|
The Committee on Health , to which was referred Senate
Bill S.310, entitled "AN ACT RELATING TO COMMON SENSE INITIATIVES IN
HEALTH CARE "
respectfully report that they have met and considered the
same and recommend that the House propose to the Senate that the bill be
amended by striking all after the enacting clause and inserting in lieu thereof
the following:
* * * WELLNESS INITIATIVES * * *
* * * Healthy Lifestyle
Insurance Discount * * *
Sec. 1. 8 V.S.A. § 4080a(h) is amended to read:
(h)(1)
A registered small group carrier shall use a community rating method acceptable
to the commissioner for determining premiums for small group plans. Except as
provided in subdivision (2) of this subsection, the following risk classification
factors are prohibited from use in rating small groups, employees, or
members of such groups, and dependents of such employees or members:
(A)
demographic rating, including age and gender rating;
(B)
geographic area rating;
(C)
industry rating;
(D)
medical underwriting and screening;
(E)
experience rating;
(F)
tier rating; or
(G)
durational rating.
(2)(A) The commissioner shall, by rule, adopt
standards and a process for permitting registered small group carriers to use
one or more risk classifications in their community rating method, provided
that the premium charged shall not deviate above or below the community rate
filed by the carrier by more than 20 percent (20%), and provided further
that the commissioner’s rules may not permit any medical underwriting
and screening.
(B) The commissioner’s regulations shall permit a
carrier, including a hospital or medical service corporation and a health
maintenance organization, to establish rewards, premium discounts, rebates, or
otherwise waive or modify applicable co-payments, deductibles, or other
cost-sharing amounts in return for adherence by a member or subscriber to
programs of health promotion and disease prevention. The commissioner shall
consult with the commissioner of health and the director of the office of Vermont
health access in the development of health promotion and disease prevention
regulations. Such regulations shall:
(i) limit any reward, discount, rebate, or waiver or
modification of cost-sharing amounts to not more than 15 percent of the cost of
the premium for the applicable coverage tier;
(ii) be designed to promote good health or prevent
disease for individuals in the program and not be used as a subterfuge for
imposing higher costs on an individual based on a health factor;
(iii) provide that the reward under the program is
available to all similarly situated individuals; and
(iv) provide a reasonable alternative standard to
obtain the reward to any individual for whom it is unreasonably difficult due
to a medical condition or other reasonable mitigating circumstance to satisfy
the otherwise applicable standard for the discount and disclose in all plan
materials that describe the discount program the availability of a reasonable
alternative standard.
(C) The commissioner’s regulations shall include:
(i) standards and procedures for health promotion and
disease prevention programs based on the best scientific, evidence-based
medical practices as recommended by the commissioner of health;
(ii) standards and procedures for evaluating an
individual’s adherence to programs of health promotion and disease prevention;
and
(iii) any other standards and procedures necessary or
desirable to carry out the purposes of this subdivision (2).
(3)
The commissioner may exempt from the requirements of this section an
association as defined in section subdivision 4079(2) of this
title which:
(A)
offers a small group plan to a member small employer which is community rated
in accordance with the provisions of subdivisions (1) and (2) of this
subsection. The plan may include risk classifications in accordance with
subdivision (2) of this subsection;
(B)
offers a small group plan that guarantees acceptance of all persons within the
association and their dependents; and
(C)
offers one or more of the common health care plans approved by the commissioner
under subsection (e) of this section.
(4)
The commissioner may revoke or deny the exemption set forth in subdivision (3)
of this subsection if the commissioner determines that:
(A)
because of the nature, size, or other characteristics of the association
and its members, the employees, or members are in need of the
protections provided by this section; or
(B)
the association exemption has or would have a substantial adverse effect on the
small group market.
Sec. 2. 8 V.S.A. § 4080b(h) is amended to read:
(h)(1)
A registered nongroup carrier shall use a community rating method acceptable to
the commissioner for determining premiums for nongroup plans. Except as
provided in subdivision (2) of this subsection, the following risk
classification factors are prohibited from use in rating individuals and their
dependents:
(A)
demographic rating, including age and gender rating;
(B)
geographic area rating;
(C)
industry rating;
(D)
medical underwriting and screening;
(E)
experience rating;
(F)
tier rating; or
(G)
durational rating.
(2)(A)
The commissioner shall, by rule, adopt standards and a process for permitting
registered nongroup carriers to use one or more risk classifications in their
community rating method. After July 1, 1993, provided that the
premium charged shall not deviate above or below the community rate filed by
the carrier by more than 40 percent (40%) for two years, and thereafter
20 percent (20%). Such rules may not permit, and provided further
that the commissioner’s regulations may not permit any medical underwriting
and screening and shall give due consideration to the need for affordability
and accessibility of health insurance.
(B) The commissioner’s regulations shall permit a
carrier, including a hospital or medical service corporation and a health
maintenance organization, to establish rewards, premium discounts, rebates, or
otherwise waive or modify applicable co-payments, deductibles, or other
cost-sharing amounts in return for adherence by a member or subscriber to
programs of health promotion and disease prevention. The commissioner shall
consult with the commissioner of health and the director of the office of Vermont
health access in the development of health promotion and disease prevention
regulations. Such regulations shall:
(i) limit any reward, discount, rebate, or waiver or
modification of cost-sharing amounts to not more than 15 percent of the cost of
the premium for the applicable coverage tier;
(ii) be designed to promote good health or prevent
disease for individuals in the program and not be used as a subterfuge for
imposing higher costs on an individual based on a health factor;
(iii) provide that the reward under the program is
available to all similarly situated individuals; and
(iv) provide a reasonable alternative standard to
obtain the reward to any individual for whom it is unreasonably difficult due
to a medical condition or other reasonable mitigating circumstance to satisfy
the otherwise applicable standard for the discount and disclose in all plan
materials that describe the discount program the availability of a reasonable
alternative standard.
(C) The commissioner’s regulations shall include:
(i) standards and procedures for health promotion and
disease prevention programs based on the best scientific, evidence-based
medical practices as recommended by the commissioner of health;
(ii) standards and procedures for evaluating an
individual’s adherence to programs of health promotion and disease prevention;
and
(iii) any other standards and procedures necessary or
desirable to carry out the purposes of this subdivision (2).
Sec. 3. 8 V.S.A. § 4516 is amended to read:
§ 4516. ANNUAL REPORT TO COMMISSIONER
Annually,
on or before March 15, a hospital service corporation shall file with the
commissioner of banking, insurance, securities, and health care administration
a statement sworn to by the president and treasurer of the corporation showing
its condition on December 31. The statement shall be in such form and contain
such matters as the commissioner shall prescribe. To qualify for the tax
exemption set forth in section 4518 of this title, the statement shall include
a certification that the hospital service corporation operates on a nonprofit
basis for the purpose of providing an adequate hospital service plan to
individuals of the state, both groups and nongroups, without discrimination
based on age, gender, geographic area, industry, and medical history, except
as allowed by subdivisions 4080a(h)(2)(B) and 4080b(h)(2)(B) of this title.
Sec. 4. 8 V.S.A. § 4588 is amended to read:
§ 4588. ANNUAL REPORT TO COMMISSIONER
Annually,
on or before March 15, a medical service corporation shall file with the
commissioner of banking, insurance, securities, and health care administration
a statement sworn to by the president and treasurer of the corporation showing
its condition on December 31, which shall be in such form and contain such
matters as the commissioner shall prescribe. To qualify for the tax exemption
set forth in section 4590 of this title, the statement shall include a
certification that the medical service corporation operates on a nonprofit
basis for the purpose of providing an adequate medical service plan to individuals
of the state, both groups and nongroups, without discrimination based on age,
gender, geographic area, industry, and medical history, except as allowed by
subdivisions 4080a(h)(2)(B) and 4080b(h)(2)(B) of this title.
Sec. 5. 8 V.S.A. § 5115 is
amended to read:
§ 5115. DUTY OF NONPROFIT
HEALTH MAINTENANCE
ORGANIZATIONS
Any
nonprofit health maintenance organization subject to this chapter shall offer
nongroup plans to individuals in accordance with section 4080b of this title
without discrimination based on age, gender, industry, and medical
history, except as allowed by subdivisions 4080a(h)(2)(B) and 4080b(h)(2)(B)
of this title.
* * * Community Grants * * *
Sec.
