Download this document in MS Word format


AutoFill Template

H.524

Introduced by   Committee on Health Care

Date:

Subject:  Health care; universal access; reform; department organization

Statement of purpose:  This bill would establish the goal of universal access to essential health care services through a publicly financed, integrated, regional health care delivery system in Vermont, provide mechanisms for cost containment in the system, and provide a framework, schedule, and process to achieve that goal.

AN ACT RELATING TO UNIVERSAL ACCESS TO HEALTH CARE IN VERMONT

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

Sec. 1.  34 V.S.A. is added to read:

TITLE 34.  HEALTH SERVICES AND ADMINISTRATION

Chapter 1.  VERMONT HEALTH SYSTEM

Subchapter 1.  General Provisions

§ 1.  FINDINGS

The general assembly hereby finds that:

(1)  Access.  There is a large and increasing number of people who have no health insurance or who are underinsured.  For this growing population, health care is unaffordable and, as a result, often not received in the most timely and effective manner.  The existing disparities in coverage result in an irrational rationing of available health care services.

(A)  Over 60,000 Vermonters have no health insurance.  Lack of insurance is associated with an increased rate of illness and a shorter life expectancy.

(B)  Premium cost increases have contributed to the growing rate of underinsurance, with more and more Vermonters purchasing high‑deductible and less comprehensive plans.

(C)  The costs of health services provided to individuals who are unable to pay are shifted onto others.  Those who bear the burden of this cost shift have an increasingly difficult time affording their own health care costs, including premiums.

(2)  Cost.  Health care costs are rising at an unsustainable rate, causing hardships to individuals, families, businesses, taxpayers, and public institutions and making the need for comprehensive health care reform urgent.

(A)  In 2005, total Vermont health care spending is projected to be $3.5 billion.

(B)  Health care costs have risen an average of 9-10 percent per year over the past 30-40 years, with the rate rising to 12-13 percent in more recent years.  These figures are well above the Consumer Price Index and, moreover, exceed by far the state’s capacity to pay for health care costs as measured against our gross state product and personal income.  For example, between 1996 and 2002, health care spending in Vermont rose 63 percent, while personal income rose 41 percent and the gross state product rose 35 percent.

(C)  Using the current health care inflation rate, for every year Vermont fails to address the health care crises, health care costs will rise by at least another $350 million.

(D)  Over one-half of bankruptcies nationally are associated with high medical expenses.  In approximately three-quarters of health-related bankruptcies, the patient had insurance.

(E)  In 2005, the state of Vermont will spend an estimated $5,700.00 per capita on health care, more than any nation -- except the United States itself -- when measured as a proportion of gross domestic product.  

(F)  Vermont’s health care spending was 14.7 percent of the gross state product in 2003.

(G)  The cost of health care has a strong and negative impact on the ability of Vermont businesses and employers to compete in national and international markets.

(3)  Inequity in financing.  The current financing of health care is complex, fragmented, and inequitable, resulting in inefficiencies. 

(A)  The financing is accomplished through a patchwork of public programs, private sector employer-sponsored self-insurance, commercial insurance, and individual payers. 

(B)  In general, costs fall disproportionately on those with serious health conditions and those with moderate and lower incomes. 

(C)  At any particular point in time, approximately 10 percent of the Vermont population generates approximately 70 percent of all health care spending.

(4)  Quality.  Although the quality of health care services in Vermont is generally very good, there is a need to improve quality, efficiency, and safety. 

(A)  There are an unacceptable number of adverse events attributable to medical errors.  According to the Institute of Medicine report entitled “To Err is Human:  Building a Safer Health System,” nationwide, the right care is given to the right person at the right time only about half the time. 

(B)  In addition, our health care infrastructure and services tend to be “disease‑focused” rather than “health-focused,” resulting in missed opportunities for less costly and more effective forms of care.

(5)  Vermont currently does not have a clearly defined, integrated health care “system.”  Rather, there is a lack of coordination and accountability among health care professionals, payers, and patients at both the regional and statewide levels.  As a result, the ability of the system to respond to rapid changes in technology and medical advances and to provide the highest quality of care to the greatest number of people is compromised.

§ 2.  GUIDELINES FOR HEALTH CARE REFORM

The general assembly adopts the following guidelines 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, for cost, for access and for 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.

§ 3.  GOALS OF HEALTH CARE REFORM

Consistent with the adopted guidelines for reforming health care in Vermont, the general assembly adopts the following goals:

(1)  Vermont policy will reflect that universal access to health care is a public good.

(2)  All Vermont residents, subject to reasonable residency requirements, will be covered under Green Mountain Health, regardless of their age, employment, economic status, or their town of residency, even if they require health care while out of state.

(3)  All essential health services will be covered under Green Mountain Health.  A process will be developed to define essential health services, taking into consideration scientific evidence, available funds, and the values and priorities of Vermonters.  Coverage will follow the individual from birth to death and be responsive and seamless through employment and life changes.

(4)  To ensure a fair financing structure under Green Mountain Health, it will be financed primarily from broad-based taxes.  

(5)  To make certain everyone contributes toward the cost of Green Mountain Health, reasonable cost sharing requirements, such as co-payments and deductibles, will be applied based on ability to pay. 

(6) To alleviate the historical dependence of health care access on employment, the burden on employers will be reduced.

(7)  Health care in Vermont will be organized and delivered in a

patient-centered manner through an integrated, community-based system.  The integrated health care system in Vermont will:  focus on meeting community health needs; match service capacity to community needs; coordinate and integrate care across the health care continuum; have information systems linking individuals, health care professionals, and payers across the continuum of care; provide information on costs, quality, outcomes, and patient satisfaction; use financial incentives and organizational structure to achieve specific objectives; and improve continuously the quality of care provided.

(8)  Health care costs will be controlled through a long-term strategy for integrating the health care delivery system, global budgeting of hospitals, aligning health care professional reimbursement with best practices and outcomes rather than utilization, lowering the rate of health care spending, and engaging Vermonters in their health care by promoting self-care and healthy lifestyles.  To ensure financial sustainability of Green Mountain Health, the state is committed to slowing the rate of growth of health care costs to seven percent or less by the year 2010.

§ 4.  DEFINITIONS

As used in this chapter:

(1)  “Department” means the department of health care administration established by section 11 of this title to administer Green Mountain Health established under this chapter.

(2)  “Green Mountain Health” means the package of essential health services established pursuant to this chapter.

