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BILL AS INTRODUCED 2007-2008

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H.531

Introduced by Committee on Health Care

Date

Subject:  Health; insurance; blueprint for health; Medicaid; VHAP; OVHA; Catamount Health; state employees’ health plan; VITL; advance practice nurses; provider bargaining

Statement of purpose:  This bill proposes to (1) establish outreach and enrollment principles for Catamount Health and state benefit programs; (2) require the agency of human services to adopt a simplified application form for state health benefit programs, enable health care professionals and community volunteers to assist individuals to apply for health benefit programs, and provide coverage for state benefit programs beginning on the date the agency received the application; (3) limit premium assistance for Catamount Health plans to the amount of assistance for the lowest priced plan, such that individuals receive the same dollar amount of premium assistance, regardless of the cost of the higher cost plans; (4) create a position in the department of health titled principal assistant to the commissioner to lead the blueprint; (5) add the director of the health care reform commission and a representative of the state employees’ health plan to the blueprint for health executive committee; (6) establish principles and benchmarks to guide development and implementation of the blueprint for health, and require the department of health to facilitate participation in the blueprint; (7) establish a project for integrated early implementation of the blueprint programs by the department of health, including a medical home project, a chronic care payment reform project, and a community‑based care coordination team development project; (8) appropriate $75,831.00 in general funds plus the federal matching funds ($185,000.00 total) to the department of health for use by the Vermont Rural Health Alliance for early integration of the blueprint projects, upon receipt of matching funds by the alliance; (9) require the board of nursing and board of health to study elimination of the requirement that advance practice nurses have a collaborative practice with a physician; (10) add the department of human resources to the list of state agencies with which provider bargaining groups can negotiate; (11) require BISHCA to annually survey and report on  the costs of the most common health services; (12) require an annual report on the alignment of the state employees’ health plan with the blueprint for health and the adequacy of networks and reimbursements for that plan; (13) move the oversight of the Vermont Information Technology Leaders (VITL) from BISHCA to the department of information and innovation; and (14) require VITL to establish both a permanent and an interim loan and grant fund for enabling providers, especially primary care providers, to create and share electronic health records. 

AN ACT RELATING TO ENSURING SUCCESS IN HEALTH CARE REFORM

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

* * * Increasing Access to Affordable Health Care Coverage * * *

Sec. 1.  OUTREACH AND ENROLLMENT PRINCIPLES

In order to achieve the general assembly’s goal that 96 percent of Vermonters have health insurance by 2010, as expressed in subdivision 902(a)(3)(D) of Title 2, an aggressive and innovative outreach and enrollment plan based on the following principles will be necessary and should be applied in all outreach and enrollment efforts conducted for Catamount Health and state health care benefit programs, including premium assistance programs.  

(1)  Outreach for all health care programs, including Catamount Health and state health care benefit programs, should be coordinated throughout state government and be a priority for all agencies that administer such programs.

(2)  Outreach activities should proactively identify potentially eligible Vermonters, and use web‑based tools, an inquiry tracking system establishing a case file for potential applicants at the first point of contact, and professional staff, community volunteers, and organizations to assist with individualized screening, counseling, and application assistance. 

Sec. 2.  ACCESS TO HEALTH CARE PROGRAMS

(a)  The agency of human services shall make available to health care professionals, at the point of health care service or treatment, the necessary information, forms, access to eligibility or enrollment computer systems, and billing procedures to facilitate enrollment for individuals eligible for Medicaid, the Vermont health access plan, Dr. Dynasaur, any Global Commitment for Health waiver program, any state‑funded pharmacy program, Catamount Health, Catamount Health Assistance, or the employer‑sponsored‑insurance assistance program. 

(b)  No later than October 2007, the agency shall provide a single, uniform, simplified form to enable individuals to assess their potential eligibility for Medicaid, the Vermont health access plan, Dr. Dynasaur, any state‑funded pharmacy program, Catamount Health Assistance, or the employer‑sponsored‑insurance assistance programs.  Within a reasonable time frame, the agency shall develop web‑based application tools to ensure that any individual eligible for these programs has the opportunity to apply easily.  The agency shall determine if the individual is eligible and in which program the individual should be enrolled.  The agency shall refer applications for Catamount Health as appropriate. 

(c)  After submission of the application, the agency shall determine if the applicant meets full eligibility requirements.  Beginning January 1, 2008, if the individual is found eligible for the Vermont health access plan or any state‑funded pharmacy program, the agency shall, subject to approval from the center for Medicare and Medicaid services, provide payment for any services received by the individual beginning with the date the application was received by the agency. 

Sec. 3.  33 V.S.A. § 1984 is amended to read:

§ 1984.  INDIVIDUAL CONTRIBUTIONS

(a)  The agency shall provide assistance to individuals eligible under this subchapter to purchase Catamount Health.  The For the lowest cost plan, the amount of the assistance shall be the difference between the premium for the lowest cost Catamount Health plan and the individual’s contribution as defined in this section subdivision (c)(1).  For plans other than the lowest cost plan, the assistance shall be the difference between the premium for the lowest cost plan and the individual’s contribution as set out in subdivision (c)(1) of this section.  

