to read:

§ 1912.  ESTABLISHMENT AND STUDY OF AN ADVERSE EVENT

              REPORTING SYSTEM

(a)  The commissioner of health shall establish by rule an adverse event reporting system for the purpose of improving patient safety and eliminating adverse events in Vermont hospitals, improving health care outcomes, and supporting and facilitating quality improvement efforts by hospitals.  The reporting system shall, at a minimum, require hospitals to:

(1)  report adverse health care events, as defined by the commissioner, to their own peer review committees;

(2)  complete analyses of adverse events and develop and implement corrective action plans that meet standards determined by the commissioner;

(3)  report promptly to the commissioner all adverse events that the hospital reasonably believes to be related to:

(A)  the performance of purposefully or recklessly unsafe or unacceptable patient care;

(B)  neglect or abuse of a patient;

(C)  any violation of law; and

(D)  continuing clinical practice by a clinician who exhibits conduct that provides the hospital with reasonable cause to believe that the clinician’s ability to practice competently or safely is impaired.

(b)  For the purpose of evaluating a hospital’s compliance with the provisions of this section, the commissioner and designees are authorized to examine and review information protected by the provisions of the patient’s privilege under subsection 1612(a) of Title 12 or otherwise required by law to be held confidential, except that the commissioner’s access to and use of minutes and records of a peer review committee established under Title 26 shall be governed by subdivision (c) of this section.

(c)  Notwithstanding the provisions of section 1443 of Title 26, the commissioner or the commissioner’s designee shall have reasonable access to the minutes and records of any peer review or comparable committee for informational purposes only.

(d)  The commissioner may share the information reported pursuant to subdivision (a)(3) of this section with state and federal licensing and other regulatory entities and, in the case of possible criminal activity, with state and federal law enforcement authorities.  All other information disclosed or otherwise made available to the department and its designees under this section shall be confidential and privileged and shall not be subject to subpoena or available for public disclosure, except that the commissioner and the board of health are authorized to use such information, other than peer review protected information, during the course of any legal or regulatory action against a hospital.

(e)  The commissioner of health shall conduct a study of best practices and principles for adverse event reporting systems and shall make recommendations for a statewide Vermont adverse event reporting system consistent with the study findings by July 1, 2007.  The recommendations shall consider the implications of the federal Patient Safety and Quality Improvement Act of 2005 and shall include:

(1)  recommendations and cost estimates for a statewide adverse event reporting system capable of aggregating and analyzing such data for the purpose of developing and implementing strategies to target and eliminate specific adverse events;

(2)  recommendations and cost estimates for a statewide adverse event reporting system capable of aggregating and analyzing such data for the purpose of public reporting.

(f)  The commissioner may retain such additional professional or other staff as needed to carry out responsibilities under this section.  Expenses incurred by the department for these and for any other related contracts authorized by the commissioner beyond those funded by hospital licensing fees for activities necessary to implement this section shall be billed to hospitals in proportion to each hospital’s share of the total of hospital licensing fees as required by this title.

(g)  If the commissioner determines that a hospital has violated or failed to comply with any of the provisions of this section, the commissioner may sanction the violation or failure to comply as provided in this title.  In evaluating compliance, the commissioner shall place primary emphasis on assuring good faith compliance and effective corrective action by the facility, reserving punitive enforcement or disciplinary action for those cases in which the facility has displayed recklessness, gross negligence, or willful misconduct, or in which there is evidence, based on other similar cases known to the department of health, the agency of human services, or the office of the attorney general, of a pattern of significant substandard performance that has the potential for or has actually resulted in harm to patients.

(h)  After notice and an opportunity for hearing, the commissioner may impose on a person who knowingly violates a provision of this subchapter or a rule or order adopted pursuant to this subchapter a civil administrative penalty of no more than $10,000.00 or, in the case of a continuing violation, a civil administrative penalty of no more than $100,000.00 or one-tenth of one percent of the gross annual revenues of the health care facility, whichever is greater.  A person aggrieved by a decision of the commissioner under this subsection may appeal the commissioner’s decision to the supreme court.

(i)  The authority granted to the commissioner under this section is in addition to any other authority granted to the commissioner under law.

* * * Tort Reform * * *

Sec. 22.  12 V.S.A. § 1911 is added to read:

§ 1911.  EXPRESSION OF REGRET OR APOLOGY BY HEALTH CARE                                     PROVIDER INADMISSIBLE

(a)  As used in this section, “health care provider” is defined by subdivision 9402(8) of Title 18.

(b)  An expression of regret or apology made by or on behalf of a health care provider, including an expression of regret or apology that is made in writing, orally, or by conduct does not constitute an admission of liability for any purpose and shall be inadmissible in any civil or administrative proceeding against the health care provider, including any arbitration or mediation proceeding.

(c)  A health care provider or any other person who makes an expression of regret or apology on behalf of the health care provider, including an expression of regret or apology that is made in writing, orally or by conduct, may not be examined by deposition or otherwise with respect to the expression of regret or apology in any civil or administrative proceeding against the health care provider, including any arbitration or mediation proceeding.