(3)  “Health care professional” means an individual licensed, registered, or certified in the state of Vermont to provide health services.

(4)  “Health service” means any medically necessary treatment or procedure to maintain, diagnose, or treat an individual’s physical or mental condition, including services provided pursuant to a physician’s order and services to assist in activities of daily living.

(5)  “Hospital” shall have the same meaning as in section 1902 of Title 18 and may include hospitals located out of state.

(6)  “Hospital service” means any health service received in a hospital and any associated costs for professional services. 

(7)  “Preventive care” means screening, counseling, treatment, or medication determined by scientific evidence to be effective preventing or detecting disease.

(8)  “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 (biological, behavioral, or social), organ system, or diagnosis.  Primary care services include health promotion, preventive care, health maintenance, counseling, patient education, case management, and the diagnosis and treatment of acute and chronic illnesses in a variety of health care settings.

(9)  “Reference pricing system” means a system of fixed reimbursement for health services, in which a payment level is established, and any difference between the fixed reimbursement and the price charged by the health care professional is paid by the individual.

(10)  “Regulatory review board” means the health care regulatory review board established by section 31 of this title to hear appeals and perform other quasi-judicial functions relating to the administration and implementation of Green Mountain Health under this chapter.

(11)  “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.  The commissioner of the department of health care administration shall establish specific criteria to demonstrate residency.

Subchapter 2.  Department of Health Care Administration

§ 11.  DEPARTMENT OF HEALTH CARE ADMINISTRATION

(a)  No later than October 1, 2005, a department of health care administration is created and shall have the powers and duties established by this chapter.  The department is the successor to and continuation of the division of health care administration of the department of banking, insurance, securities, and health care administration under chapter 221 of Title 18, the office of Vermont health access under section 3088 of Title 3, and the division of rate setting under chapter 9 of Title 33 and shall continue the duties of those departments as established in chapter 107 of Title 8, chapter 221 of Title 18, chapters 9 and 19 of Title 33.

(b)  The department shall be under the direction and supervision of a commissioner who shall be appointed by the governor with the advice and consent of the senate and shall serve at the pleasure of the governor.

(c)  The department shall carry out its duties in such as way as to further the public good and shall follow the guidelines and goals established under this chapter.

(d)  A health care quality unit is established in the commissioner’s office and is responsible for establishing policy and procedures to improve, promote, and ensure quality of care and patient safety.  The unit shall provide policy advice and oversight to the department to ensure that the department’s functions are carried out in such a way as to promote quality and safety.  The unit shall also collaborate with government and private entities and organizations which are engaged in efforts to improve quality of care.

§ 12.  AUTHORITY OF THE COMMISSIONER

(a)  The commissioner shall be responsible to the governor and shall plan, coordinate, and direct the functions vested in the department.  The commissioner shall prepare and submit to the governor an annual budget and shall prepare and submit to the governor and the general assembly in November of each year a report concerning the operations of the department for the preceding state fiscal year and the future goals and objectives of the department.

(b)  The commissioner shall establish such divisions as are necessary to carry out the duties of the department under this chapter and may establish advisory panels as necessary to further the goals of this chapter.  The commissioner may employ professional and support staff necessary to carry out the functions of the department and may employ consultants and contract with individuals and entities for the provision of services.

(c)  The commissioner may, subject to the provisions of 32 V.S.A. § 5, apply for and accept gifts, grants, or contributions from any person for purposes consistent with this chapter.

(d)  The commissioner shall meet regularly with representatives of the community health boards established in section 16 of this title, professional organizations, consumer groups and other statewide organizations in order to ensure that there is public input into the implementation and ongoing administration of the provisions of this chapter.

(e)  The commissioner shall consult and collaborate with the secretary of human services and the commissioner of education to ensure the effective and efficient operation of the provisions of this chapter.  

(f)  The commissioner may delegate the powers and assign the duties transferred from other departments, offices, and divisions to the department of health care administration in such a manner as the commissioner deems appropriate.

(g)  The commissioner may adopt rules under chapter 25 of Title 3 to implement Green Mountain Health as established by this chapter.

(h)  Subject to the approval of the general assembly, the commissioner may apply for any waivers of federal law or regulation necessary to carry out the provisions of this chapter.

§ 13.  DUTIES

(a)  In addition to the duties transferred pursuant to section 11(a) of this title, the department of health care administration shall:

(1)  establish a system of payment methodologies and amounts for hospitals and health care professionals under this chapter;

(2)  implement the cost reduction targets established under section 23(c) of this title;

(3)  conduct planning and analysis, including designing and implementing procedures to evaluate, measure, and report to the governor and general assembly whether the guidelines under section 2 of this title and the goals under section 3 of this title are being met;

(4)  establish and maintain a database with information needed to carry out the commissioner’s duties and obligations;

(5)  administer any spending for Green Mountain Health established under this chapter, which may include any billing or collection functions necessary to implement this chapter; and

(6)  develop the package of essential health services, which are in addition to primary care, preventive care, and hospital services, to be covered on July 1, 2009 under Green Mountain Health pursuant to subsection 21(b) of this title, and modifying such services as necessary. 

(b)  The department shall ensure the package of essential health services will provide a choice of services and of health care professionals, contain costs over time, and improve the quality of care and health outcomes.  In developing the package of essential health services, the department shall:

(1)  engage in a public process designed to respond to Vermonters’ health care values and priorities;

(2)  consider the current range of health services received by Vermonters through public and private benefit packages;

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

(4)  consider health care ethics;

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

(6)  consider revenues anticipated to be available to finance Green Mountain Health;

(7)  consider the state health plan and the health resource allocation plan established under section 9405 of Title 18; and

(8)  consider any Vermont-specific initiatives that would inform the department.

(c)  On or before February 1, 2008, the department shall propose to the general assembly the package of essential health services to be covered under Green Mountain Health, beginning July 1, 2009.

§ 14.  INTEGRATED SYSTEMS OF CARE; COMMUNITY HEALTH

           BOARDS

(a)  The delivery of health care in Vermont shall be reorganized into an integrated system of care in order to provide a coordinated continuum of services to the citizens of Vermont and to improve health outcomes.  Communities will integrate their health care systems by organizing existing health care professionals, health care institutions, and community members into a community health board, which will act to assess, prioritize, and define community health needs.

