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S.184
Introduced by Senator Shumlin of Windham County, Senator Bloomer of
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Rutland County, Senator Chard of Windham County, Senator
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Leddy of Chittenden County and Senator Riehle of Chittenden
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County
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Referred to Committee on
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Date:
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Subject: Health; Vermont health access plan; pharmaceutical assistance
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program; long-term care; healthy lifestyles for Vermont elders
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Statement of purpose: This bill proposes to: (1) amend the Vermont health
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access plan so that increased income will not automatically render a low
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income beneficiary ineligible for the plan; (2) expand access to the
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pharmaceutical assistance program by providing elderly and disabled
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Vermonters with coverage for extraordinary prescription drug expenses;
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(3) provide funding for both community-based and nursing facility long term
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care services in accordance with the policies of Act No. 160 of the 1996
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Session of the General Assembly; (4) provide tax credits for individuals and
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families with qualified long-term care expenses; and (5) create a successful
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aging initiative that makes grants of start-up seed financing for community-
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based programs designed promote healthy lifestyles for Vermont elders.
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AN ACT RELATING TO HEALTH CARE
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It is hereby enacted by the General Assembly of the State of Vermont:
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Sec. 1. EXPANSION OF THE VERMONT HEALTH ACCESS PROGRAM
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TO LOW INCOME VERMONTERS
(a) It is the intent of the general assembly that a low income Vermonter
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should not have to chose between accepting a pay raise and losing eligibility
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for the Vermont health access plan, and thereby depriving his or her family of
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essential health care benefits. Accordingly, sliding scale income eligibility
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criteria are established by this act so that low income beneficiaries are not
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unreasonably terminated from the Vermont health access plan.
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(b) The commissioner of social welfare shall offer health benefits to low
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income Vermonters through the Vermont health access plan authorized in Act
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No. 14 of the Acts and Resolves of the 1995 Session of the general assembly in
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accordance with the provisions of this section.
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(c) An individual shall be eligible for enrollment in the health benefit plan
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offered under this section in accordance with the eligibility requirements of the
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Vermont health access plan, except that an enrolled beneficiary shall not be
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terminated from the plan, and shall remain eligible for continued enrollment if
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he or she is a resident of Vermont whose household income, when calculated
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in accordance with the rules adopted for the Vermont health access plan, is less
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than 250 percent of the federal poverty level. The commissioner shall develop
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sliding scale income eligibility criteria such that, for each increment of an
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enrolled individual’s increased income the individual shall contribute one-half
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of such income increment towards the cost of his or her health benefit plan.
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(d) The commissioner shall monitor enrollment in the Vermont health
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access plan as authorized by this section, and shall limit enrollment as
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authorized by this section so that expenditures do not exceed the appropriations
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available to support expanded enrollment in any fiscal year.
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Sec. 2. 18 V.S.A. § 253 is amended to read:
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§ 253. ELIGIBILITY
(a)(1) A person shall be eligible for assistance if he or she is a resident of
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Vermont who is at least 65 years of age or disabled and whose household
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income, when calculated in accordance with the rules adopted for the Vermont
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health access plan under Act No. 14 of the Acts and Resolves of the 1995
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Session of the general assembly, is less than 225 percent of the federal poverty
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level.
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(2) A person whose household income is less than 175 percent of the
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federal poverty level shall be eligible pursuant to the provisions of this chapter
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for comprehensive coverage of prescription drug expenses upon payment of
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the co-payment amount required by section 254(a)(1) of this title.
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(3) A person whose household income is 175 percent of the federal
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poverty level or more and less than 225 percent of the federal poverty level
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shall be eligible pursuant to the provisions of this chapter for coverage of
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extraordinary prescription drug expenses, after he or she has incurred a
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deductible amount during any annual coverage period of $150.00 that is not
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reimbursable by any public or private health benefit plan, upon payment of the
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co-payment amount required by section 254(a)(2) of this title.
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(c)(b) A person whose prescription drug expenses are paid or
reimbursable, either in whole or in part, by any plan of assistance or insurance,
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other than Title XVIII of the Social Security Act (Medicare), shall not be
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eligible for pharmaceutical assistance under this chapter. No assistance shall
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be provided under this chapter with respect to an individual drug purchase that
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may be covered in whole or in part by Title XVIII of the Social Security Act
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(Medicare).
