H.861 AN ACT RELATED TO HEALTH CARE

AFFORDABILITY FOR VERMONTERS

COMPARISON

As Passed the House	As Passed Senate	Conference Report
Chronic Care Initiatives – Substantially similar. Focus on statewide chronic care initiatives to ensure Vermonters receive the appropriate care at the appropriate time. Blueprint for Health – develop the initiative & move to statewide implementation Medicaid, the Vermont Health Access Plan & Dr. Dynasaur – contract out services and chronic care management
Catamount Health Method of administration – self-insured w/ discretion on reinsurance Benefit package – based on state employees Who can purchase – uninsured Vermont resident; sliding scale premiums up to 350% of FPL ($34,300 annually for 1 person); full price over that income. Payment levels – Medicare + 10%	Catamount Health Method of administration – option of fully insured product or self-insured with mandatory reinsurance Benefit package – based on Blue Cross Blue Shield plan (12% less) Who can purchase – uninsured Vermont resident, sliding scale premiums up to 300% of FPL ($29,400 annually for 1 person); full price over that income. Any Vermont resident may receive minimum preventive care (immunizations) Excludes adults who are claimed as a dependent on an out-of-state resident’s tax return Adds enrollment limitation or cap provision Payment levels: Medicare +10% for health care professionals; Cost +10% for hospitals	Catamount Health Method of administration – fully insured product; legislative review of final program – both insurance product and assistance program April 1, 2007 Benefit package – similar to Senate proposal – PPO, $250 individual deductible; specifies family deductibles and out-of-pocket maximums Who can purchase  - Same as Senate proposal; sliding scale premiums established through Catamount Health Assistance Immunizations administered by department of health Enrollment cap for Catamount Health assistance Same as Senate
		Catamount Health Assistance Premium and cost-sharing assistance for individuals under 300% of FPL Covers deductibles and cost-sharing for chronic care services Enrollment cap required if eboard determines appropriation is not sufficient to support enrollment
Medicaid Reimbursement Increases Medicaid reimbursement for primary care services to Medicare levels in FY 2007	Medicaid Reimbursement · Increases Medicaid reimbursements more broadly · Adds a Hospitals reimbursement increase	Medicaid Reimbursements Clarifications in hospital reimbursements Removes incentive payments for participation in the Blueprint, because Blueprint has funding to provide these. Sec. 10 added to indicate this.
Premium Assistance Program; Employer-Sponsored Insurance Information gathered about individuals' availability to purchase employer-sponsored plans.	Premium Assistance Program; Employer-Sponsored Insurance Individuals enrolled or eligible for VHAP and Catamount Health will participate in certain employer-sponsored insurance plans, if available, with premium assistance to offset the cost Employer plans must be substantially similar to Catamount Health	Premium Assistance Program; Employer-Sponsored Insurance Senate version except: Allows more flexibility on what employer plans may be approved for individuals in VHAP, but provides protection for individuals by wrapping benefits and cost-sharing For individuals with income over VHAP amounts and under 300% of FPL, ensures the employer plans will be substantially similar to Catamount Health, but allows time for chronic care programs to improve to Catamount Health level. Enrollment cap required if eboard determines appropriation is not sufficient to support enrollment
	Hospital Uncompensated Care Policies Recommend uniform statewide policy May recommend deviations or set of policies Recommend reporting changes to ensure fair and thorough method of reporting uncompensated care Method of calculating Information about patients using policy	Same as Senate
	Nongroup Market Security Trust Provides reinsurance for insurers in nongroup market to cover 5% of the claims cost – reduces cost of insurance.	Same as Senate
Review required coverage Review in 2010; considers mandate in 2011	Required coverage Individual mandate in 2011 if 98% of Vermonters are not insured	Required coverage House version; determined by the Commission.