6. CoORDINATED Healthy Activity,
Motivation,
and Prevention Programs
(a) The department of health initiative known as
“champps,” coalition for healthy activity, motivation, and prevention programs,
shall serve as the foundation for the community wellness initiatives within the
department.
(b)
The secretary of human services shall compile an inventory of existing state
programs or initiatives, including those administered by other agencies, that
fund or promote health, recreation, wellness, or like efforts, along with the
amount of funds allotted to the program or initiative, the source of the funds,
and the period for which the funds will be available. The secretary shall file
the inventory with the senate committee on health and welfare and the house
committees on human services and on health care no later than December 15,
2006.
(c)
It is the intent of the legislature that the base funding for the department of
health programs on healthy aging and fit and healthy kids, the base funding
for community grants as part of the blueprint for health program, $500,000.00
of the grant funds received by the department of health from the U.S.
Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration and potentially other programs as identified
from the inventory to be prepared pursuant to subsection (b) above, be
incorporated into the community health and wellness grant fund program in
fiscal year 2008, through the budget process.
Sec.
7. 18 V.S.A. § 104b is added to read:
§ 104b. COMMUNITY HEALTH AND WELLNESS GRANTS
(a) The commissioner shall establish a program for
awarding competitive, substantial, multi-year grants to comprehensive community
health and wellness projects. Successful projects must:
(1) use comprehensive approaches designed to promote
healthy behavior and disease prevention across the community and across the
lifespan of individual Vermonters and address issues which may include
promoting nutrition and exercise for children, community recreation programs,
elderly wellness, lead poisoning abatement, obesity prevention, maternal and
child health and immunization, mental health and substance abuse, and tobacco
prevention and cessation.
(2) be consistent with the blueprint for health and
other state health initiatives as well as the overall goals of the applicant
community;
(3) be goal and outcome driven;
(4) use strategies that have been demonstrated to be
effective in reaching the desired outcome; and
(5) provide data for evaluating and monitoring
progress.
(b) The commissioner shall assist community projects
by:
(1) providing technical assistance;
(2) providing access to best and promising practices and
approved public policies,
(3) helping projects obtain and maximize funding from
all applicable sources;
(4) providing other assistance as appropriate.
(c)(1) No later than September 1, 2006,
the commissioner shall establish a grant committee, which the commissioner or
deputy commissioner shall chair, that shall consist of:
(A) the commissioner of education or designee; the
commissioner for children and families or designee; the secretary of
agriculture, food and markets or designee; the commissioner of disabilities,
aging, and independent living or designee; and the director of health access or
designee;
(B)
a representative from the Vermont school boards association;
(C)
a representative from the Vermont league of cities and towns;
(D)
two members of the senate appointed by the committee on committees and two
members of the house appointed by the speaker of the house;
(E)
the administrator of the Vermont tobacco evaluation and review board or designee; and
(F)
a member of the governor’s commission on healthy aging; and
(G)
six individuals appointed by the governor representing local communities,
collaboratives, or coalitions.
(2)
For attendance at meetings which are held when the general assembly is not in
session, the legislative members of the committee shall be entitled to the same
per diem compensation and reimbursement for necessary expenses as those
provided to members of standing committees under 2 V.S.A. § 406.
(d)
The grant committee shall, consistent with this section:
(1)
design comprehensive project parameters, including criteria for evaluating the
success of community projects;
(2)
create an integrated funding framework;
(3)
determine grant application criteria and procedures that are
community-friendly, including use of a single, simple grant application and
simple reporting requirements;
(4)
develop criteria for preparation grants designed to enable a community to obtain
initial funds for the purpose of preparing the community for application for a
full grant;
(5)
encourage and facilitate private participation in community projects; and
(6)
write requests for proposals to request grant applications;
(7)
review and score grant applications and recommend to the commissioner which
grants to fund and in what amount for grant funding to begin no later than July
1, 2007, all of which shall be done without participation from the legislative
members of the committee;
(e)
By January 15 of each year, the commissioner shall report on the status of the
program to the general assembly, the senate committee on health and welfare,
and the house committees on human services and on health care.
(f)
The commissioner may adopt regulations pursuant to chapter 25 of Title 3,
the administrative procedure act, necessary for the implementation of this
program.
(g)
The commissioner is authorized to accept donations or contributions from
private sources for community wellness grants.
* * * Medical Event Reporting * * *
Sec.
8. 18 V.S.A. § 1905(19) is added to read:
(19) All hospitals shall comply with the regulations
adopted by the commissioner pursuant to section 1912 of this title. License
applications shall certify compliance with the regulations.
Sec.
9. 18 V.S.A. § 1912 is added to read:
§ 1912. PATIENT SAFETY SURVEILLANCE AND IMPROVEMENT
SYSTEM
(a)
As used in this section:
(1) “Adverse event” is any untoward incident, therapeutic misadventure, iatrogenic injury, or
other undesirable occurrence directly associated with care or services provided
by a health care provider or health care facility.
“Causal analysis” means a formal
root cause analysis, similar analytic methodologies or any similarly effective
but simplified processes that use a systematic approach to identify the basic
or causal factors that underlie the occurrence or possible occurrence of a
reportable adverse event, adverse event, or near miss.
(3) “Commissioner” means the commissioner of health.
(4) “Corrective action plan” means a plan to implement
strategies intended to eliminate or significantly reduce the risk of a
recurrence of an adverse event and to measure the effectiveness of such
strategies.
(5) “Department” means the department of health.
(6) “Hospital” shall have the same meaning as in
subdivision 1902(1) of this title.
(7) “Health care provider” shall have the same meaning as
in subdivision 9402(8) of this title.
(8) "Intentional unsafe act" shall mean an adverse event or near miss that results from:
(A)
a criminal act;
(B)
a purposefully unsafe act;
(C)
alcohol or substance abuse; or
(D)
patient abuse.
(9)“Near miss” means any process variation that did not
affect the outcome, but for which a recurrence carries a significant chance of
a serious adverse outcome.
(10) “Reportable adverse event”
means those adverse events a hospital is required to report to the department pursuant
to regulations adopted under subsection (c) of this section.
(11) “Safety system” means the comprehensive patient
safety surveillance and
improvement system established pursuant to this section and the regulations
adopted hereunder.
(12) “Serious bodily injury”
means bodily injury that creates
a substantial risk of death or that causes substantial loss or impairment of
the function of any bodily member or organ or substantial impairment of health
or substantial disfigurement.
(b)
The commissioner shall establish a comprehensive patient safety surveillance
and improvement system for the purpose of improving patient safety, eliminating
adverse events in Vermont hospitals, and supporting and facilitating quality
improvement efforts by hospitals. The department may contract with a qualified
organization having expertise in patient safety to develop and implement all or
part of the safety system.
(c) The commissioner shall promulgate regulations
pursuant to chapter 25 of Title 3 necessary for the implementation of this
program. The regulations shall list reportable adverse events, which shall
include the “serious reportable events” published by the National Quality
Forum. The commissioner shall consult with experts and hospitals when making
changes to the list of reportable adverse events and shall consider the
implications of reporting requirements that may be established as a result of
the federal Patient Safety and Quality Improvement Act of 2005. The department
shall consult with other regulatory agencies and departments and, to the extent
possible, avoid imposing duplicative reporting requirements.
(d) The department shall:
(1) collect data concerning the occurrence of
reportable adverse events;
(2) aggregate and analyze data for the purpose of
developing and implementing strategies to target and eliminate specific adverse
events;
(3) verify that hospitals are in compliance with all
the requirements of this section and regulations adopted hereunder;
(4) for reportable adverse events, verify that
hospitals are conducting causal analyses and developing corrective action plans
consistent with standards set by the department, current patient safety
science, and relevant clinical standards;
(5) provide technical assistance or assist hospitals
in locating technical assistance resources for analyzing adverse events and
near misses and developing and implementing corrective action plans; and
(6) encourage hospitals to utilize anonymous
in-hospital reporting when possible.
(e) The regulations adopted hereunder shall require
hospitals to:
(1) develop, maintain, and implement internal
policies and procedures that meet the standards of the department to:
(A) identify, track, and analyze reportable adverse
events, adverse events, and near misses;
(B) determine what type of causal analysis, if any,
is appropriate;
(C) conduct causal analyses and develop corrective
action plans; and
(D)
disclose to patients, or, in the case of a
patient death, an adult member of the immediate family, at a minimum, adverse
events that cause death or serious bodily injury.
