Source: http://www.leg.state.vt.us/docs/legdoc.cfm?URL=/docs/2006/bills/intro/H-692.HTM
Timestamp: 2017-12-12 00:52:17
Document Index: 523982755

Matched Legal Cases: ['§ 4062', '§ 4062', '§ 9402', '§ 4080', '§ 4062', '§ 4062', '§ 4062', '§ 800', '§ 4062', '§ 4080', '§ 1222', '§ 5884', '§ 4062', '§ 4062', '§ 5811', '§ 9701', '§ 9741', '§ 1912', '§ 1912', '§ 1913', '§ 1913', '§ 307', '§ 4080', '§ 146', '§ 4080', '§ 146', '§ 4516', '§ 4588', '§ 5115', '§ 5115']

H.692
Introduced by Representatives Klein of East Montpelier, Corcoran of Bennington, Donovan of Burlington, Edwards of Brattleboro, Evans of Essex, Marek of Newfane, Masland of Thetford, McCullough of Williston, Mook of Bennington, Pellett of Chester, Sharpe of Bristol, Smith of Morristown and Sweaney of Windsor
Subject: Health; access; insurance; reinsurance pool; Medicaid; reimbursement rate; medical malpractice; administration
Statement of purpose: This bill proposes to: (1) require nongroup insurers to provide a health insurance plan for Vermonters which covers basic health benefits at an affordable cost; (2) require every Vermonter to have health coverage and show proof when requesting a state income tax refund or a driver’s license; (3) ensure affordability through a reinsurance pool for the individual and small group markets and through premium subsidies for low income Vermonters; (4) reform the medical malpractice system by making an expression of regret or apology made by or on behalf of a health care provider inadmissible in any civil or administrative proceeding against the provider and making compliance with facility medical practice guidelines admissible in court; (and 5) require health care providers to report medical errors to patients and the department of health and do root cause analysis of an adverse event;
(6) require the department of health to establish a medical error reporting and analysis system to look for systemic errors and suggest corrective action plans and to sanction health care facilities that do not report as required; (7) improve Medicaid reimbursement rates to health care professionals; and (8) requireing the office of Vermont health access to study and report on an efficient and effective means of covering Medicaid recipients through private insurance plans.
AN ACT RELATING TO AFFORDABLE HEALTH INSURANCE FOR VERMONTERS
* * * Package of Basic Health Services * * *
Sec. 1. 8 V.S.A. § 4062d is added to read:
§ 4062d. Standard Proof of Insurance Form
(a) Every insurer delivering or issuing for delivery in the state in the state a policy of health insurance or certificate under a policy including any endorsement, rider, or application which becomes a part of any such policy, in the state must provide each covered individual with the standard proof of insurance form developed by the commissioner under this section annually by January 31 and upon request. The proof of insurance proof of insuranceinsurer shall indicate whether the benefits provided are at least equivalent to the package of basic health care services provided in the affordable affordable common benefit plan developed under section 4080b of this title on each proof of insurance.
(b) (b)(1) Prior to approving a policy or certificate under a policy, the commissioner shall determine if the benefits provided are at least equivalent to the package of basic health care services provided in the affordable affordable common benefit plan developed under section 4080b of this title. The commissioner shall provide the results of the determination to the insurer with the approval or denial.
(2) The commissioner shall establish a process by which an individual or employer may submit a health insurance summary plan description, certificate or policy to the department in order to request the standard proof of insurance form.
(c) The commissioner shall develop a standard proof of insurance form, which shall include language indicating whether the benefits provided are at least equivalent to the package of basic health care services provided in the affordable affordable common benefit plan developed under section 4080b of this title.
(d) As used in this section, “health insurance policy” means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract or any other health benefit plan offered, issued or renewed for any person in this state by a health insurer, as defined by 18 V.S.A. § 9402(7). The term shall not include disability insurance policies, accident indemnity or expense policies, long-term care insurance policies, student or athletic expense or indemnity policies, Medicare supplemental policies, dental policies and benefit plans providing coverage for specific disease or other limited benefit coverage.
