Download this document in MS Word format
BILL AS PASSED HOUSE AND SENATE 2007-2008

AutoFill Template

H.531

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, 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) of this section.  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.  DIRECTOR OF THE BLUEPRINT

In fiscal year 2008, there is established in the agency of administration one (1) new exempt position, to be titled the director of the blueprint for health, who shall report directly to the secretary or designee.  

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 director of the blueprint, in collaboration with the commissioner of health, shall oversee the development and implementation of the blueprint for health, including the five‑year strategic plan.  Whenever private health insurers are concerned, the director shall collaborate with the commissioner of banking, insurance, securities, and health care administration.

(b)(c)(1)  The commissioner secretary 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 the commissioner of health, 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.

(f)  The director of the blueprint shall 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 director of the blueprint shall 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 secretary 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 director 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 director 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 director and in the report established under subsection (i) of this section.

(d)(1)(i)  The commissioner of health director 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  director’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

(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 director 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 director 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 director 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 director 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 director shall consult 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)  For fiscal year 2008, the department of health shall 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 by the alliance of $185,000.00 of federal grant or other matching funds. 

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

(1)  The director, with assistance from the commissioner of health, 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 director 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 director, with assistance from the commissioner of health, 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 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 director 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)  “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.

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

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

(D)  “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.

(E)  “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 director 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 director, supported by the commissioner of health, the director of the office of Vermont health access, and the commissioner of banking, insurance, securities, and health care administration, and in collaboration with 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 director 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. § 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. 10.  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.  Upon publication of the request for proposals, health care professional and trade associations may register with the secretary of administration to be provided a list of bidders.  Such associations may then submit information about the business practices of the bidders for the secretary of administration to consider in the course of evaluating bids and request meetings with the secretary to discuss the information. 

(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 status 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, developed in consultation with health care professional and trade associations, the blueprint director, and the commissioner of health, which assessments 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 delivering services in a manner consistent with the blueprint for health principles.

(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.  Prior to the secretary’s determination, health care professional and trade associations may request the opportunity to meet with the secretary to review and discuss the results of the provider satisfaction assessments.

(3)  At least annually, the secretary shall hold discussions with established health care professional and trade associations in regard to provider regulation, provider reimbursement, or quality of health care. 

* * *

* * * Other Provisions * * *

Sec. 11.  33 V.S.A. § 1986(d) is amended to read:

(d)  All monies received by or generated to the fund shall be used only as allowed by appropriation of the general assembly for the administration and delivery of the Catamount Health assistance program under this subchapter, employer‑sponsored insurance premium assistance under section 1974 of this title, immunizations under section 1130 of Title 18 the nongroup health insurance market assistance under section 4062d of Title 8, and for transfers to the state health care resources fund established in section 1901d of this title as approved by the general assembly, and development and implementation of the blueprint for health under section 702 of Title 18.

Sec. 12.  33 V.S.A. § 1974(c)(3) is amended to read:

(3)  The premium assistance program under this subsection shall provide a subsidy of premiums or cost-sharing amounts based on the household income of the eligible individual, with greater amounts of financial assistance provided to eligible individuals with lower household income and lesser amounts of assistance provided to eligible individuals with higher household income.  Until an approved employer-sponsored plan is required to meet the standard in subdivision (4)(B)(ii) of this subsection, the subsidy shall include premium assistance and assistance to cover all cost-sharing amounts for chronic care health services covered by the Vermont health access plan that are related to evidence-based guidelines for ongoing prevention and clinical management of the chronic condition specified in the blueprint for health in section 702 of Title 18.  

Sec. 13.  8 V.S.A. § 4080f(f)(1) is amended to read:

(f)(1)  Except as provided for in subdivision (2) of this subsection, the carrier shall pay a health care professionals using professional the lowest of the health care professional’s contracted rate, the health care professional’s billed charges, or the rate derived from the Medicare payment methodologies, at a level ten percent greater than for levels paid under the Medicare program in 2006.  Payments based on Medicare payment methodologies under this subsection shall be indexed to the Medicare economic index developed by the Centers for Medicare and Medicaid Services.

Sec. 14.  REPEAL

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

Sec. 15.  MENTAL HEALTH AND OTHER NON-PHYSICIAN PROVIDER

               Reimbursement surveys

(a)  In order to understand the impact of reimbursement on access to mental health care providers, the cost shift, the workforce shortages, and recruitment and retention of health care professionals, the commissioner of banking, insurance, securities, and health care administration shall administer a one-time survey of health insurers to determine the reimbursement paid for the ten most common billing codes for mental health services, along with differences in reimbursement based on the provider’s level of education or licensure.  Each insurer shall report the average reimbursement paid for a specific service for each applicable provider level of education or licensure. 

(b)  In order to understand the impact of reimbursement on access to other non-physician health care providers, the cost shift, the workforce shortages, and recruitment and retention of health care professionals, the commissioner of banking, insurance, securities, and health care administration shall administer a one-time survey of health insurers to determine the reimbursement paid for the most common billing codes for non-physician health care provider services.   Each insurer shall report the average reimbursement paid for a specific service for each provider level of education or licensure, when applicable.  The department may limit the survey to a total of 20 billing codes except that it shall ensure that the survey includes reimbursement for at least two common billing codes for each major class of provider. 

(c)  The surveys shall be managed by the department of banking, insurance, securities, and health care administration.  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.  Only the department will have access to the underlying survey responses.  Neither survey shall include hospital reimbursements.

(d)  No later than December 15, 2008, the department shall provide the results of the surveys to the commission on health care reform, the house committees on health care and human services, and the senate committee on health and welfare.   In addition, the department shall also provide the results of the survey conducted pursuant to subsection (a) to the mental health oversight committee.


Sec. 16.  STUDY ON RETROACTIVE ELIGIBILITY FOR PHARMACY

               PROGRAMS

(a)  The commissioner for children and families shall analyze the costs and benefits of providing coverage from the date of application for those applying for any state-funded pharmacy program, provided all conditions of eligibility were met as of such date. 

(b)  The commissioner shall consult with the medical care advisory committee in performing this analysis and shall report his or her findings to the health access oversight committee no later than November 15, 2007.  The report should include an explanation of why, if at all, there should be any disparate treatment in this regard between applicants for VHAP and applicants for pharmacy programs.

Sec. 17.  EFFECTIVE DATE

     Secs. 4 and 13 of this act shall take effect upon passage.  All other sections shall take effect July 1, 2007. 



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us