Financing Cigarette Tax Increase Increases the cigarette tax by .60 cents New Tobacco Settlement Funds Global Commitment	Financing Employers’ Health Care Premium Contribution Assessed quarterly by department of labor on FTE uncovered employees; Exemption for 3 FTEs FY 2007 $91.25 per FTE per quarter Uncovered employee means an employee of an employer who does not offer to pay part of health care costs; an employee who is not eligible for health care offered by employer& an uninsured employee Effective January 1, 2007, payable April 30, 2007 Cigarette and Tobacco Taxes · Increases cigarette tax by 60 cents in 2006 & 80 cents in 2008; Taxes little cigars & roll-your-own tobacco as cigarettes · Changes method of taxing moist snuff from 41% of the wholesale price to per ounce; increase in 2008 -17 cents Global Commitment – uses less than House.	Financing Employers’ Health Care Premium Contribution Increased exemptions to 8 in first 2 years (2007 & 2008); 6 in 2009 & 4 in 2010 Other financing same as senate.
Common Sense Initiatives
As Passed Senate	As Passed House	Conference Report
WELLNESS INITIATIVES – Healthy Lifestyles Insurance Discount
· Authorizes small group and nongroup carriers, including Blue Cross Blue Shield and HMOs, to offer financial incentives worth up to 20% of the premium to beneficiaries who adhere to programs of health promotion and disease prevention · Commissioner adopts rules applicable to the discounts	· Changes maximum discount to 15% in nongroup and small group markets. · Same · Caps sum of wellness discount/reward and existing allowable deviation from community rates at 30%	House version adopted
ADMINISTRATIVE SIMPLIFICATION
Common claims and procedures Work group shall form, with providers, insurers, OVHA, DOH, business groups, consumers, and BISHCA Group will make recommendations for simplifying the claims administration Report  to the governor and general assembly due 1/15/08 concerning work agreed on and recommended future actions and any cost savings Commissioner of BISHCA may amend the common claims rule based on the recommendations	Common claims and procedures Same members Same; Also, group will look at procedural issues relating to the prior authorization process and reimbursement to providers for services rendered prior to being credentialed by an insurer Work group must report its progress to the legislature and governor by 1/15/07 BISHCA must amend the rule if needed to implement group’s recommendations Chair of the work group will be responsible for coordinating the group’s meetings and work	House version adopted
Common Credentialing for Providers Authorizes BISHCA to prescribe the credentialing form to be used by hospitals and insurers, which shall be the form used by the Council for Affordable Quality Health Care or a similar nationally recognized form.  The requirement would begin 1/1/07 Hospitals and insurers would have to notify the provider within 30 days if the credentialing application form is incomplete and would have to notify the provider of the status of the application not later than 60 days after submission and every 30 days after that  Gives commissioner of BISHCA enforcement authority against insurers and hospitals for noncompliance H.607 expanded to apply to hospital credentialing of providers as well as the insurer credentialing of providers	House version the same	House and Senate the same
Multi‑payer Database and Consumer Price and Quality Information Adds objective of improving quality and affordability of patient health care and coverage Requires reporting to multi-payer database from health insurers, third party administrators, pharmacy benefit managers, and the state health plan, as well as Medicaid and Medicare, as allowed Adds prices and quality of health care to what commissioner may require to be reported Gives VITL and VPQHC access to data consistent with BISHCA rules Requires BISHCA to develop system to use data to provide consumers transparent price and quality information, which it may do incrementally, beginning with the data consumers would find most useful and understandable   Large health insurers must also file a plan for providing price and quality information to consumers	House version the same	House and Senate the same;   appropriation of $400,000 same in House, Senate, and conference agreement
Master Provider Index – not in Senate version	Master Provider Index AHEC and work group  will make recommendations for the creation of a master provider index which will allow identification and cross-reference of providers in the information technology work via a common set of data fields Work group will be composed of representatives of AHEC, VITL, providers, insurers, VPQHC, and state government including BISHCA  The group will provide cost and time estimates The group will develop recommendations for the governance of the index and its relationship to other state health information data systems Report and recommendations 1/15/07	Not in Senate version House version adopted