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ACT SUMMARY 2007-2008


ACT NO. 71


Health; insurance; blueprint for health; Medicaid; VHAP; Catamount Health;

state employees' health plan; advance practice nurses

This act establishes principles for outreach and enrollment in Catamount Health and state health care benefit programs. It requires the Agency of Human Services (“AHS”) to provide, by October 200, a single, simplified form for assessing eligibility for all state health care programs, and requires AHS to make available to health care providers any information, forms, or access to computer systems that are necessary to facilitate enrollment for individuals eligible for state health care programs. It requires AHS to develop web-based application tools for use by individuals applying for state health benefit programs. Beginning January 1, 2008, the act requires AHS to provide VHAP to eligible applicants effective the date the agency receives the application (as opposed to the date the agency determines eligibility requirements are met), provided that CMS approves. AHS is directed to analyze and report to the legislature on the costs and benefits of providing coverage from the date of application for those applying for any state-funded pharmacy programs.

The act establishes uniform state assistance for Catamount Health, such that any additional premium amount incurred because an individual chooses to enroll in a higher-cost Catamount Health plan would be borne solely by the individual.

The act establishes the director of blueprint as a new position and makes that person responsible for development and implementation of the blueprint. The director is required by the act to collaborate with the commissioner of BISHCA whenever private health insurers are concerned. The act establishes principles for development and implementation of the blueprint. The act moves the deadline for statewide participation in the blueprint back to January 1, 2011 and requires the blueprint strategic plan to ensure that all communities implement at least one component of the blueprint by January 1, 2009. It also sets benchmarks for progress in adopting and implementing clinical quality and performance measures and requires the commissioner to analyze and report his or her recommendations concerning sustainable payment mechanisms to the legislature no later than January 1, 2009.

It requires the commissioner of health to set up 3 early implementation projects: the medical home project chronic care management systems integration project; the community-based coordination project; and the chronic care payment reform project, with the medical home project serving as the baseline.

The act requires the commissioner of health, the director of the office of professional regulation, and the Board of Nursing to establish a work group to study and make recommendations on the advisability of eliminating the requirement that an advance practice nurse work in a collaborative practice with a physician, with a report due to the committees on health and welfare and on health care and to the commission on January 15, 2008.

The act requires BISHCA to survey annually insurers to determine the reimbursement for the 10 most common billing codes for primary care health services, and to report on the data to the committees of jurisdiction. A similar, one-time survey for mental health services and non-physician providers is also required. The act requires the secretary of administration to report to the legislature on the results of provider satisfaction assessments for services provided consistent with the blueprint; and, if the secretary determines that provider satisfaction levels are creating a barrier to successful implementation of the blueprint, include an action plan for improving provider satisfaction. The act authorizes health care professional and trade associations to obtain a list of bidders for a state employees’ health care plan, to submit information about the business practices of the bidders for the Secretary to consider, and to request meetings with the secretary to discuss the information.

The act eliminates the provision allowing use of the Catamount fund for the nongroup health insurance market assistance and adds a provision allowing use of the Catamount fund for the development and implementation of the blueprint.

The act limits cost-sharing for Catamount Health-eligible individuals receiving premium assistance for employer-sponsored health coverage to services covered by VHAP that are related to evidence-based guidelines for ongoing prevention and clinical management of the chronic condition specified in the blueprint for health, instead of for all chronic care services.

The act sets the Catamount Health plan reimbursement rates for non-facility health care providers in an amount equal to the least of contracted rates, billed charges, or the Medicare reimbursement rate plus ten percent.

Effective Date: on July 1, 2007, except Secs. 4 and 13, which are effective upon passage.

Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont