|HOUSE PROPOSAL OF AMENDMENT||2007-2008|
An act relating to managed care organizations and the blueprint for health.
The House proposes to the Senate to amend the bill by striking all after the enacting clause and inserting in lieu thereof the following:
Sec. 1. 18 V.S.A. § 9414(a)(1), (b), and (e) are amended to read:
(a) The commissioner shall have the power and responsibility to ensure that each managed care organization provides quality health care to its members, in accordance with the provisions of this section.
determining whether a managed care organization meets the requirements of this
section, the commissioner shall
annually review and examine,
in accordance with subsection (e) of this section, the organization’s
administrative policies and procedures, quality management and improvement
procedures, utilization management, credentialing practices, members' rights
and responsibilities, preventive health services, medical records practices,
grievance and appeal procedures, member services, financial incentives or
disincentives, disenrollment, provider contracting, and systems and data
reporting capacities. The commissioner may establish, by rule, specific
criteria to be considered under this section.
(b)(1) A managed care organization shall assure that the health care services provided to members are consistent with prevailing professionally recognized standards of medical practice.
(2) A managed care organization shall establish a chronic care program as needed to implement the blueprint for health established in chapter 13 of this title. The program shall include:
(A) appropriate benefit plan design;
(B) informational materials, training, and follow-up necessary to support members and providers; and
(C) payment reform methodologies.
(3) Each managed care organization shall have procedures to assure availability, accessibility and continuity of care, and ongoing procedures for the identification, evaluation, resolution, and follow-up of potential and actual problems in its health care administration and delivery.
evaluate review a managed care organization's
performance under the requirements of this section at least once every three
years and more frequently as the commissioner deems proper. If upon review
the commissioner determines that the organization’s performance with respect to
one or more requirements warrants further examination, the commissioner shall
conduct a comprehensive or targeted examination of the organization’s
performance. The commissioner may designate another organization to
conduct any evaluation under this subsection. Any such independent designee
shall have a confidentiality code acceptable to the commissioner, or shall be
subject to the confidentiality code adopted by the commissioner under
subdivision (f)(3) of this section. In conducting an evaluation under this
subsection, the commissioner or the commissioner's designee shall employ,
retain, or contract with persons with expertise in medical quality assurance.
Sec. 2. 8 V.S.A. § 4088f is added to read:
§ 4088f. HEALTH INSURANCE AND THE BLUEPRINT FOR HEALTH
(a) A health insurance plan shall be offered, issued, and administered consistent with the blueprint for health established in chapter 13 of Title 18, as determined by the commissioner.
(b) As used in this section, “health insurance plan” 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 in section 9402 of Title 18. The term shall include the health benefit plan offered by the state of Vermont to its employees and any health benefit plan offered by any agency or instrumentality of the state to its employees. The term shall not include benefit plans providing coverage for specific disease or other limited benefit coverage unless so directed by the commissioner.
Sec. 3. SUPPORT OF BLUEPRINT integrated early
implementation PILOT Programs
(a) As used in this section, “health insurer” means a health insurance company doing business in Vermont whose individual share of the commercially insured Vermont market, as measured by covered lives, comprises at least five percent of the commercially insured Vermont market.
(b) The blueprint director shall establish a pilot design and evaluation committee to assist with design, implementation, and evaluation of the integrated early implementation pilot programs, as defined in section 7 of No. 71 of the Acts of 2007. The committee shall:
(1) work collaboratively with the blueprint director to accomplish the provisions in subsections (c) through (g) of this section; and
(2) include a representative of each of the participating health insurers; a participating provider from each pilot community; a representative of the Vermont department of health; a representative of the office of Vermont health access; a representative of the department of banking, insurance, securities, and health care administration; a naturopathic physician; a representative of the business community; and a representative of the Vermont Medical Society.
(c) Implementation of the first pilot program shall begin no later than July 1, 2008. Implementation of the second pilot program shall begin no later than October 1, 2008. Implementation of the third pilot program shall begin no later than January 1, 2009.