(b)  Based on a plan adopted by the general assembly, there shall be established a community health board in each region of the state.  There shall be no fewer than three regions.  The community health boards shall be implemented no later than January 1, 2007.

(c)  Each community health board shall have the following duties:  solicit public input, conduct a community needs assessment for incorporation into the health resources allocation plan, plan for community health needs based on the community needs assessment, develop budget recommendations and resource allocations for the region, and provide oversight and evaluation regarding the delivery of care in its region.

Subchapter 3.  GREEN MOUNTAIN HEALTH

§ 21.  green mountain health; IMPLEMENTATION DATES

(a)  The department of health care administration shall implement Green Mountain Health to provide Vermont residents coverage for primary and preventive health services no later than July 1, 2007 and coverage for hospital services no later than October 1, 2007.

(b)  No later than July 1, 2009, Green Mountain Health shall include all other essential health services in addition to primary care, preventive care, and hospital services to Vermont residents.

§ 22.  DEVELOPMENT OF the package of primary care, preventive care, and hospital services

(a)  There is established a joint health reform committee to oversee the development of the package of primary care, preventive care, and hospital services covered under Green Mountain Health.  This committee shall be comprised of the house committee on health care and the senate committee on health and welfare.

(b)  The joint committee shall ensure that a package of primary care, preventive care, and hospital services will provide a choice of services and health care professionals, contain costs over time, and improve quality of care and health outcomes.  In developing the package of health services under this section, the joint committee shall:

(1)  engage in a public process designed to respond to Vermonters’ health care values and priorities;

(2)  consider the current range of health services received by Vermonters through public and private benefit packages;

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

(4)  consider health care ethics;

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

(6)  consider revenues anticipated to be available to finance Green Mountain Health;

(7)  consider the state health plan and the health resource allocation plan established under section 9405 of Title 18; and

(8)  consider any Vermont-specific initiatives that would inform the committee.

(c)  On or before February 1, 2006, the joint committee shall propose to the general assembly the package of primary care, preventive care, and hospital services to be covered under Green Mountain Health.

§  23.  BUDGET FOR PACKAGE OF HEALTH SERVICES

(a)  After approval of the package of health services by the general assembly, the department shall develop a budget for the package based on the payment methodologies under section 24 of this title, negotiated payment amounts under section 25 of this title, and the cost containment targets under subsection (c) of this section.

(b)  Beginning for state fiscal year 2008, the department shall propose its budget for the package of health services to the general assembly on or before January 15 of each year, including recommended expenditures during the next succeeding state fiscal year broken down by health care sector and region, and anticipated revenues available to support such expenditures.

(c)  To further the goals established in section 3 of this title, the department shall develop and issue a cost containment target for each health care sector.  The cost containment target shall be considered when negotiating payment amounts under section 25 of this title.


§  24.  PAYMENT METHODOLOGIES FOR HEALTH CARE

           PROFESSIONALS

(a)  By February 1, 2006, the department shall determine by rule pursuant to chapter 25 of Title 3 the type of payment method to be used for each health care sector which provides health services under Green Mountain Health.  The payment methods shall be in alignment with the goals of this chapter and shall encourage cost‑containment, provision of high quality, evidence-based health services in an integrated setting, patient self-management, and healthy lifestyles.  In developing the payment methods, the department shall consult with health care professionals prior to filing the draft rules for comment.

(b)  The department shall consider the following payment methods:

(1)  capitated payments;

(2)  incentive payments to the health care professionals based on performance standards, which may include evidence-based standard physiological measures, or if the health condition cannot be measured in that manner, a process measure, such as the appropriate frequency of testing or appropriate prescribing of medications;

(3)  fee supplements if necessary to encourage specialized health care professionals to offer a specific, necessary health service which is not available in a specific geographic region; and


(4)  fee for service.

§ 25.  PAYMENT AMOUNTS

(a) The intent of this section is to ensure reasonable payments to health care professionals and to eliminate the shift of costs between the payers of health services by ensuring that the amount paid to health care professionals under Green Mountain Health is not equivalent to the Medicaid rate if that rate is insufficient payment for the health service provided.

(b)  The department shall negotiate with hospitals, health care professionals, and groups of health care professionals to establish a payment amount for the health services provided by Green Mountain Health.  The amount shall be sufficient to provide reasonable access to health services, provide sufficient payment to health care professionals, and encourage the financial stability of health care professionals.  In determining the payment amount, the department shall consider:

(1)  the actual cost of the health service;

(2)  expected revenues;

(3)  cost containment targets;

(4)  shared costs between affiliated health care professionals.

(c)  As provided for in subsection (a) of this section, payment amounts to health care professionals shall not be based on whether an individual is enrolled in Medicaid, any Medicaid waiver program, or Green Mountain Health established by the state.

(d)  The department shall negotiate with each hospital to establish a global hospital payment for health services covered by Green Mountain Health and provided by the hospital.  The department shall consider the global hospital budget under section 9461 of Title 18 and other information necessary to the determination of the appropriate payment, including all other revenue received from other sources.  The global hospital payment shall be reflected as a specific line item in the department’s annual budget submitted to the general assembly.

(e)  The department shall negotiate a contract including payment methods and amounts with any out-of-state hospital that regularly treats a sufficient volume of Vermont residents to provide health services under Green Mountain Health.  The department may also contract with out-of-state hospitals for the provision of specialized health services under Green Mountain Health which are not available locally to Vermonters.

(f)  The department shall pay the amount charged for a medically necessary health service for which the individual received a referral or for an emergency health service customarily covered by Green Mountain Health received in an out-of-state hospital with which the department has not established a contract.  The department shall develop a reference pricing system for nonemergency health services usually covered by Green Mountain Health which are received in an out-of-state hospital with which the department has not contracted.

(g)  To facilitate negotiation of payment amounts under this section, the commissioner may approve the creation of one or more health care professional bargaining groups, consisting of health care professionals who choose to participate.  The commissioner shall adopt by rule criteria for forming and approving bargaining groups, and criteria and procedures for negotiations authorized by this section.  In authorizing the activities provided for in this section, the general assembly intends to displace state and federal antitrust laws by granting state action immunity for actions that might otherwise be considered to be in violation of state or federal antitrust laws.

§ 26.  GLOBAL HOSPITAL BUDGETS

(a)  Beginning for hospital fiscal year 2008, the department shall develop a global hospital budget for each hospital located in VermontThe department shall consider the health resource allocation plan under section 9405 of Title 18 and the unified health care budget under section 9406 of Title 18, as applicable to hospitals, the hospital budget review under section 9456 of Title 18, the global hospital payments under section 25 of Title 18, and all other revenue received by hospitals when developing the global hospital budget.  The global hospital budget shall be submitted to the health care regulatory review board for approval with sufficient time for the board to approve the budget no later than September 1 prior to the hospital fiscal year.

(b)  For hospital fiscal year 2008 and thereafter, the global hospital budget developed under subsection (a) of this section shall serve as a spending cap within which hospital costs are controlled, resources directed, and quality and access assured.  The global hospital budget shall limit the total annual growth of hospital costs to the Consumer Price Index plus three percent.  Prior to hospital fiscal year 2008, the growth rate of the Consumer Price Index plus three percent shall serve as a target amount.  The department shall ensure that hospital budget reviews and certificates of need are consistent with the global hospital budget.

(c)  The department shall adopt rules specifying the circumstances under which a hospital may seek amendment of its budget after approval by the health care regulatory review board.  An amendment to a hospital’s budget shall be reviewed by the department before submission to the health care regulatory review board for approval.

(d)  The department may adopt rules for the development of a voluntary three-year global hospital budget process to facilitate long-term planning and to moderate variation in utilization.  The rules shall include a process for annual budget adjustment within the three-year period.

(e)  A hospital or health care professional aggrieved by an adverse decision of the department may appeal to the health care regulatory review board under subchapter 4 of this chapter.

§ 27.  ADMINISTRATION; OPTIONAL ENROLLMENT

(a)  The department shall administer Green Mountain Health or under an open bidding process, solicit and receive bids from insurance carriers or third party administrators for administration.

(b)  Nothing in this chapter shall require an individual to enroll in Green Mountain Health nor require an individual covered by health insurance to terminate that insurance.  An individual may also elect to maintain supplemental health insurance if the individual so chooses.

(c)  Vermonters shall not be billed any additional amount for health services covered by Green Mountain Health, except as provided for as cost-sharing in section 28 of this title.

(d)  The assistance provided under this chapter shall be the secondary payer with respect to a health service that may be covered in whole or in part by Title XVIII of the Social Security Act (Medicare) or by any other health benefit plan funded solely with federal funds, such as federal health benefit plans offered by the Veteran’s Administration or to federal employees.

(e)  The department shall ensure that Green Mountain Health complies with the provisions of Title XIX of the Social Security Act (Medicaid) unless the department, after approval of the general assembly, seeks and receives a federal waiver.

(f)  Any prescription drug coverage offered by Green Mountain Health required by this chapter shall be consistent with the standards and procedures applicable to the pharmacy best practices and cost control program established by sections 1996 and 1998 of Title 33.

(g)  The department or plan administrator shall make available the necessary information, forms, and billing procedures to health care professionals to ensure payment for health services covered under Green Mountain Health.  The department or plan administrator shall use a single uniform, simplified form to determine eligibility for Medicaid, any Medicaid waiver program, any state‑funded pharmacy program, and Green Mountain Health to ensure that any individual eligible for these programs has the opportunity to enroll and to ensure that the administration of Medicaid is, as much as possible, not apparent to health care professionals and Vermonters.  The department shall provide coverage for health services up to three months prior to the date of application for Medicaid, any Medicaid waiver program, or the state pharmacy programs.  The department shall seek any necessary amendments to any state plans or federal waivers necessary to implement this subsection without further need for approval.

(h)  An individual aggrieved by an adverse decision of the department or plan administrator may appeal to the health care regulatory review board established in subchapter 4 of this chapter.

§ 28.  COST SHARING; WELLNESS DISCOUNT

(a)  As part of the department’s budget, the department of health care administration shall propose to the general assembly income-sensitized reasonable deductibles, co-payments, or other cost‑sharing amounts applicable to Green Mountain Health.  The cost-sharing amounts shall not apply to preventive health services covered by Green Mountain Health.

(b)  The department may also include financial or other incentives applicable to Green Mountain Health to encourage healthy lifestyles and patient self-management.  In particular, the department may establish discounts, rebates, or modifications of applicable cost-sharing amounts in return for an individual’s adherence to programs of health promotion and disease prevention consistent with federal regulations relating to wellness.  If such incentives are included, the commissioner shall adopt by rule:

(1)  standards for approved health promotion and disease prevention programs, based on the best scientific, evidence-based medical practices; and

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


Subchapter 4.  Health Care Regulatory Review Board

§ 31.  Health Care REGULATORY REVIEW board; members

(a)  On July 1, 2006, a health care regulatory review board is created and shall consist of a chair and two members.  The chairperson shall be a full-time state employee and the two other members shall be part-time state employees.  All members shall be exempt from the state classified system.

(b)  The chair and the two members shall be appointed in the same manner as the public service board established under section 3 of Title 30.  The term of each member shall be six years; except that of the members first appointed, one shall serve for a term of two years and one shall serve for a term of four years.  Members of the board may be removed only for cause.

(c)  A person in the employ of or holding any official relation to any health care provider subject to the supervision of the board, or engaged in the management of such health care provider, or owning stock, bonds, or other securities thereof, or who is, in any manner, connected with the operation of such health care provider shall not be a member of the board; nor shall any person holding the office of member personally or in connection with a partner or agent render professional health care services or make or perform any business contract with any health care provider subject to such supervision, relating to the business of such health care provider, except contracts made as an individual or family in the regular course of obtaining health care services.


§ 32.  PROCEDURES OF THE HEALTH CARE REGULATORY REVIEW

           BOARD

     The health care regulatory review board shall have the authority provided, and its proceedings shall be governed by provisions of the Administrative Procedure Act relating to contested cases in chapter 25 of Title 3.

§ 33.  JURISDICTION

Beginning October 1, 2006, the health care regulatory review board shall have jurisdiction to:

(1)  hear contested cases for aggrieved parties of an adverse decision under chapter 19 of Title 33 and under this chapter;

(2)  hear consumer complaints relating to health services;

(3)  approve or amend reimbursement rates and methodologies established under this chapter, including global hospital budgets under subdivision 5034(b)(3) of Title 18; and

(4)  approve or amend certificate of need proposals under subchapter 5 of chapter 221 of Title 18, the unified health care budget under section 9406 of Title 18, and hospital budget reviews under subchapter 7 of chapter 221 of Title 18.


