Journal of the Senate

________________

Thursday, April 13, 2006

The Senate was called to order by the President.

Devotional Exercises

A moment of silence was observed in lieu of devotions.

Bill Referred

House bill of the following title was read the first time and referred:

H. 858.

An act relating to the credit for affordable housing.

To the Committee on Rules.

Bill Referred to Committee on Appropriations

House bill of the following title, appearing on the Calendar for notice, and carrying an appropriation, under the rule, was referred to the Committee on Appropriations:

H. 861.

An act relating to health care affordability for Vermonters.

Joint Resolution Adopted on the Part of the Senate

Joint Senate resolution of the following title was offered, read and adopted on the part of the Senate, and is as follows:

   By Senator Welch,

     J.R.S. 64.  Joint resolution relating to weekend adjournment.

Resolved by the Senate and House of Representatives:

That when the two Houses adjourn on Friday, April 14, 2006, it be to meet again no later than Tuesday, April 18, 2006.

Proposal of Amendment; Third Reading Ordered

H. 677.

Senator Collins, for the Committee on Education, to which was referred House bill entitled:

An act relating to a standards board and licensing hearing panels for professional educators.

     Reported recommending that the Senate propose to the House to amend the bill by striking out all after the enacting clause and inserting in lieu thereof the following:

Sec. 1.  16 V.S.A. § 212(14) is added to read:

(14)  Annually, convene a meeting of directors of Vermont educator preparation programs and representatives of school boards, superintendents, principals, educators, and the Vermont standards board to determine subject and geographic areas in which there is a critical need for educators and to discuss ways to meet the need.

Sec. 2.  16 V.S.A. chapter 51 is amended to read:

CHAPTER 51.  EXAMINATION AND LICENSING OF TEACHERS PROFESSIONAL EDUCATORS

§ 1691.  PURPOSE

The purpose of this chapter is to establish a board of professional educators to oversee the training, licensing, and professional standards of teachers and administrators and to establish hearing panels to determine compliance with those standards to help assure high caliber professionals and high quality public educational programs for Vermont students.

§ 1691a.  Definitions

As used in this chapter:

(1)  “Administrator” means an individual licensed under this chapter the majority of whose employed time in a public school, school district, or supervisory union is assigned to developing and managing school curriculum, evaluating and disciplining personnel, or supervising and managing a public school system or public school program.

(2)  “Applicant” means an individual applying for a license.

(3)  “Educator” means any teacher or administrator requiring a license under this chapter.

(4)  “Endorsement” means the grade level and field in which an educator is authorized to serve.  A license shall bear one or more endorsements.

(5)  “Hearing panel” means the persons assigned in individual cases to find facts, reach conclusions of law, and make decisions regarding compliance with standards for obtaining, retaining, and renewing licenses.

(6)  “License” means a license to engage in teaching or school administration, as the context requires, in the state and includes, unless the context requires otherwise, the endorsements the licensee has applied for or possesses.  “Licensee” means an individual licensed under this chapter.

(7)  “Licensing action” means action that suspends, revokes, limits, or conditions licensure or certification in any way and includes warnings, reprimands, probation, and administrative penalties.

(8)  “Office” means the office within the department of education responsible for professional standards and educator licensing.

(9)  “Standards board” means the Vermont standards board for professional educators established under section 1693 of this title.

(10)  “Teacher” means an individual licensed under this chapter the majority of whose employed time in a public school district or supervisory union is assigned to furnish to students direct instructional or other educational services, as defined by rule of the standards board, or who is otherwise subject to licensing as determined by the standards board.

§ 1692.  REQUIREMENT AS TO LICENSE; AGE LIMIT

A person shall not teach Except for a substitute teacher in accordance with rules adopted by the standards board, a person shall not be employed as a teacher or administrator in a public school without having a license then in force.  A license shall not be issued to a person under seventeen years of age.

§ 1693.  STANDARDS BOARD FOR PROFESSIONAL EDUCATORS

(a)  There is hereby established the Vermont standards board for professional educators comprising 13 members as follows:  seven teachers, two administrators, one public member, one school board member, one representative of educator preparation programs from a public institution of higher education, and one representative of educator preparation programs from a private institution of higher education.

(b)  Appointment and qualifications.  When a vacancy occurs, except in the case of the public member position, the state board of education shall solicit up to five nominations from any of the following organizations if their members may be eligible for the vacant position:  the Vermont national education association, the Vermont school boards association, the Vermont principals association, the Vermont superintendents association, the Vermont State Colleges, the University of Vermont, and the association of independent colleges.  The state board may add other names to the list but may not remove nominations submitted by the organizations and shall forward the list to the governor.  The governor shall appoint a person on the list or, in the case of the public position, the governor shall appoint a person of his or her choosing, for a term of three years which shall begin July 1 of the year of appointment.  No person shall be eligible for more than one sequential reappointment.  The governor shall appoint a replacement to fill any vacancy on the standards board for the remainder of the term.  Appointments shall be consistent with the following requirements:

(1)  Each member of the standards board shall be a citizen of the United States and a resident of Vermont.

(2)  The educator members shall be generally representative of elementary and secondary schools and of programs of study taught in Vermont public schools and of administrative positions in Vermont public schools.  Teacher members shall hold a license and have at least five years’ experience in public school teaching, at least three of which shall have been within the five years preceding appointment.  Administrator members shall hold a license and be endorsed as an administrator and have at least five years’ experience in public school administration, at least three of which shall have been within the five years preceding appointment.

(3)  The school board member shall be a current school district board member or have served on a school district board at some period during the three years prior to appointment.

(4)  The public member shall not be a member of the state board of education or an employee of any school and shall not derive primary livelihood in the field of public or independent education at any level of responsibility.

(c)  Standards board officers; meetings.  The standards board shall elect from its members a chair, vice chair, and secretary who shall serve for one year and until their successors are elected and seated.  The board shall meet at the request of the chair or at such other times and places as the board may determine.  Seven members of the board shall constitute a quorum for the transaction of business.

(d)  Compensation.  The department of education shall compensate standards board members for the performance of their duties and reimburse them for their actual and necessary expenses in accordance with section 1010 of Title 32.

(e)  Administration.  The standards board shall be attached for administrative purposes to the office.  With respect to the standards board, the commissioner shall:

(1)  with the advice of the standards board, employ a director, prepare an annual budget, and administer money appropriated to the standards board by the general assembly.  The budget of the standards board shall be part of the budget of the department;

(2)  employ administrative staff of the office;

(3)  incur such other expenses as the commissioner determines are necessary;

(4)  act as custodian of the records of the standards board; and

(5)  annually, conduct a training for members of the standards board and the hearing panels established in this chapter, which shall include workshops regarding the powers and duties of the standards board and the panels and an opportunity for the standards board and hearing panel members to discuss the practical application of standards in quasi-judicial proceedings.

§ 1694.  POWERS AND DUTIES OF THE STANDARDS BOARD FOR PROFESSIONAL EDUCATORS

In addition to any other powers and duties prescribed by law or incidental or necessary to the exercise of such lawful powers and duties, the standards board shall:

(1)  Adopt rules pursuant to chapter 25 of Title 3 with respect to the licensing of teachers and administrators, and of speech-language pathologists and audiologists as provided in chapter 87 of Title 26;

(2)  Establish standards for educator preparation programs in Vermont and approve those that meet the standards so that a person graduating from an approved program shall be eligible for a license to engage in teaching or school administration in accordance with standards board rules.  The standards board may accept accreditation of an educator preparation program in Vermont or another state from a national accreditation entity as sufficient for approval;

(3)  Establish standards, including endorsements, according to which individuals may obtain a license or have one renewed or reinstated;

(4)  Oversee and monitor the application and licensing process administered by the office; and

(5)  Develop a code of professional ethics and act as advisor to professional educators regarding its interpretation.

§ 1695.  CREDENTIALS GRANTED IN ANOTHER STATE REVIEW OF LICENSING STANDARDS

The board shall make regulations relating to the recognition of teachers’ licenses, diplomas and educational credentials granted in any other state, provided such other state shall recognize, by substantially reciprocal regulations or laws, such licenses, diplomas and educational credentials issued in this state.  Prior to the prefiling by the standards board of a licensing standard or procedure proposed for rulemaking pursuant to section 820 of Title 3, the commissioner may object to it before the state board of education on the grounds that it would have significant adverse financial or operational impact on the public school system.  If the state board of education agrees, it may remand the proposed rule to the standards board for further deliberations consistent with its written decision.  The commissioner may also object on the same grounds to a substantive change to a proposed rule, once initiated, before a final proposal is filed pursuant to section 841 of Title 3.

§ 1696.  LICENSING

(a)  Qualifications of applicants.  An applicant shall submit to the commissioner evidence satisfactory to the commissioner that the applicant either has completed all requirements of an approved educator preparation program or has otherwise acquired the knowledge and skills required for a license through coursework and experiences apart from an approved educator preparation program.

(b)  License by reciprocity.  By rule, the standards board shall establish standards according to which an applicant who meets the licensing standards of another state with standards substantially similar to Vermont’s may be accorded a license in this state, provided the other state recognizes, by substantially reciprocal regulations or laws, licenses issued in this state.

(c)  Temporary licenses.  By rule, the standards board may establish standards, if any, by which an applicant who otherwise does not meet the standards for a license may obtain, for a period not to exceed two years, a temporary license.

(d)  Junior Reserve Officer Training Corps instructors.  The board shall accept certification of a junior Reserve Officer Training Corps instructor by the federal Department of Defense as qualification for a license to provide junior Reserve Officer Training Corps instruction to a student enrolled in a junior Reserve Officer Training Corps program.

(e)  Denial of license.  The commissioner may deny a license for:

(1)  Failure to meet the conditions for issuance of a license or endorsement or renewal or reinstatement thereof; or

(2)  Failure of a licensee to demonstrate the competencies specified in the rules of the standards board.

(f)  Appeal.  An applicant aggrieved by a decision of the commissioner regarding the issuance or renewal of a license may appeal that decision by notifying the commissioner in writing within 30 days of receiving the decision.  The commissioner forthwith shall transmit notice of the appeal to the administrative officer for hearing panels to initiate the appeal process set forth in section 1700 of this title.

§ 1697.  FEES

(a)  Each applicant and licensee shall be subject to the following fees:

(1)  Initial processing of application                               $35.00

(2)  Issuance of initial license                                         $35.00 per year

                                                                                    for the term of the                                                                                         license

(3)  Renewal of license                                 $35.00 per year

                                                                    for the term of the renewal

(4)  Replacement of license                                           $10.00

(5)  Duplicate license                                                    $3.00

(6)  Peer review process                                               $1,200.00

                                                                                    one-time fee.

(b)  Fees collected under this section shall be credited to special funds established and managed pursuant to chapter 7, subchapter 5 of chapter 7 of Title 32, and shall be available to the department to offset the costs of providing those services.

§ 1698.  CAUSES FOR LICENSING ACTION

Any one of the following, or any combination of the following, constitutes potential cause for licensing action whether occurring within or outside the state:

(1)  Unprofessional conduct which means:

(A)  Grossly negligent conduct or greater, on or off duty, that places a student or students in meaningful physical or emotional jeopardy, or conduct that evidences moral unfitness to practice as an educator.

(B)  Conviction for a criminal offense in which the underlying circumstances, conduct, or behavior, by gross negligence or greater, places a student or students in meaningful physical or emotional jeopardy, or conviction of a crime that evidences moral unfitness to practice as an educator.

(C)  Conviction of grand larceny under 13 V.S.A. § 2501 or embezzlement as defined in subchapter 2 of chapter 57 of Title 13, provided charges were brought after July 1, 2006.

(D)  Conviction of a crime charged after July 1, 2006, which involves fraudulent misrepresentation, dishonesty, or deceit, including conviction for any of the following:  13 V.S.A. §§ 1101, 1102, 1103, 1104, 1106, 1107, 1108, 3006, or 3016, provided that conviction under 13 V.S.A. §§ 2002, 2502, 2561, 2575, 2582, and 2591, if the value or amount involved is $500.00 or less, shall not be considered a conviction under this subdivision unless it is part of a larger pattern of dishonesty, deceit, or fraud.

(E)  A pattern of willful misconduct or a single egregious act of willful misconduct in violation of duties and obligations of the position.

(F)  Falsification, misrepresentation, or misstatement of material information provided in connection with the application for or renewal or reinstatement of a license or endorsement.

(G)  With respect to a superintendent, the failure to maintain the confidentiality and privileged status of information provided pursuant to subsection 1700(c) and subdivision 1708(f)(3) of this title.

(2)  Incompetence, which means the inability or incapacity to perform the duties and competencies required by the license.