(d) No later than May 31, 2008, health insurers and the office of Vermont health access shall commit in writing to participation in the three integrated early implementation pilot projects as described in section 7 of No. 71 of the Acts of 2007 and as further specified by the provisions of this section. Such commitment shall include agreement to:
(1) provide financial support for a five-member community care team in each of the three integrated early implementation pilot program communities established pursuant to subsection 7(f) of No. 71 of the Acts of 2007. The department of health, health insurers, and the office of Vermont health access shall each contribute equal shares of such financial support for the community care teams, with the exception that MVP Healthcare shall contribute one half of that share;
(2) provide financial support for payment reform for providers in practices that are participating as part of the three integrated early implementation pilot programs as referenced in subsections 7(e) and 7(g) of No. 71 of the Acts of 2007;
(3) provide claims data-sharing for evaluation of the effectiveness of these integrated pilot programs as referenced in subsections 7(c) and 7(e) of Act 71 of No. 71 of the Acts of 2007; and
(4) actively participate in program design, implementation, and evaluation activities.
(e) No later than May 31, 2008, the blueprint director shall adopt designs for the financial support models in subdivisions (d)(1) and (d)(2) of this section and for the plan to evaluate healthcare process quality, including targets for key outcomes to be achieved by the pilots.
(f) By January 1, 2010, as part of the blueprint annual report, the blueprint director shall include a report on integrated pilot program implementation and preliminary evaluation findings.
(g) No later than six months after the third integrated pilot has completed 12 months of clinical operations, the blueprint director and the pilot design and evaluation committee shall assess whether there is sufficient clinical and financial gain from these types of programs to move forward with statewide implementation.
(1) The blueprint director shall provide a final evaluation report to the senate committee on health and welfare, the house committee on health care, and the commission on health care reform.
(2) If evidence supports statewide implementation, the final evaluation report shall include recommendations to achieve this goal.
(h) If the commissioner of banking, insurance, securities, and health care administration determines that a health insurer is not participating in an adequate and appropriate manner, as determined by the commissioner, in the activities described in this section, the commissioner, in addition to any other remedy or sanction provided for by law, may order the health insurer to participate in such blueprint initiatives and take such other actions as the commissioner determines necessary to carry out the purposes of this section.
Sec. 4. REPEAL
Sec. 3 of this act, relating to blueprint integrated early implementation pilot programs, shall be repealed on July 1, 2012.
Sec. 5. 18 V.S.A. § 1120 is amended to read:
§ 1120. DEFINITIONS
As used in this
(1) “Child care facility” means a child care facility or family day care home licensed or registered under chapter 35 of Title 33, unless exempted by rule adopted under section 1123 of this title.
means a public or independent prekindergarten, kindergarten, elementary or secondary school or any postsecondary
school as defined in 16 V.S.A. § 176(b), unless exempted by rule adopted
pursuant to section 1123 of this title.
Sec. 6. 18 V.S.A. § 1121 is amended to read:
§ 1121. IMMUNIZATIONS REQUIRED PRIOR TO ATTENDING
SCHOOL AND CHILD CARE FACILITIES
(a) No person
may enroll as a student in a Vermont school, regardless of whether the student
has been enrolled in the school during a previous school year, unless the
appropriate school official has received a record or certificate of
immunization issued by a licensed
physician health care
practitioner or a health clinic that the
person has received required immunizations appropriate to age as specified by
the Vermont department of health.
(b) No person may enroll or retain a child in a child care facility, regardless of whether the child has been enrolled in the facility during a previous year, unless the facility has received a record or certificate of immunization issued by a licensed health care practitioner or a health clinic that the child has received required immunizations in the prior 12-month period appropriate to age as specified by the Vermont department of health.
