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NO. 190.  AN ACT RELATING TO CATAMOUNT HEALTH.

(H.895)

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1.  Sec. 15 of H.861 of the 2005 Adj. Sess. (2006) shall be amended by striking subsection (n) and inserting new subsections (n) and (o) to read:

(n)  The commissioner shall encourage hospital and medical service corporations and nonprofit health maintenance organizations doing business in this state to offer Catamount Health.  If necessary to ensure the availability of Catamount Health by October 1, 2007, the commissioner shall require a hospital and medical service corporation and a nonprofit health maintenance organization in this state to offer Catamount Health.  The commissioner may permit one or more health insurers to enter into a joint operating agreement to consolidate the offering of Catamount Health to uninsured Vermonters.  In connection with a rate decision, the commissioner may make reasonable supplemental orders and may attach reasonable conditions and limitations to such orders as he or she finds, on the basis of competent and substantial evidence, necessary to carry out the purposes of this section.

(o)  With approval of the commissioner, a carrier may discontinue sales of Catamount Health upon at least six months’ prior written notice to the commissioner.  Following such notice, if there are any individuals who continue to be covered by Catamount Health for whom the carrier does not have approved premium rates, the commissioner may approve premium rates adjusted by the average Vermont nongroup trends for cost and utilization for the previous six months.

Sec. 2.  Sec. 21 of H.861 of the 2005 Adj. Sess. (2006) shall be amended by striking 2 V.S.A. § 903 and inserting a new 2 V.S.A. § 903 to read:

§ 903.  CATAMOUNT HEALTH; REQUEST FOR PROPOSALS

(a)  Private carrier assumption of risk option.  It is the intent of the general assembly first to provide to carriers and insurers in the private market the opportunity to offer Catamount Health with the assumption of risk.  In the event that no private carriers or insurers elect to offer Catamount Health, the commissioner of banking, insurance, securities, and health care administration shall require hospital and medical service corporations and nonprofit health maintenance organizations to offer Catamount Health under subsection 4080f of Title 8.

(b)(1)  Administration without assumption of risk.  No earlier than October 1, 2009, the commission on health care reform shall evaluate the Catamount Health market to determine whether it is a cost-effective method of providing health care coverage to uninsured Vermonters, taking into consideration the rates and forms approved by the department of banking, insurance, securities, and health care administration, the costs of administration and reserves, the amount of Catamount Health assistance to be provided to individuals, whether the Catamount Health assistance is sufficient to make Catamount Health affordable to those individuals, and the number of individuals for whom assistance is available given the appropriated amount. Prior to making its determination, the commission shall consider the recommendations of a health care and health insurance consultant selected jointly by the commission and the secretary of administration.

(2)  If the commission determines that the market is not cost-effective, the agency of administration shall issue a request for proposals for the administration only of Catamount Health as described in section 4080f of Title 8.  A contract entered into under this subsection shall not include the assumption of risk.  If Catamount Health is administered under this subsection, the agency shall purchase a stop-loss policy for an aggregate claims amount for Catamount Health as a method of managing the state’s financial risk.  The agency shall determine the amount of aggregate stop-loss reinsurance and may purchase additional types of reinsurance if prudent and cost-effective.  The agency may include in the contract the chronic care management program established under section 1903a of Title 33.

(3)  If Catamount Health is offered as a self-insured product, the requirements of section 4080f of Title 8 and subchapter 3a of chapter 19 of Title 33 shall apply to the extent feasible.  The individual contributions set in subchapter 3a of chapter 19 of Title 33 shall be the premium amounts charged to individuals.

Sec. 3.  Sec. 49 of H.861 of the 2005 Adj. Sess. (2006) shall be amended by striking Sec. 49 and inserting a new Sec. 49 to read:

Sec. 49.  EFFECTIVE AND IMPLEMENTATION DATES

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

(1)  Secs. 9 (Medicaid reimbursement), 10 (Blueprint for Health reimbursements), 25 (hospital cost shift analysis), 33 (community health care planning grant) and 41 (state health care resources fund) shall take effect

July 1, 2006

(2)  Secs. 11 (VHAP premiums), 12 (Dr. Dynasaur premiums), 17–19 (technical insurance changes), 27, and 28 (Nongroup market security trust and insurance rates) shall take effect July 1, 2007

(3)  Secs. 13 (Employer-sponsored insurance premium assistance) and 16 (Catamount Health assistance) shall take effect June 30, 2006, for the purposes of establishing and administering the Catamount fund under section 1986 of Title 33, and preparing for administration of and enrollment of the programs; implementation of the programs, however, shall not commence until October 1, 2007.

(4)  Sec. 23 (immunizations) shall take effect July 1, 2007 for the purposes of establishing the program, but the program shall not be implemented until October 1, 2007.

Sec. 4.  Sec. 21 of H.861 of the 2005 Adj. Sess. (2006) shall be amended in 2 V.S.A. § 902(a), in the first sentence, by striking “2009” and inserting in lieu thereof “2011

Approved:  May 25, 2006



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us