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H.805

Introduced by Representatives Koch of Barre Town, Keogh of Burlington and McFaun of Barre Town

Referred to Committee on

Date:

Subject:  Health; information technology funding; billing error discovery rewards; chronic care reinsurance; common benefit plan; individual insurance mandate; small business health insurance tax credit; Medicaid reform; tort reform; primary care clinics

Statement of purpose:  This bill proposes to (1) develop a loan fund for health care information technology; (2) require insurance carriers to reward consumers for finding billing errors; (3) mandate individual health insurance, proof of which must be shown to obtain a driver’s license, state tax refund, or hunting or fishing license; (4) require the development of an affordable, basic benefit plan; (5) provide premium assistance for individuals who are eligible for VHAP or Dr. Dynasaur to purchase health insurance in the private market; (6) establish a tax credit for small businesses that begin providing employee health insurance; (7) raise Medicaid provider payment to the level of Medicare payment; (8) establish state funding to reinsure a band of chronic care costs; (9) make compliance with evidence-based practice an affirmative defense to medical malpractice and require arbitration in medical malpractice cases; (10) provide seed money for establishment of primary care clinics in the proximity of hospital emergency rooms to operate 24 hours a day and reduce nonemergency care in hospitals; (11) require one-half of all punitive damages in medical malpractice claims to be deposited into the health access trust fund; (12) tax beer, candy, and soft drinks; (13) increase the cigarette tax to $2.00 per pack; and (14) make appropriations for these programs.

AN ACT RELATING TO HEALTH INSURANCE AFFORDABILITY  

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

Sec. 1.  TITLE

This act may be referred to as the Health Insurance Affordability Act of 2006. 

* * * Health Care Capital Information Technology Fund * * *

Sec. 2.  18 V.S.A. § 9418a is added to read:

§ 9418a.   HEALTH CARE CAPITAL INFORMATION TECHNOLOGY

                 FUND

(a)  There is hereby established a special fund to be known as the health care capital information technology fund and used to provide loans to health care facilities and health care providers in Vermont for the purpose of developing information technology for the facility or provider. 

(b)  The fund shall be established and held separate and apart from any other funds or moneys of the state and shall be used and administered exclusively for the purpose of this section.  The money in the fund shall be invested in the same manner as permitted for investment of funds belonging to the state or held in the treasury.  The fund shall consist of the following:

(1)  Such sums as may be appropriated or transferred thereto from time to time by the general assembly, the state emergency board, or the joint fiscal committee during such times as the general assembly is not in session.

(2)  Interest earned from the investment of fund balances.

(3)  Any other money from any other source accepted for the benefit of the fund.

(c)  The commissioner shall make low-interest loans to health care facilities and health care providers for the purpose of improving health care information technology. 

(d)  The commissioner may adopt regulations in order to implement the program established in this section.

* * * Billing Error Discovery Incentives * * *

Sec. 3.  18 V.S.A. § 9418b is added to read:

§ 9418b.  Billing Information and Error Discovery

                Reward

(a)  As used in this section:

(1)  “Health care provider patient invoice” means the billing statement issued from a health care provider to a recipient.

(2)  “Health insurance statement” means the explanation of benefits or any other statement from the health insurer to the patient that states the payment made by the health insurer for the health care service or goods.

(3)  “Health insurer” shall have the same meaning as in section 9402 of this title.

(4)  “Recipient” shall mean the patient or other individual responsible for payment for the health care services provided to the patient and any health insurer providing coverage for the health care service, regardless of the application of any cost-sharing terms or conditions.

(b)  A health care provider, as defined in section 9402 of this title, shall send a health care provider patient invoice, or copy thereof, to the patient or, when appropriate, the patient’s attorney-in-fact, legal guardian, executor, or administrator, at the time the first billing for the invoiced goods or services is sent to any person.  

(c)  The commissioner shall adopt a regulation designed to ensure, to the extent feasible, that health care provider patient invoices and health insurance statements be provided to recipients in a common or similar format which states in clear and understandable language the specific type and date of each individual service or cost item provided and for each service:

(1)  the specific individual who provided the service in the name of the billing provider;

(2)  the provider-listed charge for that service;

(3)  the allowed amount paid by Medicaid for that service, if applicable;

(4)  the actual amount paid by the patient’s insurer or, if pending determination, the fact that such determination is pending;

(5)  the actual balance due by the patient, if known and final; otherwise an indication that the balance due is pending insurance processing.