(b)  Subject to amendment in the fiscal year 2008 budget, the agency of administration or designee shall establish individual and family contribution amounts for Catamount Health under this subchapter for the first year as established in this section and shall index the contributions in future years to the overall growth in spending per enrollee in Catamount Health as established in section 4080f of Title 8.  The agency shall establish family contributions by income bracket based on the individual contribution amounts and the average family size.  In fiscal year 2008, for the lowest‑cost Catamount Health plan offered by all carriers, the individual’s contribution shall be as established in subsection (c) of this section.  The agency shall determine the percentages that the amounts in subsection (c) are of the lowest‑cost plan and set the individual’s contribution for any other plan at the percentage for that income level.  In future years, after adjusting the individual premiums in subsection (c) of this section, the same methodology shall be used to determine the individual premiums for any other plans.

(c)(1)  An For the lowest cost plan, an individual’s contribution shall be:

(1)(A)  Income less than or equal to 200 percent of FPL:  $60.00 per month.

(2)(B)  Income greater than 200 percent and less than or equal to 225 percent of FPL: $90.00 per month.

(3)(C)  Income greater than 225 percent and less than or equal to 250 percent of FPL:  $110.00 per month.

(4)(D)  Income greater than 250 percent and less than or equal to 275 percent of FPL:  $125.00 per month.

(5)(E)  Income greater than 275 percent and less than or equal to 300 percent of FPL:  $135.00 per month.

(6)(F)  Income greater than 300 percent of FPL:  the actual cost of Catamount Health.

(2)  For plans other than the lowest cost plan, an individual’s contribution shall be the sum of:

(A)  the applicable contribution as set out in subdivision (1) of this subsection; and

(B)  the difference between the premium for the lowest cost plan and the premium for the plan in which the individual is enrolled.  

* * * Blueprint * * *

Sec. 4.  PRINCIPAL ASSISTANT POSITION

In fiscal year 2008, there is established in the department of health one (1) new exempt principal assistant position, to be titled the director of the blueprint for health, who shall report directly to the commissioner.

Sec. 5.  18 V.S.A. § 702 is amended to read:

§ 702.  BLUEPRINT FOR HEALTH; STRATEGIC PLAN

(a)  As used in this section, “health insurer” shall have the same meaning as in section 9402 of this title.

(b)  In coordination with the secretary of administration under section 2222a of Title 3 the commissioner of health shall be responsible for the development and implementation of the blueprint for health, including the five‑year strategic plan, and shall be assisted by director of the blueprint.  Whenever private health insurers are concerned, the commissioner shall collaborate with the commissioner of the department of banking, insurance, securities, and health care administration.

(b)(c)(1)  The commissioner shall establish an executive committee to advise the commissioner director of the blueprint on creating and implementing a strategic plan for the development of the statewide system of chronic care and prevention as described under this section.  The executive committee shall consist of no fewer than 10 individuals, including a representative from the department of banking, insurance, securities, and health care administration; the office of Vermont health access; the Vermont medical society; the Vermont program for quality in health care a statewide quality assurance organization; the Vermont association of hospitals and health systems; two representatives of private health insurers; consumer; a representative of the complementary and alternative medicine profession; and a primary care professional serving low income or uninsured Vermonters; and a representative of the state employees’ health plan, who shall be designated by the director of human resources and who may be an employee of the third party administrator contracting to provide services to the state employees’ health plan.  In addition, the director of the commission on health care reform shall be a nonvoting member of the executive committee.

(2)  The executive committee shall engage a broad range of health care professionals who provide services as defined under section 4080f of Title 18, health insurance plans, professional organizations, community and nonprofit groups, consumers, businesses, school districts, and state and local government in developing and implementing a five‑year strategic plan.

(c)(1)(d)  The blueprint shall be developed and implemented to further the following principles:

(1)  the primary care provider should serve a central role in the coordination of care and shall be compensated appropriately for this effort;

(2)  use of information technology will be maximized;

(3)  local service providers should be used and supported, whenever possible;

(4)  transition plans should be developed by all involved parties to ensure a smooth and timely transition from the current model to the blueprint model of health care delivery and payment;

(5)  implementation of the blueprint in communities across the state should be accompanied by payment to providers sufficient to support care management activities consistent with the blueprint, recognizing that interim or temporary payment measures may be necessary during early and transitional phases of implementation; and

(6)  interventions designed to prevent chronic disease and improve outcomes for persons with chronic disease should be maximized, should target specific chronic disease risk factors, and should address changes in individual behavior, the physical and social environment, and health care policies and systems. 