(2) report reportable adverse events to the department.
(3) provide the department with copies of its causal
analysis and corrective action plan in connection with each reportable adverse
event.
(4) for reportable adverse events that must also by
law be reported to other departments or agencies, notify the department of
health or provide a copy of any written report and provide any causal analysis
information required by the department. Such reports shall not constitute a
waiver of peer review or any other privilege.
(5) for the purpose of evaluating a hospital’s
compliance with the provisions of this section, provide the commissioner and
designees reasonable access to:
(A) information protected by the provisions of the
patient’s privilege under subsection 1612(a) of Title 12 or otherwise required
by law to be held confidential; and
(B) the minutes and records of a peer review
committee and any other information subject to peer review protection under
section 1443 of Title 26. Hospitals may replace health care provider
identifying information with a surrogate identifier that allows for tracking of
adverse events involving the same provider without disclosing the provider’s
identity.
(f)(1)
A hospital shall notify the department, within the time frames established by
regulation, if the information available supports a reasonable, good faith
belief that an intentional unsafe act as it pertains to patients has occurred.
(2)
For intentional unsafe acts reportable to other departments or agencies, notify
the department of health or provide a copy of any written report. Such reports
shall not constitute a waiver of peer review or any other privilege.
(3)
If the department confirms or independently concludes, based on a reasonable,
good faith belief, that an intentional unsafe act occurred, it shall notify
relevant state and federal licensing and other regulatory entities and, in the
case of possible criminal activity, relevant state and federal law enforcement
authorities.
(4)
There shall be no liability on the part of and no cause of action for damages
shall arise against any individual or hospital for any act or proceeding
related to activities undertaken or performed within the scope of the
obligations imposed by this subsection, provided that the individual or hospital
acts without malice and with the reasonable belief that the action is warranted
by the facts known after making reasonable efforts to obtain all the facts.
(5) Nothing in this subsection shall prevent a
hospital from conducting its own investigation or peer review.
(g)(1) All
information made available to the department and its designees under this
section shall be confidential and privileged, exempt from the public access to
records law, and in any civil or administrative action against a provider of
professional health services arising out of the matters which are subject to
evaluation and review by the department, immune from subpoena or other
disclosure and not subject to discovery or introduction into evidence. No
person with access to information made available to the commissioner or his or
her designees under this section shall be permitted or required to testify as
to any findings, recommendations, evaluations, opinions, or other actions of
the department in any civil or administrative action against a provider of
professional health services arising out of the matters which are subject to
evaluation and review by the department. Within the department, access to peer
review protected information shall be limited to individuals responsible for
verifying compliance with the safety system and for providing necessary
consultation and supervision to that program.
(2) Notwithstanding subdivision (1) of this
subsection:
(A) hospitals and the department staff responsible
for verifying compliance with the safety system are authorized to disclose
information necessary to comply with their reporting obligations in subsection
(f) of this section;
(B) the department staff responsible for verifying
compliance with the patient safety surveillance and improvement system may
disclose information to others in the department, and the department may
disclose information to the board of health and others responsible for carrying
out the department’s enforcement responsibilities with respect to this section
if the department reasonably believes that a hospital deliberately or
repeatedly has not complied with the requirements of this section and any
regulations adopted hereunder. The commissioner, the board of health, and
others responsible for carrying out the department’s enforcement
responsibilities with respect to this section are authorized to disclose such
information during the course of any legal or regulatory action taken against a
hospital for deliberate or repeated noncompliance with the requirements of this
section and any regulations adopted hereunder. Information disclosed under
this subdivision shall otherwise maintain all applicable protections under
subdivision (1) of this subsection and otherwise provided by law.
(3) Nothing in this section shall prohibit a hospital
from making a good faith report to regulatory or law enforcement authorities
based on information, documents, or records known or available to it from
original sources. Information, documents, or records otherwise available from
original sources are not to be construed as immune from discovery or use in any
other action merely because they were made available to the department’s
patient safety surveillance and improvement system.
(h) The commissioner shall consult with the
commissioner of banking, insurance, securities, and health care administration,
and with patient safety experts, hospitals, health care professionals, and
members of the public and shall make recommendations to the commissioner of
banking, insurance, securities, and health care administration concerning which
patient
safety data should be included
in the hospital community reports required by section 9405b of this title. The
commissioner shall make such recommendations no more than 18 months after data collection
is initiated.
(i) If the commissioner determines that a hospital
has failed to comply with any of the provisions of this section, the
commissioner may sanction the hospital as provided in this title. In
evaluating compliance, the commissioner shall place primary emphasis on
assuring good faith compliance and effective corrective action by the facility,
reserving punitive enforcement or disciplinary action for those cases in which
the facility has displayed recklessness, gross negligence, or willful
misconduct or in which there is evidence, based on other similar cases known to
the department, the agency of human services, or the office of the attorney
general, of a pattern of significant substandard performance that has the
potential for or has actually resulted in harm to patients.
(j) After notice and an opportunity for hearing, the
commissioner may impose on a hospital who knowingly violates a provision of
this subchapter or a rule or order adopted pursuant to this subchapter a civil
administrative penalty of no more than $10,000.00 or, in the case of a
continuing violation, a civil administrative penalty of no more than
$100,000.00 or one-tenth of one percent of the gross annual revenues of the
health care facility, whichever is greater. A hospital aggrieved by a decision
of the commissioner under this subdivision may appeal the commissioner’s
decision pursuant to section 128 of this title.
(k) The authority granted to the commissioner under
this section is in addition to any other authority granted to the commissioner
under law.
(1) The commissioner may retain or contract with such
additional professional or other staff as needed to carry out responsibilities
under this section.
(m) No later than January 15, 2008, the commissioner of health shall provide an interim report
to the senate committee on health and welfare and the house committees on human
services and on health care on the status of the safety system, its
effectiveness in improving patient safety
and health care quality in the state, and cost savings. No later than January
15, 2009, the commissioner shall make a final report to those committees on
those subjects and shall make recommendations regarding expansion of the system
to include health care facilities other than hospitals.
(n) Beginning July 1, 2007,
expenses incurred for development and implementation of the safety
system shall be borne as follows: 50 percent from general fund monies and 50
percent by the hospitals.
Sec. 10. 26 V.S.A. § 1443(b)
and (c) are amended to read:
(b)
Notwithstanding the provisions of subsection (a) of this section, a peer review
committee shall provide a board with all supporting information and evidence
pertaining to information required to be reported under section 1317 of this title
and shall provide access to such information and evidence to the department
of health as provided in and for the purpose of determining a hospital’s
compliance with section 1912 of Title 18.
(c)
Notwithstanding the provisions of section 1318 of this title, relating to
accessibility and confidentiality of disciplinary matters, the proceedings,
reports, records, reporting information, and evidence of a peer review
committee provided by the committee to a board in accordance with the
provisions of section 1317 of this title or to the department of health in
accordance with section 1912 of Title 18 and subsection (b) of this section,
may be used by the board or by the commissioner of health or board of health
for disciplinary and enforcement purposes but shall not be subject to
public disclosure.
Sec.
11. 1 V.S.A. § 317(c) is amended to read:
(c) The following public
records are exempt from public inspection and copying:
* * *
(34) affidavits of income and
assets as provided in section 662 of Title 15 and Rule 4 of the Vermont
Rules for Family Proceedings;
* * *
(36) records provided to
the department of health pursuant to the patient safety surveillance and
improvement system established by section 1912 of Title 18.