* * * STUDIES * * *

Sec. 2.  STUDY

The legislative council and the joint fiscal office shall oversee the following studies:

(1)(A)  A study of the economic impact of the implementation of a universal access health care plan in Vermont funded primarily by broad-based taxes.  The study shall include the following:

(i)  impacts on existing businesses, including medical businesses, and labor force flexibility, and on the future growth of the economy and the economic competitiveness of Vermont;

(ii)  potential for employment dislocation through changing patterns of service and reductions in system administration;

(iii)  impacts on residents, including possible relocation and demographic change, population groups’ costs of living, and access to care;

(iv)  cost impacts on state and other governmental entities of providing health care coverage through a statewide program;

(v)  specific impacts on the administrative cost by the health care sector (e.g., providers:  hospitals, nursing homes, physicians’ offices, other health care providers, and “payers” insurance companies);

(vi)  impacts on workers’ compensation and other private insurance, including health insurance;

(vii)  implications for health care system fixed and variable costs based on changes in usage due to the universal coverage availability and program design;

(viii)  transitional issues as Vermont moves from the current health care environment to Green Mountain Health; and

(ix)  impacts of continuing with the current health care system.

(B)  A study of the various financing options and implications for financing Green Mountain Health.  The study shall include the following:

(i)  financing options for consideration, including adjustments to the income tax, a payroll tax, premiums or cost-sharing measures, consumption taxes, and specific more limited taxes to support parts of the health care system financial needs;

(ii)  the tax burdens caused by changing levels of deductibility based on the tax systems contemplated;

(iii)  issues involved with federal law and taxation, including ERISA and other areas of preemption;

(iv)  other revenue sources replaced or tax offsets, including current insurance risk pools, reductions in current and future liabilities, and net costs for public and private entities and individuals due to the new system;

(v)  impacts of tax system change:

(I)  on individuals, households, businesses, public sector entities, and the nonprofit community;

(II)  over time, on changing revenue needs and possible

tax-based decision-making;

(III)  in transition, as the tax system and health care cost structure changes, including methods to avoid double payments during the transition (e.g., premiums and tax obligations).

(2)  The study may be contracted out in all or in part pursuant to the process established in subdivision (5) of this section.  In the case of contracts for services, the legislative council and joint fiscal office may:

(A)  solicit requests for proposals (RFPs) for contracts;

(B)  contract with the University of Vermont;

(C)  contract with the state economist, the legislative economist, and a third economist who specializes in health issues to produce a joint product; or

(D)  contract with or solicit, or both, with a combination of any of the above.

(3)  The study description or RFPs shall be developed in draft form and made available to the house committee on health care, the senate committee on health and welfare, the senate committee on finance, and the house committee on ways and means for input.  Draft documents shall also be distributed to those entities indicating interest and be made available on the legislative web page for public comment.

(4)  The legislative committees designated in subdivision (3) of this section are authorized to meet during the interim of the 2005 session, as necessary to review the study description or RFPs prior to issuance.  The committee members shall also consider how the study process will promote communication and interaction among the various participants to facilitate a coordinated result.  For attendance at meeting, committee members shall be entitled to per diem compensation and expenses as provided in 2 V.S.A. § 406.

(5)  The decisions on the process and selection of service providers shall be done by the legislative council and the joint fiscal office in consultation with the chairs of the committees in subdivision (3) of this section and the chair and vice chair of the joint fiscal committee.  The providers shall present interim reports to the joint health reform committee established in Sec. 4 of this act, the house committee on ways and means, and the senate committee on finance in September and November 2005.

(6)  Final reports shall be issued to the general assembly no later than January 15, 2006.

Sec. 3.  WORKERS ’ COMPENSATION STUDY

The department of health care administration shall investigate ways of coordinating or integrating Green Mountain Health with the current workers’ compensation system and shall make recommendations to the general assembly by January 1, 2006.

Sec. 4.  JOINT HEALTH REFORM COMMITTEE; PUBLIC ENGAGEMENT PROCESS

(a)  In recognition of the importance of public engagement, the house committee on health care and the senate committee on health and welfare shall form a joint health reform committee and shall meet as necessary during the interim of the 2005 legislative session to solicit input from citizens, stakeholders, and interested parties about health care.  The committee shall:

(1)  have regional public hearings;

(2)  have regional and statewide meetings with stakeholders, such as citizens, employers, hospitals, health care professionals, and insurers;

(3)  solicit information through a survey that shall be available online as well as on paper;

(4)  arrange for facilitated focus groups; and

(5)  maintain a web site.

(b)(1)  In order to obtain a broad range of information and input, the committee shall collaborate with interested parties, agencies, and organizations, including the agency of human services regional partnerships, the Vermont ethics network, and area health education centers (AHEC) in developing and implementing the public process.

(2)  The joint health reform committee shall consider any recommendations received on or before September 15, 2005 by Coalition 21, the coalition of stakeholder groups established in July 2004 to develop a sustainable plan for transforming Vermont’s health care system concerning the health care services that should be covered under a universal access plan for primary/preventive and hospital care.

(c)  The joint health reform committee shall address topics related to health care reform, including:

(1)  designing a package of preventive care, primary care, and hospital services to be covered by Green Mountain Health;

(2)  soliciting public input on the package of remaining health services to be covered by Green Mountain Health on July 1, 2009;

(3)  developing administrative and operational details of Green Mountain Health;

(4)  evaluating the interrelationship of Green Mountain Health with Medicaid and any Medicaid waiver programs;

(5)  developing opportunities for reorganizing health care delivery and improving quality;

(6)  developing methods for facilitating a seamless transition to Green Mountain Health;

(7)  developing standards and measurements for evaluating the implementation and operation of Green Mountain Health;

(8)  determining the plan for implementing the community health boards, including the number and boundaries of the regions, the composition of the boards, any other functions of the boards, and community involvement in integrated systems of care; and

(9)  determining a method for assessment and evaluation of quality.

(d)  With the approval of the speaker of the house and the president pro tempore of the senate, the joint                    committee may retain the services of one or more consultants or experts to assist in its work.

(e)  The joint committee may meet as needed and shall have such powers as are needed to carry out the purposes of this section.  For attendance at meetings, joint committee members shall be entitled to compensation and expenses as provided in 2 V.S.A. § 406.

(f)  By December 1, 2005, the joint committee shall file a joint report with the general assembly and the governor summarizing its activities and findings and recommending further legislation for health care reform.

