Introduced by Representatives Obuchowski of Rockingham, Bohi of Hartford, Botzow of Pownal, Brooks of Montpelier, Cross of Winooski, Donovan of Burlington, Edwards of Brattleboro, Fisher of Lincoln, French of Randolph, Jewett of Ripton, Kiss of Burlington, Kitzmiller of Montpelier, Klein of East Montpelier, Marek of Newfane, Martin of Springfield, Masland of Thetford, McLaughlin of Royalton, Milkey of Brattleboro, Miller of Shaftsbury, Nuovo of Middlebury, Pillsbury of Brattleboro, Shand of Weathersfield, Sharpe of Bristol, Sweaney of Windsor, Trombley of Grand Isle and Zuckerman of Burlington
Subject: Health; Vermont health care plan
Statement of purpose: This bill proposes to establish the Vermont health care plan as a universally accessible, comprehensive, publicly administered health benefit plan offering care and treatment to all Vermont residents.
AN ACT RELATING TO THE VERMONT HEALTH CARE PLAN
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 33 V.S.A. chapter 19, subchapter 3 is amended to read:
3. Vermont Health
Trust Fund Care
* * *
§ 1972. VERMONT HEALTH ACCESS TRUST FUND ESTABLISHED
The Vermont health access trust fund is hereby established as a special fund
in the state treasury for the purpose of
establishing a special fund to be
the single source to finance health care coverage for beneficiaries of all state
health care assistance programs administered by the department of prevention,
assistance, transition, and health access providing financial
support for the Vermont health care plan.
(b) Into the fund shall be deposited:
(1) revenue from the cigarette and tobacco products tax established in chapter 205 of Title 32;
(2) revenue from health care provider assessments collected and deposited into the health care trust fund pursuant to subchapter 2 of chapter 19 of this title;
(3) transfers from the tobacco litigation settlement fund established in section 435a of Title 32, authorized by the general assembly;
transfers from the general fund, authorized by the general assembly;
(5) the proceeds from grants, donations, contributions, and taxes and any other sources of revenue as may be provided by statute or by rule;
(6) all federal receipts for health care purposes, including all Medicaid receipts; and
(7) revenue sources established to fund section 1974 of this title.
(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 department 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 for the administration and delivery of
health care covered through state health care assistance programs
administered by the department of prevention, assistance, transition, and
health access, including the Medicaid program, the Vermont health access plan
program, the Vermont health access plan-pharmacy program, the VScript program,
the VScript-Expanded program, the state children’s health insurance program,
the General Assistance program, and any other state health care assistance
program administered by or through the department the Vermont health
§ 1974. THE VERMONT HEALTH CARE PLAN
(a) The governor shall appoint, with the advice of the senate, three individuals to serve as members of the Vermont health care plan board within 60 days of passage of this section. Members shall serve for three-year terms or until a successor is appointed, except that initial terms shall be staggered so that no more than one board member’s office shall become vacant during any calendar year. The governor may remove a member from office only for cause, after notice and hearing.
(b) The Vermont health care plan board, on or before January 15, 2006, shall propose to the general assembly the establishment of the Vermont health care plan, a universally accessible, comprehensive health benefit plan offering coverage of high quality care and treatment to all Vermonters.
(c)(1) The Vermont health care plan shall offer a standard health benefit plan to all residents of this state. The standard benefit plan shall provide coverage of medically appropriate and cost-effective care and treatment, including:
(A) outpatient primary and specialty care;
(B) inpatient hospital and nursing home care;
(C) prescription drugs;
(D) durable medical equipment;
(E) mental health and substance abuse treatment;
(F) preventive and medically necessary dental care;
(G) hospice and other palliative care;
(H) nursing home, community-based, and other long‑term care;
(I) preventive health care; and
(J) any other benefits established by the board.