Sec. 23.  12 V.S.A. § 551 is amended to read:

§ 551.  MINORITY, INSANITY OR IMPRISONMENT

(a)  When a person entitled to bring an action specified in this chapter is a minor, insane or imprisoned at the time the cause of action accrues, such person may bring such action within the times in this chapter respectively

limited, after the disability is removed, except as provided in subsection (c) of this section.

* * *

(c)  Notwithstanding the provisions of subsection (a) of this section, a claim by a minor to recover damages for injuries to the minor arising out of any medical or surgical treatment or operation shall be brought within the time limitations required by section 521 of this title, except that a minor under six years of age shall have until his or her ninth birthday for the limitations period to commence.

Sec. 24.  12 V.S.A. § 1910 is added to read:

§ 1910.  MEDICAL MALPRACTICE; LIMITATION ON DAMAGES FOR

               PAIN AND SUFFERING

In an action based on medical malpractice, the damages awarded for pain and suffering or other noneconomic loss shall not exceed the amount of $250,000.00.  On January 1, 2008, the department of banking, insurance, securities, and health care administration shall increase the $250,000.00 limit on damages established under this section by a percentage based on the Consumer Price Index, CPI-U, U.S. city average, not seasonally adjusted, or successor index, as calculated by the U.S. Department of Labor or successor agency for the 12 months preceding August 2007.  Thereafter, beginning on January 1, 2010, and every other January 1 thereafter, the department of banking, insurance, securities, and health care administration shall increase the $250,000.00 limit on damages established under this section by a percentage based on the same Consumer Price Index, computed for the 12 months preceding the previous August, compounded annually.  The limit on damages shall be rounded off to the nearest $1.00.

Sec. 25.  12 V.S.A. § 1911 is added to read:

§ 1911.  MEDICAL MALPRACTICE ACTIONS; DAMAGES; RECOVERY

               BY PLAINTIFF FROM OTHER PERSONS; REMITTITUR

(a)  If damages have been awarded in an action based on medical malpractice, a party may file a motion for remittitur on the grounds that the plaintiff has been or will be paid, reimbursed, or indemnified for at least part of his or her special damages under a contract, insurance agreement, or statute.  The court shall provide all other parties to the action an opportunity to reply to the motion and shall set it for hearing.

(b)  If the court finds after the hearing that the plaintiff has been or will be paid, reimbursed, or indemnified for at least part of his or her special damages under a contract, insurance agreement, or statute, the court shall grant the motion for remittitur and order the damages award reduced by the amount the plaintiff has been or will be paid, reimbursed, or indemnified.

(c)(1)  No damages award shall be reduced under this section on the basis of other amounts paid or payable to the plaintiff if a reduction on such grounds would be prohibited by state or federal law.

(2)  No damages award assessed in whole or in part for future expenses, costs, or losses shall be reduced under this section unless:

(A)  the court orders the defendant or the defendant’s insurer to provide adequate security; or

(B)  the defendant’s insurer is authorized to do business in this state and maintains reserves in compliance with rules of the department of banking, insurance, securities, and health care administration sufficient to assure payment of the amount by which the plaintiff’s future damages are reduced.

(d)  Except as expressly provided by federal law, no person may recover from the plaintiff or assert a claim of subrogation against a defendant for any sum included in an order for remittitur of damages issued under this section.

(e)  Nothing in this section shall be construed to limit motions for remittitur on any other grounds.

Sec. 26.  MANDATORY ARBITRATION

(a)  Sec. 50 of No. 160 of the Acts of the 1991 Adj. Sess. (1992) is amended to read:

Sec. 50.  EFFECTIVE DATE

Secs. 46, 47, 48 and 49, amending chapter 215 of Title 12 to provide for mandatory arbitration in medical malpractice cases and admission of practice guidelines, shall take effect on the effective date of a universal health care system enacted by the general assembly.

(b)  This section, which establishes mandatory arbitration of claims based on medical malpractice by repealing Sec. 50 and making effective Secs. 46 ‑ 49 of No. 160 of the Acts of the 1991 Adj. Sess. (1992), shall take effect on September 1, 2006.

Pending the question, Shall the House amend the bill as recommended by Rep. Errecart of Shelburne? Rep. Tracy of Burlington asked that the question be divided and that Sec. 6 be voted on separately.

Thereupon, Rep. Tracy of Burlington raised a Point of Order that Sec. 6 is in violation of House Rule 77 in that the House rejected the same language in the O’Donnell amendment earlier today which Point of Order the Speaker ruled well taken.  Thereupon, Sec. 6 was struck from the amendment.

Thereupon, Rep. Errecart of Shelburne asked and was granted leave of the House to withdraw the rest of her amendment.

