Legislative Report for the Week Ending April 15, 2016
The urgency of pending adjournment was felt in the Senate and House committee rooms last
week. Bills and amendments were considered in rapid succession. The pressure to wrap up was
especially strong in the Senate. The Senate Health and Welfare Committee will no longer hold
regular meetings. Morning committee meetings ceased to allow adequate time for
consideration of bills by the full Senate.
S.214 Large Group Repeal
The House Health Care Committee passed a bill to repeal a section of law that has been on the
books since Act 48 passed in 2011. Without the repeal, large groups (greater than 100
employees) will have the option to purchase health benefit exchange qualified health plans in
2018. The law was supposed to go into effect in 2017, but last year the legislature approved a
one-year delay and required the Green Mountain Care Board (GMCB) to study the potential
impact on the market. Federal regulations, released since the passage of Act 48, required large
groups that have the option to purchase exchange products to be community rated. This
influenced the report, produced by the GMCB’s actuarial firm, which was released at the end of
January. It concluded that this change to the large group market would raise premiums across
all markets.
The committee recognized concerns about the yet-to-be-defined regulatory framework, the
potential market disruption, and community rating pushing the best large group risk to selfinsure, creating more premium pressure on the large group insured market. The bill will be
considered on the House Floor this week.
H.812 Health Care Research Commission
The Senate Health and Welfare committee added a number of study provisions to the bill
intended to produce regulation and consumer protections in a health care system that includes
Accountable Care Organizations (ACOs). The GMCB would be required to consider the
appropriate role of multi-year budgets for accountable care organizations and provide a
Medicaid advisory rate case for ACO services. The Joint Fiscal Office, Department of Finance and
Management, Agency of Human Services Central Office and the Department of Vermont Health
Access would consider the appropriate role of multi-year budgets for Medicaid and other statefunded health care programs.
The Vermont Health Connect assessment language approved in the House, along with a
$400,000 appropriation, was added to H.812. Studies of Universal Primary Care and Dr.
Dynasaur 2.0, which would cost $240,000 in fiscal year 2017, were also added to the bill.
S.255 Regulation of Hospitals, Health Insurers, and Managed Care Organizations
S.255 would move some regulatory authority from the Department of Financial Regulation (DFR)
to the Green Mountain Care Board and evolve the regulation of the existing health care system,
previously laid out in Rule 9-03. Over the summer, representatives of the GMCB, DFR, the
Shumlin Administration, hospitals, the Vermont Medical Society, the consumer advocates office,
health plans, and other interested parties spent over 600 hours crafting the legislation. The
Senate passed the bill relatively unchanged. It is now being examined by the House Health Care
Committee, which is considering a number of amendments introduced last week, including:
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Allowing the Office of Health Care Advocate to receive copies of all hospital budget
materials submitted to the GMCB and to ask questions directly of the hospitals during the
Board’s budget review hearings.
Requiring each hospital to post on its website the membership of its governing body,
including each member’s name, town of residence, occupation or employer, and
compensation for board service, if any.
Requiring the Medicaid department to adhere to all laws and regulations governing
commercial health plans, except those specifically in conflict with federal standards.
S.107 Human Services Reorganization
The House Health Care Committee took a first look at S.107, a bill that would split the Agency of
Human Services (AHS) into two separate agencies by creating a new Agency of Health Care
Administration. The intent of the proposal is to separate and realign all the State’s health care
and human service functions in the interest of better transparency, oversight and management.
The committee did not express strong support for the idea but will continue to examine the
proposal.
S.216 Prescription Drug Disclosure Bill
House Health Care also heard testimony on S.216, which would require the Department of
Financial Regulation to create a rule to guide health plans on posting prescription drug costs
based on Qualified Health Plans available on Vermont’s Health Benefits Exchange. The
information is already available to members. This legislation would make it available to potential
enrollees who are shopping for a plan. Blue Cross Blue Shield of Vermont told the committee it
supported individuals having good drug cost information to make plan choices and the
implementation of a comparison tool.
S.245 Hospital Affiliation Notification
House Health Care began examination of S.245, a bill that requires the GMCB to review
physician acquisitions and transfers as part of the Board’s hospital budget review
responsibilities. Hospitals would be required to provide notice of a new acquisition to each
patient served by a health care provider during the previous three-year period.
The bill would require hospitals to notify the Attorney General’s Office of an affiliation. It would
also disallow increased Medicaid rates to hospitals for outpatient services as a result of a
provider transfer or acquisition. The GMCB is directed to consider the possible impacts of
extending the same prohibition to commercial insurers.
The final provision of the bill relates to Act 54 of 2015, which required Vermont health insurers
to produce plans that provide fair and equitable payments to providers at Academic Medical
Centers and other providers without increasing premiums or public funding. The plans are due
to the GMCB on July 1, 2016. The Board is required to accept, modify or reject the plans. S.245
would amend the process to require that the Legislature receive a copy of each health insurer’s
plan by July 15, and an update on implementation by December 1.
H.761 Aligning Provider Measures
Senate Health and Welfare passed H.761 out of committee last week. The intent of the bill is to
identify reporting requirements imposed on physicians who have increased data collection and
the use of outcome measures. The bill would require the GMCB to catalog and develop a plan to
align health care performance measures imposed on primary care providers.
If you are interested in this week’s Legislative Committee Meeting schedules, agendas, and a
listing of other meetings and activities, please visit the Vermont Legislature’s website at
http://legislature.vermont.gov/. Committee meetings are normally updated daily, and are
subject to change without notice. If you plan on attending, you may want to call ahead to verify
the agenda.
For more information on legislative proposals, visit the Blue Cross and Blue Shield of Vermont
website at www.bcbsvt.com or call Cory Gustafson at (802) 249-2225 or Kathy Parry at (802)
371-3205. If you wish to discontinue receiving these updates or know of anyone else who would
like to receive it, please call Kathy Parry or send an e-mail to parryk@bcbsvt.com