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SENATE PROPOSAL OF AMENDMENT 2007-2008

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H.229

 

An act relating to corrections and clarifications to the health care affordability act of 2006 and related legislation

The Senate proposes to the House to amend the bill as follows:

First:  By striking out Sec. 11 in its entirety and inserting in lieu thereof a new Sec. 11 to read:

Sec. 11.  33 V.S.A. § 1974(b) and (c) are amended to read:

(b)  VHAP‑eligible premium assistance.

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(3)  The agency shall determine whether it is cost‑effective to the state to enroll an individual in an approved employer‑sponsored insurance plan with the premium assistance under this subsection as compared to enrolling the individual in the Vermont health access plan.  If the agency determines that it is cost‑effective, the individual shall be required to enroll in the approved employer‑sponsored plan as a condition of continued assistance under this section or coverage under the Vermont health access plan, except that dependents who are children of eligible individuals shall not be required to enroll in the premium assistance program.  Notwithstanding this requirement, an individual shall be provided benefits under the Vermont health access plan until the next open enrollment period offered by the employer or insurer.  The agency shall not consider the medical history, medical conditions, or claims history of any individual for whom cost‑effectiveness is being evaluated.

(c)  Uninsured individuals; premium assistance.

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(5)  The agency shall determine whether it is cost‑effective to the state to require the individual to purchase the approved employer‑sponsored insurance plan with premium assistance under this subsection instead of Catamount Health established in section 4080f of Title 8 with assistance under subchapter 3a of chapter 19 of this title.  If providing the individual with assistance to purchase Catamount Health is more cost‑effective to the state than providing the individual with premium assistance to purchase the individual’s approved employer‑sponsored plan, the state shall provide the individual the option of purchasing Catamount Health with assistance for that product.  An individual may purchase Catamount Health and receive Catamount Health assistance until the approved employer‑sponsored plan has an open enrollment period, but the individual shall be required to enroll in the approved employer‑sponsored plan in order to continue to receive any assistance.  The agency shall not consider the medical history, medical conditions, or claims history of any individual for whom cost‑effectiveness is being evaluated.

Second:  By striking out Sec. 24 in its entirety and inserting in lieu thereof new Secs. 24 and 24a to read:

Sec. 24.  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 primary care practices serving low 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. 24a.  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 have 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 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 income Vermonters in other communities. 

(c)  Vermont information technology leaders 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 information 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 (e) 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 health.  Information in the report concerning this program 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.

Third:  In Sec. 27, 21 V.S.A. § 2002(3), by striking out the following:  “under either a private or a public plan” and inserting in lieu thereof the following:  under either a private plan or any public plan that is not supported by state funding

Fourth:  In Sec. 27, 21 V.S.A. § 2002(6), by striking out the figure “25” and inserting in lieu thereof the figure 30

Fifth:  By adding four new sections to be numbered Secs. 32, 33, 34, and 35 to read as follows:

Sec. 32.  3 V.S.A. § 2222a(c)(2) is amended to read:

(2)  The Vermont health information technology project pursuant to section 9417 of Title 18 903 of Title 22.

Sec. 33.  18 V.S.A. § 9416(a) is amended to read: 

(a)  The commissioner shall contract with the Vermont Program for Quality in Health Care, Inc. to implement and maintain a statewide quality assurance system to evaluate and improve the quality of health care services rendered by health care providers of health care facilities, including managed care organizations, to determine that health care services rendered were professionally indicated or were performed in compliance with the applicable standard of care, and that the cost of health care rendered was considered reasonable by the providers of professional health services in that area.  The commissioner shall ensure that the information technology components of the quality assurance system are incorporated into and comply with the statewide health information technology plan developed under section 9417 of this title 903 of Title 22 and any other information technology initiatives coordinated by the secretary of administration pursuant to section 2222a of Title 3.

Sec. 34.  18 V.S.A. § 9437 is amended to read: 

§ 9437.  CRITERIA

A certificate of need shall be granted if the applicant demonstrates and the commissioner finds that:

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(7)  if the application is for the purchase or lease of new health care information technology, it conforms with the health information technology plan established under section 9417 of this title 903 of Title 22, upon approval of the plan by the general assembly.

Sec. 35.  18 V.S.A. § 9440b is amended to read: 

§ 9440b.  INFORMATION TECHNOLOGY; REVIEW PROCEDURES

Notwithstanding the procedures in section 9440 of this title, upon approval by the general assembly of the health information technology plan developed under section 9417 of this title 903 of Title 22, the commissioner shall establish by rule standards and expedited procedures for reviewing applications for the purchase or lease of health care information technology that otherwise would be subject to review under this subchapter.  Such applications may not be granted or approved unless they are consistent with the health information technology plan and the health resource allocation plan.  The commissioner’s rules may include a provision requiring that applications be reviewed by the health information advisory group authorized under subsection 9417(c) of this title section 903 of Title 22.  The advisory group shall make written findings and a recommendation to the commissioner in favor of or against each application.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us