ACT NO. 203
Health insurance; Catamount Health\; nutrition\; obesity\;
This act makes several findings relating to health care costs and health care reform. It suggests that the commission on health care reform (CHCR) coordinate three studies to develop key building blocks for moving the state toward a system of integrated care by 2009 that provides all Vermonters with access to affordable, high-quality health care financed in a fair and equitable manner and find ways to position Vermont as first in line for federal health care reform. It asks the CHCR to conduct a feasibility study of various designs for a pilot project using a system-wide budgeting initiative at the regional level within the state, including a design based on the accountable care organization model. The act also recommends that the CHCR study and develop a preliminary design for merging the nongroup (including Catamount Health), small group, and association health insurance markets. And the act advises the CHCR to study financing options, including creating a common analytic basis for policy decisions on public financing of health care, exploring broad-based revenue sources, identifying and assessing major federal issues with a publicly financed system, and examining how each model would impact the underlying cost drivers in health care.
The act allows health insurers to offer plans with split benefit designs and directs the commissioner of banking, insurance, securities, and health care administration (BISHCA) to establish rules that allow insurers to promote good health, prevent disease, and encourage healthier lifestyles through the use of a split benefit design as well as through premium discounts. It provides for an expedited rulemaking process to ensure the rules are in place by January 1, 2009.
The act requires the secretary of human services to apply for a federal waiver amendment that would allow Vermont to lower the Catamount Health and Vermont Health Access Plan (VHAP) waiting periods from 12 months to six months. It clarifies that loss of employment includes a reduction in hours that results in ineligibility for employer-sponsored coverage and that loss of college- or university-sponsored insurance includes decreased enrollment below a threshold set for continued coverage. The act also allows people with certain high-deductible plans to purchase Catamount Health at full cost but does not allow them to receive premium assistance or be eligible for VHAP for their first year of coverage.
The act starts counting the 12-month exclusion period for preexisting conditions under Catamount Health from the date of earliest application rather than the effective date of coverage as under prior law and does not continue counting a break in coverage after the date of application. It eliminates pregnancy as a preexisting condition and provides an amnesty from all preexisting condition exclusions for Catamount subscribers who apply or have applied at any time before November 1, 2008. The amnesty does not affect claims incurred before the effective date of the act.
The act modifies the so-called 75% Rule so that instead of directing insurers to require 75% participation in a small employers insurance plan, it allows insurers to require participation of up to 75% of the eligible employees for small employers with 10 or more employees and up to 50% for small employers with fewer than 10 employees. It also clarifies that employees enrolled in Catamount Health, Medicaid, Medicare, VHAP, and the Employer Assistance Program are not counted when determining the number of eligible employees.
The act directs the commissioner of health and others to (1) work with communities in developing comprehensive plans to identify and prioritize community health and wellness needs; (2) compile an inventory of programs awarding grants to schools and supervisory unions and recommend a coordinated process for awarding the grants; (3) make recommendations for increasing healthy choices in communities, such as promoting physical activity, increasing access to health foods, and promoting good nutrition; (4) create pilot projects for treatment of unhealthy weight in primary care settings and recommend ways that payment policies can encourage stronger relationships between primary care practices and public policy; and (5) propose a restaurant labeling plan to inform consumers of healthy choices and the presence of trans fats and recommend ways to make Vermont free of trans fats in prepared foods by 2011.
The act directs the commissioner of education to (1) collaborate with others to update the Vermont nutrition policy guidelines for foods sold in schools in competition with school meals, report on the number of schools complying with the guidelines, and recommend ways to ensure that the guidelines are adopted by all schools statewide by 2011 and (2) update its model module for schools on the human papillomavirus. It requires the commissioner of health to convene a work group to make recommendations on worksite wellness. It directs the department of health to convene a CHAMPPS/Fit and Healthy advisory council to coordinate initiatives on improving nutrition and reducing unhealthy weight. It adds several new requirements to the community health and wellness projects for which the commissioner of health awards grants. And the act requires the University of Vermont College of Medicine Office of Primary Care and the Area Health Education Centers to establish a counter detailing project to provide information to physicians, pharmacists, and others about cost-effective prescription drugs.
The act specifies that funds provided to the Vermont Information Technology Leaders (VITL) will now be in the form of a grant rather than a contract. It directs VITL to update its health information technology plan annually and eliminates a requirement for a quarterly progress report. The act requires the CHCR director and the VITL project review committee to conduct a planning and feasibility study of the impact of implementing a statewide e-prescribing program.
The act appropriates an additional $40,000 to the department of health for a loan repayment program to be used for nurse educators. It also appropriates $100,000 to support child tele-psychiatry pilot programs in community health centers.
The act implements fair standards for provider contracts with insurers. It prohibits insurers from imposing retrospective denials of paid claims after 12 months, with certain exceptions relating to fraud or mistake. It prohibits insurers from arbitrarily changing the code on a billed claim in order to pay a lower reimbursement, with certain exceptions for fraud or mistake. The act requires insurers to make payment on claims where prior authorization was required and received, with certain exceptions for fraud or mistake. It decouples requirements for speedy credentialing relating to insurers and hospitals, removing for insurers a requirement for status updates every 30 days and instead requiring them to finish the credentialing process within 60 days of receipt of a providers completed application. And the act directs the Vermont Medical Society and others to (1) study and recommend fair and transparent standards for provider and insurer contracts, (2) study the use of restrictive covenants in health care provider employment contracts, and (3) create recommendations for more timely payment of workers compensation claims and for improving fairness and efficiency in the workers compensation system.
Effective Date: Upon passage.
The Vermont General Assembly
115 State Street