Sec. 5.  LEGISLATIVE OVERSIGHT

The joint health reform committee established by Sec. 4 of this act shall be responsible for legislative oversight of the implementation and ongoing operation of Green Mountain Health.  The department of health care administration shall report on the implementation of Green Mountain Health and the ongoing operation and financial status of the plan at such times and with such information as the joint committee determines is necessary to fulfill its legislative oversight responsibilities.

* * * Immediate Specific Access Enhancements * * *

* * * Federally Qualified Health Centers * * *

Sec. 6.  FEDERALLY QUALIFIED HEALTH CENTERS (FQHC)

             LOOK-ALIKES; CAPITALIZATION GRANTS; CASE

             MANAGEMENT

Funds appropriated by Sec. 20 of this act to the department of health shall be expended for the purpose of providing to federally qualified health center (FQHC) look-alikes funds for initial capitalization and to establish an

income-sensitized sliding scale fee schedule for patients of these organizations.  In distributing the grants, the department shall consider ensuring the geographic distribution of health centers around the state as well as criteria under federal law.  Initial priority shall be given to health centers in Lamoille, Orange, Rutland, and Washington counties, but the goal shall be to ensure there are FQHC look-alikes in each county of Vermont.


* * * Health Care Information Technology * * *

Sec. 7.  18  V.S.A. § 9417 is added to read:

§ 9417.  HEALTH CARE INFORMATION TECHNOLOGY

(a)  The commissioner shall contract with the Vermont program for quality in health care to facilitate the establishment of a health information technology plan for establishing a statewide, integrated electronic health information infrastructure in Vermont by 2010.  The plan shall include standards and protocols designed to promote patient education, patient privacy, physician best practices, electronic connectivity to health care data, and, overall, a more efficient and less costly means of delivering quality health care in Vermont.

(b)  The responsibilities of the Vermont program for quality in health care in establishing a health information technology plan shall include:

(1)  supporting the effective, efficient, statewide use of electronic health information in patient care, health care policymaking, clinical research, health care financing, and continuous quality improvements;

(2)  educating the general public and health care professionals about the value of an electronic health infrastructure for improving patient care;

(3)  promoting the use of national standards for the development of an interoperable system, which shall include provisions relating to security, privacy, data content, structures and format, vocabulary, and transmission protocols;

(4)  making strategic investments in equipment and other infrastructure elements that will facilitate the ongoing development of a statewide infrastructure;

(5)  establishing a method for assessing various stakeholders for ongoing development and maintenance costs of a statewide health information system.

(c)  A health information technology advisory group is created to develop the health information technology plan, including applicable standards, protocols, and pilot programs.  Members of the advisory group shall include the members of the preexisting Vermont information technology leaders advisory group formed by the Vermont association of hospitals and health systems, except for those members who are vendors of information technology.  Vendors of information technology, however, shall be invited to provide input on plan development, as deemed appropriate by the Vermont program for quality in health care.

(d)  On or before January 1, 2006, the Vermont program for quality in health care shall initiate a pilot program involving at least two hospitals using existing sources of electronic health information to establish electronic data sharing for clinical decision support, pursuant to priorities and criteria established in conjunction with the health information technology advisory group.  Objectives of the pilot program may include:

(1)  supporting patient care and improving quality of care;

(2)  enhancing productivity of health care professionals and reducing administrative costs of health care delivery and financing;

(3)  implementing strategies for future developments in health care technology, policy, management, governance, and finance; and

(4)  ensuring patient data confidentiality at all times. 

(e)  The standards and protocols developed by the Vermont program for quality in health care shall be no less stringent than the “Standards for Privacy of Individually Identifiable Health Information” established under the Health Insurance Portability and Accountability Act of 1996 and contained in 45 C.F.R., Parts 160 and 164, and any subsequent amendments.  In addition, the standards and protocols shall ensure that there are clear prohibitions against the out-of-state release of individually identifiable health information for purposes unrelated to treatment, payment, and health care operations, and that such information shall under no circumstances be used for marketing purposes.  The standards and protocols shall require that access to individually identifiable health information is secure and traceable by an electronic audit trail.

(f)  On or before January 1, 2007, the Vermont program for quality in health care shall submit to the commissioner and the general assembly a health information technology plan for establishing a statewide, integrated electronic health information infrastructure in Vermont, as described in this section.  Upon approval by the general assembly, the plan shall serve as the framework within which certificate of need applications for information technology are reviewed under section 9440b of this title by the commissioner.

(g)  Beginning January 1, 2006, and annually thereafter, the Vermont program for quality in health care shall file a report with the commissioner and the general assembly.  The report shall include an assessment of progress in implementing the provisions of this section, as well as an analysis of the costs, benefits, and effectiveness of the pilot program authorized under subsection (d) of this section, as well as recommendations for funding and legislation.

(h)  The Vermont program for quality in health care is authorized to seek matching funds to assist with carrying out the purposes of this section.  In addition, it may accept any and all donations, gifts, and grants of money, equipment, supplies, materials, and services from the federal or any local government, or any agency thereof, and from any person, firm, or corporation for any of its purposes and functions under this section and may receive and use the same subject to the terms, conditions, and regulations governing such donations, gifts, and grants.

(i)  The commissioner, in consultation with the Vermont program for quality in health care and the health information technology advisory group, may seek any waivers of federal law, rule, or regulation that might assist with implementation of this section.


Sec. 8.  18 V.S.A. § 9437(4) and (5) are amended and (6) is added to read:

(4)  in the case of a proposal for the addition of beds for the provision of skilled nursing or intermediate care, the number of beds to be approved is not inconsistent with the considerations identified under subsection 9439(e) of this title; and

(5)  The the proposed new health care project is consistent with the certificate of need guidelines published by the department in accordance with its rules, and is within the portion of the unified health care budget applicable to the proposed health care facility;

(6)  if the application is for the purchase or lease of new health care information technology, it conforms with the health information technology plan established under section 9417 of this title, upon approval of the plan by the general assembly.

