Introduced by Representative Pugh of S. Burlington
Subject: Health; Medicaid; global commitment; oversight
Statement of purpose: This bill proposes to codify the existing requirements for legislative approval of and oversight over Medicaid waivers.
AN ACT RELATING TO LEGISLATIVE APPROVAL OF AND OVERSIGHT OVER MEDICAID WAIVERS
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 33 V.S.A. § 1901 is amended to read:
§ 1901. ADMINISTRATION OF PROGRAM
(a)(1) The commissioner shall take appropriate action, including making of regulations, required to administer a medical assistance program under Title XIX of the Social Security Act. The commissioner shall seek approval from the general assembly prior to making changes to eligibility for any Medicaid or Medicaid waiver program and for reductions or expansions to benefits under the Medicaid or Medicaid waiver program. Prior to filing the final proposed rules for the Medicaid or Medicaid waiver program with the legislative committee on rules, the commissioner shall ask for recommendations from the house committee on human services and the senate committee on health and welfare. Outside the legislative session, the commissioner shall ask for recommendations from the health access oversight committee prior to filing final proposed rules.
(2) The commissioner shall seek approval from the general assembly prior to applying for and implementing a waiver of federal Medicaid law or an amendment to an existing waiver. Approval of a waiver for implementation by the general assembly only constitutes approval of the waiver conditions which are scheduled for implementation. For the purposes of this section, “funding for the Medicaid program” also means federal allocations or other funding for the state children’s health insurance program (SCHIP).
commissioner may charge
at the time of each enrollment, a monthly
premium , not to exceed $20.00, to each individual 18 years or older who
is eligible for enrollment in the health access program, as authorized by
section 1972 1973 of this title , and as implemented by
rules. The premium amounts shall be set by the general assembly. All
premiums collected by the Vermont health access office
for enrollment in the health access program shall be deposited in the Vermont health
access trust fund, established by section 1972 of this title. Any
co-payments, coinsurance, or other cost sharing to be charged shall also be
authorized and set by the general assembly.
commissioner may charge a monthly premium
of $10.00 per family for
pregnant women and children eligible for medical assistance under sections
1902(a)(10)(A)(i)(III), (IV), (VI), and (VII) of Title XIX of the
Social Security Act, whose family income exceeds 185 percent of the federal
poverty level, as permitted under section 1902(r)(2) of that act. The
premium amounts shall be established by the general assembly. Fees
collected under this subsection shall be credited to a special fund and shall
be available to the department to offset the costs of providing Medicaid
services. Any co-payments, coinsurance, or
other cost sharing to be charged shall also be authorized and set by the
(d)(1) To enable the state to manage public resources effectively, while preserving and enhancing access to health care services in the state, the office of Vermont health access is authorized to serve as a publicly operated managed care organization (MCO).
(2) As the publicly operated MCO, the office of Vermont health access shall be responsible for the overall management of the health care delivery system and for reimbursement of all eligible services as may be provided by state or federal law.
(3) The office of Vermont health access shall be exempt from any health maintenance organization (HMO) or MCO statutes in Vermont law and shall not be considered to be an HMO or MCO for purposes of state regulatory and reporting requirements. The MCO shall comply with the federal rules governing managed care organizations in Part 438 of Chapter IV of Title 42 of the United States Code. The Vermont rules on the primary care case management Medicaid program shall be amended to apply to the MCO unless the rules conflict with the federal rules.
(4) The agency of human services and office of Vermont health access shall report to the health access oversight committee about implementation of Global Commitment in a manner and at a frequency to be determined by the committees. Reporting shall, at a minimum, enable the tracking of expenditures by eligibility category, the type of care received, and to the extent possible allow historical comparison with expenditures under the previous Medicaid appropriation model (by department and program) and, if appropriate, with the amounts transferred by the department to the office of Vermont health access. Reporting shall include spending in comparison to any applicable budget neutrality standards.
(e)(1) The department for children and families and the office of Vermont health access shall monitor and evaluate and report quarterly beginning July 1, 2005 on the disenrollment in each of the Medicaid or Medicaid waiver programs subject to premiums, including:
(A) The number of beneficiaries receiving termination notices for failure to pay premiums;
(B) The number of beneficiaries terminated from coverage as a result of failure to pay premiums as of the second business day of the month following the termination notice. The number of beneficiaries terminated from coverage for nonpayment of premiums shall be reported by program and income level within each program; and
(C) The number of beneficiaries terminated from coverage as a result of failure to pay premiums whose coverage is not restored three months after the termination notice.
(2) The department and the office shall submit reports at the end of each quarter required by subdivision (1) of this subsection to the house and senate committees on appropriations, the senate committee on health and welfare, the house committee on human services, the health access oversight committee, and the Medicaid advisory board.
Sec. 2. GLOBAL COMMITMENT APPROVAL
The Global Commitment for Health Medicaid waiver approval constituted approval for the funding mechanism specified in the federal Terms and Conditions, the managed care organization structure, and the limitations on eligibility and benefits. The general assembly did not grant approval for the implementation of any changes in the eligibility or benefits in this approval, including any waiver of amount, duration, and scope requirements or the provision of early periodic screening, diagnosis, and treatment services for children.
Sec. 3. 33 V.S.A. § 1971(3) is amended to read:
of Vermont health access” means the office
of administering the Medicaid
within program for the agency of human services and includes
the managed care organization established in section 1901 of this title.
Sec. 4. SUNSET
Subsection 1901(d) of Title 33 shall sunset upon the expiration of the Global Commitment for Health Medicaid waiver approved under Section 1115 of the Social Security Act or any extensions of this waiver.
The Vermont General Assembly
115 State Street