* * * Hospital Infection Rate Reporting * * *
Sec. 12. 18 V.S.A. § 9405b(a) is amended to read:
§ 9405b. HOSPITAL
COMMUNITY REPORTS
(a) The commissioner, in
consultation with representatives from the public oversight commission,
hospitals, and other groups of health care professionals, and members
of the public representing patient interests, shall adopt rules
establishing a standard format for community reports, as well as the contents,
which shall include:
(1) measures of quality,
including process and outcome measures, that are valid, reliable, and
useful, including comparisons to appropriate national benchmarks for high
quality and successful outcomes;
(2) measures of patient
safety that are valid, reliable, and useful, including comparisons to
appropriate industry benchmarks for safety;
(3) measures of
hospital-acquired infections that are valid, reliable, and useful, including
comparisons to appropriate industry benchmarks;
(3)(4)
measures of the hospital’s financial health, including comparisons to
appropriate national benchmarks for efficient operation and fiscal health;
(4)(5) a
summary of the hospital’s budget, including revenue by source and
quantification of cost shifting to private payers;
(5)(6)
measures that provide valid, reliable, useful, and efficient information for
payers and the public for the comparison of charges for higher volume health
care services;
(6)(7) the
hospital’s process for achieving openness, inclusiveness, and meaningful public
participation in its strategic planning and decision-making;
(7)(8) the
hospital’s consumer complaint resolution process, including identification of
the hospital officer or employee responsible for its implementation;
(8)(9)
information concerning recently completed or ongoing quality improvement and
patient safety projects;
(9)(10) a
summary of the community needs assessment, including a description of strategic
initiatives discussed with or derived from the assessment; the one-year and
four-year capital expenditure plans; and the depreciation schedule for existing
facilities; and
(10)(11)
information on membership and governing body qualifications, a listing of the
current governing body members, and means of obtaining a schedule of meetings
of the hospital’s governing body, including times scheduled for public participation.
* * * Administrative Simplification * * *
Sec. 13. COMMON CLAIMS AND PROCEDURES
(a)
No later than July 1, 2008, the commissioner shall amend the rules adopted
pursuant to section 9408 of Title 18 as may be necessary to implement the recommendations
of the final report described in subsection (g) of this section, as the
commissioner deems appropriate in his or her discretion. Nothing in this
section shall be construed to alter the commissioner’s authority under Title 8
or chapter 221 of Title 18.
(b)
No later than July 1, 2006, a common claims and procedures work group shall
form, composed of:
(1)
two representatives selected by the Vermont association of
hospitals and health systems;
(2)
two representatives selected by the Vermont medical society;
(3)
one representative of each of the three largest health care insurers;
(4)
the director of the office of health access or designee;
(5)
two representatives from business groups appointed by the governor;
(6)
the health care ombudsman or designee;
(7)
one representative of consumers appointed by the governor; and
(8)
the commissioner of the department of banking, insurance, securities and health
care administration or designee.
(c)
The group shall design, recommend, and implement steps to achieve the following
goals:
(1)
Simplifying the claims administration process for consumers, health care
providers, and others so that the process is more understandable and less
time-consuming.
(2)
Lowering administrative costs in the health care financing system.
(d)
The group shall elect a chair at its first meeting. The chair, or the chair's
designee, shall be responsible for scheduling meetings and ensuring the
completion of the reports called for in subsection (g) of this section. Each
organization represented on the work group shall be asked to contribute funds
for the group's administrative costs.
(e)
On or before September 1, 2006, the work group shall present a two‑year work
plan and budget to the house committee on health care and the senate
committee on health and welfare.
(f)
This work plan may include the elements of the claims administration process,
including claims forms, patient invoices, and explanation of benefits forms,
payment codes, claims submission and processing procedures, including
electronic claims processing, issues relating to the prior authorization
process and reimbursement for services provided prior to being credentialed.
(g)
The work group shall make an interim report to the governor and the general
assembly on or before January 15,
2007 describing the progress of
the group and any interim steps taken to achieve the goals of the work plan.
The work group shall make a final report to the governor and the general
assembly on or before January 15, 2008 with the findings that illustrate the
outcomes of implementations derived from the work group actions along with a
list of future actions and goals, which shall specify cost savings achieved and
expected future savings.
Sec. 14. 18 V.S.A. § 9408a is added to read:
§ 9408a. Uniform Provider
Credentialing
(a)
Definitions. As used in this section:
(1)
“Credentialing” means a process through which an insurer or hospital makes a
determination, based on criteria established by the insurer or hospital,
concerning whether a provider is eligible to:
(A)
provide health care services to an insured or hospital patients; and
(B)
receive reimbursement for the health care services.
(2)
“Health care services” means health‑care‑related services or
products rendered or sold by a provider within the scope of the provider’s
license or legal authorization, including hospital, medical, surgical, dental,
vision, and pharmaceutical services or products.
(3)
“Insured” means an individual entitled to reimbursement for
expenses of health care
services under a policy issued or administered
by an insurer.
(4)
“Insurer” has the same meaning as in subdivision 9402(9) of this title.
(5)
“Provider” has the same meaning as in subdivision 9402(8) of this title.
(b)
The department shall prescribe the credentialing application form used by the
Council for Affordable Quality Healthcare (CAQH), or a similar, nationally
recognized form prescribed by the commissioner, in electronic or paper format,
which must be used beginning January 1, 2007 by an insurer or a hospital that
performs credentialing.
(c)
An insurer or a hospital shall notify a provider concerning a deficiency on a
completed credentialing application form submitted by the provider not later
than 30 business days after the insurer or hospital receives the completed
credentialing application form.
(d)
An insurer or a hospital shall notify a provider concerning the status of the
provider’s completed credentialing application not later than:
(1)
Sixty days after the insurer or hospital receives the completed
credentialing application
form; and
(2)
Every 30 days after the notice is provided under subdivision (1) of this
subsection, until the insurer or hospital makes a final credentialing
determination concerning the provider.
(e)
The commissioner may enforce compliance with the provisions of this section as
to insurers and as to hospitals as if the hospital were an insurer under
section 3661 of Title 8.
* * * INFORMATION TECHNOLOGY * * *
* * * Coordination of IT Efforts * * *
Sec.
15. 3 V.S.A. § 2222a is added to read:
§ 2222a. HEALTH CARE SYSTEM REFORM; IMPROVING QUALITY AND AFFORDABILITY
(a) The secretary of administration, working in
collaboration with the general assembly, shall be responsible for the
coordination of health care system reform initiatives among executive branch
agencies, departments, and offices.
(b) The secretary shall ensure that those executive
branch agencies, departments, and offices responsible for the development,
improvement, and implementation of Vermont’s health care system reform do so in a manner that is
timely, patient-centered, and seeks to improve the quality and affordability of
patient care.
(c) Vermont’s
health care system reform initiatives include:
(1) the state’s chronic care infrastructure, disease
prevention, and management program contained in the blueprint for health, the
goal of which is to achieve a unified, comprehensive, statewide system of care
that improves the lives of Vermonters with or at risk for chronic disease.
(2) the Vermont health information technology project pursuant to section 9417 of Title 18.
(3) the multi-payer data collection project pursuant
to section 9410 of Title 18.
(4) the common claims administration project pursuant
to section 9408 of Title 18.
(5) the consumer price and quality information system
pursuant to section 9410 of Title 18.
(6) any information technology work done by the
quality assurance system pursuant to section 9416 of Title 18.
(7) the
public health promotion programs of the department of health and the department
of disabilities, aging, and independent living.
(8) Medicaid, the Vermont health access plan, Dr.
Dynasaur, VPharm, and Vermont Rx, which are established in chapter 19 of Title
33 and provide health care coverage to elderly,
disabled, and low to middle income Vermonters.
(d) The secretary shall report to the commission on
health care reform, the health access oversight committee, the house committee
on health care, the senate committee on health and welfare, and the governor on
or before December 1, 2006 with a five-year strategic plan for implementing
Vermont’s health care system reform initiatives, together with any recommendations
for administration or legislation. Annually, beginning January 15, 2007, the secretary shall report to the general assembly on the progress of
the reform initiatives.
(e) The secretary of administration or designee shall
provide information and testimony on the activities included in this section to
the health access oversight committee, the commission on health care reform,
and to any legislative committee upon request.
Sec. 16. AGENCY OF
HUMAN SERVICES INFORMATION
TECHNOLOGY
Sec. 17. 18 V.S.A. §
9416(a) is amended to read:
§ 9416. VERMONT
PROGRAM FOR QUALITY IN HEALTH CARE
Sec. 18. 18 V.S.A. § 9417 is amended to read:
§ 9417. 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; and
(5) recommend funding
mechanisms for the ongoing development and maintenance costs of a statewide
health information system;
(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 project in the
department of health, 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 electronic medical record systems in primary care
practices with loans and grants, 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) 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 in the
certificate of need regulations to ensure that deliberations and decisions are
fair and equitable.