Sec. 7. 18 V.S.A. § 1122 is amended to read:
§ 1122. EXEMPTIONS
(a) A person may remain in school or in the child care facility without a required immunization:
(1) If the person, or in the case of a minor the person’s parent or
guardian presents a written statement from a licensed
care practitioner, health clinic, or nurse that the person is in the process of
being immunized. The person may continue to attend school or the child
care facility as long as the immunization
process is being accomplished;
(2) If a
physician health care practitioner, licensed to practice in Vermont, certifies in
writing that a specific immunization is or may be detrimental to the person’s
health or is not appropriate;
(3) If the person, or in the case of a minor the person’s parent or
guardian states in writing that the person, parent, or guardian has religious beliefs or
philosophical convictions opposed to
(b) The health department may provide by rule for further exemptions to immunization based upon sound medical practice.
Sec. 8. 18 V.S.A. § 1123 is amended to read:
§ 1123. IMMUNIZATION RULES AND REGULATIONS
department shall adopt rules for administering this subchapter. Such
rules shall be developed in consultation
with the department of education
shall establish rules for administering
this subchapter with respect to immunization requirements for
Vermont schools, and in consultation with the department for children and
families with respect to immunization requirements for child care facilities. Such rules shall establish which immunizations
shall be required and the manner and frequency of their
administration, and may provide for exemptions as authorized by this subchapter.
Sec. 9. 18 V.S.A. § 1124 is amended to read:
§ 1124. ACCESS TO RECORDS
health personnel, including school nurses, shall have access to
student immunization records of
anyone enrolled in Vermont schools or child care facilities, when access is required in the performance of
official duties related to the immunizations required by this subchapter. Access
to student immunization records shall only be provided with the prior written
consent of parents and students as required by the Family Educational Rights
and Privacy Act, 20 U.S.C. § 1232g, and any regulations adopted thereunder.
Sec. 10. 18 V.S.A. § 1126 is amended to read:
§ 1126. NONCOMPLIANCE
The school board
of each district, or the board of trustees of each independent school, or the
chief executive officer of each
post-secondary postsecondary school, or the director of each child care
facility shall exclude from school or
a child care facility any person not
otherwise exempted under this subchapter who fails to comply with its
provisions. No person shall be excluded for failure to comply with the
provisions of this subchapter unless there has been a notification by the
appropriate school or child care facility authority to the person, or in the case of a minor to the person’s
parent or guardian of the noncompliance with this subsection, and of their
rights under section 1122 of this title. In the event of exclusion, school
officials or the director of the child care facility shall notify the department of health and contact
the parents or guardians in an effort to secure compliance with the
requirements of this subchapter so that the person may attend school or
the child care facility.
Sec. 11. 18 V.S.A. § 1129 is amended to read:
health care provider shall report to the department all data regarding
immunizations of adults and of children under the age of 18 within seven
days of the immunization, provided that required reporting of immunizations
of adults shall commence within one month after the health care provider has established
an electronic health records system and data interface pursuant to the e-health
standards developed by the Vermont information technology leaders. A health
insurer shall report to the department all data regarding immunizations of
adults and of children under the age of 18 at least quarterly. The All
data required pursuant to this subsection shall be reported in a form
required by the department.
department may use the data to create a registry of
childhood immunizations. Registry information regarding a
particular adult shall be provided, upon request, to the adult, the adult’s
health care provider, and the adult’s health insurer. A minor child’s record
also may be provided, upon request, to school nurses, and upon request and with
written parental consent, to licensed day care providers, to document
compliance with Vermont immunization laws. Registry information regarding
a particular child shall be provided, upon request, to the child after the
child reaches the age of majority and to the child’s parent, guardian,
health insurer, and health care provider. Registry information shall be
kept confidential and privileged and may be shared only in summary, statistical,
or other form in which particular individuals are not identified.
Sec. 12. EFFECTIVE DATE
This act shall take effect July 1, 2008, except that Sec. 3 and this section shall take effect upon passage.
The Vermont General Assembly
115 State Street