Source: http://www.leg.state.vt.us/docs/2006/journal/HJ060411.htm
Timestamp: 2017-12-13 01:36:24
Document Index: 377772292

Matched Legal Cases: ['§ 102', '§ 102', '§ 1303', '§ 1303', '§ 4080', '§ 4080', '§ 4516', '§ 4588', '§ 5115', '§ 104', '§ 406', '§ 1905', '§ 1912', '§ 1912', '§ 1443', '§ 317', '§ 9405', '§ 9408', '§ 2222', '§ 2222', '§ 9417', '§ 9416', '§ 9416', '§ 9417', '§ 9417', 'arts 160', '§ 9410', '§ 10', '§ 10', '§ 9701', '§ 1320', '§ 160', '§ 9702', '§ 9704', '§ 9712', '§ 9713', '§ 9714', '§ 9718', '§ 9719', '§ 5240', '§ 9417', '§ 9417', '§ 1912', '§ 9410', '§ 9719', '§ 9417', '§ 9417', '§ 1912', '§ 9410', '§ 9719']

Devotional exercises were conducted by Speaker Gaye Symington of Jericho.
Page Chelsea Downey of Manchester Center led the House in the Pledge of Allegiance.
“April 10, 2006
Dear Speaker Symington,
I have the honor to inform you that I have appointed Christopher Pearson to serve the unexpired term of Representative Robert Kiss serving House District Chittenden 3-4.
/s/ James H. Douglas
cc: Deborah Markowitz, Secretary of State of Vermont
Donald G. Milne, Clerk of the House”
Oath Administered to Rep. Pearson of Burlington
The Speaker directed the Doorkeeper to conduct Mr. Pearson of Burlington, the appointed member from Chittenden 1-2 District, to the bar of the House where he took the subscribed oath, administered by the Clerk, as required by the Constitution and laws of the State.
Rep. Pearson of Burlington, the newly appointed member, having taken and subscribed the oath administered by the Clerk, as required by the Constitution and laws of the State, was conducted to his seat by the Doorkeeper.
An act relating to early childhood education;
H. 892
Rep. Sweaney of Windsor introduced a bill, entitled
An act relating to amending the charter of the town of Windsor;
Which was read the first time and referred to the committee on Government Operations.
J.R.H. 70
Reps. Pellett of Chester, Allaire of Rutland City, Leriche of Hardwick and Shaw of Derby offered a joint resolution, entitled
Joint resolution requesting Congress to authorize a 90,000‑pound weight limitation for all commodities transported in five- or more axle truck tractors, semi-trailer combinations, or truck trailer combinations traveling on interstate highways in Vermont;
Whereas, the interstate highways which cross the state of Vermont serve as major thoroughfares for the long‑distance shipment of commodities, and
Whereas, interstate highways are built to the highest safety standards of any roads in the United States, and
Whereas, haulers of water and milk traveling on Vermont’s interstate highways are now authorized to ship a maximum load of 90,000 pounds when transporting those items in five- or more axle truck tractors, semi-trailer combinations, or truck trailer combinations, and
Whereas, the 80,000-pound weight limitation for haulers shipping commodities other than milk or water on these vehicles is inequitable and not justified, and
Whereas, Congress has authorized a 90,000-pound weight limitation for the transporting of all goods in these vehicles on the interstate highways in the state of New Hampshire, and
Whereas, if haulers are authorized to ship 90,000-pound loads, regardless of the commodity, in these vehicles on Vermont’s interstate highways, the transporting of goods would be accomplished more efficiently and in fewer vehicles, and
Whereas, operating vehicles on the interstate in Vermont instead of on state roads and city streets promotes greater efficiencies and an improved quality of life, and
Whereas, the Congressional authorization of the 90,000-pound weight limitation for interstate highways located in the state of New Hampshire demonstrates that the highway safety issues related to this weight increase have already been examined in detail, now therefore be it
That the General Assembly requests Congress to grant statutory authorization permitting a 90,000-pound weight limitation for all commodities transported in five- or more axle truck tractors, semi-trailer combinations, or truck trailer combinations traveling on interstate highways in Vermont, and be it further
Resolved: That the secretary of state be directed to send a copy of this resolution to U.S. Secretary of Transportation Norman Mineta and the members of the Vermont Congressional Delegation.