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Sec. 3. 18 V.S.A. § 254 is amended to read:
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§ 254. CO-PAYMENT; ENROLLMENT
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(a) Benefits under this chapter shall be subject to a co-payment by the
recipient. in accordance with the provisions of this section:
(1) In the case of recipients with household income of less than 175
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percent of the federal poverty level such co-payment shall be the same
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co-payment requirements that exist under the pharmaceutical benefits
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component of the Vermont health access plan under Act No. 14, Sec. 14(a)(6)
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of the Acts and Resolves of the 1995 Session of the general assembly.
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(2)(A) In the case of recipients whose household income is 175 percent
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of the federal poverty level or more and less than 225 percent of the federal
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poverty level such co-payment shall be $6.00 for each purchase of a drug
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costing $30.00 or less, and $15.00 for each purchase of a drug costing more
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than $30.00.
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(B) During each annual coverage period, no co-payment shall be
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required for the remainder of such period by any eligible recipient whose
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personal covered drug expenditures exceed 5.75 percent of the recipient’s
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household income.
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(C) The commissioner shall adjust the co-payment amounts required
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by subdivision (2)(A) of this subsection annually on or before January 1 to
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account for increases in the cost of living for program beneficiaries, in
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accordance with rules adopted by the commissioner.
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(b) Prior to the beginning of each fiscal year, the department shall establish,
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by rule, the percentage of the charge for a drug to be paid as a co-payment by
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eligible recipients. The percentage adopted under this section shall be
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reasonably calculated to insure that the state's obligation to provide benefits
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under this chapter shall not exceed funds appropriated for the program.
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(c)(b) A pharmacy shall dispense a drug to an eligible recipient upon
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payment of the required co-payment. The pharmacy shall collect the
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remainder of the charge for the drug from the department.
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(d)(c) A drug may also be dispensed to an eligible recipient, subject to the
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required co-payment, provided such dispensing is pursuant to and in
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accordance with any contractual arrangement that the department may enter
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into or approve for the group discount purchase of drugs. When a person or
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business located in Vermont and employing citizens of this state has submitted
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a bid for the group discount purchase of drugs and has not been selected, the
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commissioner of social welfare shall record the reason for nonselection. The
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commissioner's report shall be a public record available to any interested
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person. All bids or quotations shall be kept on file in the commissioner's office
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and open to public inspection.
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(e)(d) If in the course of a fiscal year the department determines that
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expenditures will exceed funds appropriated the department shall, by
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emergency rule, increase the co-payment to an amount sufficient to insure that
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expenditures will not exceed appropriations within that fiscal year.
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The department shall monitor enrollment in the program on a monthly basis,
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and shall limit enrollment in the pharmaceutical assistance program so that
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expenditures do not exceed the appropriation available for the program in any
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fiscal year.
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Sec. 4. RECODIFICATION
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18 V.S.A. §§ 251, 252, 253, 254, and 255 shall be recodified in the
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Vermont Statutes Annotated as 33 V.S.A. §§ 1991, 1992, 1993, 1994, and
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1995, respectively, as part of a new subchapter 4 of chapter 19 of Title 33.
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Sec. 5. LONG-TERM CARE TARGETS FOR THE DEVELOPMENT OF
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ADEQUATE SYSTEM CAPACITY FOR HOME AND
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COMMUNITY-BASED SERVICES
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On or before January 1, 2000, the commissioner of aging and disabilities
shall propose to the general assembly system capacity targets for the
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development of new home and community based residential and other
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long-term care services so that the system will have adequate capacity to meet
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the noninstitutional residential care needs of elderly and disabled Vermonters.
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The commissioner’s proposal shall include the governor’s proposed budget of
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the public funding needed to implement the proposal. The commissioner shall
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establish an advisory commission to assist in developing the proposal, and
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shall invite to participate in the commission’s deliberations representatives of
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Vermont’s nursing homes, representatives of home and community-based
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long-term care services, and families and other representatives of elderly and
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disabled Vermonters.
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Sec. 6. 32 V.S.A. § 5828c is added to read:
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§ 5928c. CREDIT FOR QUALIFIED LONG-TERM CARE
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EXPENDITURES
(a) A nonrefundable credit shall be available to a resident individual
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against the tax imposed for that taxable year by section 5822 of this title in an
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amount, not to exceed $1,000.00, or $2,000.00 for married taxpayers filing
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jointly, of the individual’s qualified long term care expenditures during that
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taxable year.