§ 1699.  REPORTS OF ALLEGED UNPROFESSIONAL CONDUCT OR INCOMPETENCE

(a)  An individual who has reasonable cause to believe a licensee has engaged in unprofessional conduct or is incompetent may, and a superintendent who has reasonable cause to believe a licensee has engaged in unprofessional conduct or is incompetent shall, submit a written report to the commissioner concerning allegations of unprofessional conduct or incompetence about a licensee.  A principal submitting a report under this section shall submit it to the superintendent and may also submit it to the commissioner.

(b)  Except as provided in section 1708 of this title, information provided the licensing office under this section shall be confidential.

(c)  A person who acts in good faith under the provisions of this section shall not be liable for damages in any civil action.

§ 1700.  INVESTIGATION

(a)  Investigation committee.  Upon receiving notice of either an applicant’s appeal of a licensing office decision or an allegation of unprofessional conduct or incompetence on the part of a licensee, the hearing panel administrative officer shall assign one or more of its licensee members to serve on an investigation committee with an investigator and prosecuting attorney assigned by the commissioner of education to investigate the licensing decision or allegation and make recommendations to the commissioner in accordance with subsections (b) and (d) of this section.  Teacher members shall be assigned to assist in the investigation of matters involving teachers and administrator members in matters involving administrators.  Members shall not serve on a hearing panel regarding any matter they assisted in investigating.  If the administrative officer is unable to assign one or more members to the investigation committee by reason of disqualification, resignation, vacancy, or necessary absence, the officer shall appoint ad hoc members who shall meet the requirements of subsection 1693(b) of this title.

(b)  Preliminary review.  After conducting a preliminary review of an allegation of unprofessional conduct or incompetence or of a denial of a license based on alleged unprofessional conduct or incompetence, the investigation committee shall make a recommendation to the commissioner regarding whether to conduct a formal investigation.

(c)  Formal investigation.  If the commissioner decides to conduct a formal investigation, the commissioner shall:

(1)  notify the educator and direct the investigation committee to proceed with a formal investigation; and

(2)  notify the superintendent of the school district in which the educator may be employed, or if the educator is currently employed as a superintendent, the chair of the board of the supervisory union or supervisory district that employs the superintendent, that the office has commenced a formal investigation of an allegation of unprofessional conduct or incompetence and shall specify the provisions of section 1698 of this title that best describe the allegation.

(d)  Recommendation.  Upon completing its investigation, the investigation committee shall recommend that the commissioner, with respect to a license application, affirm or reverse a licensing office decision or, with respect to alleged unprofessional conduct or incompetence, issue or not issue formal charges.

(e)  Professional guidance.  In its recommendation as to whether the commissioner should issue formal charges and, if so, what form they should take, the committee may consider the effect it believes its professional guidance may have in mitigating the need for and nature of licensing action.

§ 1701.  COMMISSIONER’S DETERMINATION

(a)  Matters involving denial of licensure.  With respect to an applicant’s appeal, the commissioner shall, within 10 days of receiving the committee’s recommendation, affirm or reverse the licensing decision and notify the applicant in writing.  If the commissioner reverses the decision, the office shall issue a license accordingly.  If the commissioner affirms the decision, the applicant may appeal by notifying the commissioner in writing within 10 days of receiving the commissioner’s decision.  The commissioner shall forthwith notify the hearing panel administrative officer of the appeal.

(b)  Matters involving alleged unprofessional conduct or incompetence.  With respect to a licensee alleged either incompetent or to have engaged in unprofessional conduct, the commissioner shall, within 10 days of receiving the investigation committee’s recommendation, determine whether to issue a formal charge and what, if any, licensing action should be imposed.  If the commissioner determines no formal charge is warranted, the commissioner shall notify in writing the licensee and, if the licensee is employed, the superintendent of the school district of employment.  If the commissioner determines a formal charge is warranted, the commissioner shall prepare a formal charge, file it with the hearing panel administrative officer, and cause a copy to be served upon the licensee charged together with a notice of hearing and procedural rights, as provided in this chapter.  The commissioner shall provide a copy of the formal charge to the superintendent of the school district, if any, in which the licensee is employed, or if the licensee is employed as a superintendent, to the chair of the supervisory union that employs the superintendent, provided the superintendent or board chair agrees to maintain the confidentiality and privileged status of the information as provided in subsection 1708(d) of this title.  If the commissioner finds that public health, safety, or welfare imperatively requires emergency action and incorporates a finding to that effect in the formal charge, the hearing panel may order summary suspension of a license pending proceedings for revocation or other action.  These proceedings shall be promptly instituted and determined.

§ 1702.  HEARING PANELS

(a)  Appointment.  The governor shall appoint seven teachers, four administrators, and three members of the public to serve on hearing panels for terms of three years beginning on July 1 of the year of appointment.  No person shall be eligible for more than one sequential reappointment.  The governor shall ensure appointments are consistent with the requirements found in subdivisions 1693(b)(1)–(3) of this title.  By appointment, the governor shall fill any vacancy for the remainder of its term.  Panel members shall be considered appointive officers for the purposes of chapter 29 of Title 3 and shall be compensated in accordance with section 1010 of Title 32.

(b)  Administration.  The hearing panels shall be attached for administrative purposes to the office.  Annually, the panel members shall meet collectively to:

(1)  elect an administrative officer for the purpose of assigning hearing panels in licensing matters;

(2)  approve a pool, based upon the commissioner’s recommendation, of impartial hearing officers who shall be attorneys admitted to practice in this state; and

(3)  plan professional development activities. 

(c)  Powers and duties of hearing panels.  Hearing panels shall have the authority to determine compliance by applicants, licensees, and the office with standards board standards according to which individuals may obtain, renew, and retain a license.  Upon notification that the applicant has appealed under subsection 1701(a) of this title or that the commissioner has issued a formal charge under subsection 1701(b) of this title, the administrative officer shall appoint a hearing officer and a panel, as well as a chair for the panel.  Panels hearing appeals of teachers shall comprise two teacher members and one public member.  Panels hearing appeals of administrators shall comprise two administrator members and one public member.  In the conduct of proceedings, the hearing officer, or the panel if it takes additional evidence under subsection 1706(a) of this title, may:

(1)  Issue subpoenas to compel the attendance of witnesses and the furnishing of evidentiary material in connection with a hearing;

(2)  Authorize depositions to be taken as needed in any investigation, hearing, or proceeding;

(3)  Conduct administrative hearings in accordance with this section, section 1705 of this title, and chapter 25 of Title 3 regarding appeals of licensing decisions and charges of unprofessional conduct or incompetence;

(4)  In the case of the hearing officer, recommend and, in the case of a hearing panel, make decisions regarding appeals of licensing decisions and formal charges; and

(5)  Undertake any other actions and procedures specified in or required or appropriate to carry out the provisions of this chapter.

§ 1703.  TIME AND NOTICE OF HEARING

The chair of the panel shall fix the time of hearing, which shall be between 30 and 60 days after, as applicable, filing of the license application appeal or service of the charge on the licensee.  The chair shall provide the applicant or licensee notice of the hearing, in it stating the following:  the time and place of the hearing; the right of the applicant or licensee charged to file with the chair a written response within 20 days of the date of service; the fact that a record of the proceeding will be kept; the rights of the applicant or licensee charged at the hearing to appear personally, to be represented by counsel, to produce witnesses and evidence, to cross-examine witnesses, and to examine such documentary evidence as may be produced; and, in the case of formal charges against the licensee, the range of licensing actions to which the licensee charged may be subject if the formal charges are substantiated.

§ 1704.  BURDEN OF PROOF

(a)  Denial of licensure.  Except as provided in subsection (b) of this section, the burden of proof in matters involving the denial of an initial license or the addition of an endorsement to a license once issued shall be on the applicant by a preponderance of the evidence.

(b)  Alleged unprofessional conduct or incompetence.  The burden of proof in matters involving alleged unprofessional conduct or incompetence, including denial of a license based on alleged unprofessional conduct or incompetence, shall be on the commissioner by a preponderance of the evidence, except that in the case of revocation or suspension for more than one year, the proof shall be by clear and convincing evidence.

§ 1705.  HEARING OFFICER RECOMMENDATION

The hearing officer shall conduct the hearing for the purpose of issuing recommended findings of fact, conclusions of law, and a proposed decision to the hearing panel.  The hearing officer may administer oaths and otherwise exercise the powers of a judicial officer regarding the conduct of a fair and impartial hearing.  Within 30 days of the hearing, the hearing officer shall recommend to the hearing panel findings of fact, conclusions of law, and a decision and by certified mail provide a copy to the applicant or licensee.

§ 1706.  DECISION AND ORDER

(a)  Hearing panel decision.  The hearing panel may take additional evidence and may accept, reject, or modify the recommendations of the hearing officer and shall issue findings of fact, conclusions of law, and an order within 30 days of receiving the recommendations, unless the hearing panel grants an extension for good cause.  The hearing panel shall provide a copy of the decision to the commissioner and, by certified mail, the applicant or licensee charged.  If formal charges are not substantiated, the hearing panel shall include in its order a statement that the charges were not substantiated by the evidence, and it shall dismiss the charges.

(b)  Charges substantiated.  If formal charges are substantiated, the hearing panel, in its order, may:  take no action; issue a warning; issue a private reprimand; issue a public reprimand; or condition, limit, suspend, or revoke the license to practice.  An administrative penalty not to exceed $1,000.00 may be imposed by itself or in connection with the issuance of a warning or of a private or public reprimand.

§ 1707.  APPEAL FROM PANEL ORDER

(a)  Appeal to state board of education.

(1)  A party aggrieved by a final decision of a hearing panel may, within 30 days of the decision, appeal that decision by filing a notice of appeal with the administrative officer of the hearing panel who shall refer the case to the state board of education.  The parties may agree to waive this review by written stipulation filed with the state board of education.  The state board of education shall conduct its review on the basis of the record created before the hearing panel, and it shall allow the presentation of evidence regarding alleged irregularities in hearing procedure not shown in the record.

(2)  The state board of education shall not substitute its judgment for that of the hearing panel as to the weight of the evidence on questions of fact.  It may affirm the decision or may reverse and remand the matter with recommendations if substantial rights of the appellant have been prejudiced because the hearing panel’s finding, inferences, conclusions, or decisions are:

(A)  in violation of constitutional or statutory provisions;

(B)  in excess of the statutory authority of the hearing panel;

(C)  made upon unlawful procedure;

(D)  affected by other error of law;

(E)  clearly erroneous in view of the evidence on the record as a whole;

(F)  arbitrary or capricious; or

(G)  characterized by abuse of discretion or clearly unwarranted exercise of discretion.

(b)  Following appeal or waiver of appeal to the state board of education, a party may appeal to the superior court in Washington County which shall review the matter de novo.

§ 1708.  ACCESSIBILITY AND CONFIDENTIALITY OF LICENSING MATTERS

(a)  It is the purpose of this section both to protect the reputation of licensees from public disclosure of unwarranted complaints and to fulfill the public’s right to know of any action taken against an applicant or a licensee when that action is based on a determination of unprofessional conduct or incompetence.

(b)  All meetings and hearings of the standards board and hearing panels shall be held in accordance with chapter 5 of Title 1.

(c)  The commissioner shall prepare and maintain a register of all complaints which shall be a public record and which shall show:

(1)  with respect to all complaints for which a formal investigation is initiated under subsection 1700(c) of this title, the following information:

(A)  the date and the nature of the complaint, but not the identity of the licensee or information that could be used to identify the licensee; and

(B)  a summary of the completed investigation; and

(2)  only with respect to complaints resulting in the filing of a formal charge under subsection 1701(b) of this title, the following additional information:

(A)  the name and business addresses of the licensee and the name of the complainant if disclosure is permitted under federal or state law and does not provide personally identifying information about a student;

(B)  formal charges, provided they have been served or a reasonable  effort to serve them has been made;

(C)  except as provided under chapter 5 of Title 1, the findings, conclusions, and order of the hearing panel; and

(D)  final disposition of the matter.

(d)  The hearing panel and the commissioner shall not disclose to anyone but the applicant or the licensee charged any information regarding a complaint, proceeding, or record, except the information required to be released under this section.

(e)  A licensee or applicant shall have the right to inspect and copy all  information in the possession of the department of education pertaining to the licensee or applicant, except investigatory files not resulting in formal charges and attorney work product.