Pending third reading of the bill, Rep. Koch of Barre Town moved to amend the bill as follows:

First:  In Sec. 14, 33 V.S.A. chapter 19, subchapter 6, § 2023, page 22, by striking subsection (a) and by inserting in lieu thereof the following: 

(a)(1) An individual shall be eligible for catamount health if the individual:

(A) is an uninsured Vermont resident;

(B) filed a Vermont resident full-time or part-time income tax return for the year immediately preceding the date of application for catamount health; and

(C) does not have access to employer sponsored health insurance at a cost not in excess of the premiums and other cost-sharing amounts set for catamount health.

(2) An individual receiving Medicaid, the Vermont health access plan, or Dr. Dynasaur within 12 months of applying for catamount health shall not be required to wait 12 months to be eligible for catamount health.  An individual who has coverage under catamount health may purchase an insurance policy designed to provide health services not covered by catamount health and remain eligible.

Second:  In Sec. 15 (Catamount health; premiums), page 27, line 15, by striking the colon and inserting the following:  “, determined annually by July 1 by reference to the individual's or family's Vermont income tax form HI-144 for the previous calendar year.  Initial premium amounts shall be:"

 Pending the question, Shall the House amend the bill as recommended by the Rep. Koch of Barre Town? Rep. Koch of Barre Town demanded the Yeas and Nays, which demand was sustained by the Constitutional number.  The Clerk proceeded to call the roll and the question, Shall the House amend the bill as recommended by the Rep. Koch of Barre Town?  was decided in the negative.  Yeas, 21.  Nays, 82.

Those who voted in the affirmative are:


Allaire of Rutland City

Allard of St. Albans Town

Baker of West Rutland

Bostic of St. Johnsbury

Donaghy of Poultney

Dowland of Holland

Endres of Milton

Flory of Pittsford

Helm of Castleton

Houston of Ferrisburgh

Johnson of Canaan

Koch of Barre Town

Livingston of Manchester

Marron of Stowe

McFaun of Barre Town

Miller of Elmore

Morley of Barton

Peaslee of Guildhall

Sunderland of Rutland Town

Winters of Swanton

Young of Orwell


Those who voted in the negative are:


Ancel of Calais

Aswad of Burlington

Atkins of Winooski

Bohi of Hartford

Botzow of Pownal

Branagan of Georgia

Brooks of Montpelier

Chen of Mendon

Clarkson of Woodstock

Condon of Colchester

Copeland-Hanzas of Bradford

Corcoran of Bennington

Cross of Winooski

Darrow of Dummerston

Deen of Westminster

Donovan of Burlington

Dostis of Waterbury

Edwards of Brattleboro

Emmons of Springfield

Evans of Essex

Fallar of Tinmouth

Fisher of Lincoln

Frank of Underhill

French of Randolph

Gervais of Enosburg

Grad of Moretown

Green of Berlin

Haas of Rochester

Head of S. Burlington

Heath of Westford

Hosford of Waitsfield

Howard of Rutland City

Howrigan of Fairfield

Hunt of Essex

Hutchinson of Randolph

Jerman of Essex

Jewett of Ripton

Johnson of South Hero

Keenan of St. Albans City

Keogh of Burlington

Kiss of Burlington

Kitzmiller of Montpelier

Klein of East Montpelier

Kupersmith of S. Burlington

Larson of Burlington

Leriche of Hardwick

Lippert of Hinesburg

Lorber of Burlington

Maier of Middlebury

Marek of Newfane

Martin of Wolcott

Masland of Thetford

McCullough of Williston

McLaughlin of Royalton

Milkey of Brattleboro

Miller of Shaftsbury

Minter of Waterbury

Molloy of Arlington

Mook of Bennington

Nease of Johnson

Nitka of Ludlow

Nuovo of Middlebury

Obuchowski of Rockingham

Orr of Charlotte

Otterman of Topsham

Partridge of Windham

Pellett of Chester

Perry of Richford

Peterson of Williston

Potter of Clarendon

Pugh of S. Burlington

Randall of Troy

Reese of Pomfret

Rusten of Halifax

Seibert of Norwich

Shand of Weathersfield

Sharpe of Bristol

Smith of Morristown

Sweaney of Windsor

Tracy of Burlington

Trombley of Grand Isle

Zuckerman of Burlington


Those members absent with leave of the House and not voting are:


Acinapura of Brandon

Adams of Hartland

Audette of S. Burlington

Barnard of Richmond

Bartlett of Dover

Brennan of Colchester

Canfield of Fair Haven

Clark of St. Johnsbury

Clark of Vergennes

Dates of Shelburne

DePoy of Rutland City

Donahue of Northfield

Dunsmore of Georgia

Errecart of Shelburne

Hube of Londonderry

Hudson of Lyndon

Kainen of Hartford

Kennedy of Chelsea

Kilmartin of Newport City

Komline of Dorset

Krawczyk of Bennington

Larocque of Barnet

Larrabee of Danville

LaVoie of Swanton

Lawrence of Lyndon

Louras of Rutland City

Malcolm of Pawlet

Marcotte of Coventry

Martin of Springfield

McAllister of Highgate

Monti of Barre City

Morrissey of Bennington

Myers of Essex

Niquette of Colchester

O'Donnell of Vernon

Parent of St. Albans City

Pillsbury of Brattleboro

Rodgers of Glover

Severance of Colchester

Shaw of Derby

Smith of New Haven

Turner of Milton

Valliere of Barre City

Westman of Cambridge

Winters of Williamstown

Wright of Burlington


 

     Rep. Klein of East Montpelier explained his vote as follows:

“Madam Speaker:

     I vote no because this amendment would likely block people who do not file income or homestead tax return from eligibility for Catamount Health,  which is exactly the opposite of our intent to reduce the cost shift caused by uninsured Vermonters to the health care system and other Vermonters.”