(d) The following persons
shall be members of VITL:
(1) the commissioner of
information and innovation, 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; and
(3) the commissioner of
health or his or her designee; and
(3)(4) the
commissioner 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. Objectives
of the pilot program may include:
(1) Objectives of the
pilot program shall include:
(A) supporting patient care and improving quality of
care;
(2)(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:
(3)(A)
determining whether and how best to expand the pilot program on a statewide
basis;
(4)(B)
implementing strategies for future developments in health care technology,
policy, management, governance, and finance; and
(5)(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 secretary of administration, the
commissioner, the commissioner of information and innovation, the director of
the office of Vermont health access, and the general assembly 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 this title by the commissioner.
(h) Beginning January 1, 2006, and
annually thereafter, VITL shall file a report with the secretary of
administration, the commissioner, the commissioner of information and
innovation, the director of the office of Vermont health access, and the general assembly. 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. In addition, VITL shall file quarterly
progress reports with the secretary of administration, 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, 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, rule, or
regulation that might assist with implementation of this section.
(k) The commissioner, in
collaboration with VITL and other departments and agencies of state government,
shall establish a loan and grant program to provide for the capitalization of
electronic medical records systems at primary care practices. 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.
* * * Multi-Payer Database and
Consumer Price and Quality Information * * *
Sec. 19. 18 V.S.A. § 9410 is
amended to read:
§ 9410. HEALTH CARE DATA
BASE DATABASE
(a)(1)
The commissioner shall establish and maintain a unified health care data base
to enable the commissioner to carry out the duties under this chapter and Title
8, including:
(1)(A)
Determining the capacity and distribution of existing resources.
(2)(B)
Identifying health care needs and informing health care policy.
(3)(C)
Evaluating the effectiveness of intervention programs on improving patient
outcomes.
(4)(D)
Comparing costs between various treatment settings and approaches.
(5)(E)
Providing information to consumers and purchasers of health care.
(F) Improving the quality and affordability of patient
health care and health care coverage.
(2)(A) The
program authorized by this section shall include a consumer health care price
and quality information system designed to make available to consumers
transparent health care price information, quality information, and such other
information as the commissioner determines is necessary to empower individuals,
including uninsured individuals, to make economically sound and medically
appropriate decisions.
(B)
The commissioner shall convene a working group composed of the commissioner of
health, the director of the office of Vermont health access, health care
consumers, the office of the health care ombudsman, employers and other payers,
health care providers and facilities, the Vermont program for quality in health
care, health insurers, and any other individual or group appointed by the
commissioner to advise the commissioner on the development and implementation
of the consumer health care price and quality information system.
(C)
The commissioner may require a health insurer covering at least five percent of
the lives covered in the insured market in this state to file with the
commissioner a consumer health care price and quality information plan in
accordance with regulations adopted by the commissioner.
(D)
The commissioner shall adopt such regulations as are necessary to carry out
the purposes of this subdivision. The commissioner’s regulations may permit
the gradual implementation of the consumer health care price and quality
information system over time, beginning with health care price and quality
information that the commissioner determines is most needed by consumers or
that can be most practically provided to the consumer in an understandable
manner. The regulations shall permit health insurers to use security measures
designed to allow subscribers access to price and other information without
disclosing trade secrets to individuals and entities who are not subscribers.
The regulations shall avoid unnecessary duplication of efforts relating to price
and quality reporting by health insurers, health care providers, health care
facilities, and others, including activities undertaken by hospitals pursuant
to their community report obligations under section 9405b of this title.
* * *
(c)
Health insurers, health care providers, health care facilities and governmental
agencies shall file reports, data, schedules, statistics, or other
information determined by the commissioner to be necessary to carry out the
purposes of this section. Such information may include:
(1)
health insurance claims and enrollment information used by health insurers;
(2)
information relating to hospitals filed under subchapter 7 of this chapter
(hospital budget reviews); and
(3)
any other information relating to health care costs, prices, quality, utilization,
or resources required to be filed by the commissioner.
* * *
(h)(1) Data Collection and
Information Sharing. All health insurers shall electronically provide to the
commissioner in accordance with standards and procedures adopted by the
commissioner by rule:
(A) their encrypted
health insurance claims data;
(B) cross-matched claims data
on requested members, subscribers, or policyholders; and
(C) member, subscriber, or
policyholder information necessary to determine third party liability for
benefits provided.
(2) The collection, storage,
and release of health care data and statistical information that is subject to
the federal requirements of the Health Insurance Portability and Accountability
Act (“HIPAA”) shall be governed exclusively by the rules adopted thereunder in
45 CFR Parts 160 and 164.
(A) All health insurers that
collect the Health Employer Data and Information Set (HEDIS) shall annually
submit the HEDIS information to the commissioner in a form and in a manner
prescribed by the commissioner.
(B) All health insurers shall
accept electronic claims submitted in Centers for Medicare and Medicaid
Services format for UB-92 or HCFA-1500 records, or as amended by the Centers
for Medicare and Medicaid Services.
(3)(A) The commissioner shall
collaborate with the agency of human services and participants in agency of
human services initiatives in the development of a comprehensive health care
information system. The collaboration is intended to address the formulation
of a description of the data sets that will be included in the comprehensive
health care information system, the criteria and procedures for the development
of limited use data sets, the criteria and procedures to ensure that HIPAA
compliant limited use data sets are accessible, and a proposed time frame for
the creation of a comprehensive health care information system.
(B) To the extent allowed by
HIPAA, the data shall be available as a resource for insurers, employers,
providers, purchasers of health care, and state agencies to continuously review
health care utilization, expenditures, and performance in Vermont and
to enhance the ability of Vermont consumers and employers to make informed and
cost-effective health care choices.
In presenting data for public access, comparative considerations shall be made
regarding geography, demographics, general economic factors, and institutional
size.
(C) Consistent with the
dictates of HIPAA, and subject to such terms and conditions as the commissioner
may prescribe by regulation, the Vermont information technology leaders (VITL)
shall have access to the
database for use in the
development of a statewide health information technology plan pursuant to
section 9417 of this title, and the Vermont program for quality in health care
shall have access to the
database for use in improving the
quality of health care services in Vermont.
(C)(D)
Notwithstanding HIPAA or any other provision of law, the comprehensive health
care information system shall not include or publicly disclose
any data that contains direct personal identifiers. For the purposes of this
section, “direct personal identifiers” include information relating to an
individual that contains primary or obvious identifiers, such as the
individual’s name, street address, e-mail address, telephone number, and Social
Security number.
(i)(1)
As used in this section, and without limiting the meaning of subdivision
9402(9) of this title, the term “health insurer” includes:
(A)
any entity defined in subdivision 9402(9) of this title;
(B)
any third party administrator, any pharmacy benefit manager, any entity
conducting administrative services for business, and any other similar entity
with claims data, eligibility data, provider files, and other information relating
to health care provided to Vermont resident, and health care provided by
Vermont health care providers and facilities required to be filed by a health
insurer under this section;
(C)
any health benefit plan offered or administered by or on behalf of the state of
Vermont or an agency or instrumentality of the state; and
(D)
any health benefit plan offered or administered by or on behalf of the federal
government with the agreement of the federal government.
(2)
The commissioner may adopt rules to carry out the provisions of this
subsection, including standards and procedures requiring the registration of
persons or entities not otherwise licensed or registered by the commissioner
and criteria for the required filing of such claims data, eligibility data,
provider files, and other information as the commissioner determines to be
necessary to carry out the purposes of this section and this chapter.
* * * Master
Provider Index * * *
Sec. 19a. MASTER PROVIDER INDEX
(a)
No later than September 1, 2006, a work group shall be convened by the
area health education centers (AHEC) program for the purpose of making
recommendations for the creation of a master
provider index designed to assure uniform and consistent identification and
cross‑reference of all Vermont health care professionals in the
development and implementation of health care technology in Vermont. The
work group shall:
(1)
be composed of interested parties, including representatives of health care
provider associations and societies, public and private insurers, the
Vermont program for quality health care (VPQHC), appropriate departments of state government, including the commissioner
of the department of banking, insurance, securities, and health care
administration or designee, the area health education centers (AHEC) program,
and Vermont information technology leaders (VITL), for the purpose of creating
a set of common data fields for a master provider index of all health care
providers, as defined in subdivision 9402(8) of Title 18;
(2) compile recommendations from those parties regarding data fields
that are necessary to be included in a database that allows for comprehensive
cross‑referencing of the multiple “unique identification codes” applied
to health care providers through licensure, credentialing, and billing and
claims processing mechanisms for the purpose of supporting the implementation
of health information exchange and public health and policy research, analysis
and planning;
(3) provide cost and time
estimates for development and implementation of such an index; and
(4) develop recommendations for the governance of the index and its
relationship to other state health information data systems, technologies, and
records.