(f)  Nothing in this section shall prohibit the disclosure of information:

(1)  Regarding complaints to state or federal law enforcement agencies in the course of an investigation, provided the agency agrees to maintain the confidentiality and privileged status of the information as provided in subsection (d) of this section;

(2)  Regarding denials of licensure for cause, and license suspensions or revocations, and including reinstatements of licenses, to the National Association of State Directors of Teacher Education and Certification, consistent with the member agreement executed between it and the state of Vermont.  For the purposes of this subdivision, “cause” includes any circumstance or activity also deemed to be a revocable offense; or

(3)  As is necessary in investigating a complaint, to the superintendent of a school district in which the licensee is employed or, if the licensee is employed as a superintendent, to the chair of the board that employs the superintendent, provided the superintendent or chair agrees to maintain the confidentiality and privileged status of the information as provided in subsection (d) of this section.  Where, in the judgment of the commissioner, the alleged unprofessional conduct or incompetence places the students in immediate physical or emotional jeopardy, the office shall inform the superintendent of the school district in which the licensee is employed.  The superintendent may take only such action as is both necessary to protect students and consistent with the rights of the licensee.  The superintendent shall not do anything which compromises the integrity of the investigation.

§ 1709.  REPORTS

The commissioner of education shall issue annually a report to the standards board which shall contain:

(1)  the number of new licensees and endorsements they receive, the number of licenses that have lapsed without renewal, and the total number of licensees;

(2)  a summary of all complaints requiring preliminary review, formal investigation and formal charges; and

(3)  an accounting of all fees and administrative penalties received by the office and all expenditures and costs of the office for the year.

Sec. 3.  16 V.S.A. § 1931(20) is amended to read:

(20)  “Teacher” shall mean any licensed teacher, principal, supervisor, superintendent, or any professional licensed by the state board of education Vermont standards board for professional educators regularly employed for the full normal working time for his or her position in a public day school within the state, or in any school or teacher-training institution located within the state, controlled by the state board of education, and supported wholly by the state; or any teacher, principal, supervisor, superintendent, or any professional regularly employed for the full normal working time for his or her position in any nonsectarian independent school which serves as a high school for the town or city in which the same is located, provided such school is not conducted for personal profit.  It shall also mean any person employed in a teaching capacity in certain public independent schools designated for such purposes by the board of trustees in accordance with section 1935 of this title. In all cases of doubt the board of trustees, herein defined, shall determine whether any person is a teacher as defined in this chapter.  It shall not mean a person who is teaching with an emergency license.

Sec. 4.  16 V.S.A. § 1981(1) and (5) are amended to read:

(1)  “Administrator” means any person so licensed by the state board of education Vermont standards board for professional educators, the majority of whose employed time in a school or a school district is devoted to serving as superintendent, assistant superintendent, assistant to the superintendent, supervisor, principal, or assistant principal.

(5)  “Teacher” means any person licensed employable as a teacher by the state board of education Vermont standards board for professional educators who is not an administrator as herein defined.

Sec. 5.  26 V.S.A. § 4451(3), (10), and (14) are amended to read:

(3)  “Board” means the state board of education Vermont standards board for professional educators unless the context clearly requires otherwise.

(10)  “Private practice” means any work performed by a licensed

speech-language pathologist or audiologist that is not within the jurisdiction of the state board of education.

(14)  “Within the jurisdiction of the state board of education” means conduct or work performed by a licensed speech-language pathologist or audiologist on behalf of a supervisory union or public school district in Vermont or an independent school approved for special education purposes, or conduct otherwise subject to discipline under the state board of education licensing rules of the board.

Sec. 6.  26 V.S.A. § 4454(b) is amended to read:

(b)  This chapter shall not be construed to limit the authority of the state board of education to determine and evaluate the qualifications of, issue licenses to, or discipline licensees who are within the jurisdiction of the state board of education or the Vermont standards board for professional educators.

Sec. 7.  26 V.S.A. § 4455(b) is amended to read:

(b)  The secretary shall seek the advice of the individuals appointed under this section in matters related to qualifications or alleged misconduct not within the jurisdiction of the state board of education.  The advisors shall be entitled to compensation and necessary expenses as provided in section 1010 of Title 32 for meetings called by the director.

Sec. 8.  26 V.S.A. § 4456(a)(6) is amended to read:

(6)  refer all complaints and disciplinary matters not within the jurisdiction of the state board of education to the secretary of state;

Sec. 9.  26 V.S.A. § 4457 is amended to read:

§ 4457.  LICENSURE; APPLICATIONS; ELIGIBILITY

Applicants for licenses under this chapter shall submit an application to the department on a form furnished by the department, along with payment of the specified fee and evidence of the eligibility qualifications established by the state board of education which shall include, at a minimum:

* * *

Sec. 10.  26 V.S.A. § 4458(a) is amended to read:

(a)  A license shall be renewed at an interval determined by the state board of education which shall be no fewer than every two years and no more than every seven years upon payment of the renewal fee, provided the person applying for renewal completes professional development activities in accord with the processes approved by the department or the Vermont standards board for professional educators, during the interval.  The board shall establish, by rule, guidelines and criteria for the renewal or reinstatement of licenses issued under this chapter.

Sec. 11.  VERMONT EDUCATORS; CRITICAL NEEDS

At the 2006 meeting convened pursuant to subdivision 212(14) of Title 16, the group shall discuss, at a minimum, the need for teachers of children with autism and for speech-language pathologists.  If the group determines that there is a need for speech-language pathologists in Vermont, it shall discuss whether a new level of licensure which does not require a master’s degree would help to meet the need.

Sec. 12.  REPEAL

16 V.S.A. § 164(5) is repealed.

Sec. 13.  TRANSITION; EFFECTIVE DATE

(a)  The current Vermont standards board for professional educators shall continue to perform its duties under existing state board of education rules and its appointed members shall continue in their positions during fiscal year 2007. Notwithstanding any state board rule to the contrary, the state board may reappoint current standards board members for fiscal year 2007.

(b)  Regulations and standards adopted by the state board of education which relate to the areas under the authority of the Vermont standards board for professional educators pursuant to this act shall remain in effect upon passage of this act until the standards board officially changes them.

(c)  During fiscal year 2007, the governor shall appoint members of the Vermont standards board for professional educators and the individuals to serve on the hearing panels for staggered terms commencing July 1, 2007.

(d)  This section shall become effective on passage.  The remainder of this act shall take effect on July 1, 2007.

The Committee further recommends that after passage of the bill the title be amended to read as follows:

     AN ACT RELATING TO A STANDARDS BOARD AND LICENSING HEARING PANELS FOR PROFESSIONAL PUBLIC EDUCATORS.

And that the bill ought to pass in concurrence with such proposals of amendment.

Senator Miller, for the Committee on Appropriations, to which the bill was referred, reported recommending that the bill ought to pass in concurrence, when so amended.

Thereupon, the bill was read the second time by title only pursuant to Rule 43, the proposal of amendment was agreed to, and third reading of the bill was ordered.

Proposal of Amendment; Bill Passed in Concurrence with Proposals of Amendment; Bill Messaged

H. 856.

House bill entitled:

An act relating to enhancing sentences for and preventing risks posed by dangerous sexual offenders.

Was taken up.

Thereupon, pending third reading of the bill, Senator Sears, on behalf of the Committee on Judiciary, moved to amend the Senate proposal of amendment as follows:

First: In Sec. 7, 13 V.S.A. § 2602(b), by striking out subdivision (1) in its entirety and inserting in lieu thereof a new subdivision (1) to read as follows:

(1)  For a first offense, imprisoned not less than one year two years and not more than 15 years or, and, in addition, may be fined not more than $5,000.00, or both.

Second:  By striking out Sec. 27 in its entirety and inserting in lieu thereof a new Sec. 27 to read as follows:

Sec. 27.  13 V.S.A. § 5412 is amended to read:

§ 5412.  Active community notification by the department of public safety, the department of corrections, and local law enforcement; immunity

(a)  The department, the department of corrections, any authorized local law enforcement agency, and their employees shall be immune from liability in carrying out the provisions under this subchapter except in instances of gross negligence or willful misconduct, provided that the agencies complied with the rules adopted pursuant to this subchapter.

(b)  The department, the department of corrections, and any authorized local law enforcement agency are authorized to notify members of the public who are likely to encounter a sex offender who poses a danger under circumstances that are not enumerated in this subchapter.

(c)  Notification of the community beyond those persons likely to encounter a sex offender shall be authorized only under circumstances which constitute a compelling risk to public safety and only after consultation with the Vermont crime information center and the department of corrections.

(d)  Active community notification regarding registered sex offenders who may pose a danger to members of the community is an important public safety tool which the general assembly intends for authorized agencies to use at their discretion in accordance with this subchapter.

Third:  In Sec. 25, 13 V.S.A. § 5411, by striking out subsection (c) in its entirety and by adding two new sections to be numbered Sec. 36 and Sec. 37, to read as follows:

*** Community Notification Expansion ***

Sec. 36.  13 V.S.A. § 5411(c) is amended to read:

§ 5411.  NOTIFICATION TO LOCAL LAW ENFORCEMENT AND LOCAL COMMUNITY

(c)(1)  Except as provided for in subsection (e) of this section, upon request of a member of the public about a specific person, the department, the department of corrections, and any authorized local law enforcement agency shall release registry information on the following registrants: sex offenders and violent offenders whose information is required to be posted on the internet in accordance with section 5411a of this title.

(A)  Sex offenders who have been convicted of section 3253 of this title (aggravated sexual assault), subdivision 2405(a)(1)(D) of this title if a registrable offense (kidnapping and sexual assault of a child), or 33 V.S.A. § 6913(d)(sexual activity with a vulnerable adult).

(B)  Sex offenders who have at least one prior conviction for an offense described in subdivision 5401(10) of this subchapter or a comparable offense in another jurisdiction.

(C)  Sex offenders who have failed to comply with sex offender registration requirements and for whose arrest there is an outstanding warrant for such noncompliance.

(D)  Sex offenders who have been designated as sexual predators pursuant to section 5405 of this title.

(E)  Sex offenders who have been designated by the department of corrections, pursuant to section 5411b of this title, as high risk.

(2)  The department, the department of corrections, and any authorized local law enforcement agency shall release the following registry information to a requestor in accordance with subdivision (1) of this subsection:

(A)  the offender's known aliases;

(B)  the offender's date of birth;

(C)  a general physical description of the offender;

(D)  the offender's town of residence;

(E)  the date and nature of the offender's conviction;

(F)  if the offender is under the supervision of the department of corrections, the name and telephone number of the local department of corrections office in charge of monitoring the offender;

(G)  whether the offender complied with treatment recommended by the department of corrections;

(H)  whether there is an outstanding warrant for the offender's arrest; and

(I)  the reason for which the offender information is accessible under subdivision (1) of this subsection.


Sec. 37.  13 V.S.A. § 5411c is added to read:

§ 5411c.  Active community notification by the department of public safety, the department of corrections, and local law enforcement

(a)  Notwithstanding other provisions to the contrary, the department, the department of corrections, and any authorized local law enforcement agency are authorized to notify members of the public at their discretion about any sex offender or violent offender whose information is required to be posted on the internet in accordance with section 5411a of this title.

(b)  The department, the department of corrections, and any authorized local law enforcement agency are authorized to notify members of the public at their discretion about a sex offender or violent offender whose information is not required to be posted on the internet in accordance with section 5411a of this title only under circumstances which constitute a compelling risk to public safety and only after consultation with the Vermont crime information center and the department of corrections.

(c)  Active community notification regarding registered sex offenders and violent offenders who may pose a danger to members of the community is an important public safety tool which the general assembly intends for authorized agencies to use at their discretion in accordance with this subchapter.

And by renumbering the remaining sections to be numerically correct.

Which was agreed to.

Thereupon, the bill was read the third time and passed in concurrence with proposal of amendment.

Thereupon, on motion of Senator Mazza, the rules were suspended and the bill was ordered messaged to the House forthwith.

Rules Suspended; Proposal of Amendment; Consideration Interrupted by Recess

H. 861.

Appearing on the Calendar for notice, on motion of Senator Welch, the rules were suspended and House bill entitled:

An act relating to health care affordability for Vermonters.

Was taken up for immediate consideration.


Senator Leddy, for the Committee on Health and Welfare, to which the bill was referred, reported recommending that the Senate propose to the House to amend the bill by striking out all after the enacting clause 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 conditions; coverage of the uninsured through catamount health, a self‑insured, comprehensive benefit plan with sliding-scale premiums; and providing minimum preventive services starting with immunizations for all Vermonters.  The general assembly finds that chronic care management is one tool to contain health care costs and ensure that the costs of Vermont’s health care system become 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.  In addition, standardizing the minimum criteria and reporting requirements for uncompensated care and bad debt write-offs by hospitals will more clearly identify and account for 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 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 manner that is timely, patient-centered, and seeks to improve the quality and affordability of patient care.

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

(1)  the state’s chronic care infrastructure, 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 a chronic condition or disability.