(2) Specific health care and treatment covered by the standard benefit plan shall be determined and amended by the board after consideration of:
(A) a public process designed to respond to Vermonters’ health care values and priorities;
(B) credible scientific research and comment by health care professionals concerning clinical efficacy and risk;
(C) health care ethics;
(D) the cost-effectiveness of health care services and technology; and
(E) revenues anticipated to be available to finance the Vermont health care plan.
(3)(A) The board shall establish a public process for the development of an annual budget to finance the Vermont health care plan. The budget process shall provide an opportunity for informed debate by consumers, health care providers, and any other individuals or organizations with an interest in the development of the annual budget. The board shall propose its budget to the general assembly on or before January 1 of each year, including recommended expenditures during the next succeeding calendar year for each sector of the health care system providing care and treatment under the Vermont health care plan and anticipated revenues available to support such expenditures.
(B) After the general assembly’s approval of the budget for the Vermont health care plan, the board shall establish by rule standards and procedures to provide health care coverage and expenditures that are in financial balance with the approved budget. Such standards and procedures may include:
(i) annual budget allocations for hospitals, health care provider specialties, and other health care sectors;
(ii) uniform reimbursement mechanisms, including a fee‑for‑service mechanism with volume controls for licensed or certified health care providers. Reimbursement mechanisms shall adequately compensate for the operating costs of providing health care and treatment efficiently, and may include fee supplements to encourage care and treatment by different specialties or in different geographic regions of the state;
(iii) a reference pricing reimbursement mechanism whereby a consumer may choose to pay additional reimbursement for health care treatment determined by the board to be less effective or more expensive than other comparable health care treatment; and
(iv) limits on the number of health care specialists that may be licensed under chapter 23 of Title 26 during any two-year period.
(4) No assistance shall be provided under this chapter with respect to a health care expense that may be covered in whole or in part by Title XVIII of the Social Security Act (Medicare) or by any public or private health insurance plan.
(d)(1) Any Vermont resident and any insured or self-insured group on behalf of Vermont resident beneficiaries may enroll in the Vermont health care plan.
(2) The board shall adopt by rule eligibility criteria for enrollment in the Vermont health care plan. The board shall not require that the applicant demonstrate that he or she has been without health care coverage prior to enrollment, but the board may establish rules to protect the financial solvency of the plan from adverse selection.
(3) The board shall establish a residency requirement that the applicant demonstrate that he or she is 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. The board shall adopt by rule standards and procedures for determining whether a person is a resident. Such rules shall include:
(A) a provision requiring that the applicant has the burden of proof in determining residency;
(B) reasonable durational domicile requirements;
(C) a provision that a residence established for the purpose of seeking health care coverage shall not by itself establish that the applicant is a resident of this state; and
(D) any other provision useful in determining whether the applicant is permanently domiciled in this state.
(e) The board shall have the powers of a nonprofit corporation established under Title 11B in carrying out the purposes of this section. The board may adopt such rules as are necessary or desirable in carrying out the purposes of this section.
Sec. 2. STUDY OF FUNDING MECHANISM
(a) A sustainable health care special committee is created to determine the appropriate funding mechanisms for the Vermont health care plan and shall consider at a minimum the following funding sources: an income tax, a payroll tax, premiums or cost-sharing measures, a value-added tax, or other consumption tax.
(b) The sustainable health care special committee shall consist of the joint fiscal committee, the chair and vice chair of the health access oversight committee, the secretaries of the agency of human services and agency of administration, and the commissioner of the department of banking, insurance, securities, and health care administration. The committee may meet for no more than six meetings or public hearings and shall have such powers as are needed to carry out the purposes of this section. Committee members who are not full-time state employees shall be entitled to per diem and expenses as provided in 32 V.S.A. § 1010.
(c) The sustainable health care special committee shall issue to the general assembly no later than January 15, 2006 a report with a recommendation on funding the Vermont health care plan.
Sec. 3. APPROPRIATION
The sum of $500,000.00 is appropriated from the Vermont health access trust fund to the Vermont health care plan board in fiscal year 2006 to carry out the purposes of this act.
The Vermont General Assembly
115 State Street