Sec. 22. 8 V.S.A. § 4080b(e) is amended to read:
(e) A registered nongroup carrier shall offer two or more common health care plans approved by the commissioner. The commissioner, by rule, shall adopt standards and a process for approval of common health care plans that ensure that consumers may compare the cost of plans offered by carriers. At least one plan shall be a low-cost The commissioner shall develop an affordable common health care plan that includes a package of basic services and may provide for low deductibles, low coinsurance arrangements, managed care, cost-containment provisions, and any other term, not inconsistent with the provisions of this title, deemed useful in making the plan affordable. The basic service plan shall cover preventive care, including health services provided to individuals to prevent the onset of a targeted medical condition and to identify and treat asymptomatic individuals who have developed risk factors, but in whom the medical condition is not clinically apparent. A plan shall be affordable if it costs no more than ten percent of the income of a family of two at 300 percent of the federal poverty level. The commissioner shall determinebase the benefits included in the package on the affordability measure, on evidence‑based guidelines for health care services and after a public input process. If necessary to ensure affordability and notwithstanding provisions in this chapter, the commissioner may approve an affordable common health care plan that does not comply with the coverage requirements in this chapter. A health maintenance organization may add limitations to a common health care plan if the commissioner finds that the limitations do not unreasonably restrict the insured from access to the benefits covered by the plans. A registered nongroup carrier may offer additional benefits as riders to the basic benefit package upon approval by the commissioner.
Sec. 33. REPEAL
Sec. 44. 8 V.S.A. § 4062e is added to read:
§ 4062e. PREMIUM ASSISTANCE PROGRAM
(a) The secretary of human services shall establish the premium assistance program within the office of Vermont health access for the purpose of providing uninsured low and moderate income Vermonters with financial assistance to enroll in or purchase the affordable common health benefit plan developed pursuant to section 4080b of this title. Financial assistance shall be in the form of a reduced premium obligation of an eligible individual.
(b) The secretary of human services shall determine financial assistance amounts and eligibility after public hearing and an opportunity for comment by interested parties and the public.
(1) At minimum to be eligible, an individual must be a Vermont resident and have family income above 150 percent of the federal poverty income level and at or below 300 percent of the federal poverty income level for that individual’s family size.
(2) The financial assistance amounts shall be established on a sliding scale based on the federal poverty guidelines, including family size and income, and shall limit the family’s spending to no more than five percent of the family’s annual income.
(c) Annually on or before October 1 of each year, the secretary of human services, in consultation with commissioner of banking, insurance, securities, and health care administration, and the after public hearing and an opportunity for comment by interested parties and the public, shall order the adjustment of the financial assistance amounts to account for anticipated cost and utilization trends medical inflationfor the next calendar year.
(d) The secretary shall adopt rules for the premium assistance program. Such rules shall include:
(2) Standards and procedures for participating health insurers to be compensated for the financial assistance amounts; and
(e) Any health insurer offering the affordable common benefit plan developed pursuant to section 4080b of this title may participate in the program.
(2) “Secretary” means the secretary of the agency of human services.
(g) The secretary may apply to the federal government to include the program authorized by this section as a Medicaid program or a state children’s health program, if the secretary determines that it is cost-effective to do so.
Sec. 5. 8 V.S.A. § 4062g is added to read:
Every individual who resides in Vermont is required to have health coverage that provides at least the coverage of the affordable common benefit plan developed pursuant to section 4080b of this title.
Sec. 56. 23 V.S.A. § 800(a) is amended to read:
(a) No owner or operator of a motor vehicle required to be licensed shall operate or permit the operation of the vehicle upon the highways of the state without having in effect an automobile liability policy or bond in the amounts of at least $25,000.00 for one person and $50,000.00 for two or more persons killed or injured and $10,000.00 for damages to property in any one accident. In lieu thereof, evidence of self-insurance in the amount of $115,000.00 must be filed with the commissioner of motor vehicles. Such financial responsibility shall be maintained and evidenced in a form prescribed by the commissioner. A junior operator and an operator’s license shall not be issued or renewed without the proof of health insurance pursuant to 8 V.S.A. § 4062d that indicates that the coverage has been certified by the commissioner of banking, insurance, securities and health care administration to be at least equivalent to the basic benefit package required by 8 V.S.A. § 4080b or proof of coverage by Medicaid, the Vermont health access plan or Medicare. The commissioner may require that evidence of financial responsibility be produced before motor vehicle inspections are performed pursuant to the requirements of 23 V.S.A. § 1222.
Sec. 67. 32 V.S.A. § 5884(d) is added to read:
(d) Any personal income tax refund balance remaining after debt setoff under subchapter XII or other reduction or adjustment by the commissioner, shall be disbursed to the taxpayer only upon presentation to the commissioner of proof of health insurance of the taxpayer, or in the case of a joint return, proof of health insurance of both taxpayers. No interest shall accrue on any refund during the period it remains undisbursed under this subsection. “Proof of health insurance” means presentation to the commissioner of certificate issued by the commissioner of banking, insurance, securities, and health care administration that the taxpayer is covered by health insurance as required under 4062g of Title 8. All appeals related to issues this subsection shall be to the commissioner of banking, insurance, securities and health care administration.