Sec. 9.  18 V.S.A. § 9440b is added to read:

§ 9440b.  INFORMATION TECHNOLOGY; REVIEW PROCEDURES

Notwithstanding the procedures in section 9440 of this title, upon approval by the general assembly of the health information technology plan developed under section 9417 of this title, the commissioner shall establish by rule standards and expedited procedures for reviewing applications for the purchase or lease of health care information technology that otherwise would be subject to review under this subchapter.  Such applications may not be granted or approved unless they are consistent with the health information technology plan.  The commissioner’s rules shall include a provision requiring applications be reviewed by the health information advisory group established under subsection 9417(c) of this title.  The advisory group shall make written findings and a recommendation to the commissioner in favor of or against each application.

* * * Medical Malpractice * * *

Sec. 10.  MEDICAL MALPRACTICE ARBITRATION

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

Sec. 50.  EFFECTIVE DATE

Secs. 46, 47, 48, and 49, amending chapter 215 of Title 12 to provide for mandatory arbitration in medical malpractice cases and admission of practice guidelines, shall take effect on the effective date of a universal access health care system enacted by the general assembly upon implementation of universal access under subsection 21(b) of Title 34.

(b)  Three years after mandatory medical malpractice arbitration goes into effect, the commissioner of the department of health care administration shall review medical malpractice and tort law, and file a report with the general assembly.  The report shall include recommendations for changes to the mandatory arbitration process, if appropriate.  If universal cost‑containment measures affect or place limits on clinical decision‑making, the department shall recommend limitations on the liability of providers who follow practice guidelines, if appropriate.  The commissioner shall seek advice and assistance in developing recommendations under this subsection from an advisory group established under subdivision 9411(3) of Title 18 consisting of representatives of the judicial branch, the health care provider community, the legal community, health insurers, medical malpractice insurers, and health care consumers.  To the fullest extent possible, the recommendations shall be based upon the board’s collection of data specific to Vermont.

* * * Healthy Lifestyles Insurance Discount * * *

Sec. 11.  8 V.S.A. § 4080a(h) is amended to read:

(h)(1)  A registered small group carrier shall use a community rating method acceptable to the commissioner for determining premiums for small group plans.  Except as provided in subdivision (2) of this subsection, the following risk classification factors are prohibited from use in rating small groups, employees, or members of such groups, and dependents of such employees or members:

(A)  demographic rating, including age and gender rating;

(B)  geographic area rating;

(C)  industry rating;

(D)  medical underwriting and screening;

(E)  experience rating;

(F)  tier rating; or

(G)  durational rating.

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

(B)  The commissioner’s rules shall permit a carrier, including a hospital or medical service corporation, to establish premium discounts or rebates or otherwise modify applicable co-payments or deductibles in return for adherence to programs of health promotion and disease prevention, in accordance with federal regulations relating to bona fide wellness programs.  Under the federal regulations, permissible bona fide wellness programs shall:

(i)  limit any discount, rebate, or waiver of cost-sharing to no more than 10 percent of the cost of employee-only coverage;

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

(iii)  provide that the reward under the program is available to all similarly situated individuals.

(C)  The commissioner, in consultation with the commissioner of health, shall adopt by rule:

(i)  standards for approved health promotion and disease prevention programs, based on the best scientific, evidence-based medical practices; and

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

(3)  The commissioner may exempt from the requirements of this section an association as defined in section subdivision 4079(2) of this title which:

(A)  offers a small group plan to a member small employer which is community rated in accordance with the provisions of subdivisions (1) and (2) of this subsection.  The plan may include risk classifications in accordance with subdivision (2) of this subsection;

(B)  offers a small group plan that guarantees acceptance of all persons within the association and their dependents; and

(C)  offers one or more of the common health care plans approved by the commissioner under subsection (e) of this section.

(4)  The commissioner may revoke or deny the exemption set forth in subdivision (3) of this subsection if the commissioner determines that:

(A)  because of the nature, size or other characteristics of the association and its members, the employees or members are in need of the protections provided by this section; or

(B)  the association exemption has or would have a substantial adverse effect on the small group market.

Sec. 12.  8 V.S.A. § 4080b(h) is amended to read:

(h)(1)  A registered nongroup carrier shall use a community rating method acceptable to the commissioner for determining premiums for nongroup plans.  Except as provided in subdivision (2) of this subsection, the following risk classification factors are prohibited from use in rating individuals and their dependents:

(A)  demographic rating, including age and gender rating;

(B)  geographic area rating;

(C)  industry rating;

(D)  medical underwriting and screening;

(E)  experience rating;

(F)  tier rating; or

(G)  durational rating.

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

(B)  The commissioner’s rules shall permit a carrier, including a hospital or medical service corporation, to establish premium discounts or rebates or otherwise modify applicable co-payments or deductibles in return for adherence to programs of health promotion and disease prevention, in accordance with federal regulations relating to bona fide wellness programs.  Under the federal regulations, permissible bona fide wellness programs shall:

(i)  limit any discount, rebate, or waiver of cost-sharing to no more than 10 percent of the cost of employee-only coverage;

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

(iii)  provide that the reward under the program is available to all similarly situated individuals.

(C)  The commissioner, in consultation with the commissioner of health, shall adopt by rule:

(i)  standards for approved health promotion and disease prevention programs, based on the best scientific, evidence-based medical practices; and

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

Sec. 13.  8 V.S.A. § 4516 is amended to read:

§ 4516.  ANNUAL REPORT TO COMMISSIONER

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


Sec. 14.  8 V.S.A. § 4588 is amended to read:

§ 4588.  ANNUAL REPORT TO COMMISSIONER

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

* * * DRUG UTILIZATION REVIEW BOARD * * *

Sec. 15.  1 V.S.A. § 313(a) is amended to read:

(a)  No public body described in section 312 of this title may hold an executive session from which the public is excluded, except by the affirmative vote of two-thirds of its members present in the case of any public body of state government or of a majority of its members present in the case of any public body of a municipality or other political subdivision.  A motion to go into executive session shall indicate the nature of the business of the executive session, and no other matter may be considered in the executive session.  Such vote shall be taken in the course of an open meeting and the result of the vote recorded in the minutes.  No formal or binding action shall be taken in executive session except actions relating to the securing of real estate options under subdivision (2) of this subsection.  Minutes of an executive session need not be taken, but if they are, shall not be made public subject to section subsection 312(b) of this title.  A public body may not hold an executive session except to consider one or more of the following:

* * *

(9)  Information relating to a pharmaceutical rebate or to supplemental rebate agreements, other than information protected from disclosure by federal law, by the terms and conditions required by the federal Centers for Medicare and Medicaid Services as a condition of rebate authorization under the Medicaid program.