(d)  The rules shall also require that a health insurer shall develop a consumer reward program that will pay to a consumer a share of the recovery of any amount of overpayment or improper payment made to a provider that the consumer brought to the attention of the health insurer.  The rules shall require a health insurer to pay the consumer at least ten percent of any recovery over $100.00.

* * * Individual Proof of Insurance * * *

Sec. 4.  8 V.S.A. § 4062g is added to read:

§ 4062g.  REQUIRED HEALTH INSURANCE

Every individual who resides in Vermont is required to have health coverage that provides at least the coverage of the affordable basic benefit plan developed pursuant to section 4080b of this title.

Sec. 55.  23 V.S.A. § 603(e) is added to read:

§ 603.  APPLICATION FOR AND ISSUANCE OF LICENSE

* * *

(e)  A junior operator’s license and an operator’s license shall not be issued or renewed without the proof of health insurance pursuant to 8 V.S.A. § 4062e that indicates that the coverage has been certified by the commissioner of banking, insurance, securities, and health care administration to be at least equivalent to the basic benefit package required by 8 V.S.A. § 4080b or proof of coverage by Medicaid, the Vermont health access plan, or Medicare.

Sec. 66.  32 V.S.A. § 5884(d) is added to read:

(d)  Any personal income tax refund balance remaining after debt setoff under subchapter 12 of this chapter or other reduction or adjustment by the commissioner shall be disbursed to the taxpayer only upon presentation to the commissioner of proof of health insurance of the taxpayer, or in the case of a joint return, proof of health insurance of both taxpayers.  No interest shall accrue on any refund during the period it remains undisbursed under this subsection.  “Proof of health insurance” means presentation to the commissioner of a certificate issued by the commissioner of banking, insurance, securities, and health care administration that the taxpayer is covered by health insurance as required under section 4062g of Title 8.  All appeals related to this subsection shall be to the commissioner of banking, insurance, securities, and health care administration.

Sec. 7.  10 App. V.S.A. § 16a is added to read:

§ 16a.  ENFORCEMENT OF INDIVIDUAL INSURANCE MANDATE

(a)  For the purposes of this section, the term “license” shall include any and all licenses and permits issued by the department of fish and wildlife.

(b)  No license shall be issued without the proof of health insurance pursuant to 8 V.S.A. § 4062e that indicates that the coverage has been certified by the commissioner of banking, insurance, securities, and health care administration to be at least equivalent to the basic benefit package required by 8 V.S.A. § 4080b or proof of coverage by Medicaid, the Vermont health access plan, or Medicare. 

* * * Basic Benefit Plan Mandate * * *

Sec. 1.   8  V.S.A. §4062 is amended to read:

§ 4062. FILING AND APPROVAL OF POLICY FORMS AND PREMIUMS

(a) No policy of health insurance or certificate under a policy not exempted by subdivision 3368(a)(4) of this title shall be delivered or issued for delivery in this state nor shall any endorsement, rider, or application which becomes a part of any such policy, or any proof of insurance form, , or any proof of insurance form, be used, until a copy of the form, premium rates and rules for the classification of risks pertaining thereto have been filed with the commissioner of banking, insurance, securities, and health care administration; nor shall any such form, premium rate or rule be so used until the expiration of thirty days after having been filed, unless the commissioner shall sooner give his or her written approval thereto. The commissioner shall notify in writing the insurer which has filed any such form, premium rate or rule if it contains any provision which is unjust, unfair, inequitable, misleading, or contrary to the law of this state. In such notice, the commissioner shall state that a hearing will be granted within twenty days upon written request of the insurer. In all other cases, the commissioner shall give his or her approval. After the expiration of such thirty days from the filing of any such form, premium rate or rule, or at any time after having given written approval, the commissioner may, after a hearing of which at least twenty days written notice has been given to the insurer using such form, premium rate or rule, withdraw approval on any of the grounds stated in this section. Such disapproval shall be effected by written order of the commissioner which shall state the ground for disapproval and the date, not less than thirty days after such hearing when the withdrawal of approval shall become effective.

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

§ 4062e.  Standard Proof of Insurance Form

Sec. 2.   8  V.S.A. §4062d is added to read:

(a)  Every insurer delivering or issuing for delivery in the state in the state a policy of health insurance or certificate under a policy including any endorsement, rider, or application which becomes a part of any such policy, in the state must provide each covered individual with the standard proof of insurance form developed by the commissioner under this section annually by January 31 and upon request.  The proof of insurance proof of insuranceinsurer shall indicate whether the benefits provided are at least equivalent to the package of basic health care services provided in the affordable affordable basic benefit plan developed under section 4080b of this title on each proof of insurance.