     Pending third reading of the bill, Rep. Koch of Barre Town moved to amend the bill as follows:

By inserting Sec. 19a to read: 

Sec. 19a.  PRIMARY CARE CLINICS; CAPITALIZATION GRANTS; CASE MANAGEMENT

(a) There is appropriated the amount of $1,000,000.00 from the general fund in fiscal year 2007 to the department of health for the purpose of providing grants or loans for initial capitalization to primary care clinics.  The department shall distribute the grants and loans in a manner that furthers the state policy of eliminating the use of the emergency room for nonemergency treatment.  Grants or loans shall be available only to those primary care clinics that are:

(1)  located in proximity to a hospital emergency room;

(2)  staffed principally by physician’s assistants and nurse practitioners; and

(3)  open 24 hours a day, seven days a week.

(b) The commissioner of health may adopt rules governing eligibility for and use of the funds appropriated by this section, as well as rules relating to the operation of primary care clinics receiving grants or loans under this section.

     Which was disagreed to.

     Pending third reading of the bill, Rep. Johnson of Canaan moved to amend the bill as follows:

     In Sec. 14, 33 V.S.A. § 2023, by adding a subsection (d) to read:

(d)(1)  If the monies available in the catamount fund established under section 2027 of this title are insufficient to support ongoing, new enrollment in catamount health, the agency shall recommend to the health access oversight committee a plan to cap or limit enrollment.

(2)  If at any time after enrollment is capped or limited under subdivision (1) of this section, expenditures are anticipated to be equal to or less than the aggregate amount of funds appropriated for catamount health, the agency shall recommend to the health access oversight committee a plan to open enrollment in catamount health.

(3)  The agency’s determinations under this section shall be based on monthly enrollment figures and the official revenue estimates for the catamount fund under section 305a of Title 32.

(4)  An enrollment plan under this section shall be deemed approved unless the committee disapproves the plan after 21 days’ notice of the agency’s recommendation and financial analysis.  The committee shall notify the general assembly and the agency of its action on an enrollment plan within 15 days.

     Thereupon, Rep. Johnson of Canaan asked and was granted leave of the House to withdraw his amendment.

     Pending third reading of the bill, Reps. Krawczyk of Bennington, Morrissey of Bennington and Clark of Vergennes moved to amend the bill as follows:

     By adding a new Sec. 21a to read:

Sec. 21a     REALLOCATION OF HEALTH CARE FUNDS

     (a) The amount of $350,000 of the general funds appropriated by Sec. 255(a)(7)(A) of Act 71 of 2005 to the legislature to support the activities and studies of the legislative commission on health care reform is reallocated and transferred to the Vermont National Guard to fund family support and counseling services to Vermont National Guard members and their families through June 30, 2007.  The funds shall be expended for:

(1)  Continuation of the programs for family support and counseling services, including preventive and educational services to family members and Vermont National Guard members, and training for other community leaders and guard commanders, chaplains, and others; and

(2)  Other initiatives that meet this programmatic need.

(b)  The Vermont National Guard may negotiate with the U.S. Department of Defense and Veterans’ Administration a sharing agreement as necessary.

Pending the question, Shall the House amend the bill as recommended by Reps. Krawczyk of Bennington, et al? Rep. Krawczyk of Bennington demanded the Yeas and Nays, which demand was sustained by the Constitutional number.  The Clerk proceeded to call the roll and the question,  Shall the House amend the bill as recommended by Reps. Krawczyk of Bennington, et al? was decided in the negative.  Yeas, 58.  Nays, 76.

