2023 Vermont Statutes › Title 33 - Human Services › Chapter 18 - Public-Private Universal Health Care System › § 1822. Implementation; waiver

§ 1822. Implementation; waiver
(a) Green Mountain Care shall be implemented 90 days following the last to occur of:
(1) Receipt of a waiver under Section 1332 of the Affordable Care Act pursuant to subsection (b) of this section.
(2) Enactment of a law establishing the financing for Green Mountain Care.
(3) Approval by the Green Mountain Care Board of the initial Green Mountain Care benefit package pursuant to 18 V.S.A. § 9375.
(4) Enactment of the appropriations for the initial Green Mountain Care benefit package proposed by the Green Mountain Care Board pursuant to 18 V.S.A. § 9375.
(5) A determination by the Green Mountain Care Board, as the result of a detailed and transparent analysis, that each of the following conditions will be met:
(A) Each Vermont resident covered by Green Mountain Care will receive benefits with an actuarial value of 80 percent or greater.
(B) When implemented, Green Mountain Care will not have a negative aggregate impact on Vermont’s economy. This determination shall include an analysis of the impact of implementation on economic growth.
(C) The financing for Green Mountain Care is sustainable. In this analysis, the Board shall consider at least a five-year revenue forecast using the consensus process established in 32 V.S.A. § 305a, projections of federal and other funds available to support Green Mountain Care, and estimated expenses for Green Mountain Care for an equivalent time period.
(D) Administrative expenses in Vermont’s health care system for which data are available will be reduced below 2011 levels, adjusted for inflation and other factors as necessary to reflect the present value of 2011 dollars at the time of the analysis.
(E) Cost-containment efforts will result in a reduction in the rate of growth in Vermont’s per-capita health care spending without reducing access to necessary care or resulting in excessive wait times for services.
(F) Health care professionals will be reimbursed at levels sufficient to allow Vermont to recruit and retain high-quality health care professionals.
(b) As soon as allowed under federal law, the Secretary of Administration shall seek a waiver to allow the State to suspend operation of the Vermont Health Benefit Exchange and to enable Vermont to receive the appropriate federal fund contribution in lieu of the federal premium tax credits, cost-sharing subsidies, and small business tax credits provided in the Affordable Care Act. The Secretary may seek a waiver from other provisions of the Affordable Care Act as necessary to ensure the operation of Green Mountain Care.
(c) The Green Mountain Care Board’s analysis prepared pursuant to subdivision (a)(5) of this section shall be made available to the General Assembly and the public and shall include:
(1) a complete fiscal projection of revenues and expenses, as described in subdivision (a)(5) of this section, including reserves, if recommended, and other costs in addition to the cost of services, over at least a five-year period for a public-private universal health care system providing benefits with an actuarial value of 80 percent or greater;
(2) the financing plans provided to the General Assembly in January 2013 pursuant to 2011 Acts and Resolves No. 48, Sec. 9;
(3) an analysis of how implementing Green Mountain Care will further the principles of health care reform expressed in 18 V.S.A. § 9371 beyond the reforms established through the Blueprint for Health; and
(4) a comparison of best practices for reducing health care costs in self-funded plans, if available. (Added 2011, No. 48, § 4; amended 2011, No. 171 (Adj. Sess.), § 36a, eff. May 16, 2012.)