(e)(1)  The strategic plan shall include:

(A)  a description of the Vermont blueprint for health model, which includes general, standard elements established in section 1903a of Title 33, patient self‑management, community initiatives, and health system and information technology reform, to be used uniformly statewide by private insurers, third party administrators, and public programs;

(B)  a description of prevention programs and how these programs are integrated into communities, with chronic care management, and the blueprint for health model;

(C)  a plan to develop and implement reimbursement systems aligned with the goal of managing the care for individuals with or at risk for conditions in order to improve outcomes and the quality of care;

(D)  the involvement of public and private groups, health care professionals, insurers, third party administrators, associations, and firms to facilitate and assure the sustainability of a new system of care;

(E)  the involvement of community and consumer groups to facilitate and assure the sustainability of health services supporting healthy behaviors and good patient self‑management for the prevention and management of chronic conditions;

(F)  alignment of any information technology needs with other health care information technology initiatives;

(G)  the use and development of outcome measures and reporting requirements, aligned with existing outcome measures within the agency of human services, to assess and evaluate the system of chronic care;

(H)  target timelines for inclusion of specific chronic conditions to be included in the chronic care infrastructure and for statewide implementation of the blueprint for health;

(I)  identification of resource needs for implementation and sustaining the blueprint for health and strategies to meet the needs; and

(J)  a strategy for ensuring statewide participation no later than January 1, 2009 2011 by health insurers, third‑party administrators, health care professionals, hospitals and other professionals, and consumers in the chronic care management plan, including common outcome measures, best practices and protocols, data reporting requirements, payment methodologies, and other standards.  In addition, the strategy should ensure that all communities statewide will have implemented at least one component of the blueprint by January 1, 2009. 

(2)  The strategic plan shall be reviewed biennially and amended as necessary to reflect changes in priorities.  Amendments to the plan shall be reported to the general assembly included in the report established under subsection (d)(i) of this section.

(e)(1)(f)  The commissioner shall work with the director for the blueprint to facilitate timely progress in adoption and implementation of clinical quality and performance measures as indicated by the following benchmarks:

(1)  by July 1, 2007, clinical quality and performance measures are adopted for each of the chronic conditions included in the Medicaid Chronic Care Management Program.  These conditions include, but are not limited to, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes, and coronary artery disease.

(2)  at least one set of clinical quality and performance measures will be added each year and a uniform set of clinical quality and performance measures for all chronic conditions to be addressed by the blueprint will be available for use by health insurers and health care providers by January 1, 2010. 

(3)  in accordance with a schedule established by the blueprint executive committee, all clinical quality and performance measures are reviewed for consistency with those used by the Medicare program and updated, if appropriate. 

(g)  The commissioner shall work with the director of the blueprint to facilitate timely progress in coordination of chronic care management as indicated by the following benchmarks:

(1)  by October 1, 2007, risk stratification strategies are used to identify individuals with or at risk for chronic disease and to assist in the determination of the severity of the chronic disease or risk thereof, as well as the appropriate type and level of care management services needed to manage those chronic conditions.

(2)  by January 1, 2009, guidelines for promoting greater commonality, consistency, and coordination across health insurers in care management programs and systems are developed in consultation with employers, consumers, health insurers, and health care providers.  

(3)  beginning July 1, 2009, and each year thereafter, health insurers, in collaboration with health care providers, report to the commissioner on evaluation of their disease management programs and the progress made toward aligning their care management program initiatives with the blueprint guidelines. 

(h)(1)  No later than January 1, 2009, the commissioner shall, in consultation with employers, consumers, health insurers, and health care providers, complete a comprehensive analysis of sustainable payment mechanisms.  No later than January 1, 2009, the commissioner shall report to the health care reform commission and other stakeholders, his or her recommendations for sustainable payment mechanisms and related changes needed to support achievement of blueprint goals for health care improvement, including the essential elements of high quality chronic care, such as care coordination, effective use of health care information by physicians and other health care providers and patients, and patient self‑management education and skill development. 

(2)  By January 1, 2009, and each year thereafter, health insurers will participate in a coordinated effort to determine satisfaction levels of physicians and other health care providers participating in the blueprint care management initiatives, and will report on these satisfaction levels to the commissioner and in the report established under subsection (i) of this section.

(i)  The commissioner of health shall report annually, no later than

January 1, on the status of implementation of the Vermont blueprint for health for the prior calendar year, and shall provide the report to the house committee on health care, the senate committee on health and welfare, the health access oversight committee, and the commission on health care reform.  The report shall include the number of participating insurers, health care professionals and patients; the progress for achieving statewide participation in the chronic care management plan, including the measures established under subsection (c)(e) of this section; the expenditures and savings for the period; the results of health care professional and patient satisfaction surveys; the progress toward creation and implementation of privacy and security protocols; information on the progress made toward the requirements in subsections (g) and (h) of this section, and other information as requested by the committees.  The surveys shall be developed in collaboration with the executive committee established under subsection (b)(c) of this section.