Those who voted in the affirmative are:


Acinapura of Brandon

Adams of Hartland

Allaire of Rutland City

Allard of St. Albans Town

Baker of West Rutland

Bartlett of Dover

Bostic of St. Johnsbury

Branagan of Georgia

Brennan of Colchester

Canfield of Fair Haven

Clark of St. Johnsbury

Clark of Vergennes

Condon of Colchester

Dates of Shelburne

Donaghy of Poultney

Donahue of Northfield

Dowland of Holland

Dunsmore of Georgia

Endres of Milton

Errecart of Shelburne

Flory of Pittsford

Grad of Moretown

Helm of Castleton

Houston of Ferrisburgh

Howrigan of Fairfield

Hube of Londonderry

Hudson of Lyndon

Johnson of Canaan

Kainen of Hartford

Kennedy of Chelsea

Kilmartin of Newport City

Koch of Barre Town

Krawczyk of Bennington

Larocque of Barnet

Larrabee of Danville

Lawrence of Lyndon

Livingston of Manchester

Louras of Rutland City

Marcotte of Coventry

Marron of Stowe

McAllister of Highgate

Miller of Elmore

Molloy of Arlington

Morley of Barton

Morrissey of Bennington

Myers of Essex

Niquette of Colchester

O'Donnell of Vernon

Otterman of Topsham

Peaslee of Guildhall

Smith of New Haven

Sunderland of Rutland Town

Turner of Milton

Valliere of Barre City

Winters of Swanton

Winters of Williamstown

Wright of Burlington

Young of Orwell


Those who voted in the negative are:


Ancel of Calais

Aswad of Burlington

Atkins of Winooski

Audette of S. Burlington

Bohi of Hartford

Botzow of Pownal

Brooks of Montpelier

Chen of Mendon

Clarkson of Woodstock

Copeland-Hanzas of Bradford

Cross of Winooski

Darrow of Dummerston

Deen of Westminster

Donovan of Burlington

Dostis of Waterbury

Edwards of Brattleboro

Emmons of Springfield

Evans of Essex

Fallar of Tinmouth

Fisher of Lincoln

Frank of Underhill

French of Randolph

Gervais of Enosburg

Green of Berlin

Haas of Rochester

Head of S. Burlington

Heath of Westford

Hosford of Waitsfield

Howard of Rutland City

Hunt of Essex

Hutchinson of Randolph

Jerman of Essex

Jewett of Ripton

Johnson of South Hero

Keenan of St. Albans City

Keogh of Burlington

Kiss of Burlington

Kitzmiller of Montpelier

Klein of East Montpelier

Kupersmith of S. Burlington

Leriche of Hardwick

Lippert of Hinesburg

Lorber of Burlington

Maier of Middlebury

Marek of Newfane

Martin of Wolcott

Masland of Thetford

McCullough of Williston

McFaun of Barre Town

McLaughlin of Royalton

Milkey of Brattleboro

Miller of Shaftsbury

Minter of Waterbury

Mook of Bennington

Nease of Johnson

Nitka of Ludlow

Nuovo of Middlebury

Obuchowski of Rockingham

Orr of Charlotte

Partridge of Windham

Pellett of Chester

Perry of Richford

Peterson of Williston

Potter of Clarendon

Pugh of S. Burlington

Randall of Troy

Reese of Pomfret

Rusten of Halifax

Seibert of Norwich

Shand of Weathersfield

Sharpe of Bristol

Smith of Morristown

Sweaney of Windsor

Tracy of Burlington

Trombley of Grand Isle

Zuckerman of Burlington


Those members absent with leave of the House and not voting are:


Barnard of Richmond

Corcoran of Bennington

DePoy of Rutland City

Komline of Dorset

Larson of Burlington

LaVoie of Swanton

Malcolm of Pawlet

Martin of Springfield

Monti of Barre City

Parent of St. Albans City

Pillsbury of Brattleboro

Rodgers of Glover

Severance of Colchester

Shaw of Derby

Westman of Cambridge


 

     Rep. French of Randolph explained her vote as follows:

“Madam Speaker:

     H. 861 is a first step in health care reform.  I voted no because we need the studies in order to be able to continue to move forward on health care reform.  My understanding is that we are already appropriating more money to fund services for Guard members and their families.

     Rep. Houston of Ferrisburgh explained her vote as follows:

“Madam Speaker:

     It is unfortunate that we continue to waste taxpayers money for reports that are not produced when we could be directing that same taxpayer money…. $450,000 to the families of the Vermont National Guard members who are our real heroes.”

     Rep. Hunt of Essex explained his vote as follows:

“Madam Speaker:

     It should not be forgotten that this body opposed today, the $250,000 originally recommended to fund mental health services to our guard members and their families.  It should also be remembered that this money was put forward because our Federal government has not recognized and met its obligation to our valued guard members.

     Rep. Leriche of Hardwick explained her vote as follows:

“Madam Speaker:

     I voted no because I object to using our troops; our guardsmen and women as pawns for political gain in the debate on whether or not people should have affordable healthcare.”

     Rep. Milkey of Brattleboro explained her vote as follows:

“Madam Speaker:

     The effect of this proposal of amendment is to use the men and women of our National Guard as a political football in a debate on health care.  I find that shameful.”   

     Rep. Perry of Richford explained his vote as follows:

“Madam Speaker:

     I fully support the objective of continuing these programs of support to Vermont National Guard members and their families.  I do not support this proposed source of funds.

     Rep. Young of Orwell explained his vote as follows:

“Madam Speaker:

     It would be better to spend money buying yellow ribbons for our returning guardsmen than claiming to have spent it on missing red tape.”

     Thereupon, the bill was read the third time.