(b)
No later than January 15, 2007, the work group shall report to the general
assembly on the information obtained and shall make recommendations regarding
the advisability of creating and sustaining a master provider index.
* * * PROVIDER INITIATIVE * * *
* * * Loan Repayment for Health Care Providers
in Underserved Areas and Health Educators * * *
Sec. 20. 18 V.S.A. § 10a is
added to read:
§ 10a. LOAN REPAYMENT FOR
HEALTH CARE PROVIDERS AND HEALTH EDUCATORS FUND
(a)
There is hereby established a special fund to be known as the Vermont
educational loan repayment fund which shall be used for the purpose of ensuring
a stable and adequate supply of health care providers and health educators to
meet the health care needs of Vermonters, with a focus on recruiting and
retaining providers and health educators in underserved geographic and
specialty areas.
(b) The fund shall be
established and held separate and apart from any other funds or moneys of the
state and shall be used and administered exclusively for the purpose of this
section. The money in the fund shall be invested in the same manner as
permitted for investment of funds belonging to the state or held in the
treasury. The fund shall consist of the following:
(1) Such sums as may be
appropriated or transferred thereto from time to time by the general assembly,
the state emergency board, or the joint fiscal committee during such times as
the general assembly is not in session.
(2) Interest earned from
the investment of fund balances.
(3) Any other money from
any other source accepted for the benefit of the fund.
(c)
The fund shall be administered by the department of health, which shall make
funds available to the University of Vermont college of Medicine area health education centers (AHEC) program for loan
repayment awards. The commissioner may require certification of compliance
with this section prior to the making of an award.
(d)
AHEC shall administer awards in such a way as to comply with the requirements
of Section 108(f) of the Internal Revenue Code.
(e)
AHEC shall make loan repayment awards in exchange for service commitment by
health care providers and health educators and shall define the service
obligation in a contract with the health care provider or health educator.
Payment awards shall be made directly to the educational loan creditor of the
health care provider or health educator.
(f)
Loan repayment awards shall only be available for a health care provider or
health educator who :
(1)
is a Vermont resident;
(2)
serves Vermont;
(3)
accepts patients with coverage under Medicaid, Medicare, or other state-funded
health care benefit programs, if appropriate; and
(4)
has outstanding educational debt acquired in the pursuit of an undergraduate or
graduate degree from an accredited college or university that exceeds the amount
of the loan repayment award.
(g)
Additional eligibility and selection criteria will be developed annually by the
commissioner in consultation with AHEC and may include local goals for improved
service, community needs, or other awarding parameters.
(h)
The commissioner may adopt regulations in order to implement the program
established in this section.
(i) As used in this section, "health care
provider" shall mean an individual licensed, certified, or authorized by
law to provide professional health care service in this state to an individual
during that individual’s medical or dental care, treatment, or confinement.
* * * Advance Directives * * *
Sec. 21. 18 V.S.A. §
9701 is amended as follows:
§ 9701. DEFINITIONS
As used in this chapter:
* * *
(3) “Anatomical gift”
shall have the same meaning as provided in subdivision 5238(1) of this title.
(3)(4)
“Capacity” means an individual’s ability to make and communicate a decision
regarding the issue that needs to be decided.
(A) An individual shall be
deemed to have capacity to appoint an agent if the individual has a basic
understanding of what it means to have another individual make health care
decisions for oneself and of who would be an appropriate individual to make
those decisions, and can identify whom the individual wants to make health care
decisions for the individual.
(B) An individual shall be
deemed to have capacity to make a health care decision if the individual has a
basic understanding of the diagnosed condition and the benefits, risks, and
alternatives to the proposed health care.
(4)(5)
“Clinician” means a medical doctor licensed to practice under chapter 23 of
Title 26, an osteopathic physician licensed pursuant to subdivision 1750(9) of
Title 26, an advance practice registered nurse licensed pursuant to subdivision
1572(4) of Title 26, and a physician’s assistant certified pursuant to section
1733 of Title 26 acting within the scope of the license under which the
clinician is practicing.
(5)(6)
“Commissioner” means the commissioner of the department of health.
(6)(7)
“Do-not-resuscitate order” or “DNR order” means a written order of the
principal’s clinician directing health care providers not to attempt
resuscitation.
(7)(8) “DNR
identification” means a document, bracelet, other jewelry, wallet card, or
other means of identifying the principal as an individual who has a DNR order.
(8)(9)
“Emergency medical personnel” shall have the same meaning as provided in
section 2651 of Title 24.
(9)(10)
“Guardian” means a person appointed by the probate court who has the authority
to make medical decisions pursuant to subdivision 3069(b)(5) of Title 14.
(10)(11)
“Health care” means any treatment, service, or procedure to maintain, diagnose,
or treat an individual’s physical or mental condition, including services
provided pursuant to a clinician’s order, and services to assist in activities
of daily living provided by a health care provider or in a health care facility
or residential care facility.
(11)(12)
“Health care decision” means consent, refusal to consent, or withdrawal of
consent to any health care.
(12)(13)
“Health care facility” shall have the same meaning as provided in subdivision
9432(7) of this title.
(13)(14) “Health
care provider” shall have the same meaning as provided in subdivision 9432(8)
of this title and shall include emergency medical personnel.
(14)(15)
“HIPAA” means the Health Insurance Portability and Accountability Act of 1996,
codified at 42 U.S.C. § 1320d and 45 C.F.R.
§§ 160-164.
(15)(16) “Informed
consent” means the consent given voluntarily by an individual with capacity
after being fully informed of the nature, benefits, risks, and consequences of
the proposed health care, alternative health care, and no health care.
(16)(17)
“Interested individual” means:
(A) the principal’s spouse,
adult child, parent, adult sibling, adult grandchild, reciprocal beneficiary,
or clergy person; or
(B) any adult who has
exhibited special care and concern for the principal and who is personally
familiar with the principal’s values.
(17)(18) “Life
sustaining treatment” means any medical intervention, including nutrition and
hydration administered by medical means and antibiotics, which is intended to
extend life and without which the principal is likely to die.
(18)(19)
“Nutrition and hydration administered by medical means” means the provision of
food and water by means other than the natural ingestion of food or fluids by
eating or drinking. Natural ingestion includes spoon feeding or similar means
of assistance.
(19)(20)
“Ombudsman” means an individual appointed as a long-term care ombudsman under
the program contracted through the department of aging and independent living
pursuant to the Older Americans Act of 1965, as amended.
(20)(21)
“Patient’s clinician” means the clinician who currently has responsibility for
providing health care to the patient.
(21)(22)
“Principal” means an adult who has executed an advance directive.
(22)(23)
“Principal’s clinician” means a clinician who currently has responsibility for
providing health care to the principal.
(23)(24)
“Probate court designee” means a responsible, knowledgeable individual
independent of a health care facility designated by the probate court in the
district where the principal resides or the county where the facility is
located.
(25) “Procurement
organization” shall have the same meaning as in subdivision 5238(10) of this
title.
(24)(26)
“Reasonably available” means able to be contacted with a level of diligence
appropriate to the seriousness and urgency of a principal’s health care needs,
and willing and able to act in a timely manner considering the urgency of the
principal’s health care needs.
(25)(27)
“Registry” means a secure, web-based database created by the commissioner to
which individuals may submit an advance directive or information regarding the
location of an advance directive that is accessible to principals and agents
and, as needed, to individuals appointed to arrange for the disposition of
remains, organ procurement organizations, tissue and eye banks,
health care providers, health care facilities, residential care facilities,
funeral directors, crematory operators, cemetery officials, probate court
officials, and the employees thereof.
(26)(28)
“Residential care facility” means a residential care home or an assisted living
residence as those terms are defined in section 7102 of Title 33.
(27)(29)
“Resuscitate” or “resuscitation” includes chest compressions and mask
ventilation; intubation and ventilation; defibrillation or cardioversion; and
emergency cardiac medications provided according to the guidelines of the
American Heart Association’s Cardiac Life Support program.