(2)  If statewide participation in the blueprint for health is not achieved by January 1, 2009, the commissioner shall evaluate the blueprint for health and recommend to the general assembly changes necessary to create alternative measures to ensure statewide participation by health insurers, third party administrators, and health care professionals.

(j)  It is the intent of the general assembly that health insurers shall participate in the blueprint for health no later than January 1, 2009 and shall engage health care providers in the transition to full participation in the blueprint.  

Sec. 6.  Blueprint for Health: Plan for Regulatory

             Enforcement

(a)  Findings:

(1)  The blueprint for health is based on a voluntary collaborative approach which has to date achieved significant progress toward its goals. 

(2)  If, based on the commissioner’s annual report required by subsection 702(i) of Title 18, it appears that a voluntary approach is unlikely to meet the goal set forth in subsection 702(j) of Title 18, a regulatory approach will become necessary. 

(b)  The commissioner of banking, insurance, securities, and health care administration is directed to prepare an implementation plan, including recommendations for enhanced authority, outlining the steps necessary to ensure that health insurers will successfully implement the blueprint by January 1, 2009.  The implementation plan need not address Medicaid, the Vermont health access plan, Dr. Dynasaur, any Global Commitment for Health waiver program, any state‑funded pharmacy program, Catamount Health Assistance, or the employer‑sponsored‑insurance assistance program.  This plan should be delivered to the senate committee on health and welfare, the house committee on health care, and the commission on health care reform by January 1, 2008.

* * * Integrating Care Coordination and
Payment Reform into the Blueprint * * *

Sec. 7.  INTEGRATED EARLY IMPLEMENTATION OF BLUEPRINT
 PROGRAMS; APPROPRIATION

(a)(1)  Findings.

(A)  A core goal of the blueprint for health is to create a greater degree of cohesiveness in the delivery of care to people with chronic conditions.

(B)  Given the complexity of the health care delivery system, it is necessary to test, within a small number of early implementation communities, how to integrate the various key components of the chronic care model.

(C)  Health insurers currently assume the costs (both in claims costs and administrative expenses for existing disease management programs) for care coordination and for provider payment.

(2)  Purpose and intent it is the intent of the general assembly that all health insurers, including those who offer the state employees’ health plan or who administer chronic care management for state health benefits programs, shall voluntarily participate in early implementation projects.

(b)  The commissioner of health shall establish early implementation projects necessary to demonstrate and evaluate best practices in the integration and delivery of chronic care as part of the blueprint for health.  Projects shall include those listed in subsections (e), (f), and (g) of this section.  The commissioner shall develop the projects using the medical home project as the baseline and shall consider the options for community‑based care coordination described in subsection (f) and the options for payment reform described in subsection (g) of this section as options for the final design of the early implementation projects.  The commissioner shall, in designing these early implementation projects, integrate the other components of the blueprint such as patient self‑management, the use of decision support tools such as the chronic care information system, and the development of community resources. 

(c)  Early implementation projects shall meet the following criteria:

(1)  Communities.  The implementation should occur concurrently within one or more of the existing blueprint communities and, if the commissioner approves, in the Vermont rural health alliance.   

(2)  Timetable.  The program design, integration and implementation plan, and selection of the initial community for the early implementation projects should be completed by October 1, 2007.  Implementation in the initial community should be commenced by January 1, 2008.  Implementation into at least one additional community should begin by July 1, 2008. 

(3)  Evaluation.  The implementation plan should include ongoing structured feedback from the major stakeholders to help inform the implementation while it is occurring, and, as part of the annual report required by 18 V.S.A. § 702(i), a more formal evaluation after one year of operation.  During implementation, the commissioner shall collaborate with the commissioner of banking, insurance, securities, and health care administration to determine whether statewide implementation of the early implementation projects would have an impact on health insurance premium rates, and the extent to which implementation costs would be offset by reduced administration costs or savings in medical claims.   

(d)  Appropriation.  There is appropriated $185,000.00 from the global commitment fund to the department of health.  These funds shall be used to provide a grant to the Vermont rural health alliance for the early implementation projects described in this section, upon the approval by the commissioner and upon receipt of $185,000.00 by the alliance of federal grant or other matching funds.  In order to provide the funding for this grant, $75,831.00 in general funds and $109,169.00 in federal funds is appropriated to the agency of human services for the Global Commitment. 

(e)  Medical home project chronic care management systems integration.

(1)  The commissioner, in collaboration with the director of the office of Vermont health access, the commissioner of human resources, and the commissioner of banking, insurance, securities, and health care administration, shall establish a medical home project for use with Medicaid beneficiaries, Catamount Health, and the state employees’ health plan.  The commissioner shall also encourage other health insurers to participate in the project and adopt and pay similar care management fees.