An act relating to the tax credit for affordable housing;
An act relating to expanding employer access to applicants’ criminal history records;
H. 883
Rep. Morrissey of Bennington, for the committee on Government Operations, to which had been referred House bill, entitled
An act relating to amending the charter of the city of Burlington;
By adding a new Sec. 3 to read:
Rep. Donovan of Burlington, for the committee on Ways and Means, recommended the bill ought to pass when amended as recommended by the committee on Government Operations and when further amended as follows:
By striking Sec. 2 of the bill and inserting in lieu thereof:
§ 102d. LOCAL OPTION SALES TAX AUTHORITY
Sec. 2. 24 App.V.S.A. chapter 3 § 102d is added to read:
The Burlington City Council is authorized to impose a one percent sales tax upon sales within the city which are subject to the state of Vermont sales tax with the same exemptions as the state sales tax. The city sales tax shall be effective beginning on the next tax quarter following 30 day’s notice in 2006 to the department of taxes, or shall be effective on the next tax quarter following 90 days’ notice to the department of taxes if notice is given in 2007 or after. Any tax imposed under the authority of this section shall be collected and administered by the Vermont department of taxes in accordance with state law governing the state sales tax. Seventy percent of the taxes collected shall be paid to the city, and the remaining amount of the taxes collected shall be remitted to the state treasurer for deposit in the PILOT special fund first-established in Sec. 89 of No. 60 of the Acts of 1997. The cost of administration and collection of this tax shall be paid 70 percent by the city, and 30 percent by the state from the PILOT special fund. The tax to be paid to the city, less its obligation for 70 percent of the costs of administration and collection, shall be paid to the city on a quarterly basis, and may be expended by the city for municipal services only and not for education expenditures.
The bill, having appeared on the Calendar one day for notice, was taken up, read the second time, report of the committees on Government Operations and Ways and Means agreed to and third reading ordered.
An act relating to the uniform mediation act;
Was taken up and pending the question, Shall the House concur in the Senate proposal of amendment? on motion of Rep. Lippert of Hinesburg, action on the bill was postponed until the next legislative day.
Senate Proposal of Amendment to House Proposal of
Amendment Concurred in with a Further Amendment Thereto
The Senate proposed to the House to amend Senate bill, entitled
An act relating to a safe haven defense to the crime of abandoning a baby;
In Sec. 3, 13 V.S.A. § 1303(b)(1), by striking out subparagraph (B) in its entirety and inserting in lieu thereof a new subparagraph (B) to read as follows:
(B) An employee, staff member, or volunteer at a fire station, police station, or place of worship.
Pending the question, Shall the House concur in the Senate proposal of amendment to the House proposal of amendment? Rep. Lippert of Hinesburg moved that the House concur in the Senate proposal of amendment with a further amendment thereto:
In Sec. 1, 13 V.S.A. § 1303(b)(1), by striking out subparagraph (B) in its entirety and inserting in lieu thereof a new subparagraph (B) to read as follows:
(B) An employee, staff member, or volunteer at a fire station, police station, place of worship, or an entity that is licensed or authorized in this state to place minors for adoption.
Which proposal of amendment was considered and agreed to.
Rep. Clarkson of Woodstock, for the committee on Judiciary, to which had been referred Senate bill, entitled
An act relating to lawsuits arising from exercise of right to freedom of speech or to petition government for redress of grievances;
First: In Sec. 2, subdivision (e)(1)(A), after the words “factual support” by striking the word “or” and inserting in lieu thereof “and”
Second: In Sec. 2, subsection (g), after the words “shall be appealable” by adding the words “in the same manner”
Rep. Adams of Hartland spoke for the committee on Fish, Wildlife and Water Resources.
Rep. Nitka of Ludlow, for the committee on Appropriations, to which had been referred House bill, entitled
An act relating to sustainable funding of the fish and wildlife department;
Reported in favor of its passage when amended as follows;
First: In Sec. 1, on line 14, following the period, by inserting a new sentence to read:
The task force shall, among other things, consider whether costs of work carried out by fish and wildlife department personnel in providing technical services to permitting bodies and in enforcing laws and regulations other than fish and wildlife laws and regulations, should be paid for from other agency and department funds, as appropriate.