Sec. 16.  33 V.S.A. § 1998(f)(2) is amended to read:

(2)  The board shall meet at least quarterly.  The board shall comply with the requirements of subchapter 2 of chapter 5 of Title 1 (open meetings) and subchapter 3 of chapter 5 of Title 1 (open records), except that the board may go into executive session as provided for in subdivision 313(a)(9) of Title 1 in order to comply with subsection 2002(c) of this title.


Sec. 17.  33 V.S.A. chapter 19, subchapter 5 is added to read:

Subchapter 5.  PREMIUM ASSISTANCE PROGRAM

§ 2030.  MEDICARE PREMIUM ASSISTANCE PROGRAM

(a)  The office of Vermont health access shall establish a premium assistance program by rule under chapter 25 of Title 3 to assist eligible individuals who are unable to afford Medicare supplemental insurance under section 4062b of Title 8 or Medicare part B premiums.

(b)  The program shall provide a fixed grant of $20.00 per month to eligible individuals who apply until such time as the funds appropriated to support the program are exhausted. This program is not an entitlement.

(c)  An “eligible individual” means an individual enrolled in or applying for Medicare who is not eligible for Medicaid under 42 U.S.C. § 1396a, is under 300 percent of the federal poverty guidelines, and does not have health insurance coverage through a group or association.

* * * TECHNICAL PROVISIONS * * *

Sec. 18.  TRANSFER OF POSITIONS

(a)  Effective October 1, 2005 and consistent with the provisions of this act, the Secretary of Administration shall transfer to the department of health care administration and place under the supervision of the department’s commissioner:

(1)  All employees, professional and support staff, contracts, consultants, and positions of the office of Vermont health access under section 3088 of Title 3 and the remaining balances of all appropriation amounts for personal services and operating expenses;

(2)  All employees, professional and support staff, contracts, consultants, and positions of the division of rate setting under chapter 9 of Title 33 and the remaining balances of all appropriation amounts for personal services and operating expenses; and

(3)  All employees, professional and support staff, contracts, consultants, and positions of the division of health care administration pursuant to chapter 221 of Title 18 and the remaining balances of all appropriation amounts for personal services and operating expenses.

(b)  On or before November 1, 2005, the secretary of administration, in consultation with the commissioner of health care administration, shall provide a detailed report to the joint fiscal committee of all the transfers made under this section.

Sec. 19.  STATUTORY REVISION AND RECODIFICATION

The Statutory Revision Commission shall revise the Vermont Statutes Annotated as necessary to reflect the purposes of this act. The legislative council may recodify such provisions in chapter 107 of Title 8, chapters 9 and 19 of Title 33, and chapter 221 of Title 18 with the exception of the sections repealed in Sec. 21 of this act in Title 34 as new chapters with the appropriate section number designations.

Sec. 20.  APPROPRIATION; POSITIONS

     (a)  Fiscal year 2005.  There is appropriated in fiscal year 2005 the following amounts:

          (1)  $60,000.00 from the general fund to the Secretary of Administration:  for regulatory entity start-up planning for the Health Care Regulatory Review Board established by Sec. 1 of this act (subchapter 4 of chapter 1 of Title 34).

          (2)  $425,000.00 from the general fund to the legislature for the following purposes:

               (A)  $125,000.00 for the economic impact study and the tax financing study authorized by Sec. 2 of this act.

               (B)  $100,000.00 for actuarial services for the purposes of supporting the studies required by Sec. 2 and other provisions of this act.

               (C)  $50,000.00 for interim committee meetings of the joint health care reform committee established by Sec. 4 of this act.

               (D)  $150,000.00 to support the public engagement process of Sec. 4 of this act.

(3)  $200,000.00 from the general fund to the Department of Health for the purpose of providing to federally qualified health center (FQHC)

look-alikes funds under Sec. 6 of this act.

          (4)  $200,000.00 from the general fund to the Department of Banking, Insurance, Securities, and Health Care Administration for the purpose of a health information technology plan under Sec. 7 of this act.

(b)  Fiscal year 2005 designated balance (waterfall).

Sec. 263(a) of H.516 of 2005 is amended by inserting two new subdivisions after subdivision (7) to read as follows:

(8)  Eighth, $200,000.00 shall be appropriated to the department of health for use as an additional appropriation to fund the free clinic association.

(9)  Ninth, $500,000.00 shall be appropriated to the office of Vermont health access or its successor in interest to fund the Medicare premium assistance program established under 33 V.S.A. § 2030 and Sec. 17 of this act.

and by renumbering the remaining subdivisions to be numerically correct        (c)  Fiscal year 2006. 

          (1)  There is appropriated in fiscal year 2006 the amount of $120,000.00 of general funds and up to $50,000.00 of federal matching funds to the Department of Health Care Administration for the purposes of Sec. 1 of this act, establishing subchapter 2 of chapter 1 of Title 34.

          (2)  There is established in the Department of Health Care Administration two (2) new exempt positions – one (1) Commissioner of the Department of Health Care Administration and one (1) Staff assistant – in fiscal year 2006.  These positions shall be transferred and converted from existing vacant positions in the executive branch of state government.

(d)  The legislative council, the joint fiscal committee, and the department of health care administration are authorized to seek matching funds to assist with carrying out the purposes of this act.  In addition, they may accept any and all donations, gifts, and grants of money, equipment, supplies, materials, and services from the federal or any local government, or any agency thereof and from any person, firm, or corporation for any of their purposes and functions under this section and may receive and use the same subject to the terms, conditions, and regulations governing such donations, gifts, and grants.

     (e)  Subsection (b) of this section shall take effect July 1, 2005.

Sec. 21.  REPEAL

Sections 9403 of Title 18 (division of health care administration of the department of banking, insurance, securities, and health care administration), section 3088 of Title 3 (the office of Vermont health access), and section 902 of Title 33 (the division of rate setting) are repealed October 1, 2005, and the departments are transferred to the department of health care administration established in this act.

Sec. 22.  EFFECTIVE DATES AND TRANSITION

This act shall be effective upon passage.  The commissioner of the department of health care administration shall be appointed within 60 days of passage.  The functions delegated to the health care regulatory review board established in section 31 of Title 34 shall not become effective until October 1, 2006.  Unless explicitly repealed by this act, current law and regulation are intended to remain effective and operational, and these functions shall remain with the agency, department, or division designated by law or its successor in interest.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us