(2)  The project shall facilitate provision of accessible, continuous, and coordinated family‑centered care to high‑need populations.  The project shall ensure that:

(A)  Medicaid, Catamount Health carriers, and the state employees’ health plan pay care management fees to primary care providers providing care management under the project and in compliance with subsection (e) of this section;

(B)  incentive payments for demonstrated compliance with established clinical protocols are paid to primary care providers participating in practices that provide services as a medical home.

(3)  The commissioner shall develop a care management fee schedule and shall determine the amount of care management and incentive payments. 

(4)  A primary care provider participating in the project shall:

(A)  Provide ongoing support, oversight, and guidance to implement a plan of care that provides an integrated, coherent, cross‑discipline plan for ongoing medical care developed in partnership with patients and including all other physicians furnishing care to the patient.  

(B)  Use evidence‑based medicine and clinical decision support tools to guide decision‑making at the point of care based on patient‑specific factors.

(C)  Use health information technology, which may include remote monitoring and patient registries, to monitor and track the health status of patients and to provide patients with enhanced and convenient access to health care services.

(D)  Encourage patients to engage in the management of their own health through education and community support systems, including the blueprint healthier living workshops or similar evidence‑based, self‑management tools. 

(5)  The commissioner shall include an evaluation of this project for the previous calendar year, with recommendations for expansion of the project, in the annual report required by 18 V.S.A. § 702(i). 

(6)  To the extent that it is not inconsistent with provisions herein, this section shall be construed in accordance with the terms and conditions of the Tax Relief and Health Care Act of 2006, Pub. L. No. 109‑432, § 204, 120 Stat 2922, 2987–89 (2006) (Medicare Medical Home Demonstration Project). 

(7)  For purposes of this subsection:

(A)  “Commissioner” shall mean the commissioner of health.

(B)  “Coordinated care management” is a system that includes at least the following components:

(i)  population identification processes;

(ii)  evidence‑based practice guidelines;

(iii)  collaborative practice models to include physician and support‑service providers;

(iv)  patient self‑management education, which may include primary prevention, behavior modification programs, and compliance surveillance;

(v)  process and outcome measurement, evaluation, and management; and

(vi)  routine reporting and sharing of information among the patient, primary care provider, ancillary providers, and health insurers.

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

(D)  “High‑need population” means individuals with chronic illnesses that require regular medical monitoring, advising, or treatment areas.

(E)  “Medical home” means a primary care provider practice that is responsible for:

(i)  targeting patients for participation in the project; and

(ii)  providing safe and secure technology to promote patient access to personal health information;

(iii)  developing a health assessment tool for the individuals targeted; and

(iv)  providing training programs for personnel involved in the coordination of care.

(F)  “Primary care provider” means a health care provider who:

(i)  is board certified, if applicable;

(ii)  provides first contact and continuous care for individuals under his or her care; and

(iii)  has staff and resources sufficient to manage the comprehensive and coordinated health care of each such individual.

(f)  Community‑based care coordination.

(1)  The commissioner of health shall encourage the development of community‑based care coordination teams, which will provide local support to primary care providers in a community, particularly those serving as medical homes to patients with chronic conditions.  Such teams will collaborate with the medical home practices to:

(A)  Devise care plans through assessment of current treatments, services, and resources that directly address patients’ needs.

(B)  Ensure patient compliance with the care plan and monitor appropriate emergency room use, hospitalizations, length of stay, and discharge planning.

(C)  Strive to enhance the relationship between the patient and his or her medical home, and to educate patients on how to become more proactive in meeting their own health care needs.

(D)  Utilize community‑based resources, where feasible, to support the formation of care plans, to ensure compliance with such care plans, and to enhance patient education.

(2)  The commissioner, in collaboration with the director of the office of Vermont health access, the commissioner of banking, insurance, securities, and health care administration, and health insurers, as defined in section 9402 of Title 18, shall examine methods of funding, including the use of funds from existing disease management programs, to support community based care coordination teams.

(g)  Chronic care payment reform.  In addition to the care management fee and incentive payments to be made pursuant to the medical home project required by subsection (e) of this section, the commissioner of health should consider other payment reforms in the early implementation of blueprint programs, such as: 

(1)  A bundled payment provided on a monthly basis that includes 90 percent of the cost associated with providing all evidence‑based preventive services for the applicable chronic disease state, as developed in the blueprint.  Additional payments of up to 10 percent could be provided in cases where all of the recommended evidence‑based preventive services are provided.

(2)  Separate fee‑for‑service payments for office visits (Payments for care management services that fall outside the office visit should not result in a reduction in payments for office visits.).

(3)  Other projects designed to set payment based on the quality of the outcome, which may include projects such as shared savings for reductions in hospitalizations associated with physician‑coordinated care management in the office setting.

* * * Support for Primary Care Providers * * *

Sec. 8.  PRIMARY CARE PROVIDERS; NURSE AUTHORITY STUDY;
 AHEC APPROPRIATION

(a)  Findings:

(1)  Primary care providers are essential to the success of the blueprint.