Pending the question, Shall the bill pass? Rep. Morrissey of Bennington demanded the Yeas and Nays, which demand was sustained by the Constitutional number.  The Clerk proceeded to call the roll and the question, Shall the bill pass? was decided in the affirmative.  Yeas, 77.  Nays, 58.

Those who voted in the affirmative are:


Ancel of Calais

Aswad of Burlington

Atkins of Winooski

Audette of S. Burlington

Bohi of Hartford

Botzow of Pownal

Brooks of Montpelier

Chen of Mendon

Clarkson of Woodstock

Condon of Colchester

Copeland-Hanzas of Bradford

Cross of Winooski

Darrow of Dummerston

Deen of Westminster

Donovan of Burlington

Dostis of Waterbury

Dowland of Holland

Edwards of Brattleboro

Emmons of Springfield

Evans of Essex

Fallar of Tinmouth

Fisher of Lincoln

Frank of Underhill

French of Randolph

Gervais of Enosburg

Grad of Moretown

Green of Berlin

Haas of Rochester

Head of S. Burlington

Heath of Westford

Hosford of Waitsfield

Howard of Rutland City

Hunt of Essex

Hutchinson of Randolph

Jerman of Essex

Jewett of Ripton

Johnson of South Hero

Kainen of Hartford

Keenan of St. Albans City

Keogh of Burlington

Kiss of Burlington

Kitzmiller of Montpelier

Klein of East Montpelier

Kupersmith of S. Burlington

Leriche of Hardwick

Lippert of Hinesburg

Lorber of Burlington

Maier of Middlebury

Marek of Newfane

Martin of Wolcott

Masland of Thetford

McCullough of Williston

McFaun of Barre Town

McLaughlin of Royalton

Milkey of Brattleboro

Miller of Shaftsbury

Minter of Waterbury

Nease of Johnson

Nitka of Ludlow

Nuovo of Middlebury

Obuchowski of Rockingham

Orr of Charlotte

Partridge of Windham

Pellett of Chester

Peterson of Williston

Potter of Clarendon

Pugh of S. Burlington

Randall of Troy

Reese of Pomfret

Rusten of Halifax

Seibert of Norwich

Shand of Weathersfield

Sharpe of Bristol

Smith of Morristown

Sweaney of Windsor

Tracy of Burlington

Trombley of Grand Isle


Those who voted in the negative are:


Acinapura of Brandon

Adams of Hartland

Allaire of Rutland City

Allard of St. Albans Town

Baker of West Rutland

Bartlett of Dover

Bostic of St. Johnsbury

Branagan of Georgia

Brennan of Colchester

Canfield of Fair Haven

Clark of St. Johnsbury

Clark of Vergennes

Corcoran of Bennington

Dates of Shelburne

Donaghy of Poultney

Donahue of Northfield

Dunsmore of Georgia

Endres of Milton

Errecart of Shelburne

Flory of Pittsford

Helm of Castleton

Houston of Ferrisburgh

Hube of Londonderry

Hudson of Lyndon

Johnson of Canaan

Kennedy of Chelsea

Kilmartin of Newport City

Koch of Barre Town

Krawczyk of Bennington

Larocque of Barnet

Larrabee of Danville

Lawrence of Lyndon

Livingston of Manchester

Louras of Rutland City

Marcotte of Coventry

Marron of Stowe

McAllister of Highgate

Miller of Elmore

Molloy of Arlington

Mook of Bennington

Morley of Barton

Morrissey of Bennington

Myers of Essex

Niquette of Colchester

O'Donnell of Vernon

Otterman of Topsham

Peaslee of Guildhall

Perry of Richford

Smith of New Haven

Sunderland of Rutland Town

Turner of Milton

Valliere of Barre City

Westman of Cambridge

Winters of Swanton

Winters of Williamstown

Wright of Burlington

Young of Orwell

Zuckerman of Burlington


Those members absent with leave of the House and not voting are:


Barnard of Richmond

DePoy of Rutland City

Howrigan of Fairfield

Komline of Dorset

Larson of Burlington

LaVoie of Swanton

Malcolm of Pawlet

Martin of Springfield

Monti of Barre City

Parent of St. Albans City

Pillsbury of Brattleboro

Rodgers of Glover

Severance of Colchester

Shaw of Derby


 

     Rep. Botzow of Bennington explained his vote as follows:

“Madam Speaker:

     Dr. Thorpe focused us on costs and how to control them.  Chronic care management and health care for the uninsured will move us out of the dilemma we’ve been debating.”

     Rep. Cross of Winooski explained his vote as follows:

“Madam Speaker:

     My votes on H. 861 today have been cast so as to continue Vermont’s effort to provide high quality health care, including preventative care and chronic disease management, to all our citizens.  My votes coupled with the majority have prevented a $50 million cost shift onto the backs of our state’s employers, large and small, who are currently providing health insurance as the administration’s plan would have done.  Today’s action on this floor was the right thing to do.”