(2)  the Vermont health information technology project pursuant to section 9417 of Title 18.

(3)  the multi-payer data collection project pursuant to section 9410 of Title 18.

(4)  the common claims administration project pursuant to section 9408 of Title 18.

(5)  the consumer price and quality information system pursuant to section 9410 of Title 18.

(6)  any information technology work done by the quality assurance system pursuant to section 9416 of Title 18.

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

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

(9)  Catamount health, established in subchapter 6 of chapter 19 of Title 33, which provides a comprehensive benefit plan with a sliding-scale premium based on income to uninsured Vermonters.

(10)  the uniform hospital uncompensated care policies.

(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 recommendations for administration or legislation.  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 of the general assembly 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” chronic condition 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 the strategic plan for the blueprint for health are codified in Sec. 5 of this act as chapter 13 of Title 18. 

(c)(1)  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

(2)  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.

(3)  Due to the increase in funding and expected expanded capacity of the blueprint for health, the commissioner of health, in collaboration with the executive committee established under section 702 of Title 18, shall consider and include recommendations in the revised strategic plan for an implementation structure and time line.  The considerations and recommendations shall include at minimum an assessment of the options for an organizational structure, and a recommendation as to which structure is most likely to achieve the statewide goals of the blueprint for health, to maintain an effective partnership between the public and private sectors, and to broaden the participation of stakeholders statewide.  The commissioner of health shall submit a preliminary report on the implementation structure no later than June 15, 2006 to the commission on health care reform.

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

Chapter 13.  CHRONIC CARE INFRASTRUCTURE

AND PREVENTION MEASURES

§ 701.  DEFINITIONS

For the purposes of this chapter:

(1)  “Blueprint for health” means the state’s plan for chronic care infrastructure, prevention of chronic conditions, and chronic care management program, and includes an integrated approach to patient self-management, community development, health care system and professional practice change, and information technology initiatives.

(2)  “Chronic care” means health services provided by a health care professional for an established disease, condition, or disability 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 condition or disability, and prevent complications related to chronic conditions or disabilities.  Examples of chronic conditions 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 conditions or disabilities, 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 examinations 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 that will include information on all cases of a particular disease or health condition in a defined population of individuals.

§ 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)(1)  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 and prevention as described under this section.  The executive committee shall consist of no fewer than 10 individuals, including a representative from the department of banking, insurance, securities, and health care administration; the office of Vermont health access; the Vermont medical society; the Vermont program for quality in health care; the Vermont association of hospitals and health systems; two representatives of private health insurers; a consumer; a representative of the complementary and alternative medicine profession; and a primary care professional serving low-income or uninsured Vermonters. 

(2)  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 model, which includes general, standard elements established in section 703 of this title, patient self-management, community initiatives, and health system and information technology reform, 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, with chronic care management, and the blueprint for health model;


(C)  a plan to develop and implement reimbursement systems aligned with the goal of managing the care for individuals with or at risk for conditions 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)  the involvement of community and consumer groups to facilitate and assure the sustainability of health services supporting healthy behaviors and good patient self-management for the prevention and management of chronic conditions;

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

(G)  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 chronic care;

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

(I)  identification of resource needs for implementation and sustaining the blueprint for health and strategies to meet the needs; and

(J)  a strategy for ensuring statewide participation no later than January 1, 2009, by insurers, third-party administrators, health care professionals, hospitals and other providers, and consumers 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 annually 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 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; the results of health care professional and patient satisfaction surveys; and other information as requested by the committees.  The surveys shall be developed in collaboration with the executive committee established under subsection (b) of this section.

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

§ 703.  CHRONIC CARE MANAGEMENT PROGRAM

(a)(1)  The secretary of administration or designee shall create a chronic care management program administered or provided by a private entity for individuals with chronic conditions who are enrolled in Medicaid, the Vermont health access plan (VHAP), Dr. Dynasaur, or catamount health. 

(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 conditions who are enrolled in catamount health shall be included in the chronic care management program upon enrollment.  The secretary may provide a time period for implementing chronic care management to individuals currently enrolled in Medicaid, VHAP, 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 a broad range of chronic conditions in the chronic care management program.

(c)  The chronic care management program shall be designed to 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 communications 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 to align reimbursements and create financial incentives and rewards for health care professionals to establish management systems for chronic conditions, to improve health outcomes, and to improve the quality of care, including case management fees, pay for performance, payment for technical support and data entry associated with patient registries, the cost of staff coordination within a medical practice, and any reduction in a health care professional’s productivity;

(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;

(8)  a requirement that the data on enrollees be shared, to the extent allowable under federal law, with the secretary in order to inform the health care reform initiatives under section 2222a of Title 3;

(9)  a method for the care management organization to participate closely in the blueprint for health and other health care reform initiatives; and

(10)  participation in the pharmacy best practices and cost-control program under subchapter 5 of chapter 19 of Title 33, including the multi-state purchasing pool and the statewide preferred drug list.

(d)  The secretary shall ensure that the chronic care management program is modified over time to comply with the Vermont blueprint for health strategic plan and to the extent feasible, collaborate in its initiatives.

Sec. 6.  PREVENTION AND CHRONIC 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 prevention of chronic conditions and for chronic 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 Vermont blueprint for health 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)  Where permitted under federal law, the agency shall require recertification or reapplication for Medicaid, the Vermont health access plan (VHAP), and Dr. Dynasaur no more often than once a year.

Sec. 7.  PREVENTION AND CHRONIC CARE MANAGEMENT; STATE EMPLOYEES

The commissioner of human resources shall include in any request for proposals for the administration of the health benefit plans for state employees 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 strategic plan 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.

* * * Administration of Medicaid and Catamount Health * * *

Sec. 7a.  REQUEST FOR PROPOSALS; MEDICAID; CATAMOUNT HEALTH

(a)  The agency of administration shall issue a request for proposals no later than January 1, 2007 for a single, private entity to provide coverage for health services for individuals with chronic conditions who are enrolled in Medicaid, the Vermont health access plan (VHAP), Dr. Dynasaur, or catamount health as provided for in section 703 of Title 18 and for health services for individuals enrolled in catamount health as provided for in chapter 19 of Title 33.  The request for proposals shall provide that responses may allow an entity to accept the financial risk and administration of the programs, to administer the programs without accepting financial risk, or to provide for a combination of risk sharing.

(b)  The secretary shall review the request for proposals with the commission on health care reform prior to issuance.  The issuance of the request for proposals is conditioned on the approval of the commission in order to ensure that the request meets the intent of this section, section 702 of Title 18, and chapter 19 of Title 33.


(c)  Within 10 days of the receipt of the proposals, the secretary shall provide copies of the proposals to an independent actuary or other appropriate consultant retained by the joint fiscal committee to review the proposals and provide the commission on health care reform and the joint fiscal committee with an analysis and recommendation.

(d)  The implementation of the programs is conditional upon approval by act of the general assembly, or, if the general assembly is not in session and the speaker and the president pro tempore determine that it will not reconvene within the next 30‑day period, by a majority vote of the combined membership of the joint fiscal committee and the commission on health care reform at a joint meeting.  Prior to consideration by the general assembly, the commission on health care reform and the joint fiscal committee shall provide the general assembly with recommendations on the proposals.   

* * * Medicaid Initiatives * * *

Sec. 8.  MEDICAID REIMBURSEMENT

(a)(1)  The office of Vermont health access shall adjust Medicaid and the Vermont health access plan reimbursement to reflect the following priorities in the following order:

(A)  an increase in base rates for evaluation and management procedure codes to enhance payment to primary care specialties for primary care services to a level equivalent to the 2006 rates in the Medicare program;

(B)  an increase in the PCPlus case management rates by $5.00 per member per month for patients whose primary care provider participates in the Vermont blueprint for health established in section 702 of Title 18;

(C)  the provision of incentives and payment restructuring for health care professionals participating in the care coordination program;

(D)  an increase in base rates for frequently used current procedural terminology (CPT) codes which are significantly lower than the 2006 Medicare reimbursement levels; and

(E)  an increase in dental reimbursement by increasing the dental cap for adults and by rate increases.   

(2)  The Medicaid reimbursement rate increases in subdivision (1) of this section shall be effective on January 1, 2007 for fiscal year 2007, and July 1 for fiscal years 2008 through 2010.

(b)  For fiscal year 2007, the office of Vermont health access shall increase Medicaid reimbursement rates for inpatient services to hospitals by five percent effective January 1, 2007.  In fiscal year 2008 and thereafter, the office shall increase Medicaid reimbursement rates for inpatient services to hospitals by five percent annually on July 1. 

(c)  In fiscal years subsequent to 2007, it is the intent of the general assembly that 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 and quality or performance measures developed under the Vermont blueprint for health strategic plan established in section 702 of Title 18.  Prior to implementation, these standards shall be approved by the general assembly through the appropriations process.

(d)  No later than October 31, 2006, the office shall report to the health access oversight committee with a plan for allocation of the appropriated amounts for fiscal year 2007 among the priorities established in subsection (a) of this section and among inpatient services for hospitals as provided for in subsection (b) of this section.  Prior to the implementation of the reimbursement adjustments in this section, the health access oversight committee shall review and determine if the allocation among the priorities is equitable and reflects legislative intent.

Sec. 9.  VHAP PREMIUM REDUCTIONS 

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. 10.  DR. DYNASAUR AND SCHIP PREMIUM REDUCTIONS

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.

* * *

Sec. 11.  PREMIUM ASSISTANCE PROGRAM; EMPLOYER‑SPONSORED INSURANCE

(a)  No later than October 1, 2007, the agency of human services shall establish a premium assistance program to assist individuals eligible for or enrolled in the Vermont health access plan and catamount health and their dependents to purchase an approved employer-sponsored insurance plan if offered to those individuals by an employer.  Children who are eligible for Medicaid or Dr. Dynasaur may be enrolled in either the premium assistance program or the Medicaid or Dr. Dynasaur programs.  

(b)  VHAP-eligible premium assistance.  For individuals enrolled in the Vermont health access plan on October 1, 2007 or for those who apply for enrollment in the Vermont health access plan on or after October 1, 2007 who have access to an approved employer‑sponsored insurance plan, the employer premium assistance program shall provide:

(1)  A subsidy of premiums or cost‑sharing amounts based on the household income of the eligible individual to ensure that the individual is obligated to make out‑of‑pocket expenditures for premiums and cost‑sharing amounts which are substantially equivalent to or less than the premium and cost‑sharing obligations on an annual basis under the Vermont health access plan.

(2)  A requirement that eligible individuals enroll in an approved employer‑sponsored insurance plan as a condition of continued assistance under this section or coverage under the Vermont health access plan, except that dependents who are children of eligible individuals shall not be required to enroll in the premium assistance program.

(3)  Supplemental benefit coverage to some or all individuals eligible for premium assistance under this subsection if offered by the office of Vermont health access.

(c)  Catamount health-eligible premium assistance.  For individuals who are eligible for catamount health and who have access to an approved employer-sponsored insurance plan, the employer premium assistance program shall provide:

(1)  A subsidy of premiums or cost‑sharing amounts which are substantially equivalent to or less than the premium and cost‑sharing obligations on an annual basis under catamount health. 

(2)  A requirement that eligible individuals enroll in an approved employer‑sponsored insurance plan as a condition of continued assistance under this section or coverage under catamount health, except that dependents who are children of eligible individuals shall not be required to enroll in the premium assistance program.

(d)  In consultation with the department of banking, insurance, securities, and health care administration, the agency shall develop criteria for approving employer‑sponsored health insurance plans to ensure the plans provide comprehensive and affordable health insurance when combined with the assistance under this section.  At minimum, an approved employer-sponsored insurance plan shall include covered benefits and chronic care management to be substantially similar, as determined by the agency, to the benefits covered under catamount health.

(e)  In the event that the agency determines that appropriations for the premium assistance program are insufficient to meet the projected costs of enrolling new program participants, the agency may suspend or terminate new enrollment for participants in the program or restrict enrollment to eligible lower-income individuals.

(f)  The agency of human services shall request federal approval for an amendment to the Global Commitment for Health Medicaid Section 1115 waiver for the premium assistance program authorized by this section.

(g)  There is appropriated to the agency in fiscal year 2007 the amount of $1,000,000 for the establishment, administration, and development of the employer-sponsored insurance premium assistance program under this section. Of this amount, no more than $250,000 may be expended until additional information and analysis is provided to determine the specific parameters involved in an employer-sponsored premium assistance program, the costs of the program, and savings that may be attributable to the transition of individuals from the Vermont health access plan to an available employer-sponsored plan.  Expenditures of any additional amounts appropriated by this section may be made after November 15, 2006 only upon approval by a majority of the combined membership of the joint fiscal committee and the health access oversight committee at a joint meeting upon receipt of a report from the agency including the following:

(1)  A plan for additional expenditures;

(2)  A survey to determine whether individuals currently enrolled in Vermont health access plan, including those eligible as caretakers, are potentially eligible for employer-sponsored premium assistance under this section; and

(3)  A report on the anticipated budgetary impact of an employer-sponsored insurance premium assistance program for fiscal year 2008, including savings attributable to enrolling current VHAP enrollees in the premium assistance program established under this section and the cost of providing the subsidy to these enrollees.