(2)  Loan repayment is an essential component of recruiting and retaining a strong primary care provider workforce. 

(b)  No later than September 1, 2007, the commissioner of health, the director of the office of professional regulation, and the board of nursing shall establish a work group to study and make recommendations on the advisability of eliminating the requirement for an advance practice nurse to work in a collaborative practice with a licensed physician, with the goal of evaluating whether advance practice nurses might serve a greater role as primary care providers who provide essential chronic care management.  The work group shall include a representative of the Vermont Nurse practitioner association and a representative of the medical practice board.  The work group shall make its recommendations in a report delivered to the house committee on health care, the senate committee on health and welfare, and the commission on health care reform no later than January 15, 2008. 

Sec. 9.  18 V.S.A. § 9409 is amended to read:

§ 9409.  HEALTH CARE PROVIDER BARGAINING GROUPS

(a)  The commissioner may approve the creation of one or more health care provider bargaining groups, consisting of health care providers who choose to participate.  A bargaining group is authorized to negotiate, on behalf of all participating providers, with the commissioner, the secretary of human services or, the commissioner of human resources, or the commissioner of labor with respect to any matter in this chapter; chapters 9 and 11 of Title 21; chapter 21 of Title 3, and chapter 19 of Title 33, in regard to provider regulation, provider reimbursement or quality of health care.

(b)  The commissioner shall adopt by rule criteria for forming and approving bargaining groups, and criteria and procedures for negotiations authorized by this section.

(c)  The rules relating to negotiations shall include a nonbinding arbitration process to assist in the resolution of disputes.  Nothing in this section shall be construed to limit the authority of the commissioner, the commissioner of labor, the commissioner of human resources, or the secretary of human services to reject the recommendation or decision of the arbiter.

Sec. 10.  18 V.S.A. § 9409a is added to read:  

§ 9409a.  Health care insurance reimbursement survey

In order to understand the impact of reimbursement on access to health care, the cost shift, the workforce shortages and recruitment and retention of health care professionals, the commissioner shall annually survey health insurers to determine the reimbursement paid for the ten most common billing codes for primary care health services.  Each insurer shall report the average reimbursement paid for a specific service.  The survey shall be managed by the department of banking, insurance, securities, and health care administration, and any public reports shall be sufficiently aggregated so that they would not enable readers to determine the amount of reimbursement paid for specific services to any particular provider or facility.  No provider‑specific or facility‑specific reimbursement information shall be included in the public survey reports, or be available through public records requests.  When published, survey data will be at least 90 days old.  Only the department will have access to the underlying survey responses.  The department shall provide a copy of the survey results to the house committee on health care and the senate committee on health and welfare.


Sec. 11.  3 V.S.A. § 631 is amended to read:

§ 631.  GROUP INSURANCE FOR STATE EMPLOYEES; SALARY

            DEDUCTIONS FOR INSURANCE, SAVINGS PLANS, AND

            CREDIT UNIONS

(a)(1)  The secretary of administration may contract on behalf of the state with any insurance company or nonprofit association doing business in this state to secure the benefits of franchise or group insurance.  Beginning July 1, 1978, the terms of coverage under the policy shall be determined under section 904 of this title, but it may include:

(A)  life, disability, health, and accident insurance and benefits for any class or classes of state employees; and

(B)  hospital, surgical, and medical benefits for any class or classes of state employees or for those employees and any class or classes of their dependents.

* * *

(c)(1)  At least every five years, the secretary of administration shall advertise for bids on the insurance contracts and shall award the contract to the person whose bid or quotation is in the best interest of the state.  The secretary of administration may reject any bids or quotations and may request additional bids.

(2)  Annually, the secretary of administration shall submit a report to the house committee on health care and the senate committee on health and welfare that includes:

(A)  an assessment of the state of alignment between chronic care management programs provided to state employees through the health coverage benefit and the Vermont blueprint for health strategic plan developed under section 702 of Title 18;

(B)  the results of provider satisfaction assessments, which shall be designed to evaluate whether the contractor for administrative services for health benefits has created and maintained adequate provider networks and has entered into participating provider agreements designed to effectively and efficiently compensate providers for services consistent with the blueprint for health.

(C)  if the secretary determines that provider satisfaction levels are creating a barrier to successful implementation of the blueprint for health for the state employees health plan, an action plan to improve provider satisfaction relative to the blueprint implementation and institute changes to the chronic care management program. 

* * *


* * * Health Information Technology Fund * * *

Sec. 12.  22 V.S.A. § 903 is added to read:

§ 903.  HEALTH INFORMATION TECHNOLOGY

(a)  The commissioner shall facilitate the development of a statewide health information technology plan that includes the implementation of an integrated electronic health information infrastructure for the sharing of electronic health information among health care facilities, health care professionals, public and private payers, and patients.  The plan shall include standards and protocols designed to promote patient education, patient privacy, physician best practices, electronic connectivity to health care data, and, overall, a more efficient and less costly means of delivering quality health care in Vermont.