Second: In Sec. 1, on line 14 in the current second sentence, before the words “legislative council” by inserting “office of finance and management,”
Third: In Sec. 1, on line 17, in the current fourth sentence, following the words “recommendations to” by inserting “the governor and”
Rep. Klein of East Montpelier, for the committee on Natural Resources and Energy, to which had been referred Senate bill, entitled
An act relating to increasing the beverage container handler’s fee and an ongoing evaluation of the bottle redemption system;
Rep. Kainen of Hartford, for the committee on Judiciary, to which had been referred Senate bill, entitled
An act relating to advisement of immigration consequences of pleading guilty to a criminal offense;
(c)(1) Prior to accepting a plea of guilty or a plea of nolo contendere from a defendant in a criminal proceeding pursuant to Rule 11 of the Vermont Rules of Criminal Procedure, the court shall address the defendant personally in open court, informing the defendant and determining that the defendant understands that, if he or she is not a citizen of the United States, admitting to facts sufficient to warrant a finding of guilt or pleading guilty or nolo contendere to a crime may have the consequences of deportation or denial of United States citizenship.
(2) If the court fails to advise the defendant in accordance with this subsection, and he or she later at any time shows that the plea and conviction may have or has had a negative consequence regarding his or her immigration status, the court, upon the defendant’s motion, shall vacate the judgment and permit the defendant to withdraw the plea or admission and enter a plea of not guilty.
Sec. 2. Vermont Rules of Criminal Procedure Rule 11(c) is amended to read:
(c) Advice to Defendant. The court shall not accept a plea of guilty or nolo contendere without first, by addressing the defendant personally in open court, informing him the defendant determining that he the defendant understands the following:
(5) if there is a plea agreement and the court has not accepted it pursuant to subdivision (e)(3) of this rule, that the court is not limited, within the maximum permissible penalty, in the sentence it may impose; and
(6) if the court intends to question the defendant under oath, on the record, and in the presence of counsel about the offense to which he has pleaded, that his answers may later be used against him in a prosecution for perjury or false statement; and
(7) if he or she is not a citizen of the United States, admitting to facts sufficient to warrant a finding of guilt or pleading guilty or nolo contendere to a crime may have the consequences of deportation or denial of United States citizenship.
This act shall take effect September 1, 2006 and shall apply to pleas of guilty, pleas of nolo contendere, and admissions to sufficient facts which occur on or after the effective date of this act.
An act relating to sexual exploitation of an inmate;
Appearing on the Calendar for action, was taken up and pending the reading of the report of the committee on Institutions, on motion of Rep. Rodgers of Glover, the bill was committed to the committee on Judiciary
Rep. Maier of Middlebury, for the committee on Health Care, to which had been referred Senate bill, entitled
An act relating to common sense initiatives in healthcare;
Sec. 1. 8 V.S.A. § 4080a(h) is amended to read:
(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;
Sec. 2. 8 V.S.A. § 4080b(h) is amended to read:
Sec. 3. 8 V.S.A. § 4516 is amended to read:
Sec. 4. 8 V.S.A. § 4588 is amended to read:
Sec. 5. 8 V.S.A. § 5115 is amended to read:
* * * Community Grants * * *
Sec. 6. CoORDINATED Healthy Activity, Motivation,
(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:
(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;
(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
(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.
(2) “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.
(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:
(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.
(3) verify that hospitals are in compliance with all the requirements of this section and regulations adopted hereunder;
(e) The regulations adopted hereunder shall require hospitals to:
(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.
(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:
(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:
(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.
Sec. 13. COMMON CLAIMS AND PROCEDURES
(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.
Sec. 14. 18 V.S.A. § 9408a is added to read:
* * * 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.
(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.
(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.
(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
The secretary of the agency of human services shall ensure that the blueprint for health project in the department of health, the global clinical record being developed by the office of Vermont health access, and any other health care‑related information technology initiatives are incorporated into and comply with the statewide health information technology plan developed under 18 V.S.A. § 9417 and any other information technology initiatives coordinated by the secretary of administration pursuant to section 2222a of Title 3.