Sec. 12.  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, Dr. Dynasaur, and catamount health.  

* * * Private Insurance Cost Shift Reviews * * *

Sec. 13.  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. 14.  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, employers offering private health insurance, and other interested parties to determine how to ensure that reductions in hospital and provider charges, and reductions in private insurance claims through the nongroup market security trust and the provision of minimum preventive services through catamount health 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.

* * * Catamount Health * * *

Sec. 15.  33 V.S.A. chapter 19, subchapter 6 is added to read:

Subchapter 6.  Catamount Health

§ 2021.  POLICY AND PURPOSE

Catamount health is established to provide uninsured Vermont residents a defined benefit package of primary, preventive, hospital, acute episodic care, and chronic care, including assistance in preventing and managing chronic conditions.  Catamount health will also provide certain minimum preventive services without cost to all Vermonters.

§ 2022.  DEFINITIONS

As used in this subchapter:

(1)  “Administrator” means the private entity that administers and, if applicable, assumes financial risk for catamount health.

(2)  “Agency” means the agency of administration.

(3)  “Benefits” means health services and amounts of coverage provided by catamount health, including allocation of cost-sharing amounts, deductibles, and benefit limits.

(4)  “Catamount health” means the health benefit plan offered under this subchapter.

(5) “Chronic care” means health services provided by a health care professional for an established disease, condition, or disability 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 condition or disability, and prevent complications related to chronic conditions or disabilities.  Examples of chronic conditions include diabetes, hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental illness, and hyperlipidemia.

(6)  “Chronic care management” means a system of coordinated health care interventions and communications for individuals with chronic conditions or disabilities, 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.

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

(8)  “Health risk assessment” means screening by a health care professional for the purpose of assessing an individual’s health, including tests or physical examinations 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.

(9)  “Health service” means any medically necessary treatment or procedure to maintain, diagnose, or treat an individual’s physical or mental condition, including services ordered by a health care professional and services to assist in activities of daily living.

(10)  “Immunizations” means vaccines and the application of the vaccines as recommended by the practice guidelines for children and adults established by the Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC).

(11)  “Preventive care” means health services provided by health care professionals to identify and treat asymptomatic individuals who have developed risk factors or preclinical disease, but in whom the disease is not clinically apparent, including immunizations and screening, counseling, treatment, and medication determined by scientific evidence to be effective in preventing or detecting a condition or disability.

(12)  “Primary care” means health services provided by health care professionals specifically trained for and skilled in first-contact and continuing care for individuals with signs, symptoms, or health concerns, not limited by problem origin, organ system, or diagnosis, and shall include prenatal care and the treatment of mental illness.

(13)  “Uninsured” means an individual who does not qualify for Medicare, Medicaid, the Vermont health access plan, or Dr. Dynasaur, had no private insurance or employer-sponsored coverage that includes both hospital and physician services within 12 months prior to the month of application, or lost private insurance or employer-sponsored coverage during the prior 12 months for the following reasons:

(A)  the individual’s employer-sponsored coverage ended because of:

(i)  loss of employment;

(ii)  death of the principal insurance policyholder;

(iii)  divorce or dissolution of a civil union;

(iv)  no longer qualifying as a dependent under the plan of a parent or caretaker relative; or

(v)  no longer qualifying for COBRA, VIPER, or other state continuation coverage; or

(B)  college- or university-sponsored health insurance became unavailable to the individual because the individual graduated, took a leave of absence, or otherwise terminated studies.

(14)  “Vermont resident” means an individual domiciled in Vermont as evidenced by an intent to maintain a principal dwelling place in Vermont indefinitely and to return to Vermont if temporarily absent, coupled with an act or acts consistent with that intent.

§ 2023.  ELIGIBILITY

(a)(1)  Except as provided in subdivision (2) of this subsection, an individual shall be eligible for catamount health if the individual is an uninsured Vermont resident.  Any Vermont resident shall be eligible for the minimum preventive care offered under section 2025 of this title.

(2)  An individual shall not be eligible for catamount health if the individual is of the age of majority and is claimed on a tax return as a dependent of a resident of another state.

(b)  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.

(c)  The agency shall establish rules pursuant to chapter 25 of Title 3 on the specific criteria to demonstrate eligibility, including criteria for and proof of residency, income, and insurance status.

(d)  Nothing in this subchapter shall require an individual already covered by health insurance to terminate that insurance or enroll in catamount health.

(e)(1)  If the monies available in the catamount fund established under section 2028 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)  The agency’s determinations that monies available are insufficient shall be based on monthly enrollment figures and the official revenue estimates for the catamount fund under section 305a of Title 32.

(3)  A plan to cap or limit enrollment submitted to the health access oversight committee under this section shall be deemed approved unless the committee disapproves the plan within 21 days of submission by the agency.

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

§ 2024.  BENEFITS

(a)  The agency shall develop by rule pursuant to chapter 25 of Title 3 a comprehensive benefit package of health services and chronic care management to be provided under catamount health beginning October 1, 2007.

(b)(1)  The benefits shall include primary care, preventive and chronic care, acute episodic care, and hospital services.  The benefits shall be actuarially equivalent to the Vermont Freedom Plan with a preferred provider organization, $200.00 deductible, and $10.00 office co‑payment offered by Blue Cross Blue Shield of Vermont in 2006. 

(2)(A)  The agency shall propose to the general assembly reasonable sliding‑scale premiums for individuals up to 300 percent of the federal poverty level, deductibles, co‑payments, benefit limits, or other cost‑sharing amounts applicable to the catamount health benefits under this section.  Co‑payment amounts shall not apply to chronic care for individuals in chronic care management or to preventive care.  Individuals with incomes above 300 percent of federal poverty level shall be charged a premium reflecting the actual cost of catamount health.

(B)  The agency may include financial or other incentives to encourage healthy lifestyles and patient self‑management.  These incentives shall comply with the rules developed by the department of banking, insurance, securities, and health care administration for health promotion and prevention programs offered by health insurers.

(c)  To the extent catamount health provides coverage for any particular type of health service or for any particular medical condition, it shall cover those health services and conditions when provided by any type of health care professional acting within the scope of practice authorized by law.  Catamount health may establish a term or condition that places a greater financial burden on an individual for access to treatment by the type of health care professional only if it is related to the efficacy or cost-effectiveness of the type of service.

(d)  The agency shall ensure that catamount health will provide a choice of services and health care professionals, contain costs over time, include chronic care management, and improve quality of care and health outcomes.  In determining the amount, duration, and scope of benefits to be provided under this subchapter, the agency shall consider:

(1)  credible, evidence-based, scientific research and comment by health care professionals both nationally and internationally concerning clinical efficacy and risk;

(2)  the cost-effectiveness of health services and technology; and

(3)  revenues anticipated to be available to finance catamount health.

§ 2025.  MINIMUM PREVENTIVE SERVICES

(a)  Notwithstanding the eligibility, premium, and cost-sharing criteria in this subchapter, any Vermont resident may receive minimum preventive services through catamount health.  For the purposes of this section, minimum preventive services shall include immunizations and may include additional services as funding permits.

(b)  For the purposes of this section, catamount health shall be the secondary payer to Medicaid, the Vermont health access plan, Dr. Dynasaur, Medicare, and any federal health insurance or federal program covering immunizations.

§ 2026.  ADMINISTRATION

(a)  Catamount health shall be administered by a private entity, which also may contract to assume partial or all financial risk of the program.  Catamount health shall include a chronic care management program as provided for in section 703 of Title 18.  The agency shall include criteria for an aggressive enrollment strategy by the administrator.  The agency or administrator shall ensure that each individual receives a health risk assessment upon enrollment in catamount health.  The agency shall weigh the costs and benefits of purchasing a reinsurance policy for catamount health as a method of managing risk and reducing the cost of the premium amounts.  The agency may purchase reinsurance if it determines that it is cost-effective and prudent to do so.  The agency may also include in the contract for the administration of catamount health any utilization review procedures and other benefit management provisions consistent with section 703 of Title 18 and any federal requirements, if applicable, through the Global Commitment for Health Medicaid Section 1115 waiver.

(b)  The agency or administrator of catamount health shall make available the necessary information, forms, and billing procedures to health care professionals to ensure payment for health services covered under catamount health.  To facilitate enrollment, the agency or administrator shall use a single, uniform, simplified form to determine eligibility for Medicaid, any Medicaid waiver program, Dr. Dynasaur, any state‑funded pharmacy program, or catamount health.  The agency or administrator shall collect data necessary to evaluate catamount health, including the individual’s reason for not having insurance, whether the individual’s employer offers insurance, and how the individual got information about catamount health.  Receipt of this information shall not be an eligibility requirement.  If permitted under federal law, the agency or administrator shall require individuals to reapply or recertify no more often than annually.  

(c)  The agency shall structure the administration of catamount health to ensure that individuals may transition smoothly between Medicaid, the Vermont health access plan, Dr. Dynasaur, and catamount health.  The agency may also modify the administrative systems for Medicaid, the Vermont health access plan, or Dr. Dynasaur to achieve this purpose.

(d)  If pharmacy benefits are offered under catamount health, the agency or administrator shall ensure that catamount health complies with the pharmacy best practices and cost-control program under subchapter 5 of this chapter.  The agency or administrator shall collaborate with the office of Vermont health access in negotiating prescription drug prices and shall participate in the multi-state drug purchasing pool and the preferred drug list administered by the office of Vermont health access.  To the extent feasible, the agency or administrator shall offer pharmacy benefits through pharmacies able to access the federal Section 340B of U.S. Public Law 102-585 price.

(e)  An individual enrolled in catamount health who is aggrieved by an adverse decision of the agency or the administrator may grieve or appeal the decision under rules and procedures consistent with 42 C.F.R. § 438.402.

§ 2027.  PAYMENT; HEALTH CARE PROFESSIONALS; HOSPITALS

(a)  Except as provided for in subsection (b) of this section, the agency or administrator shall pay health care professionals using the Medicare payment methodologies at a level at least ten percent greater than for levels paid under the Medicare program.  Payments under this subsection shall be indexed to the
Medicare economic index developed by the Centers for Medicare and Medicaid Services.  

(b)  Payments for hospital services shall be calculated using the Medicare payment methodology adjusted for each hospital to ensure payments at 110 percent of the hospital’s actual cost for services.  Payments under this subsection shall be indexed to changes in the Medicare payment rules.

(c)  Payments for chronic care and chronic care management shall meet the requirements in section 703 of Title 18.

(d)  If Medicare does not pay for a service covered under catamount health, the commissioner shall establish some other payment amount for such services determined after consultation with affected providers.  Members of catamount health shall not be billed any additional amount for health services, except as provided for as cost sharing in section 2024 of this title.

§ 2028.  Catamount Fund

(a)  The catamount fund is established in the treasury as a special fund to be a source of financing for catamount health.

(b)  Into the fund shall be deposited:

(1)  revenues established for funding catamount health;

(2)  premium amounts paid by individuals unless paid directly to a third-party administrator; and

(4)  the proceeds from grants, donations, contributions, taxes, and any other sources of revenue as may be provided by statute, rule, or act of the general assembly.

(c)  The fund shall be administered pursuant to subchapter 5 of chapter 7 of Title 32, except that interest earned on the fund and any remaining balance shall be retained in the fund.  The agency shall maintain records indicating the amount of money in the fund at any time.

(d)  All monies received by or generated to the fund shall be used only as allowed by appropriation of the general assembly for the administration and delivery of catamount health and transfers to the state health care resources fund established in section 1901d of this title.

Sec. 16.  CATAMOUNT HEALTH; PREMIUMS

Subject to amendment in the fiscal year 2008 budget, the agency of administration shall establish individual and family premium amounts for catamount health under subchapter 6 of chapter 19 of Title 33.  The agency shall establish family premium amounts by income bracket based on the individual premium amounts and the average family size.  The individual
premiums shall be by income bracket as a percentage of federal poverty level (FPL):

(1)  Income less than or equal to 200 percent of FPL:  $60.00 per month.

(2)  Income greater than 200 percent and less than or equal to 225 percent of FPL:  $90.00 per month.

(3)  Income greater than 225 percent and less than or equal to 250 percent of FPL:  $110.00 per month.