     Rep. Donahue of Northfield explained her vote as follows:

“Madam Speaker:

     There was a commitment made in last year’s appropriations bill that I would receive economic impact and financing studies so that I could responsibly assess a new plan.  We received no such information, and I can only see in the Catamount Health Plan a potentially devastating impact on our obligations to our poorest elderly and disabled Vermonters/  I regret that its attachment to the rest of this bill forces my “no” vote.”

     Rep. Errecart of Shelburne explained her vote as follows:

“Madam Speaker:

     I vote no because I don’t want to repeat last year’s exercise in gridlock and futility.  Vermonters don’t need more political posturing and promises that we can’t keep.  Vermonters need more affordable health insurance now.”

     Rep. Flory of Pittsford explained her vote as follows:

“Madam Speaker:

     I cannot support a bill that threatens to bankrupt Medicaid, harming our most vulnerable, poorest people, in order to provide a more generous, inexpensive insurance plan to people earning over $70,000.  Our poor cannot afford to subsidize our wealthy simply so that we can claim we did health care reform.”

     Rep. Hosford of Waitsfield explained her vote as follows:

“Madam Speaker:

     The point of H. 861 is to control health care costs.  Everyday we do nothing, our health care costs rise by one million dollars.  We have to take action now.  To change how we manage health care.  H. 861 is an important first step.”

     Rep. Johnson of South Hero explained her vote as follows:

“Madam Speaker:

     One million daily increase in health care costs. 65,000 uninsured Vermonters. 183 million annual cost shift. Funding sources that carry us through 2011.  This is the information I need to proudly vote ‘yes’ on this bill that chips away at those tragic numbers by providing affordable insurance, curbing costs and improving quality of life for my chronically ill constituents.”

     Rep. Keogh of Burlington explained his vote as follows:

“Madam Speaker:

     There are those who think we went too far; others think we didn’t go far enough.  Nevertheless, this bill is a step in responding to our constituents’ cry for health care relief.”

     Rep. Kilmartin of Orleans explained his vote as follows:

“Madam Speaker:

     Catamount Health is a leap off Niagara Falls with no wooden barrel or life vest.  We ignored the signs that said “danger, Rapids Ahead”.  Then we ignored the rapids of “cost shifting”, provider underpayment, and growing deficits which have already disintegrated our life rafts and safety nets.

     While the moments of freefall between now and the November election may be exhilarating to some, everyone who can count on their fingers and toes knows that after November 2006, we are going to be sucked down the raging whirlpools of deficits and drowned in debt.

     Creating fiscal corpses of Vermonters in the name of “better health” will lead to the destruction of essential health services for the most vulnerable and needy.

     Out of love and respect for my neighbor, I cannot consent to harm them in the name of helping them.”

     Rep. Louras of Rutland City explained his vote as follows:

“Madam Speaker:

     I am unable to support a bill that initiates a new program that is by design and by admission already broken.  Medicaid must be brought into balance, not driven into bankruptcy.”

     Rep. Minter of Waterbury explained her vote as follows:

“Madam Speaker:

     H. 861 is a first step to control costs without a proactive effort to reform our health care delivery system, address chronic care and increase access to care .  We accept the status quo: more uninsured Vermonters and rising health care costs that are swamping our economy and breaking the bank on our State, municipal and school budgets.”

     Rep. Morrissey of Bennington explained her vote as follows:

“Madam Speaker:

     H. 861 truly has all the fiscal implications and complexities of Act 60 when it was passed.  There is a saying  “If you don’t heed the mistakes of the past you are  doomed to repeat them”.

     Rep. Peterson of Williston explained her vote as follows:

“Madam Speaker:

     I vote for this bill because I applaud that it is focused on one thing – reducing costs.  It accomplished that in two ways, with innovative chronic care and Catamount Health.  Catamount Health is responsible initiative leveraging available federal fund to drive down the number of uninsured.”

     Rep. Sunderland of Rutland Town explained his vote as follows:

“Madam Speaker:

     Because this bill is built; unsustainable funds, unknown costs and unknown benefits, and because it places in further jeopardy our already unsustainable Medicaid system, because it is built without the very information that just one years ago, this body said was critical in order to proceed, because the Vermont taxpayer is on the hook for 100% of the cost overruns with no Federal match assistance, because this bill threatens the already over-taxed and under-protected Vermonter, I have no other choice but to vote “No”.”

     Rep. Wright of Burlington explained his vote as follows:

“Madam Speaker:

     For those Vermonters concerned about the high cost of Health Care, of creating a scholarship program to keep young Vermonters in Vermont and concerned about the future of our Medicaid program, passage of this bill must cause great concern.”

Joint Resolution Adopted

J.R.H. 62

Joint resolution, entitled

Joint resolution in support of the 25 by 25 agricultural energy initiative;

Was taken up and adopted on the part of the House.