(28)(30)
“Suspend” means to terminate the applicability of all or part of an advance
directive for a specific period of time or while a specific condition exists.
Sec. 22. 18 V.S.A. § 9702 is amended to read:
§ 9702. ADVANCE DIRECTIVE
(a) An adult may do any or
all of the following in an advance directive:
* * *
(10) identify those interested
individuals, or entities, whether or not otherwise qualified to
bring an action under section 9718 of this title, who shall or shall not
have authority to bring an action under that section;
* * *
(13) identify a preferred primary
care clinician and affirm that the clinician has been notified;
* * *
(c) The principal’s health
care provider may not be the principal’s agent. Unless related to the principal
by blood, marriage, civil union, or adoption, an agent may not be an
owner, operator, employee, agent, or contractor of a residential care facility,
a health care facility, or a correctional facility in which the principal
resides at the time of execution of an advance directive.
(d) Unless related to the
principal by blood, marriage, civil union, or adoption, an individual
may not exercise the authority pursuant to an advance directive for disposition
of remains, anatomical gifts, or funeral goods and services while serving the
interests of the principal in one of the following capacities:
(1) a funeral director or employee
of the funeral director;
(2) a crematory operator or
employee of the crematory operator; or
(3) a cemetery official or
employee of the cemetery; or
(4) an employee or
representative of a procurement organization.
Sec. 23. 18 V.S.A. § 9704 is amended to read:
§ 9704. AMENDMENT, SUSPENSION, AND REVOCATION
* * *
(b)(1) Except as provided in
subdivision (2)(3) of this subsection, a principal with or
without capacity may suspend or revoke all or part of an advance directive,
including the designation of an agent:
(A) by signing a statement
suspending or revoking the designation of an agent all or part of an
advance directive;
(B) by personally informing
the principal's clinician, who shall make a written record of the suspension or
revocation in the principal's medical record; or
(C) by burning, tearing, or
obliterating the advance directive, either by the principal personally or by
another person at the principal’s express direction and in the presence of the
principal; or
(D) For any provision
other than the designation of an agent, orally, in writing, or by any other act
evidencing a specific intent to suspend or revoke.
(2) Except as provided in
subdivision (3) of this subsection, a principal with or without capacity may
suspend or revoke any provision other than the designation of an agent, orally,
in writing, or by any other act evidencing a specific intent to suspend or
revoke.
(2)(3) A
provision in an advance directive executed pursuant to subsection 9707(h) of
this title may be suspended or revoked only if the principal has capacity.
(3)(4) To the
extent possible, the principal shall communicate any suspension or revocation
to the agent or other interested individual.
(c)(1) A clinician, health
care provider, health care facility, or residential care facility who becomes
aware of an amendment, suspension, or revocation while treating an
incapacitated principal shall make reasonable efforts to:
* * *
(C) flag the amendment,
suspension, or revocation in the principal's medical record on the front of the
medical folder or on the front of any advance directive filed in the medical
record; and
(D) notify the principal,
agent, and guardian of the amendment, suspension, or revocation; and
(E) inform the registry of
the amendment, suspension, or revocation.
* * *
(3) A health care provider,
health care facility, or residential care facility not currently providing
health or residential care to a principal who becomes aware of an amendment,
suspension, or revocation shall ensure that the amendment, suspension, or
revocation is recorded and flagged in the principal’s medical record and is
submitted to the registry.
* * *
Sec. 24. 18 V.S.A. § 9712 is amended to read:
§ 9712. OBLIGATIONS OF FUNERAL DIRECTORS, CREMATORY
OPERATORS, CEMETERY OFFICIALS, PROCUREMENT
ORGANIZATIONS, AND INDIVIDUALS
APPOINTED TO
ARRANGE FOR THE DISPOSITION OF THE
PRINCIPAL’S
REMAINS
* * *
(c) Any procurement
organization having knowledge of a principal’s advance directive shall follow
the advance directive and any instructions of the individual appointed in the
advance directive to arrange for the recovery of the principal’s anatomical
gifts unless the procurement organization determines such gifts are unsuitable
for the purposes for which they are made or if recovery of such gifts would
cause the procurement organization to violate standards of professional conduct
or any applicable regulation or law.
(c)(d) Every
funeral director, crematory operator, and cemetery official, and
procurement organization shall develop systems:
(1) to ensure that a principal’s advance directive is
promptly available when services are to be provided, including that the
existence of an advance directive is prominently noted on any file jacket or
folder, and that a note is entered into any electronic database of the
director, operator, or official, or organization;
(2) within 120 days of the
commissioner’s announcing the availability of the registry, to ensure that the
director, operator, official, or organization checks the registry at the time
services are to be provided to determine whether the decedent has an advance
directive.
(d)(e) In the
event the principal’s instructions in an advance directive regarding
disposition of remains or for funeral goods and services are in apparent
conflict with a contract entered into by the principal for the disposition of
remains, funeral goods, or services, the most recent document created by the
principal shall be followed to the extent of the conflict. Nothing in this
subsection shall be construed as limiting any other available remedies.
Sec. 25. 18 V.S.A. § 9713 is amended to read:
§ 9713. IMMUNITY
* * *
(b)(1) No health care
provider, health care facility, residential care facility, funeral director, crematory operator, cemetery
official, or any other person acting for or under such person's
control shall, if the provider, or facility, director, operator, or official has
complied with the provisions of this chapter, be subjected subject
to civil or criminal liability for:
(A) providing or withholding
health care or services in good faith pursuant to the provisions of an advance
directive, a DNR identification of the principal, the consent of a principal
with capacity or of the principal’s agent or guardian, or a decision or objection
of a principal; or
(B) relying in good faith on
a suspended or revoked advance directive.
(2) No funeral director,
crematory operator, cemetery official, or procurement organization, or
any other person acting for or under such person's control, shall, if the director, operator, official, or
organization has complied with the provisions of this chapter, be subject to
civil or criminal liability for providing or withholding its services in good
faith pursuant to the provisions of an advance directive, whether or not the
advance directive has been suspended or revoked.
(2)(3) Nothing
in this subsection shall be construed to establish immunity for the failure to
follow standards of professional conduct and to exercise due care in the
provision of services.
* * *
Sec. 26. 18 V.S.A. §
9714(b) is amended to read:
(b) A health care provider,
health care facility, residential care facility, funeral home director,
crematory operator, or cemetery official, probate court official, or
procurement organization, or an employee of any of them, who
accesses the registry without authority or when authority has been denied
specifically by the principal, agent, or guardian is subject to review and
disciplinary action by the appropriate licensing, accreditation, or
approving entity.
Sec. 27. 18 V.S.A. § 9718(a) is amended to read:
(a) A petition may be filed
in probate court under this section by:
(1) a, principal,
guardian, agent, ombudsman, or interested individual other than one
identified in an advance directive, pursuant to subdivision 9702(a)(10) of this
title, as not authorized to bring an action under this section;
(2) a social worker or health
care provider employed by or directly associated with the health care provider,
health care facility, or residential care facility providing care to the
principal;
(3) the defender general if
the principal is in the custody of the department of corrections; or
(4) a representative of the
state-designated protection and advocacy system if the principal is in the custody
of the department of health; or
(5) an individual or
entity identified in an advance directive, pursuant to subdivision 9702(a)(10)
of this section, as authorized to bring an action under this section.
Sec. 28. 18 V.S.A. § 9719 is amended to read:
§ 9719. OBLIGATIONS OF STATE AGENCIES
(a)
Within 180 days of the effective date of this chapter No later than July 1, 2006, and from time to time thereafter, the commissioner, in consultation
with all appropriate agencies and organizations, shall adopt rules pursuant to
chapter 25 of Title 3 to effectuate the intent of this chapter. The rules
shall cover at least one optional form of an advance directive with an
accompanying form providing an explanation of choices and responsibilities, the
form and content of clinician orders for life sustaining treatment, the use of
experimental treatments, a model DNR order which meets the requirements of
subsection 9708(a) of this title, DNR identification, revocation of a DNR
identification, and consistent statewide emergency medical standards for DNR
orders and advance directives for patients and principals in all settings. The
commissioner shall also provide, but without the obligation to adopt a rule,
optional forms for advance directives for individuals with disabilities,
limited English proficiency, and cognitive translation needs.