(4)  Income greater than 250 percent and less than or equal to 275 percent of FPL:  $125.00 per month.

(5)  Income greater than 275 percent and less than or equal to 300 percent of FPL:  $135.00 per month.

(6)  Income greater than 300 percent of FPL:  the actual cost of catamount health, which for fiscal year 2008 is estimated at $350.00 per month.

Sec. 16a.  IMMUNIZATIONS; ADMINISTRATION

(a)  The secretary of administration or designee shall study methods to ensure that all Vermonters have access to immunizations through catamount health as provided for in section 2025 of Title 33.  In conducting the study, the secretary shall consult with the immunization program advisory committee, the department of health, the department of banking, insurance, securities, and health care administration, the office of Vermont health access, and other interested parties.

(b)  The study shall include findings and recommendations concerning the following:

(1)  Effective strategies for improving immunization rates, including options for:

(A)  enhancing access to vaccination services in both medical and public health settings; and

(B)  strengthening school and child care immunization requirements;

(2)  Recommendations for expanding the immunization program to adults, including recording of immunizations for adults in the Vermont immunization registry;

(3)  Recommendations for improving quality assurance and quality improvement in assuring proper vaccine storage and handling, measuring immunization coverage rates, and addressing barriers to coverage; and 

(4)  Options for sustainable funding of the purchase and administration of vaccines, including:

(A)  Equitable sharing of cost of the state’s immunization program between public and private resources;

(B)  Payment by the state of a reasonable fee to health care professionals for individuals receiving coverage for immunizations through catamount health.

(c)  The secretary shall report the findings and recommendations of the study to the house committee on health care and the senate committee on health and welfare no later than January 15, 2007.

Sec. 17.  RULES PROCESS AND OVERSIGHT

(a)  The secretary of administration or designee shall submit any final proposed rules, developed under chapter 25 of Title 3, required to implement this act to the commission on health care reform established by Sec. 277c of No. 71 of the Acts of 2005 and the health access oversight committee for consideration.  The commission and committee may submit separate recommendations, limit comment to certain provisions in the rules, or to the extent feasible, make joint recommendations to the joint legislative committee on administrative rules.

(b)  The health access oversight committee shall monitor the development, implementation, and ongoing operation of catamount health established by subchapter 6 of chapter 19 of Title 33.  The agency of administration shall submit to the committee quarterly progress reports that shall include revenue and expenditures for catamount health for the prior months, enrollment and projected enrollment, projected expenditures related to enrollment for the fiscal year, and other information as requested by the committee.  At least annually, the secretary shall report the results of health care professional and patient satisfaction surveys regarding the administration of catamount health.

(c)  The agency shall submit annual reports on the receipts, expenditures, and balances in the catamount fund established in section 2028 of Title 33 to the joint fiscal committee at its September meeting.

Sec. 18.  GLOBAL COMMITMENT FINANCING

To the extent feasible and allowable under federal law, the agencies of administration and of human services shall finance catamount health through the Global Commitment for Health Medicaid Section 1115 waiver.  No later than July 1, 2006, the agencies shall seek a waiver amendment from the Centers for Medicare and Medicaid Services to include catamount health in the premium amount paid to the office of Vermont health access under Global Commitment.  The agencies may require the office of Vermont health access to use revenue from the capitation payments related to beneficiaries covered under Global Commitment as described in Term and Condition 40 to finance some or all of catamount health.  The agencies may administer catamount health in the manner required by the Global Commitment.

* * * Nongroup Health Insurance Market * * *

Sec. 19.  8 V.S.A. § 4062d is added to read:

§ 4062d.  NONGROUP MARKET SECURITY TRUST

(a)  The commissioner shall establish the nongroup market security trust for the purpose of lowering the cost of and thereby increasing access to health care coverage in the individual or nongroup health insurance market.

(b)  The nongroup market security trust shall permit nongroup carriers to transfer five percent of the carriers’ claims costs, based on the earned premium as reported on the most recent annual statement of the carrier.  At the close of the year, the commissioner shall reconcile the amount paid against the actual expenses of the carriers and collect or expend the necessary funds to ensure that five percent of the actual expenses are paid under this section.  The individuals incurring the claims shall remain enrolled policyholders, members, or subscribers of the carrier’s or insurer’s plan, and shall be subject to the same terms and conditions of coverage, premiums, and cost sharing as any other policyholder, member, or subscriber.

(c)  The commissioner may develop the nongroup market security trust in a manner that permits the trust to be eligible for a federal grant to administer the trust, including a grant under the federal Trade Adjustment Act.

(d)  All of the revenues appropriated shall be deposited into the nongroup market security trust to be administered by the commissioner for the sole purpose of providing financial support for the nongroup market security trust authorized by this section.  The trust shall be administered in accordance with subchapter 5 of chapter 7 of Title 32, except that interest earned shall remain in the trust.

(e)  The commissioner may adopt rules for the nongroup market security trust relating to:

(1)  Criteria governing the circumstances under which a nongroup carrier may transfer five percent of the claims expenses of the carrier to the trust as provided for in this section.

(2)  Eligibility criteria for providing financial support to carriers under this section, including carrier claims’ expenses eligible for financial support, standards and procedures for the treatment and chronic care management as defined in section 701 of Title 18, and any other eligibility criteria established by the commissioner.

(3)  The operation of the trust.

(4)  Any other standards or procedures necessary or desirable to carry out the purposes of this section.

(f)  As used in this section, “nongroup carrier” means a nongroup carrier registered under section 4080b of this title that has an annual earned premium in excess of $100,000.00.

Sec. 20.  8 V.S.A. § 4080b(n) is amended to read:

(n)  On or before January 15, 1993, the commissioner shall report to the senate finance committee and the house commerce committee concerning implementation of the community rating provisions set forth in subsection (h) of this section, describing areas in which additional legislation may be needed  The commissioner shall ensure that any rates filed by any registered nongroup carrier, whether initial or revised, for nongroup insurance policies reflect the reduction in claims costs attributable to the nongroup market security trust established in section 4062d of this title.

* * * Hospital Uncompensated Care * * *

Sec. 21.  HOSPITAL UNCOMPENSATED CARE; FINDINGS

(a)  The general assembly finds that all of Vermont’s community hospitals are nonprofit charity hospitals which provide care regardless of patient ability to pay.  Any uncompensated care received is paid for by someone other than the patient receiving it.  This uncompensated care is substantial. 

(b)  Uncompensated care is already being paid for.  It is subsidized through the “cost shift” and is absorbed principally by the payers of private health insurance premiums, including self‑insurance plans.  This cost shift functions as a hidden surcharge for the cost of care to lower income individuals.

Sec. 22.  HOSPITAL UNCOMPENSATED CARE; STANDARDS; REPORTING

(a)  The commissioner of banking, insurance, securities, and health care administration, in consultation with representatives of the Vermont association of hospitals and health systems, third-party payers, and health care consumers, shall review the uncompensated care and bad debt policies of Vermont’s hospitals and recommend a standard statewide uniform uncompensated care and bad debt policy.  The standard policy shall include criteria for payment forgiveness for the cost of health services received by low income patients, criteria for a sliding scale payment amount for patients under certain income levels, a method for calculating the amount of services received by the patient, and other criteria necessary for ensuring that the care received by the uninsured and underinsured patients is billed in a uniform and consistent manner.  In addition to a standard policy, the commissioner may recommend reasons for and a method of approving deviations from the standard policy by a hospital or may recommend a set of standard policies to be applied to hospitals based on particular criteria, such as a designation as a critical access hospital, the income median in an area, or any other rationale.

(b)  The commissioner, in consultation with the representatives listed in subsection (a) of this section, shall determine a fair and thorough method for calculating and reporting information about uncompensated care and bad debt to the department of banking, insurance, securities, and health care administration to ensure accurate accounting in the hospital budgets and other health care facility planning, as well as collecting information about the types of patients accessing uncompensated care or who are unable to pay for the care received.  The commissioner shall consider collecting information about the patient receiving the care, including the patient’s primary insurance status and employer, the actual cost of the care received, any amounts paid toward the care, and any discounts provided to the patient by the hospital.

(c)  The commissioner’s findings and recommendations shall be submitted in a report to the senate committee on health and welfare and the house committee on health care not later than January 15, 2007.

* * * Health Care Coverage Planning * * *

Sec. 23.  SCHEDULE FOR ATTAINING UNIVERSAL HEALTH CARE

(a)  By February 15, 2007, the commission on health care reform shall recommend to the general assembly a schedule, benchmarks, and additional analysis needed for incremental expansions over time to Vermont’s health care system with the goal of achieving universal health care for all Vermonters no later than 2011.

(b)  In making its recommendations, the commission shall give priority to:

(1)  extending universal access to diagnostic or other services to all Vermonters;

(2)  methods of reducing the cost of health insurance or providing alternative coverage through catamount health to individuals who pay 10 percent or more of their gross income for premiums and cost-sharing or medical expenses;


(3)  strategies for reducing the cost of health insurance or providing alternative coverage through catamount health to individuals in the individual or other high cost markets; and

(4)  determining needed analysis and criteria for implementing a health insurance requirement on January 1, 2011 if 98 percent of Vermonters do not have health insurance by 2010, including methods of enforcement, providing proof of insurance to individuals, and any other criteria necessary for the requirement to be effective in achieving universal health care coverage.

(c)  Recommendations by the commission shall be based on data received by the secretary of administration or designee, review of the strategic plan developed under section 2222a of Title 3, information on Vermont’s current health care system reform initiatives, other research and assistance provided by the commission’s staff, and public input received by the commission.

Sec. 24.  REQUIRED COVERAGE; HEALTH CARE

If 98 percent of Vermonters do not have coverage for health services by January 1, 2010, every individual who resides in Vermont is required to have coverage under health insurance, employer-sponsored insurance, or a federal or state program providing payment for health services no later than January 1, 2011.

Sec. 25.  COMMUNITY PLANNING; HEALTH CARE COVERAGE

In fiscal year 2007, the department of health shall provide a planning grant of $100,000.00 to one community organization or corporation to assist in establishing a local initiative to provide health care coverage or insurance to a community, region, or geographic area of the state.

* * * Technical Amendments * * *

Sec. 26.  32 V.S.A. § 305a is amended to read:

§ 305a.  OFFICIAL STATE REVENUE ESTIMATE

On or about January 15 and on or about July 15 of each year, and at such other times as the emergency board or the governor deems proper, the joint fiscal office and the secretary of administration shall provide to the emergency board their respective estimates of state revenues in the general, transportation, education, and health access trust catamount health, state health care resources, and Global Commitment funds.  The January revenue estimate shall be for the current and next two succeeding fiscal years, and the July revenue estimate shall be for the current and immediately succeeding fiscal years.  Federal fund estimates shall be provided at the same times for the current fiscal year.  Within 10 days of receipt of such estimates, the board shall determine an official state revenue estimate for deposit in the respective funds for the years covered by the estimates.  For the purpose of revising an official revenue estimate only, a majority of the legislative members of the emergency board may convene a meeting of the board.  The health access trust fund estimate secretary shall include estimated caseloads and estimated per member per month expenditures for the current and next succeeding fiscal years for each population category eligible for state health care assistance programs supported by the fund.

* * * Oversight and Reporting * * *

Sec. 27.  REPORT; HEALTH CARE REFORM

No later than January 15, 2009, the agency of administration shall report to the general assembly on:

(1)  the percentage of uninsured Vermonters and the number of insured Vermonters by coverage type;

(2)  an analysis of the trends of catamount health costs and trends in the revenue sources for catamount health;

(3)  the feasibility of allowing individuals who are not uninsured and employers to buy into catamount health at full premium cost; and

(4)  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.

Sec. 28.  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. 29.  APPROPRIATIONS

(a)(1)  For fiscal year 2007, the sum of $2,500,000.00 (federal and state) is appropriated from the Global Commitment fund for the increase in Medicaid rates to health care professionals on January 1, 2007 under Sec. 8(a) of this act.

(2)  For fiscal year 2007, the sum of $1,000,000.00 (federal and state) is appropriated from the Global Commitment fund for the increase in Medicaid rates to hospitals on January 1, 2007 under Sec. 8(b) of this act.

(b)  For fiscal year 2007, the sum of $100,000.00 is appropriated from the general fund for the planning grant established in Sec. 25 of this act.

Sec. 30.  EFFECTIVE AND IMPLEMENTATION DATES

This act shall take effect upon passage, except as follows:

(1)  Secs. 8 (Medicaid reimbursement), 13 (cost shift review), and 25 (community health care planning grant) shall take effect July 1, 2006

(2)  Secs. 9 (VHAP premiums) and 10 (Dr. Dynasaur premiums) shall take effect July 1, 2007

(3)  Sec. 15 (catamount health) shall take effect June 30, 2006 for the purposes of establishing and administering the catamount fund under section 2028 of Title 33, and preparing for administration of and enrollment in catamount health; implementation of the catamount health program, however, shall not commence until October 1, 2007.