(b) (b)(1)  Prior to approving a policy or certificate under a policy, the commissioner shall determine if the benefits provided are at least equivalent to the package of basic health care services provided in the affordable affordable basic benefit plan developed under section 4080b of this title.  The commissioner shall provide the results of the determination to the insurer with the approval or denial.

(2)  The commissioner shall establish a process by which an individual or employer may submit a health insurance summary plan description, certificate, or policy to the department in order to request the standard proof of insurance form.

(c)  The commissioner shall develop a standard proof of insurance form, which shall include language indicating whether the benefits provided are at least equivalent to the package of basic health care services provided in the affordable affordable basic benefit plan developed under section 4080b of this title.

 

(d)  As used in this section, health insurance policy means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this state by a health insurer, as defined by 18 V.S.A. § 9402(7).  The term shall not include disability insurance policies, accident indemnity or expense policies, long-term care insurance policies, student or athletic expense or indemnity policies, Medicare supplemental policies, dental policies and benefit plans providing coverage for a specific disease, or other limited benefit coverage.

(c) As used in this section, "health insurance policy" means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract or any other health benefit plan offered, issued or renewed for any person in this state by a health insurer, as defined by 18 V.S.A. § 9402(7). The term shall not include disability insurance policies, accident indemnity or expense policies, long-term care insurance policies, student or athletic expense or indemnity policies, Medicare supplemental policies, dental policies and benefit plans providing coverage for specific disease or other limited benefit coverage.

 

 

Sec. 29.  8 V.S.A. § 4080b(e) is amended to read:

(e)  A registered nongroup carrier shall offer two or more common health care plans approved by the commissioner.  The commissioner, by rule, shall adopt standards and a process for approval of common health care plans that ensure that consumers may compare the cost of plans offered by carriers.  At least one plan shall be a low-cost The commissioner shall develop an affordable common health care plan that includes basic services, excluding primary care, experimental treatment, elective surgery and nonemergency use of the emergency room.  The package shall cover health services for preventive care, including screening, counseling, treatment, medication determined by scientific evidence to be effective in preventing or detecting disease, immunizations, and physical examinations on recommended schedules.  The package may provide for deductibles, coinsurance arrangements, managed care, cost‑containment provisions, and any other term, not inconsistent with the provisions of this title, deemed useful in making the plan affordable.  A plan shall be determined affordable if it costs no more than ten percent of the income of a family of four at 300 percent of the federal poverty level.  The commissioner shall determinebase the benefits included in the package on the affordability measure, on evidence‑based guidelines for health care services and after a public input process.  If necessary to ensure affordability and notwithstanding provisions in this chapter, the commissioner may approve an affordable basic health care plan that does not comply with the coverage requirements in this chapter.  A health maintenance organization may add limitations to a common health care plan if the commissioner finds that the limitations do not unreasonably restrict the insured from access to the benefits covered by the plans.  A registered nongroup carrier may offer additional benefits as riders to the basic benefit package upon approval by the commissioner. 

Sec. 103.  REPEAL

8 V.S.A. § 4080b(n) is repealed.

* * * Premium Assistance Program * * *

Sec. 411.  8 V.S.A. § 4062f is added to read:

§ 4062f.  PREMIUM ASSISTANCE PROGRAM

(a)  As used in this section:

(1)  “Approved high deductible health insurance plan” means a high deductible health benefit plan with deductible amounts no less than and no greater than the deductible amounts required of a high deductible health insurance plan under Section 223 of the Internal Revenue Code (health savings accounts).

(2)  “Secretary” means the secretary of human services.

(b)  The secretary of human services shall establish the premium assistance program within the office of Vermont health access for the purpose of providing uninsured low and moderate income Vermonters and individuals eligible for the Vermont health access plan (VHAP) and Dr. Dynasaur with financial assistance to enroll in or purchase health insurance in the nongroup or small group market, including the affordable basic health benefit plan developed pursuant to section 4080b of this title, an approved high deductible health insurance plan, and insurance offered through an individual’s employer.  Financial assistance shall be in the form of:

(1)  a reduced premium obligation of an eligible individual;

(2)  in the case of an approved high deductible plan, a reduced deductible payment obligation for the eligible individual; or

(3)  a voucher, in an amount determined by the commissioner, reflecting a sliding scale of benefits based on the beneficiary’s income, that can be used toward the purchase of health care services or health care insurance in the private market.