Sec. 17. 18 V.S.A. § 9416(a) is amended to read:
§ 9416. VERMONT PROGRAM FOR QUALITY IN HEALTH CARE
(a) The commissioner shall contract with the Vermont Program for Quality in Health Care, Inc. to implement and maintain a statewide quality assurance system to evaluate and improve the quality of health care services rendered by health care providers of health care facilities, including managed care organizations, to determine that health care services rendered were professionally indicated or were performed in compliance with the applicable standard of care, and that the cost of health care rendered was considered reasonable by the providers of professional health services in that area. The commissioner shall ensure that the information technology components of the quality assurance system are incorporated into and comply with the statewide health information technology plan developed under section 9417 of this title and any other information technology initiatives coordinated by the secretary of administration pursuant to section 2222a of Title 3.
Sec. 18. 18 V.S.A. § 9417 is amended to read:
§ 9417. HEALTH INFORMATION TECHNOLOGY
(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;
(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
(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.
(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)(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:
(2)(B) enhancing productivity of health care professionals and reducing administrative costs of health care delivery and financing;
(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.
Sec. 19. 18 V.S.A. § 9410 is amended to read:
Sec. 19a. 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.
(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:
(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.
(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:
(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:
(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;
(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.
(4) an employee or representative of a procurement organization.
Sec. 23. 18 V.S.A. § 9704 is amended to read:
(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
(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) 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:
OPERATORS, CEMETERY OFFICIALS, PROCUREMENT
ORGANIZATIONS, AND INDIVIDUALS APPOINTED TO
ARRANGE FOR THE DISPOSITION OF THE PRINCIPAL’S
(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:
(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:
(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:
(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;
(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:
(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.
(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.
(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.
Rep. Heath of Westford, for the committee on Appropriations, recommended the bill ought to pass in concurrence when amended as recommended by the committee on Health Care and when further amended as follows:
First: In Sec. 7 [Community Health and Wellness Grants], in subdivision 104b(c)(1), by striking subdivision (D), and redesignating the subsequent subdivisions to be alphabetically correct
Second: By striking Sec. 30 and inserting in lieu thereof a new Sec. 30 as follows:
Sec. 30. APPROPRIATIONS AND FUNDING
(a) In fiscal year 2007, the amount of $700,000.00 of the funds appropriated under Sec. 87 of H. 881 (Fiscal Year 2007 General Appropriations Act) is allocated to the department of banking, insurance, securities, and health care administration 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 required by 18 V.S.A. § 9417.
(b) For fiscal year 2007, the sums of $84,000.00 from the general fund and $76,000.00 from the Global Commitment fund are appropriated 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. In addition, the department of health, with assistance from the department of banking, insurance, securities, and health care administration, shall collect and utilize for such purposes the sum of $40,000.00 to be contributed from hospitals licensed in Vermont. In fiscal year 2007, there is appropriated $31,300.00 of general funds and $44,700.00 federal funds to the agency of human services for the Global Commitment for Health Demonstration Waiver.
(c) In fiscal year 2007, the amount of $400,000.00 of the funds appropriated under Sec. 87 of H. 881 (Fiscal Year 2007 General Appropriations Act) is allocated 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 $340,000.00 is appropriated from the Global Commitment fund to the department of health in fiscal year 2007. These funds combined with $540,000.00 which shall be allocated from funds appropriated in Sec. 119 of H.881, providing a total of $880,000.00, shall be deposited in the Vermont educational loan repayment fund established under Sec. 20 of this act and used for the purposes of loan repayment for health care providers and health care educators. There is appropriated $340,000.00 from the general fund to the agency of human services for the Global Commitment for Health Demonstration Waiver.
(e) The amount of $80,000.00 of funds appropriated in Sec. 119 of H.881 (Fiscal Year 2007 General Appropriations Act) is allocated for the Vermont student assistance corporation for loan forgiveness programs for health care providers through the dental hygienist incentive loan program and the nursing incentive loan program.
(f) The sum of $50,000.00 of funds appropriated in Sec. 118 of H.881 (Fiscal Year 2007 General Appropriations Act) is allocated to the commissioner of health for the 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 Sec. 29a of this act.