(4)  Sec. 24 (health care coverage requirement) shall take effect on January 1, 2008.

Sec. 31.  TECHNICAL PROVISION

It is the intent of the general assembly that the provisions of Sec. 3 of this act, adding section 2222a of Title 3, are complementary to the provisions in Sec. 15 of S.310 (2006), an act relating to common sense initiatives, also adding section 2222a of Title 3.  Any additional provisions contained in Sec. 3 of this act that are not contained in Sec. 15 of S.310 shall not be superseded.  Any technical revisions necessary to ensure accuracy or conformity between the sections, such as the numbering of subdivisions, may be made by the office of legislative council.

And that the bill ought to pass in concurrence with such proposal of amendment.

Senator Cummings, for the Committee on Finance, to which the bill was referred, reported recommending that the bill be amended as recommended by the Committee on Health and Welfare with the following amendments thereto:

First: By striking out Sec. 2 in its entirety and inserting in lieu thereof a new Sec. 2 to read as follows:

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 conditions; coverage of the uninsured through Catamount Health, a comprehensive and affordable benefit plan with sliding-scale premiums; and providing minimum preventive services starting with immunizations for all Vermonters.  The general assembly finds that chronic care management is one tool to contain health care costs and ensure that the costs of Vermont’s health care system become sustainable.

(b)  It is also the intent of the general assembly to ensure that any reduction in the “cost shift” to private insurance is returned to consumers by slowing the rate of growth in insurance premiums.  This 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 this cost shift.  In addition, standardizing the minimum criteria and reporting requirements for uncompensated care and bad debt write-offs by hospitals will more clearly identify and account for this cost shift.

Second: In Sec. 15, 33 V.S.A. § 2024(b) by striking out subdivision (2)(A) and inserting in lieu thereof a new (2)(A) to read as follows:

(2)(A)  The agency shall propose to the general assembly reasonable sliding‑scale premiums for individuals up to 300 percent of the federal poverty level, deductibles, co‑payments, benefit limits, or other cost‑sharing amounts applicable to the Catamount Health benefits under this section.  Deductible and other cost-sharing amounts shall not apply to chronic care for individuals in chronic care management or to preventive care.  Individuals with incomes above 300 percent of federal poverty level shall be charged a premium reflecting the actual cost of Catamount Health.

Third: In Sec. 15, 33 V.S.A. by striking out § 2028 in its entirety and inserting in lieu thereof a new § 2028 to read as follows:

§ 2028.  Catamount Fund

(a)  The Catamount fund is established in the treasury as a special fund to be a source of financing for Catamount Health.

(b)  Into the fund shall be deposited:

(1)  revenue from the employer health care premium contribution pursuant to chapter 25 of Title 21;

(2)  17.5 percent of the revenue from the cigarette tax levied pursuant to chapter 205 of Title 32;

(3)  premium amounts paid by individuals unless paid directly to the administrator; and

(4)  the proceeds from grants, donations, contributions, taxes, and any other sources of revenue as may be provided by statute, rule, or act of the general assembly.

(c)  The fund shall be administered pursuant to subchapter 5 of chapter 7 of Title 32, except that interest earned on the fund and any remaining balance shall be retained in the fund.  The agency shall maintain records indicating the amount of money in the fund at any time.

(d)  All monies received by or generated to the fund shall be used only as allowed by appropriation of the general assembly for the administration and delivery of Catamount Health and for transfers to the state health care resources fund established in section 1901d of this title.

Fourth: In Sec. 16 by striking out the first sentence in its entirety and inserting in lieu thereof the following: Subject to amendment in the fiscal year 2008 budget, the agency of administration shall establish individual and family premium amounts for Catamount Health under subchapter 6 of chapter 19 of Title 33 for the first year in the amounts established in this section and shall index the premiums in future years to the overall growth in spending per enrollee in Catamount Health.

Fifth: By inserting thirteen new sections to be numbered Secs.25a through 25m to read as follows:

Sec. 25a.  21 V.S.A. chapter 25 is added to read:

CHAPTER 25.  EMPLOYERS’ HEALTH CARE PREMIUM CONTRIBUTION

§2001.  PURPOSE

For the purpose of more equitably distributing the costs of health care to uninsured residents of this state an employers’ health care premium contribution is established to provide a fair and reasonable method for sharing health care costs with employers who do not offer their employees health care coverage.

§ 2002.  DEFINITIONS

For the purposes of this chapter:

(1)  “Employee” means an individual over the age of majority employed full-time or part‑time by an employer to perform services in this state.

(2)  “Employer” means a person who is required under subchapter 4 of chapter 151 of Title 32 to withhold income taxes from payments of income with respect to services, but shall not include the government of the United States.

(3) “Full-time equivalent” or “FTE” means the number of employees expressed as the number of employee hours worked during a calendar quarter divided by 520.

(4) “Uncovered employee” means:

     (A) an employee of an employer who does not offer to pay any part of the cost of health care coverage for its employees; or

     (B)  an employee who is not eligible for health care coverage offered by an employer to any other employees.

§ 2003.  PREMIUM CONTRIBUTION ASSESSMENT

(a)  The commissioner of labor shall assess and an employer shall pay a quarterly health care premium contribution for each full-time equivalent uncovered employee employed during that quarter in excess of three full-time equivalent employees.

(b) For any quarter in fiscal year 2007, the amount of the health care premium contribution shall be $91.25 for each full-time equivalent employee.  For each fiscal year after fiscal year 2007, the amount of the health care premium contribution shall be adjusted by a percentage equal to any percentage change in premiums for Catamount Health for that fiscal year. 

(c)  Premium contribution assessments under this chapter shall be determined on a calendar quarter basis, due and payable 30 days after the close of each quarter.  Late filings, late payments and underpayments of the premium contribution assessments due shall be subject to the same fees, interest and penalties as pertain to contributions for unemployment compensation under chapter 17 of this title. The commissioner shall establish rules for the administration and collection of premiums under this chapter.  To the extent feasible any reports required of employers under this chapter shall be combined with other reports and information collected from employers by the department of labor.

(c) Revenues from the premiums collected shall be deposited into the catamount fund established under 33 V.S.A. § 2029 for the purpose of financing health care coverage under catamount health, as provided under subchapter 6 of chapter 19 of Title 33.

Sec. 25b.  EFFECTIVE DATE

     Sec. 25a, establishing an employers’ health care premium contribution assessment, shall take effect October 1, 2006, with the first premium assessments due and payable 30 days after the close of the quarter on January 30, 2007.


* * * Cigarette and tobacco product taxes * * *

Sec. 25c.  32  V.S.A. §7702 (1) and (12) are amended to read:

          (1) "Cigarette" shall mean the common article of commerce known by this name consisting of a small cylindrical roll composed in whole or in part of finely-cut tobacco, wrapped in paper or in any substance other than tobacco. “Cigarette” shall also mean the common article of commerce known as “little cigars” or “cigarillos”, or by a similar designation, consisting of a small cylindrical roll of the approximate size as cigarettes and wrapped in paper or other substance which may be or include tobacco. 

* * *

(12) "Tobacco products" means cigars (except little cigars or cigarillos defined as cigarettes); cheroots; stogies; periques; granulated, plug cut, crimp cut, ready rubbed, and other smoking tobacco; snuff, snuff flour; cavendish; plug and twist tobacco; fine-cut and other chewing tobaccos; shorts; refuse scraps, clippings, cuttings and sweeping of tobacco, and other kinds and forms of tobacco, prepared in such manner as to be suitable for chewing or smoking in a pipe or otherwise, or both for chewing and smoking; but shall not include cigarettes as defined in this section.

Sec. 25d.  32 V.S.A. § 7771 is amended to read:

§ 7771.  RATE OF TAX

A tax is imposed on all cigarettes held in this state by any person for sale or by any person in possession of more than 10,000 cigarettes, unless such cigarettes shall be:

(1)  in the possession of a licensed wholesale dealer;

(2)  in the course of transit and consigned to a licensed wholesale dealer or retail dealer; or

(3)  in the possession of a retail dealer who has held the cigarettes for 24 hours or less.  Such tax shall be at the rate of 59.5 89.5 mills for each cigarette, and the payment thereof to be evidenced by the affixing of stamps to the packages containing the cigarettes, as hereinafter provided.  Any cigarette on which the tax imposed by this chapter has been paid, such payment being evidenced by the affixing of such stamp, shall not be subject to a further tax under this chapter.  Nothing contained in this chapter shall be construed to impose a tax on any transaction the taxation of which by this state is prohibited by the constitution of the United States.  The amount of taxes advanced and paid by a licensed wholesale dealer or a retail dealer as herein provided shall be added to and collected as part of the retail sale price on the cigarettes.  All taxes upon cigarettes under this chapter are declared to be a direct tax upon the consumer at retail and shall conclusively be presumed to be precollected for the purpose of convenience and facility only.

Sec. 25e.  32 V.S.A. § 7814(b) is amended to read:

(b)  Cigarettes.  Notwithstanding the prohibition against further tax on stamped cigarettes under section 7771 of this title, a floor stock tax is hereby imposed upon every dealer of cigarettes in this state who is either a wholesaler, or a retailer who at 12:01 a.m. o’clock on July 1, 2003 2006, has more than 10,000 cigarettes for retail sale in his or her possession or control.  The rate of tax shall be 13 30 mills for each cigarette in the possession or control of the wholesaler or retailer at 12:01 a.m. o’clock on July 1, 2003 2006, and on which cigarette stamps have been affixed before July 1, 2003 2006.  A floor stock tax is also imposed on each Vermont cigarette stamp in the possession or control of the wholesaler at 12:01 a.m. o’clock on July 1, 2003 2006, and not yet affixed to a cigarette package, and the tax shall be at the rate of 26 60 cents per stamp.  Each wholesaler and retailer subject to the tax shall, on or before September 25, 2003 August 25, 2006, file a report to the commissioner in such form as the commissioner may prescribe showing the cigarettes and stamps on hand at 12:01 a.m. o’clock on July 1, 2003 2006, and the amount of tax due thereon.  The tax imposed by this section shall be due and payable on or before September 25, 2003 2006, and thereafter shall bear interest at the rate established under section 3108 of this title.  In case of timely payment of the tax, the wholesaler or retailer may deduct from the tax due two and three‑tenths of one percent of the tax.  Any cigarettes with respect to which a floor stock tax has been imposed under this section shall not again be subject to tax under section 7771 of this title.

Sec. 25f.  32 V.S.A. §7811 is amended to read: 

§ 7811. Imposition of tobacco products tax

There is hereby imposed and shall be paid a tax on all tobacco products possessed in the state of Vermont by any person for sale on and after July 1, 1959 which were imported into the state or manufactured in the state after said date, except that no tax shall be imposed on tobacco products sold under such circumstances that this state is without power to impose such tax, or sold to the United States, or sold to or by a voluntary unincorporated organization of the armed forces of the United States operating a place for the sale of goods pursuant to regulations promulgated by the appropriate executive agency of the United States. Such tax on tobacco products shall be at the rate of 41 percent of the wholesale price for all tobacco products except snuff and other chewing tobacco which shall be taxed at the rate of $1.66 per ounce, or fractional part thereof, and is intended to be imposed only once upon any tobacco product. Provided, however, that upon payment of the tax within ten days, the distributor or dealer may deduct from the tax two percent of the tax due. It shall be presumed that all tobacco products within the state are subject to tax until the contrary is established and the burden of proof that any tobacco products are not taxable hereunder shall be upon the person in possession thereof.

Sec. 25g.  CIGARETTE AND TOBACCO PRODUCTS; EFFECTIVE DATE; INCREASE

Sections 25c. through 25g. and this section shall take effect July 1, 2006.  On and after July 1, 2008, the cigarette tax under 32 V.S.A. §7771 shall be at the rate of 99.5 mills for each cigarette.  On July 1, 2008, the floor stock tax imposed by 32  V.S.A. §7814 (b) shall be at the rate of 10 mills for each cigarette in the possession or control of a wholesaler or retailer who has more than 10,000 cigarettes on July 1, 2008, shall be reported by the wholesaler or dealer on or before August 25, 2008, and due and payable on or before September 25, 2008.

Sec. 25h.  33 V.S.A. § 1901d is amended to read:

§ 1901d.  STATE HEALTH CARE RESOURCES FUND

(a)  The state health care resources fund is established in the treasury as a special fund to be a source of financing health care coverage for beneficiaries of the state health care assistance programs under the global commitment to health care waiver approved by the Centers for Medicare and Medicaid Services under Section 1115 of the Social Security Act.