* * * Small Market Access Reinvestment Trust * * *
Sec. 78. 8 V.S.A. § 4062f is added to read:
§ 4062f. SMALL MARKET ACCESS REINVESTMENT TRUST
(a) The commissioner shall establish the small market access reinvestment trust plan for the purpose of lowering the cost of and thereby increasing access to health care coverage in the small group and nongroup health insurance markets.
(b) The small market access reinvestment trust plan shall include a reinsurance mechanism permitting nongroup and small group carriers to transfer a portion of the incurred expenses over the specified attachment point, in accordance with rules adopted by the commissioner. Such individuals shall remain enrolled policyholders, members, or subscribers of the carrier’s or insurer’s plan, and shall be subject to the same terms and conditions of coverage, premiums, and cost sharing as any other policyholder, member, or subscriber.
(c) The commissioner may develop the small market access reinvestment trust plan in a manner that permits the plan to be eligible for a federal grant to administer the plan, including a grant under the federal Trade Adjustment Act.
(d) The commissioner may adopt rules for the small market access reinvestment trust plan relating to:
(2) Criteria governing the circumstances under which a small group carrier or a nongroup carrier may transfer a portion of the incurred expenses associated with individuals insured by the carrier to the reinsurance mechanism.
(1) “Health insurer” means a health insurance company, nonprofit hospital and medical service corporation, or a health maintenance organization.
(2) “Nongroup carrier” means a nongroup carrier registered under section 4080b of this title.
(3) “Plan” means the small market access reinvestment trust plan established by this section.
(4) “Small group carrier” means a small group carrier registered under section 4080a of this title.
* * * Revenue Sources * * *
Sec. 8a. 32 V.S.A. § 5811(21)(B) is amended to read:
(B) decreased by the following items of income (to the extent such income is included in federal adjusted gross income):
(i) income from United States government obligations;
(ii) 40 percent of adjusted net capital gain income as defined in Section 1(h) of the Internal Revenue Code.
(iii)(ii) 60 percent of capital gain income that is invested in the taxable year, or (through filing an amended return) within two years of receipt, in an eligible venture capital investment under section 5930v of this title.
Sec. 8b. Subsection 87(17) of No. 68 of the Acts of 2003 is amended to read:
Sec. 8c. 32 V.S.A. § 9701(45) and (46) are added to read:
(46) Soft drinks: means nonalcoholic beverages that contain natural or artificial sweeteners. Soft drinks do not include beverages that contain milk or milk products, soy, rice, or similar milk substitutes, or greater than 50 percent vegetable or fruit juice by volume.
Sec. 8d. 32 V.S.A. § 9741(13) is amended to read:
* * * Error Reporting and Medical Malpractice Reform * * *
Sec. 98. 12 V.S.A. § 1912 is added to read:
§ 1912. EXPRESSION OF REGRET OR APOLOGY BY HEALTH
CARE PROVIDER INADMISSIBLE
(a) An expression of regret or apology or an explanation of how a medical error occurred made by or on behalf of a health care provider, including one that is made in writing, orally, or by conduct, that is provided within 14 days of when the provider knew or should have known of the consequences of the error, does not constitute a legal admission of liability for any purpose and shall be inadmissible in any civil or administrative proceeding against the health care provider, including any arbitration or mediation proceeding.
(b) In any civil or administrative proceeding against a health care provider, including any arbitration or mediation proceeding, the health care provider or any other person who makes an expression of regret, apology, or explanation on behalf of the health care provider, including one that is made in writing, orally, or by conduct, that is provided within 14 days of when the provider knew or should have known of the consequences of the potential adverse outcome may not be examined by deposition or otherwise with respect to the expression of regret, apology, or explanation.
Sec. 10. 12 V.S.A. § 1913 is added to read:
§ 1913. ADMISSIBILITY OF PRACTICE GUIDELINES
Practice guidelines duly established by professional organizations of health care providers, by licensed hospitals, or by quality assurance programs recognized by state law shall be admissible as evidence on the question of whether the respondent met or failed to meet the applicable standard of care.
Sec. 11. MEDICAL EVENT REPORTING SYSTEM
(a) The department of health shall conduct a feasibility study to determine whether a medical event reporting system could be developed which would provide health care professionals or entities with immunity from lawsuits when the professional or entity discloses the medical event and agrees to compensate the patient for actual harm in an amount to be determined by a neutral third party.
(b) The department shall consult with interested parties, including the Vermont association of hospitals and health systems, the medical society, the Vermont health care ombudsman or designee, and consumer groups.
(c) The department shall report its findings and recommendations to the general assembly by January 15, 2007.