(b)  The health information technology plan shall:

(1)  support the effective, efficient, statewide use of electronic health information in patient care, health care policymaking, clinical research, health care financing, and continuous quality improvements;

(2)  educate the general public and health care professionals about the value of an electronic health infrastructure for improving patient care;

(3)  promote the use of national standards for the development of an interoperable system, which shall include provisions relating to security, privacy, data content, structures and format, vocabulary, and transmission protocols;

(4)  propose strategic investments in equipment and other infrastructure elements that will facilitate the ongoing development of a statewide infrastructure;

(5)  recommend funding mechanisms for the ongoing development and maintenance costs of a statewide health information system, including funding options and an implementation strategy for a loan and grant program;

(6)  incorporate the existing health care information technology initiatives in order to avoid incompatible systems and duplicative efforts;

(7)  integrate the information technology components of the blueprint for health established in chapter 13 of Title 18, the global clinical record, and all other Medicaid management information systems being developed by the office of Vermont health access, information technology components of the quality assurance system, the program to capitalize with loans and grants electronic medical record systems in primary care practices, and any other information technology initiatives coordinated by the secretary of administration pursuant to section 2222a of Title 3; and

(8)  address issues related to data ownership, governance, and confidentiality and security of patient information.

(c)(1)  The commissioner shall contract with the Vermont information technology leaders (VITL), a broad‑based health information technology advisory group that includes providers, payers, employers, patients, health care purchasers, information technology vendors, and other business leaders, to develop the health information technology plan, including applicable standards, protocols, and pilot programs.  In carrying out their responsibilities under this section, members of VITL shall be subject to conflict of interest policies established by the commissioner to ensure that deliberations and decisions are fair and equitable.

(2)  VITL shall be designated in the plan to operate the exclusive

statewide health information exchange network for this state, notwithstanding the provisions of subsection (g) of this section requiring the recommendation of the commissioner and the approval of the general assembly before the plan can take effect.  Nothing in this section shall impede local community providers from the exchange of electronic medical data.

(d)  The following persons shall be members of VITL:

(1)  the commissioner, who shall advise the group on technology best practices and the state’s information technology policies and procedures, including the need for a functionality assessment and feasibility study related to establishing an electronic health information infrastructure under this section;

(2)  the director of the office of Vermont health access or his or her designee;

(3)  the commissioner of health or his or her designee; and

(4)  the commissioner of banking, insurance, securities, and health care administration or his or her designee.

(e)  On or before July 1, 2006, VITL shall initiate a pilot program involving at least two hospitals using existing sources of electronic health information to establish electronic data sharing for clinical decision support, pursuant to priorities and criteria established in conjunction with the health information technology advisory group.

(1)  Objectives of the pilot program shall include:

(A)  supporting patient care and improving quality of care;

(B)  enhancing productivity of health care professionals and reducing administrative costs of health care delivery and financing;

(2)  Objectives of the pilot program may include:

(A)  determining whether and how best to expand the pilot program on a statewide basis;

(B)  implementing strategies for future developments in health care technology, policy, management, governance, and finance; and

(C)  ensuring patient data confidentiality at all times.

(f)  The standards and protocols developed by VITL shall be no less stringent than the “Standards for Privacy of Individually Identifiable Health Information” established under the Health Insurance Portability and Accountability Act of 1996 and contained in 45 C.F.R., Parts 160 and 164, and any subsequent amendments.  In addition, the standards and protocols shall ensure that there are clear prohibitions against the out‑of‑state release of individually identifiable health information for purposes unrelated to treatment, payment, and health care operations, and that such information shall under no circumstances be used for marketing purposes.  The standards and protocols shall require that access to individually identifiable health information is secure and traceable by an electronic audit trail.

(g)  On or before January 1, 2007, VITL shall submit to the commission on health care reform, the secretary of administration, the commissioner, the commissioner of banking, insurance, securities, and health care administration, the director of the office of Vermont health access, the senate committee on health and welfare, and the house committee on health care a preliminary health information technology plan for establishing a statewide, integrated electronic health information infrastructure in Vermont, including specific steps for achieving the goals and objectives of this section.  A final plan shall be submitted July 1, 2007.  The plan shall include also recommendations for self‑sustainable funding for the ongoing development, maintenance, and replacement of the health information technology system.  Upon recommendation by the commissioner and approval by the general assembly, the plan shall serve as the framework within which certificate of need applications for information technology are reviewed under section 9440b of Title 18 by the commissioner.