(h) For fiscal year 2007, the sum of $40,000.00 from the Global Commitment fund is appropriated to the office of Vermont health access to be expended upon approval of the health access oversight committee for Medicaid outreach, consistent with the report specified in Sec. 29b of this act. There is appropriated $16,470.00 general funds and $23,530.00 federal funds to the agency of human services for the Global Commitment for Health Demonstration Waiver.
Third: By adding a Sec. 32 to read:
Sec. 32. Sec. 87 of H.881 of the 2005 adjourned session is amended to read:
Personal services 4,641,080 4,541,080
Operating expenses 379,818 379,818
Total 5,020,898 4,920,898
General fund 790,000 711,000
Special funds 2,423,717 2,423,717
Global Commitment fund 1,737,181 1,716,181
Interdepartmental transfer 70,000 70,000
Fourth: By adding a Sec. 33, to read:
Sec. 33. Sec. 101 of H.881 of the 2005 adjourned session is amended to read:
Grants 788,357,850 788,336,850
General fund 116,951,586 116,942,938
Special funds 13,011,162 13,011,162
Global Commitment fund 0 0
State health care resources fund 151,803,088 151,803,088
Federal funds 485,013,100 485,000,748
Total 788,357,850 788,336,850
Fifth: By adding a new section 34, to read:
Sec. 34. Subdivision (a)(1) of Sec. 271 of H.881 of the 2005 adjourned session is amended to read:
(1) $1,325,800 $1,013,357 in general funds and $1,454,200 $1,079,289 in Global Commitment funds to the department of health - administration for implementation of “The Vermont Blueprint for Health Chronic Care Initiative,” and $1,124,200 $859,266 in general funds to the agency of human services for Global Commitment.
Pending the question, Shall the House amend the recommendation of proposal of amendment offered by the committee on Health Care as offered by the committee in Appropriations?
At twelve o’clock and thirty-two minutes in the afternoon, the Speaker declared a recess until two o’clock and thirty minutes in the afternoon.
At two o’clock and fifty minutes in the afternoon, the Speaker called the House to order.
Proposals of Amendment Agreed to; Third Reading Ordered
Consideration resumed on Senate bill, entitled
Thereupon, the recurring question, Shall the House amend the recommendation of proposal of amendment offered by the committee on Health Care as offered by the committee in Appropriations? was agreed to.
Pending the question, Shall the House propose to the Senate to amend the bill as recommended by the committee on Health Care, as amended? Rep. Flory of Pittsford demanded the Yeas and Nays, which demand was sustained by the Constitutional number. The Clerk proceeded to call the roll and the question, Shall the House propose to the Senate to amend the bill as recommended by the committee on Health Care, as amended? was decided in the affirmative. Yeas, 116. Nays, 4.
Rep. Klein of East Montpelier explained his vote as follows:
I vote yes for these very minor improvements. However, no one should mistake this legislation for real meaningful health care reform.”
I vote no. All that I can see of this bill is 41 pages of bureaucratic health care cost increases!
“Madam Speaker;
While there may be steps of improvement, here, as long as we continue to perpetuate an inefficient health care system of gambling and profiteering through health insurance schemes, I cannot vote yes.”
Was taken up and pending the reading of the report of the committees on Health Care and Appropriations, on motion of Rep. French of Randolph, action on the bill was postponed until the next legislative day.
An act relating to informing parents and students of their rights and responsibilities under state and federal law;
Was taken up and pending the question, Shall the House concur in the Senate proposal of amendment? on motion of Rep. Mook of Bennington, action on the bill was postponed until Thursday, April 13, 2006.
Message from the Senate No. 50
H. 777. An act relating to resident ownership of mobile home parks using cooperative and condominium structures.
The Senate has considered House proposal of amendment to Senate proposal of amendment to House bill entitled:
H. 238. An act relating to minimum service retirement allowance for state employees and teachers.
At three o’clock and thirty minutes in the afternoon, on motion of Rep. Sunderland of Rutland Town, the House adjourned until tomorrow at nine o’clock and thirty minutes in the forenoon.