Sec. 9. * * * Medicaid Reform * * *
Sec. 120. 32 V.S.A. § 307(d) is amended to read:
(d) The governor’s budget shall include his or her recommendations for an annual budget for Medicaid and all other health care assistance programs administered by the department of prevention, assistance, transition, and health access office of health access. The governor’s proposed Medicaid budget shall include a proposed annual financial plan, and a proposed five-year financial plan, with the following information and analysis:
(1) anticipated revenues;
(2) anticipated expenditures, including anticipated per member per month expenditures for each population category eligible for health care assistance;
(3) anticipated caseloads, including anticipated caseloads for each population category eligible for health care assistance;
(4) anticipated utilization;
(5) health care inflation trends;
(6) recommendations for funding provider reimbursement at levels sufficient ensure reasonable access to care, and at levels at least equal to Medicare reimbursement to cover the cost of care provided no later than July 1, 2007. This recommendation shall also include a process that will result in a commensurate decrease in provider charges and plan premiums as Medicaid payments are increased;
(7) recommendations relating to Medicaid and other program eligibility, the benefit plan, cost-sharing, utilization controls, reimbursement, and any other matter necessary to align anticipated expenditures and revenues; and
Sec. 113. REFORM STUDY
The office of Vermont health access and the department of banking, insurance, securities, and health care administration shall review and study Medicaid, the Vermont health access plan, and Dr. Dynasaur to determine the most efficient and effective method of providing health benefits to eligible individuals by contracting with health insurers for administrative services, medical management services, and benefit packages. The study shall include a review of the benefits provided by these programs, redundancy in administrative or medical management services between the office of Vermont health access and private insurers, and eligibility rules regarding divestment of assets. The office and department shall report to the general assembly by January 1, 2007 with a recommendation on these issues, and a plan for administering Medicaid, the Vermont health access plan, and Dr. Dynasaur through private insurers.
Sec. 141. 8 V.S.A. § 4080a(h) is amended to read:
(B) The commissioner’s rules shall permit a carrier, including a hospital or medical service corporation, to establish premium discounts or rebates or otherwise modify applicable co-payments or deductibles in return for adherence to programs of health promotion and disease prevention, in accordance with proposed federal regulations relating to bona fide wellness programs, 45 C.F.R. § 146.121(f), as amended. Under the federal regulations, permissible bona fide wellness programs shall:
(i) limit any discount, rebate, or waiver of cost sharing to not more than 15 percent of the cost of employee-only coverage, provided that the sum of any rate deviation under subdivision (2)(A) of this subsection plus any premium discount authorized under this subdivision (2)(B) does not exceed 30 percent of the premium;
(iii) provide that the reward under the program is available to all similarly situated individuals;
(iv) provide a reasonable alternative standard to obtain the reward to any individual for whom it is unreasonably difficult due to a medical condition 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.
Sec. 156. 8 V.S.A. § 4080b(h) is amended to read:
(B) The commissioner’s rules shall permit a carrier, including a hospital or medical service corporation, to establish premium discounts or rebates or otherwise modify applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention, in accordance with proposed federal regulations relating to bona fide wellness programs, 45 C.F.R. § 146.121(f), as amended. Under the federal regulations, permissible bona fide wellness programs shall:
(i) limit any discount, rebate, or waiver of cost sharing to not more than 15 percent of the cost of employee-only coverage, provided that the sum of any rate deviation under subdivision (2)(A) of this subsection plus any premium discount authorized under this subdivision (h)(2)(B) does not exceed 30 percent of the premium;
Sec. 176. 8 V.S.A. § 4516 is amended to read:
Annually, on or before the fifteenth day of 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 the thirty-first day of 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. 187. 8 V.S.A. § 4588 is amended to read:
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. 198. 8 V.S.A. § 5115 is amended to read:
§ 5115. DUTY OF NONPROFIT HEALTH MAINTENANCE
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.
Sec. 19. EFFECTIVE DATES
(a) This act shall be effective July 1, 2006, except that the proof of insurance provisions of Sec. 1 shall be implemented on July 1, 2007, the affordable common health plan under Sec. 2 and the premium assistance program under Sec. 4 shall be available to eligible individuals no later than January 15, 2007, the insurance mandate under Secs. 5, 6, and 7 shall be effective January 15, 2008, and the small market reinvestment trust under Sec. 8 shall be implemented no later than October 1, 2006.
(b) Sec. 8a of this act (repeal of capital gain deduction) shall apply to taxable years 2006 and after.
(c) Sec. 8b of this act (extending sales tax to beer as of July 1, 2006) shall take effect upon passage.
(d) Secs. 8c and 8d of this act (extending sales tax to candy and soft drinks) shall take effect July 1, 2006.
(e) This section shall take effect upon passage.