(c)  The secretary of human services shall determine financial assistance amounts, including premium discounts and cost-sharing, and eligibility after public hearing and an opportunity for comment by interested parties and the public.  To be eligible, at a minimum, an individual must be a Vermont resident and have family income less than 300 percent of the federal poverty level for that individual’s family size.

(d)  Annually on or before October 1 of each year, the secretary of human services, in consultation with the commissioner of banking, insurance, securities, and health care administration, and after public hearing and an opportunity for comment by interested parties and the public, shall order the adjustment of the premium discount, deductible, and voucher assistance amounts to account for anticipated cost and utilization trends medical inflationfor the next calendar year.

(e)  The secretary shall adopt rules for the premium assistance program.  Such rules shall include:

(1)  The form and manner of an individual’s application for assistance authorized by this section;

(2)  Standards and procedures for participating health insurers to be compensated for the premium discounts, cost-sharing assistance, and other approved costs associated with the premium assistance program; and

(3)  Any other rules necessary to carry out the purposes of this section.

(f)  Any health insurer offering health insurance in the small or nongroup market may participate in the program.

(g)  The secretary may apply to the federal government to include the program authorized by this section as a Medicaid program or a state children’s health program if the secretary determines that it is cost-effective to do so.

* * * Medicaid Reform and Reimbursement Increase * * *

Sec. 12.  33 V.S.A. § 1901(d) is added to read:

(d)   The commissioner shall pay for Medicaid-covered and Medicaid‑waiver‑covered health services at a level equivalent to the Medicare program.  If Medicare does not pay for a service covered under Medicaid or Medicaid waiver programs, the office shall establish some other payment amount for such services determined after consultation with affected providers.

Sec. 113.  GLOBAL COMMITMENT MEDICAID REFORMS

The agency of human services shall seek a waiver amendment to the Global Commitment to health to modify the method by which the Vermont health access plan (VHAP) provides health insurance coverage to eligible individuals.  The agency shall seek the necessary waiver amendments to provide coverage for individuals eligible for VHAP solely through the premium assistance program in section 4062f of Title 8 by allowing these individuals to purchase the affordable basic health benefit plan under section 4080b of Title 8, an approved high-deductible health insurance plan, or health insurance from the individual’s employer.  The agency shall also seek any necessary waiver amendments to allow families with coverage through Dr. Dynasaur to elect to participate in the affordable basic health benefit plan under section 4080b of Title 8, an approved high-deductible health insurance plan, or health insurance from the individual’s employer.

* * * Small Business Health Insurance Tax Credit * * *

Sec. 14.  32 V.S.A. § 5830e is added to read:

§ 5830e.  TAX CREDITS; SMALL BUSINESS HEALTH INSURANCE

                CREDIT

(a)  For purposes of this section:

(1)  “Approved employee policy” means an insured health benefit plan offered by a small group carrier registered under section 4080a of Title 8 providing single, two-person, or family coverage that:

(A)  covers eligible preventive care which meets the requirements of Section 223 of the Internal Revenue Code (health savings accounts), as amended, notwithstanding any deductible amount; and

(B)  has deductible amounts no greater than the deductible amounts required under a high deductible health insurance plan which meets the requirements of Section 223 of the Internal Revenue Code (health savings accounts), as amended.

(2)  “Eligible employer” means any employer, including private nonprofit organizations, which:

(A)  employed 25 or fewer full-time-equivalent employees, on average, for the three months preceding January 1 of the taxable year;

(B)  pays in the taxable year at least 50 percent of the cost of premiums for an approved employee policy, pro-rated for a part-time employee as a portion of the workweek of a full-time employee of the employer; and

(C)  has been an employer at least 24 months and has not paid any portion of employee health insurance premium costs in the preceding 24 months; provided that the commissioner of banking, insurance, securities, and health care administration shall adopt small business affordability criteria to permit employers currently offering employee health insurance coverage to be considered an eligible employer, notwithstanding the provisions of this subdivision (C), if the commissioner of finance and management determines that funds are available for these purposes.

(3)  “Full-time-equivalent employee” means the sum of hours worked in one week by all employees of the employer, divided by 40.  For purposes of this calculation, no individual employee’s hours during the week in excess of 40 shall be included in the sum.

(b)  Beginning in taxable year 2007, an eligible employer shall be entitled to a refundable health insurance credit against the tax imposed by section 5822 or 5832 of this title in an amount equal to $600.00 per year per approved employee policy or $50.00 per month per approved employee policy for policies in force for less than a full year.