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(b) As used in this section, “qualified long-term care expenditures” means
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expenditures made by the taxpayer residing in this state for his or her
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long-term care needs, or made by such taxpayer for the long term care needs of
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his or her relative residing in this state. The commissioner of aging and
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disabilities shall adopt such further rules as are necessary to carry out the
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purposes of this section, including an exclusive list of qualifying expenditures.
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Such list may include, at the discretion of the commissioner and pursuant to
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such further criteria as the commissioner shall prescribe by rule:
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(1) the construction of renovations to the individual’s Vermont
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residence to accommodate the residential needs of an elderly or disabled
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Vermont resident;
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(2) the purchase of adaptive equipment;
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(3) respite care;
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(4) the individual’s Medicare supplemental insurance premiums or
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uninsured health care services in excess of 5.75 percent of the individual’s
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household income, as defined by section 6061(4) of this title;
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(5) such other long-term care expenditures as the commissioner in his or
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her sole discretion determines by rule are appropriate.
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Sec. 7. FINDINGS AND PURPOSE
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(a) The General Assembly finds that:
(1) Vermont’s elders are living longer, more active and more productive
lives, but the state’s existing long term care policies and programs are not
always able to address the needs of these “young old” Vermonters.
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(2) It is the policy of the State of Vermont to ensure that Vermont elders
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live successful and productive lives in their homes and communities whenever
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possible.
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(3) By focusing on the needs of younger and healthier Vermont elders,
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state policy will promote healthy lifestyles and thereby prevent unnecessary
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utilization of more costly, institutional-based long-term care services.
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(b) It is the purpose of this act to appropriate monies to the department of
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aging and disabilities, in order to provide start-up, seed financing of cost-
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effective, community-based programs for Vermont’s elders designed to
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promote healthy lifestyles and successful aging, funded over the long term
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with sliding scale contributions from those elders who benefit from the
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programs. Such programs may include fitness centers with a focus on
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activities which are age appropriate for seniors, educational collaborations
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between public and private institutions of higher education and the professorial
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talent among Vermont seniors, programs to encourage healthy lifestyles and
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nutrition among seniors for whom congregate meals or “Meals on Wheels”
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programs are not appropriate, employment training of seniors in the skills
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needed to work in the modern world of business and volunteer public service
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work, transportation programs to provide seniors access to other programs and
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activities using the volunteer efforts of neighbors and friends, and cultural
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services and activities.
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Sec. 8. 33 V.S.A. § 504(a)(5) is added to read:
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§ 504. DUTIES OF DEPARTMENT
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(a) The department shall administer all laws and programs specifically
assigned to it for administration, including:
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(5) Grants or loans for start-up, seed financing of community-based
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programs designed to promote healthy lifestyles and successful aging for
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Vermont elders.
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Sec. 9. APPROPRIATIONS
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(a) $900,000.00 is appropriated in fiscal year 2000 from the monies
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received by the State of Vermont in connection with the Master Settlement
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Agreement between members of the tobacco industry and the state of Vermont,
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approved by Vermont superior court on December 14, 1998 and finalized in
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Vermont on January 13, 1999 to support the expansion of the Vermont health
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access plan authorized by this act.
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(b) $2,300,000.00 is appropriated in fiscal year 2000 from the monies
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received by the State of Vermont in connection with the Master Settlement
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Agreement between members of the tobacco industry and the state of Vermont,
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approved by Vermont superior court on December 14, 1998 and finalized in
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Vermont on January 13, 1999 to support expansion of the pharmaceutical
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assistance program for elderly and disabled Vermonters authorized by this act.
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(c) $1,600,000.00 is transferred from the general fund in fiscal year 2000 to
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the long-term care special administration fund, Sec. 1(d) of Act 160 (1996),
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and is hereby appropriated to the commissioner of aging and disabilities to
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support home and community-based services.
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(d) $1,600,000.00 is appropriated from the general fund to the
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commissioner of social welfare to support increased Medicaid reimbursement
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of nursing homes pursuant to the policies and principles established in Act
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No. 160 of the 1995 Session of the General Assembly.
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(e) $200,000.00 is appropriated from the general fund in fiscal year 2000 to
the commissioner of aging and disabilities for a pilot program to carry out the
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successful aging initiative authorized by this act in no more than two regions of
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the state.