(b)(1) Within 180 days of
the effective date of this chapter Within one year of the effective date
of this chapter, the commissioner shall develop and maintain a registry to
which a principal may submit his or her advance directive, including a terminal
care document and a durable power of attorney. The rules shall describe when
health care providers, health care facilities, and residential care facilities
may access an advance directive in the registry. In no event shall the
information in the registry be accessed or used for any purpose unrelated to
decision-making for health care or disposition of remains, except that the
information may be used for statistical or analytical purposes as long as the
individual’s identifying information remains confidential.
(2)(A) Within 180 days
one year of the effective date of this chapter, the commissioner shall
adopt rules pursuant to chapter 25 of Title 3 on the process for securely
submitting, revoking, amending, replacing, and accessing the information
contained in the registry. The rules shall provide for incorporation into the
registry of notifications of amendment, suspension, or revocation under
subsection 9704(c) of this title and revocations of appointment under
subsection 9704(d) of this title.
(B) The commissioner shall
provide to any individual who submits an advance directive to the registry a
sticker that can be placed on a driver’s license or identification card
indicating that the holder has an advance directive in the registry.
(c)(1) Within 180 days
one year of the effective date of this chapter, the commissioner shall
provide on the department’s public website information on advance directives
and the registry to appropriate state offices. The commissioner shall also
include information on advance directives, and on the registry and the optional
forms of an advance directive.
(2) Within 180 days one
year of the effective date of this chapter, the commissioner of motor
vehicles shall provide motor vehicle licenses and identity cards, as soon as
existing licenses or cards have been depleted, which allow the license holder
or card holder to indicate that he or she has an advance directive and whether
it is in the registry.
Sec. 29. 18 V.S.A. § 5240(a) is amended to read:
(a) Any member of the
following classes of individuals, in the order of priority listed, may make an
anatomical gift of all or a part of the decedent’s body for an authorized
purpose, unless the decedent has made an unrevoked refusal to make that
anatomical gift:
(1) An individual
appointed by the decedent, pursuant to an advance directive under chapter 231
of this title, to make an anatomical gift.
(1)(2) The
spouse of the decedent.
(2)(3) The
reciprocal beneficiary of the decedent.
(3)(4) An
adult son or daughter of the decedent.
(4)(5) Either
parent of the decedent.
(5)(6) An
adult brother or sister of the decedent.
(6)(7) A
grandparent of the decedent.
(7)(8) An individual
possessing a durable power of attorney agent named in an advance
directive.
(8)(9) A
guardian of the person of the decedent at the time of death.
(9)(10) Any
other individual authorized or under obligation to dispose of the body.
* * *
Improving Access to Care * * *
Sec. 29a. FQHC LOOK-ALIKES AND UNCOMPENSATED CARE
POOL
(a) Funds appropriated to the
department of health in Section 263(e)(4) and Section 255(a)(7)(C) related to
Section 277(f) of Act 71 of 2005 for state fiscal year 2006 may be carried
forward by the department for the purposes described in Section 277(f) of Act
71 of 2005 to state fiscal year 2007. Of those appropriated funds, a total of
$150,000 shall be provided as a direct grant to new federally qualified health
center look-alike entities approved during state FY06 and shall be split evenly
between qualifying organizations on a non-competitive basis.
(b) Funds appropriated in
Section 30 of this act to the department of health shall be expended for the
purpose of providing to federally qualified health center (FQHC) look-alikes
uncompensated care pool funds for an income‑sensitized sliding scale fee
schedule for patients of these organizations. In distributing the grants, the
department shall consider ensuring the geographic distribution of health
centers around the state as well as criteria under federal law. Initial
priority shall be given to health centers in Lamoille, Washington,
Windsor/Windham, and Addison counties, and other counties that
demonstrate readiness to achieve look-alike status. The goal shall be to
ensure there are FQHC look-alikes in each county in Vermont.
(c) If funds appropriated for
this Section exceed $200,000, additional uncompensated care pool funds shall be
made available to primary care practices meeting conditions for serving a
disproportionate share of the uninsured and Medicaid populations comparable to
the federal expectations for federally qualified health centers and
look-alikes, including:
(1) Seeing all patients
regardless of ability to pay, on a sliding scale fee schedule;
(2) Remaining open to new and
existing patients enrolled in the Medicaid and Medicare programs;
(3) Maintaining no less than a
combined 25 percent Medicaid and uninsured patient payer mix; and
(4) Participating in the
blueprint for health program as it expands across the state.
(5) Existing federally qualified
health center Section 330 grantees shall also be eligible to participate in
this uncompensated care pool.
(6) Funding from the pool shall
not be permitted to supplant existing state, federal or private grants or
funding for pre-existing “charity care” and patient assistance programs.
(d) Uncompensated care pool
funds under this section shall be distributed to participating providers under
criteria and methodology developed by the department of health office of rural
health and primary care and bi-state primary care association, with input from
the Vermont medical society and Vermont chapter of
the American academy of family practice physicians.
(e) If deemed appropriate, funds
appropriated for this section may be disbursed by the Vermont
community foundation or other suitable charitable organization.
Sec. 29b. MEDICAID OUTREACH
Bi-State Primary Care
Association, in consultation with the Medicaid Advisory Board, will research
efforts in Vermont and in other states that have succeeded in
enrolling individuals eligible for Medicaid and Medicaid waiver programs. The
association will report its findings and recommendations to the house committee
on health care, the senate committee on health and welfare, the health access
oversight committee and the agency of human services no later than November 15,
2006.
* * * Appropriations * * *
Sec.
30. APPROPRIATIONS
(a) For fiscal year 2007, the sum of $500,000.00 is
appropriated from the general fund and $200,000.00 from the department of
banking, insurance, securities and health care administration special fund for
the pilot program authorized under 18 V.S.A. § 9417(e) and to contract for the
development of the health information technology plan and other duties in 18
V.S.A. § 9417.
(b) For fiscal year 2007, the sum of $160,000.00 is
appropriated from the general fund to the department of health for development
and implementation of the patient safety surveillance and improvement system
established pursuant to 18 V.S.A. § 1912. The sum of $40,000.00 shall be
contributed from hospitals licensed in Vermont and shall be
collected by the department of health with assistance from the department of
banking, insurance, securities, and health care administration.
(c) For fiscal year 2007, the sum of $400,000.00 is
appropriated from the general fund to the department of banking, insurance,
securities, and health care administration for further development of the
multi-payer database established by 18 V.S.A. § 9410(h), and the consumer price
and quality information system.
(d) The sum of $880,000.00 is appropriated from the
general fund to the department of health in fiscal year 2007 to fund the Vermont
educational loan repayment fund program established under Sec. 20.
(e) The sum of $80,000.00 is appropriated from the
general fund to the department of health in fiscal year 2007 to fund loan
forgiveness programs for health care providers through the dental hygienist
incentive loan program and the nursing incentive loan program, as administered
through the Vermont student assistance corporation.
(f) The sum of $50,000.00 is appropriated from the
general fund to the department of health in fiscal year 2007 to establish an
advance directive registry established by 18 V.S.A. § 9719.
(g) For fiscal year 2007, the sum of $200,000.00 is
appropriated from the general fund to the department of health for federally
qualified health center (FQHC) look-alike uncompensated care pool funds, as
described in section 29a.
(h) For fiscal year 2007, the sum of $40,000.00 is appropriated
to the Agency of Human Services, upon approval by the health access oversight
committee of AHS plans for Medicaid outreach, consistent with the report
specified in section 29b.
* * * Technical Provision *
* *
Sec.
31. TECHNICAL PROVISION
Except for subdivision 2222a(c)(1) of Title 3, the
provisions in Sec. 15 of this Act shall supersede any conflicting provisions in
Sec. 3 of H.861 (An Act Relating to Health Care Affordability for Vermonters)
if enacted. Subdivision (c)(1) of section 2222a of Title 3, if enacted in
H.861, shall supercede subdivision (c)(1) of section 2222a of Title 3 in this
act. Any additional provisions contained in Sec. 3 of H.861 that are not
contained in Sec. 15 of this Act shall not be superseded. Any technical
revisions necessary to ensure accuracy or conformity between the sections, such
as the numbering of subdivisions, may be made the office of legislative
council.
|