Message from the Senate No. 34

     A message was received from the Senate by Mr. Marshall, its Assistant Secretary, as follows:

Madam Speaker:

I am directed to inform the House that the Senate has on its part passed Senate bill of the following title

S. 310.  An act relating to common sense initiatives in health care.

In the passage of which the concurrence of the House is requested.

The Senate has considered a bill originating in the House of the following title:

H. 873.  An act relating to procedural protections for Vermonters eligible for Medicare Part D and VPharm.

And has passed the same in concurrence.

     The Senate has on its part adopted Senate concurrent resolutions of the following titles:

     S.C.R. 53.  Senate concurrent resolution recognizing Robert E. Miller for his contributions in Vermont.

     S.C.R. 54.  Senate concurrent resolution congratulating Richard Cassidy on his 50 years of service as Highgate town moderator.

     The Senate has on its part adopted concurrent resolutions originating in the House of the following titles:

     H.C.R. 244.  House concurrent resolution congratulating Peter Miller of Colbyville on his being named the Burlington Free Press’s Vermonter of the Year.

     H.C.R. 245.  House concurrent resolution honoring the Vermont Youth Orchestra.

     H.C.R. 246.  House concurrent resolution honoring Woodford Town Clerk Aileen C. O’Neil.

     H.C.R. 247.  House concurrent resolution designating April 29, 2006 as Vermont National Guard Family Readiness Volunteer Day in honor of the outstanding volunteers who are assisting National Guard families whose loved ones are deployed.

     H.C.R. 248.  House concurrent resolution congratulating Allethaire (Gussie) Goodrum on her 80th birthday.

     H.C.R. 249.  House concurrent resolution recognizing the extraordinary public service of retiring Weston town moderator Sam Lloyd.

     H.C.R. 250.  House concurrent resolution congratulating David Hamilton for his many years of civic service in the town of Jamaica.

     H.C.R. 251.  House concurrent resolution congratulating Bruce Chapin for his many years of civic serviced in the town of Jamaica.

     H.C.R. 252.  House concurrent resolution congratulating Raymond Landman for his many years of civic service in the town of Jamaica.

     H.C.R. 253.  House concurrent resolution designating March 2006 as National Social Work Month in Vermont.

     H.C.R. 254.  House concurrent resolution congratulating the Peace Corps on its 45th anniversary.

Senate Bill Referred

S. 310

Senate bill, entitled

An act relating to common sense initiatives in health care;

Was taken up, read the first time and referred to the committee on Health Care.

Message from Governor

A message was received from His Excellency, the Governor, by Mr. Neale Lunderville, Secretary of Civil and Military Affairs, as follows:

Madam Speaker:

I am directed by the Governor to inform the House that on the third day of March, 2006, he approved and signed a bill originating in the House of the following title:

H. 617    An act relating to fiscal year 2006 budget adjustments

Adjournment

At four o’clock  and thirty minutes in the afternoon, on motion of Rep. Sunderland of Rutland Town, the House adjourned until Tuesday, March 14, 2006, at ten o’clock in the forenoon, pursuant to the provisions of J.R.S. 44.

Concurrent Resolutions Adopted

     The following concurrent resolutions, having been placed on the Consent Calendar on the preceding legislative day, and no member having requested floor consideration  as provided by the Joint Rules of the Senate and House of Representatives, are hereby adopted in concurrence.

H.C.R.  244

House concurrent resolution congratulating Peter Miller of Colbyville on his being named the Burlington Free Press’s Vermonter of the Year

H.C.R.  245

House concurrent resolution honoring the Vermont Youth Orchestra

H.C.R.  246

House concurrent resolution honoring Woodford Town Clerk Aileen C. O’Neil

H.C.R.  247

House concurrent resolution designating April 29, 2006 as Vermont National Guard Family Readiness Volunteer Day in honor of the outstanding volunteers who are assisting National Guard families whose loved ones are deployed

H.C.R.  248

House concurrent resolution congratulating Allethaire (Gussie) Goodrum on her 80th birthday

H.C.R.  249

House concurrent resolution recognizing the extraordinary public service of retiring Weston town moderator Sam Lloyd

H.C.R.  250

House concurrent resolution congratulating David Hamilton for his many years of civic service in the town of Jamaica

H.C.R. 251

House concurrent resolution congratulating Bruce Chapin for his many years of civic service in the town of Jamaica

H.C.R.  252

House concurrent resolution congratulating Raymond Landman for his many years of civic service in the town of Jamaica

H.C.R.  253

House concurrent  resolution designating March 2006 as National Social Work Month in Vermont

 

 

H.C.R. 254

House concurrent resolution congratulating the Peace Corps on its 45th anniversary

S.C.R. 53

  Senate concurrent resolution recognizing Robert E. Miller for his contributions to Vermont.

S.C.R. 54

  Senate concurrent resolution congratulating Richard Cassidy on his 50 years of service as Highgate town moderator.

     [The full text of the concurrent resolutions appeared in the Senate and House Calendar Addendum on the preceding legislative day and will appear in the volume of the Public Acts and Resolves of the 2006, sixty-eighth  Adjourned session]