(c)  Eligibility for the credit established by this section shall terminate following the fifth consecutive year after the credit is first claimed.

(d)  The credit authorized by this section shall be allocated on a pro rata basis among the members of a pass-through entity.

(e)  Annually on or before October 1 of each year, the commissioner of banking, insurance, securities, and health care administration, after public hearing and an opportunity for comment by interested parties and the public, shall order the adjustment of the credit amount established in subsection (a) of this section to account for anticipated medical inflation for the next calendar year, as determined by the commissioner in his or her sole discretion.

(f)  The total aggregate credit available to employers shall be no more than $4,000,000.00 in any given tax year. 

(g)(1)  The commissioner of taxes shall adopt by rule standards and procedures necessary to carry out the purposes of this section.

(2)  The commissioner of taxes may adopt the initial rules required or permitted by this section by emergency rule so as to permit the standards and procedures necessary to carry out the purposes of this section to be adopted by January 1, 2007.

* * * Insurance Access Reinsurance Trust * * *

Sec. 15.  8 V.S.A. § 4062d is added to read:

§ 4062d.  INSURANCE ACCESS REINSURANCE TRUST

(a)  As used in this section:

(1)  “Chronic condition” means an established disease that is expected to last one year or more and that requires ongoing clinical management attempting to restore the individual to highest function, minimize the negative effects of disease, and prevent disease-related complications.

(2)  “Health insurer” means a health insurance company, a hospital or medical service corporation, or a health maintenance organization.

(3)  “Plan” means the insurance access reinsurance trust plan established by this section.

(4)  “Reinsurance mechanism” means the system by which the reinsurance trust plan pays or reimburses insurance carriers for the cost of health care services for chronic conditions pursuant to the section and the rules developed hereunder.

(b)  The commissioner shall establish the insurance access reinsurance trust plan for the purpose of lowering the cost of and thereby increasing access to health care coverage in all health insurance markets.

(c)  The insurance market access reinsurance trust plan shall permit carriers in all markets to transfer costs for health care for chronic conditions, in accordance with rules adopted by the commissioner.  Costs between $50,000.00 and $75,000.00 per individual shall be transferable.  Such individuals shall remain enrolled policyholders, members, or subscribers of the carrier’s or insurer’s plan and shall be subject to the same terms and conditions of coverage, premiums, and cost-sharing as any other policyholder, member, or subscriber.

(d)  The commissioner may develop the plan in a manner that permits the plan to be eligible for a federal grant to administer the plan, including a grant under the federal Trade Adjustment Act.

(e)  An insurance access reinsurance trust special fund shall be established to be administered by the commissioner for the sole purpose of providing financial support for the plan authorized by this section.  The fund shall be administered in accordance with subchapter 5 of chapter 7 of Title 32, except that interest earned shall remain in the special fund.

(f)  The commissioner may adopt rules for the plan relating to:

(1)  The creation of a private, nonprofit business organization to operate the plan and the appointment of individuals to govern the organization.

(2)  Criteria governing the circumstances under which a carrier may transfer expense and risk to the reinsurance mechanism, consistent with this section.    

(3)  Eligibility criteria for providing financial support to carriers under the reinsurance mechanism, including carrier expenses eligible for financial support, standards and procedures for the treatment and management of chronic conditions, and any other eligibility criteria established by the commissioner.

(4)  Rules for operation of the reinsurance mechanism and the plan.

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

* * * Evidence-Based Practice as Affirmative Defense * * *

Sec. 16.  12 V.S.A. § 1913 is added to read:

§ 1913.  EVIDENCE-BASED PRACTICE AS AFFIRMATIVE DEFENSE

Compliance with evidence-based practice guidelines duly established by national evidence-based practice organizations shall serve as an affirmative  defense against a medical malpractice claim. 

* * * Medical Malpractice * * *

Sec. 17.  MEDICAL MALPRACTICE ARBITRATION

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 on July 1, 2006 and apply only to cases filed on or after July 1, 2006. 

* * * Caps on Awards * * *

Sec. 18.  12 V.S.A. § 1910 is added to read:

§ 1910.  PUNITIVE DAMAGES

One‑half of all punitive or exemplary damages for any claim against a health care provider or health care facility, as those terms are defined in section 9402 of Title 18, for a cause of action relating to the provision of medical care or failure to provide medical care shall be paid to the state and deposited in the health access trust fund, as established in section 1971 of Title 33.