(b)  Into the fund shall be deposited:

(1)  revenue from the cigarette and tobacco products tax established in  all revenue from the tobacco products tax and 82.5 percent of the revenue from the cigarette tax levied pursuant to chapter 205 of Title 32;

(2)  revenue from health care provider assessments pursuant to subchapter 2 of chapter 19 of this title; and

(3)  the proceeds from grants, donations, contributions, taxes, and any other sources of revenue as may be provided by statute, rule, or act of the general assembly.

(c)  The fund shall be administered pursuant to subchapter 5 of chapter 7 of Title 32, except that interest earned on the fund and any remaining balance shall be retained in the fund.  The agency shall maintain records indicating the amount of money in the fund at any time.

(d)  All monies received by or generated to the fund shall be used only as allowed by appropriation of the general assembly for the administration and delivery of health care covered through state health care assistance programs administered by the agency under the global commitment Global Commitment for Health Medicaid Section 1115 waiver.

Sec. 25i. DISTRIBUTION OF REVENUE

The percentage of revenues from the cigarette tax increase in 2008, which is distributed between the state health care resources fund in section 1901d of Title 33 and the catamount fund in section 2028 of Title 33, shall be amended to reflect this increase.

Sec. 25j.  32 V.S.A. § 435(b) is amended to read:

(b)  The general fund shall be composed of revenues from the following sources:

* * *

(8)  Cigarettes and tobacco products taxes levied pursuant to chapter 205 of this title;

* * *

Sec. 25k.  ALLOCATION OF FLOOR STOCK TAX REVENUE

The revenue from the floor stock tax under subsection 7814(b) of Title 32 as amended by this act shall be deposited in the catamount fund.

* * * Pharmacy Provisions * * *

Sec. 25l.  33 V.S.A. § 2005(3) is amended to read:

(3) The office of the attorney general shall keep confidential all trade secret information , as defined by subdivision 317(b)(9) of Title 1. The disclosure form shall permit the company to identify any information that it claims is a trade secret. as defined in subdivision 317(c)(9) of Title 1. In the event that the attorney general receives a request for any information designated as a trade secret, the attorney general shall promptly notify the company of such request. Within 30 days after such notification, the company shall respond to the requester and the attorney general by either consenting to the release of the requested information or by certifying in writing the reasons for its claim that the information is a trade secret.  Any requester aggrieved by the company’s response may apply to the superior court of Washington County for a declaration that the company’s claim of trade secret is invalid. The attorney general shall not be made a party to the superior court proceeding. Prior to and during the pendency of the superior court proceeding, the attorney general shall keep confidential the information that has been claimed as trade secret information, except that the attorney general may provide the requested information to the court under seal.

Sec. 25m.  Sec. 1. of S.90 of the 2005 adjourned session is amended by striking 18 V.S.A. § 4284(a) and inserting in lieu thereof a new 18  V.S.A. § 4284(a) to read:

§ 4284.  ADVISORY COMMITTEE

(a)  The commissioner shall establish an advisory committee to assist in the implementation and periodic evaluation of the electronic database for prescriptions.  The advisory committee shall be chaired by the commissioner or his or her designee and shall include the following members:

(1)  the deputy commissioner for alcohol and drug abuse programs;

(2)  a representative from the Vermont medical society;

(3)  a representative from the Vermont state nurses association;

(4)  a representative from the Vermont board of medical practice;

(5)  a representative from the Vermont board of pharmacy;

(6)  an emergency room physician;

(7)  a pharmacist;

(8)  a representative of the Vermont state dental society;

(9)  the commissioner of public safety;

(10)  a representative of the Vermont attorney general;

(11)  a representative of the Vermont substance abuse treatment providers association;

(12)  a mental health provider or a certified alcohol and drug counselor;

(13)  a consumer in recovery from prescription abuse;

(14)  a consumer receiving medical treatment for chronic pain; and

(15)  any other member invited by the commissioner. 

Sixth:  By striking out Sec. 28 in its entirety and inserting in lieu thereof a new Sec. 28 to read as follows:

Sec. 28.  COMMISSION ON HEALTH CARE REFORM; FINANCE

Any reports required by this act shall be provided to the senate finance committee and 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.

Seventh:  By striking out Sec. 30 in its entirety and inserting in lieu thereof a new Sec. 30 to read as follows:

Sec. 30.  EFFECTIVE AND IMPLEMENTATION DATES

This act shall take effect upon passage, except as follows:

(1)  Secs. 8 (Medicaid reimbursement), 13 (cost shift review), and 25 (community health care planning grant) shall take effect July 1, 2006

(2)  Secs. 9 (VHAP premiums), 10 (Dr. Dynasaur premiums), and Sec. 19 (Nongroup market security trust) shall take effect July 1, 2007

(3)  Sec. 15 (Catamount Health) shall take effect June 30, 2006, for the purposes of establishing and administering the Catamount fund under section 2028 of Title 33, and preparing for administration of and enrollment in Catamount Health; implementation of the Catamount Health program, however, shall not commence until October 1, 2007.

(4)  Sec. 24 (health care coverage requirement) shall take effect on January 1, 2011.

Eighth:  By capitalizing “catamount health” wherever it appears in the bill.

And that the bill ought to pass in concurrence with such proposals of amendment.

Senator Bartlett, for the Committee on Appropriations, to which the bill was referred, reported recommending that the bill be amended as recommended by the Committee on Health and Welfare with the following amendments thereto:

First:  In Sec. 5, 18 V.S.A. § 702 by striking out subsection (d)(1) in its entirety and inserting in lieu thereof a new subsection (d)(1) to read as follows:

(d)(1)  The commissioner of health shall report annually 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 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; the results of health care professional and patient satisfaction surveys; the progress toward creation and implementation of privacy and security protocols; and other information as requested by the committees.  The surveys shall be developed in collaboration with the executive committee established under subsection (b) of this section.

Second:  In Sec. 11, by striking out subsection (g) in its entirety and inserting in lieu thereof a new subsection (g) to read as follows:

(g)  Of the amount appropriated in Sec. 271 of H.881 of the 2005 adjourned session for the employer-sponsored insurance premium assistance program established by this section, no more than $250,000.00 may be expended until additional information and analysis is provided to determine the specific parameters involved in an employer-sponsored premium assistance program, the costs of the program, and savings that may be attributable to the transition of individuals from the Vermont health access plan (VHAP) to an available employer‑sponsored plan.  Expenditures of any additional amounts appropriated by this section may be made after November 15, 2006, only upon approval by a majority of the combined membership of the joint fiscal committee and the health access oversight committee at a joint meeting upon receipt of a report from the agency, including the following:

(1)  a plan for additional expenditures;

(2)  a survey to determine whether individuals currently enrolled in VHAP, including those eligible as caretakers, are potentially eligible for employer-sponsored premium assistance under this section; and

(3)  the anticipated budgetary impact of an employer-sponsored insurance premium assistance program for fiscal year 2008, including savings attributable to enrolling current VHAP enrollees in the premium assistance program established under this section and the cost of providing the subsidy to these enrollees.

Third:  By striking out Sec. 29 in its entirety and inserting in lieu thereof a new Sec. 29 to read as follows:

Sec. 29.  FUNDING SOURCES

(a)(1)  The amount of $2,500,000.00 of the funds appropriated in Sec. 107 of H.881 of the 2005 adjourned session is to increase Medicaid rates to health care professionals on January 1, 2007, under Sec. 8(a) of this act.

(2)  The amount of $1,000,000.00 of the funds appropriated in Sec. 107 of H.881 of the 2005 adjourned session is to increase Medicaid rates to hospitals on January 1, 2007, under Sec. 8(b) of this act.

(b)  The amount of $100,000.00 appropriated to the department of health in Sec. 271 of H.881 of the 2005 adjourned session is for the planning grant established in Sec. 25 of this act.

(c)  The amount of $1,000,000.00 appropriated in Sec. 271 of H.881 of the 2005 adjourned session is for the establishment, initial administration and development of the infrastructure for the employer-sponsored premium assistance program under Sec. 11 of this act.

And that the bill ought to pass in concurrence with such proposals of amendment.

Thereupon, the bill was read the second time by title only pursuant to Rule 43, and pending the question, Shall the recommendation of proposal of amendment of the Committee on Health and Welfare be amended as recommended by the Committee on Finance?, on motion of Senator Doyle the Senate recessed until 3:15 P.M.

Called to Order

At 3:55 P.M. the Senate was called to order by the President.

Consideration Resumed; Third Reading Ordered

H. 861.

Consideration was resumed on House bill entitled:

An act relating to health care affordability for Vermonters.

Thereupon, the question, Shall the recommendation of proposal of amendment of the Committee on Health and Welfare be amended as recommended by the Committee on Finance? was decided in the affirmative.

Thereupon, the pending question, Shall the recommendation of amendment of the Committee on Health and Welfare, as amended, be amended as recommended by the Committee on Appropriations?, was decided in the affirmative.

Thereupon, the proposal of amendment recommended by the Committee on Health and Welfare, as amended, was agreed to and third reading of the bill was ordered on a roll call, Yeas 25, Nays 4.

Senator Leddy having demanded the yeas and nays, they were taken and are as follows:

Roll Call

Those Senators who voted in the affirmative were: Ayer, Bartlett, Campbell, Collins, Condos, Cummings, Doyle, Dunne, Gander, Giard, Illuzzi, Kitchel, Kittell, Leddy, Lyons, MacDonald, Mazza, Miller, Mullin, Scott, Sears, Snelling, Starr, Welch, White.

Those Senators who voted in the negative were: Coppenrath, Maynard, Shepard, Wilton.

The Senator absent and not voting was: Flanagan.

House Proposal of Amendment Concurred In; Bill Delivered

S. 246.

House proposal of amendment to Senate bill entitled:

An act relating to eminent domain.

Was taken up.

The House proposes to the Senate to amend the bill in Sec. 1, 12 V.S.A. § 1040(b), by striking out the following: “purposes of constructing, maintaining, or operating” and inserting in lieu thereof the following: the following purposes

Thereupon, the question, Shall the Senate concur in the House proposal of amendment?, was decided in the affirmative.

Thereupon, on motion of Senator Welch, the rules were suspended and the bill was ordered delivered to the Governor forthwith.

Message from the House No. 72

     A message was received from the House of Representatives by Ms. Wrask, its Second Assistant Clerk, as follows:

Mr. President:

I am directed to inform the Senate the House has passed a bill of the following title:

H. 893.  An act relating to extending pharmacy coverage due to Medicare Part D problems.

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

Message from the House No. 73

     A message was received from the House of Representatives by Mr. MaGill, its First Assistant Clerk, as follows:

Mr. President:

     I am directed to inform the Senate the House has passed bills of the following titles:

     H. 883.  An act relating to amending the charter of the city of Burlington.

     H. 888.  An act relating to sustainable funding of the Fish and Wildlife Department.

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

The House has considered Senate proposal of amendment to House bill of the following title:

H. 710.  An act relating to organization of supervisory districts.

And has concurred therein.

     The House has considered Senate proposals of amendment to House bill of the following title:

     H. 33.  An act relating to the Uniform Mediation Act.

And has concurred therein with proposals of amendment in the adoption of which the concurrence of the Senate is requested.

     The House has considered Senate proposals of amendment to House bill of the following title:

     H. 611.  An act relating to life threatening chronic allergies and illnesses in schools.

And has refused to concur therein and asks for a Committee of Conference upon the disagreeing votes of the two Houses;

And the Speaker has appointed as members of such Committee on the part of the House

                                         Rep. Mook of Bennington

                                         Rep. Kilmartin of Newport City

                                         Rep. Cross of Winooski

The House has considered Senate bills of the following titles:

S. 103.  An act relating to lawsuits arising from exercise of right to freedom of speech or to petition government for redress of grievances.

S. 106.  An act relating to increasing the beverage container handlers’ fee and an ongoing evaluation of the bottle redemption system.

S. 182.  An act relating to advisement of immigration consequences of pleading guilty to a criminal offense.

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

And has passed the same in concurrence with proposals of amendment in the adoption of which the concurrence of the Senate is requested.

The Governor has informed the House of Representatives that on the 11th day of April, 2006, he approved and signed a bill originating in the House of the following title:

H. 655.  An act relating to the towns and gores of Essex County.

The Governor has informed the House of Representatives that on the 12th day of April, 2006, he approved and signed a bill originating in the House of the following title:

H. 862.  An act relating to home study programs.

Adjournment

On motion of Senator Welch, the Senate adjourned until eleven o’clock in the morning.