ACT NO. 70
Health; insurance; Catamount Health; premium assistance;
chronic care; blueprint for health; employer assessment
This act makes corrections, clarifications, and changes to the 2006 Health Care Affordability Act and related legislation.
The act clarifies that when an employer terminates an employee for the primary purpose of establishing program eligibility for the employee, the employee must still be uninsured for 12 months before he or she is eligible for Catamount Health, Catamount Health premium assistance, or employer-sponsored-insurance premium assistance (ESIA).
It clarifies that an individual who has been enrolled in Medicaid, VHAP, Dr. Dynasaur, Catamount Health, Catamount Health premium assistance, or ESIA shall not be subject to a 12-month waiting period before becoming eligible for another such program. The act clarifies that loss of COBRA or VIPER at any time is an exception to the 12-month uninsured requirement for Catamount Health, Catamount Health premium assistance, and employer-sponsored insurance premium assistance.
The act clarifies that a Catamount Health network provider may not balance bill, i.e., bill the insured for any amount above the reimbursement amount provided for in the plans participating provider agreement.
The act makes individuals who are eligible for Medicare ineligible to purchase Catamount Health. It also makes an individual who is eligible for or becomes eligible for Medicare ineligible for employer-sponsored insurance assistance or Catamount Health premium assistance.
The act adjusts the method for determining Catamount Health reimbursement rates for health care providers and for hospitals. The act enables the Department of Banking, Insurance, Securities, and Health Care Administration (BISHCA) to approve adjustments to Catamount Health reimbursement rates for health care providers (including hospitals) if the adjustments are consistent with a carriers pay for performance standards, a quality improvement program, or other payment methodologies consistent with the blueprint for health.
The act allows Medicaid to negotiate how much of a chronic care management organizations fee is to be at risk (the language previously required all of the fee to be at risk).
The act gives authority to contract with and oversight of the Vermont Technology Leaders (VITL) to the Department of Information and Innovation and repeals the provision giving BISHCA this authority. It shifts from BISHCA to VITL the responsibility for creating the structure for a loan and grant fund for providers to set up office capability for creating and sharing electronic health records (EHRs). The act also requires VITL to set up an interim fund to provide loans and grants in blueprint communities and to primary care providers serving low income Vermonters. VITL and the Secretary of Administration are directed to work together to solicit voluntary contributions to the fund, with a goal of $1 million (no state appropriation).
The act replaces the term premium with the word fund with regard to the employers health care fund contribution, in order to clarify that employer payment of the contribution does not entitle its employees to Catamount Health insurance. The act excludes hours worked by seasonal and part-time employees from the computation conducted by an employer to determine the amount of contribution due when (a) the employer offers health care coverage to all of its regular full-time employees, and (b) the seasonal or part-time employee has health care coverage under either a private plan or a public plan other than Medicaid or VHAP. It changes the definition of seasonal employee to an individual who works 20 weeks or fewer (in a calendar year) in a job scheduled to last 20 weeks or fewer. It defines a part-time employee as one who works for fewer than 30 hours a week. The act gives the Department of Labor the same enforcement powers for the health care fund contribution that it has for unemployment insurance contributions. It requires the Department of Labor to develop a form that employers will be required to use to determine the health coverage status of employees. The form shall be designed to preserve the confidentiality of the type of coverage possessed by the employee to the greatest extent possible. The act prohibits an employer or employment agency from asking a job applicant about his or her health care coverage and from otherwise discriminating among job applicants or employees on the basis of health coverage status. It explicitly authorizes employers to inform applicants about the employers health coverage benefits. The act provides a private right of action against an employer for violating the prohibition and authorizes the award of damages. The act makes all the provisions relating to the employers health care fund contribution effective April 1, 2007 (the first day of the first reporting period).
The act finds that affording employers relief from paying the assessment on seasonal and part-time employees reduces Catamount Health revenues by $800,000.00 and affects sustainability of the program. The Secretary of Administration in conjunction with the Joint Fiscal Committee is directed to propose to the General Assembly, no later than 12/1/2007, a means of restoring the lost revenue.
Effective Date: The provisions relating to the employers health care fund contribution are effective April 1, 2007; the remaining sections are effective July 1, 2007.
The Vermont General Assembly
115 State Street