* * * Source of Revenue * * *

Sec. 19.  Sec. 87(17) of No. 68 of the Acts of 2003 is amended to read:

(17)  Secs. 51-67, relating to streamlined sales tax provisions, including provisions relating to alcoholic beverages, clothing, and $20.00 telecommunications credit, and provisions relating to local option taxation of telecommunications and exemption of clothing, shall take effect on the first day of the second quarter following the date of Vermont’s membership in the multistate streamlined sales and use tax agreement, but no earlier than January 1, 2005, except the repeal of the sales tax exemption for beer shall take effect July 1, 2006.

Sec. 20.  32 V.S.A. § 9701(45) and (46) are added to read:

(45)  Candy:  means a preparation of sugar, honey, or other natural or artificial sweeteners, in combination with chocolate, fruits, nuts, or other ingredients or flavorings in the form of bars, drops, or pieces.  “Candy” shall not include any preparation containing flour and shall require no refrigeration.

(46)  Soft drinks:  means nonalcoholic beverages that contain natural or artificial sweeteners.  Soft drinks do not include beverages that contain milk or milk products; soy, rice, or similar milk substitutes; or greater than 50 percent vegetable or fruit juice by volume.

Sec. 21.  32 V.S.A. § 9741(13) is amended to read:

(13)  Sales of food, food stamps, purchases made with food stamps, food products, and beverages (other than candy and soft drinks), sold for human consumption off the premises where sold; food stamps, purchases made with food stamps.

Sec. 22.  32 V.S.A. § 7771 is amended to read:

§ 7771.  RATE OF TAX

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

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

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

(3)  in the possession of a retail dealer who has held the cigarettes for 24 hours or less.  Such tax shall be at the rate of 59.5 100 mills for each cigarette and the payment thereof to be evidenced by the affixing of stamps to the packages containing the cigarettes, as hereinafter provided.  Any cigarette on which the tax imposed by this chapter has been paid, such payment being evidenced by the affixing of such stamp, shall not be subject to a further tax under this chapter.  Nothing contained in this chapter shall be construed to impose a tax on any transaction the taxation of which by this state is prohibited by the constitution of the United States.  The amount of taxes advanced and paid by a licensed wholesale dealer or a retail dealer as herein provided shall be added to and collected as part of the retail sale price on the cigarettes.  All taxes upon cigarettes under this chapter are declared to be a direct tax upon the consumer at retail and shall conclusively be presumed to be precollected for the purpose of convenience and facility only.

* * * Primary Care Clinics Appropriation * * *

Sec. 23.  PRIMARY CARE CLINICS; CAPITALIZATION GRANTS; CASE

               MANAGEMENT

There is appropriated the amount of $1,000,000.00 from the general fund in fiscal year 2007 to the department of health for the purpose of providing funds for initial capitalization to primary care clinics.  The department shall distribute the grants in a manner that furthers the state policy of eliminating the use of the emergency room for nonemergency treatment.  Grants shall be available only to those primary care clinics that are:

(1)  located in proximity to a hospital emergency room;

(2)  staffed principally by physician’s assistants and nurse practitioners; and

(3)  open 24 hours a day, seven days a week. 

Sec. 24.  AppropriationS

(a)  There is appropriated the amount of $10,000,000.00 from the general fund in fiscal year 2007 to the health care capital information technology fund. 

(b)  There is appropriated the amount of $4,000,000.00 from the general fund in fiscal year 2007 for administration of the individual insurance mandate and basic benefit plan mandate provided in Secs. 4, 5, 6, 7, 8, and 9 of this act. 

(c)  There is appropriated the amount of $20,000,000.00 from the general fund in fiscal year 2007 to the agency of human services for the premium assistance program in Sec. 11 of this act.

(d)  There is appropriated the amount of $12,000,000.00 from the general fund in fiscal year 2007 to the agency of human services for the purposes of making Medicaid reform and reimbursement increases as outlined in Sec. 12 of this act.

(e)  There is appropriated the amount of $15,000,000.00 from the general fund in fiscal year 2007 to the department of banking, insurance, securities, and health care administration for the insurance access reinsurance trust.

Sec.  25.  EFFECTIVE DATE

Sec. 11 of this act shall be effective on January 1, 2007.  To the extent that this section applies to individuals eligible for the Vermont health access plan or Dr. Dynasaur, it becomes effective only upon approval of a waiver amendment to the Global Commitment to health by the Centers on Medicare and Medicaid Services.  Sec. 18 of this act shall apply to all cases filed on or after July 1, 2006. 



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us