(h)  Beginning January 1, 2006, and annually thereafter, VITL shall file a report with the commission on health care reform, the secretary of administration, the commissioner, the commissioner of banking, insurance, securities, and health care administration, the director of the office of Vermont health access, the senate committee on health and welfare, and the house committee on health care.  The report shall include an assessment of progress in implementing the provisions of this section, recommendations for additional funding and legislation required, and an analysis of the costs, benefits, and effectiveness of the pilot program authorized under subsection (e) of this section, including, to the extent these can be measured, reductions in tests needed to determine patient medications, improved patient outcomes, or reductions in administrative or other costs achieved as a result of the pilot program.  In addition, VITL shall file quarterly progress reports with the secretary of administration and the health access oversight committee and shall publish minutes of VITL meetings and any other relevant information on a public website.

(i)  VITL is authorized to seek matching funds to assist with carrying out the purposes of this section.  In addition, it may accept any and all donations, gifts, and grants of money, equipment, supplies, materials, and services from the federal or any local government, or any agency thereof, and from any person, firm, or corporation for any of its purposes and functions under this section and may receive and use the same, subject to the terms, conditions, and regulations governing such donations, gifts, and grants.

(j)  The commissioner, in consultation with VITL, may seek any waivers of federal law, of rule, or of regulation that might assist with implementation of this section.

(k)  VITL, in collaboration with the commissioner, health insurers, the Vermont Association of Hospitals & Health Systems, Inc., and other departments and agencies of state government, shall establish a loan and grant program to provide for the capitalization of electronic health records systems in blueprint communities and at other primary care practices serving low and moderate income Vermonters.  Health information technology acquired under a grant or loan authorized by this section shall comply with data standards for interoperability adopted by VITL and the state health information technology plan.  An implementation plan for this loan and grant program shall be incorporated into the state health information technology plan.

Sec. 13.  HEALTH INFORMATION TECHNOLOGY INTERIM FUND

               AND ELECTRONIC HEALTH RECORD PILOT PROGRAM

(a)  Purpose.  It is the intent of the general assembly that use of electronic health records for all Vermonters shall be promoted and encouraged.  The general assembly recognizes that the use and sharing of electronic health records has the potential to improve the quality of care delivered to Vermonters and, in the long term, to help contain increases in the costs of medical care.  Since many providers, especially primary care providers serving low and moderate income Vermonters, lack the capital to acquire the information technology necessary to implement electronic health records for their patients, a financing program is needed to facilitate the adoption of electronic health record use by providers. 

(b)  For the purposes of this section:

(1)  “Commissioner” shall mean the commissioner of the department of information and innovation.

(2)  “Department” shall mean the department of information and innovation.

(3)  “Pilot site” shall mean a blueprint community and primary care providers serving low and moderate income Vermonters in other communities. 

(c)  VITL shall establish a health information technology fund which shall be used only during the duration of the electronic health record pilot program described in this section.  The interim fund shall be used for the purposes of:

(1)  encouraging and facilitating the development and utilization of electronic health records by pilot sites; and

(2)  promoting the sharing of electronic health records using the Vermont health information infrastructure created and managed by the Vermont health technology leaders.  

(d)  VITL and the secretary of administration shall engage in activities designed to achieve the goal of raising at least $1 million for the interim fund created by this section and shall seek to raise these funds from a broad range of stakeholders who would benefit from electronic health records, including commercial health insurers, in relation to the number of insured and self‑insured lives each services in Vermont, the Vermont Association of Hospitals & Health Systems, Inc., self‑insured employers, other payers, and other sources.  On or before September 1, 2007, VITL and the secretary of administration shall report the results of the fundraising activities to the house committee on health care, the senate committee on health and welfare and the commission on health care reform. 

(e)  On or before October 1, 2007, VITL shall issue a request for proposals:

(1)  to provide computer software or systems, or both, in connection with the development and implementation of a system to enable electronic health records use by pilot sites; and

(2)  for implementation consulting vendors to assist pilot sites with related training and system configuration support and upgrades to enable the implementation and use of electronic health record systems.  

(f)  On or before November 1, 2007, VITL shall establish criteria and award conditions for the selection of pilot sites. 

(g)  On or before January 1, 2008, VITL shall commence awarding pilot sites licenses to implement electronic health record systems making use of the vendors selected in the process described in subsection (d) of this section. 

(h)  VITL shall include in the annual report required pursuant to section 9417 of Title 18 information concerning the interim fund and pilot program created pursuant to this section and shall additionally provide that report to the commissioner of the department of health.  Information concerning this program in the report shall include:

(1)  an assessment of progress in implementing the provisions of this section including the acceptance of electronic health record use by providers, patients, and payers;

(2)  recommendations for additional funding and legislation required; and

(3)  an analysis of the costs, benefits, and effectiveness of the health information technology fund.    

(i)  VITL may use a portion of the interim fund for its costs in implementing and managing the electronic health record pilot program.

Sec. 14.  REPEAL

18 V.S.A. § 9417 (health information technology) is repealed.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us