Legislative Deadlines in Vermont’s Health Care Reform (Act 48) for 2012

There is a great deal of interest here and nationally in Vermont’s pioneering effort to redesign its health care system.  Even though the proposal for how to finance Vermont’s reformed health care system is not due to the General Assembly for another year, there are plenty of deadlines in Act 48 for the Administration to comply with to keep the public and the legislature abreast of ongoing work towards a transformed system.  Act 48 is entering its first full year of existence in 2012 and it establishes an aggressive schedule for reviewing and recommending the changes that may be needed to implement a health care exchange and then move to Green Mountain Care.  Even though many of the deadlines relate to reporting requirements, the information provided to the General Assembly through the reports is vital for health care providers, businesses and individuals for understanding how reform is proceeding.

January 1, 2012

• The Green Mountain Care Board is now fully staffed.  The last pieces to fall into place were the transfer of up to nine positions from the Department of Banking, Insurance, Securities and Health Care Administration (BISHCA) to the Green Mountain Care Board by the first of the year. Sec. 3b
• The first pilot payment reform project is to be operational.  The payment reform pilot projects act as test runs or preliminary experiments for the payment system under revision. Sec. 3c.; 18  V.S.A. § 722(e)
• Health insurance policies and rate increases are now posted on the BISHCA website, along with related filings, and are available for public comment. Sec. 15; 8 V.S.A. § 4062(c)(2)
• The Green Mountain Care Board now reviews and approves health insurance rate increases. Sec. 3; 18 V.S.A. § 9375(b)(6)(A)

January 15, 2012

A variety of reports and updates are due to specified legislative committees in the house and senate, as outlined below.

• The Secretary of Administration will submit:

1. A proposal for improving or reforming the medical malpractice system. Sec. 2 (7)
2. A plan for transferring to the Department of Health Access (DVHA) the health care eligibility unit’s employees, consultants, and related appropriations that currently reside in the Department for Children and Families (DCF).  The actual transfer will occur between March 15, 2012 and July 1, 2013. Sec. 6
3. Recommendations relating to the Health Information Technology Plan. Sec. 10(c)
4. Recommendations on “how to unify Vermont’s current efforts around health system planning, regulation, and public health.” Sec. 11(a)
5. An integration  report and recommendations on how to either integrate or align Medicare, Medicaid, private insurance, associations, state employees, and municipal employees with the health benefit exchange and Green Mountain care.  This is a significant undertaking that will include:

o    Whether the State should establish a basic health program for certain lower income individuals;
o    How to handle association health care policies;
o    How to make the statutory changes necessary to integrate the private health care insurance market with the health benefit exchange;
o    What the advantages and disadvantages are in defining a small employer as having up to 50 employees versus having up to 100 employees in the health benefit exchange;
o    What the advantages and disadvantages are in allowing qualified health benefit  plans (plans that contain specified essential benefits as per 33 V.S.A. § 1806) to be sold to individuals and small groups inside and outside the health care exchange;
o    What the advantages and disadvantages are in allowing non-qualified health plans to be sold outside the exchange;
o    How the common benefit package should be designed, a recommendation made in consultation with the Green Mountain Care Board;
o    What the impact will be of supplemental insurance plans in the small and individual group markets;
o    Whether prescription drugs in Green Mountain Care could be purchased through Medicaid, the 340B pricing program, or some other bulk purchasing arrangement;
o    Whether employers and individuals should be able to purchase supplemental coverage through Green Mountain Care or private insurers;
o    How to structure coverage through Green Mountain Care for adult children up to age 26;
o    Whether to implement a financial reserve or reinsurance mechanism to reduce the state’s financial risk in operating Green Mountain Care;
o    How to  achieve administrative savings by aligning the public and private health care programs, including an estimate of the savings and an analysis of federal waivers that may be necessary. Sec. 8

• The Green Mountain Care Board, in collaboration with the director of health care reform, will develop and submit a work plan for the Board, including timelines. Sec. 2(b)

• The Commissioner of Labor will report on aligning the workers’ compensation system with Green Mountain Care. Sec. 8(b)

• The Commissioner of DVHA, after conferring with BISHCA, and the Departments of Taxes and Motor Vehicles, will report on whether additional enforcement mechanisms will be necessary to ensure that most, if not all, Vermonters will obtain sufficient health benefit coverage. Sec. 8(c)

• The boards of nursing and medical practice, and the Office of Professional Responsibility, will look at how to improve the primary care workforce and will make joint recommendations on changes to rules and procedures and scopes of practice so health care professionals are able to perform “to the fullest extent of their professional competence.” Sec. 13(a)

• The Department of Labor and the Agency of Human Services will report on retraining employees who may become dislocated as a result of health care reform. Sec. 13(b)

• BISHCA will report on the advantages and disadvantages of Vermont adopting the National Association of Insurance Commissioners Model Act, which prohibits insurers from reserving the discretion to interpret the terms of policies or to implement review standards that are inconsistent with state law. Sec. 17

• BISHCA will also recommend the statutory changes that will be needed to permit the Green Mountain Care Board to participate in the hospital budget review and Certificate of Need processes. Sec. 11(b)

• DVHA will make recommendations for a single prescription drug formulary to be used by all payers. Sec. 18

• Although the Green Mountain Care Board is charged with reporting on or before each January 15th about its activities the previous fiscal year, it did not exist in the 2010-2011 fiscal year that ended on June 30, 2011.  Presumably it does not owe the general assembly a report this year. Sec. 3; 18 V.S.A. § 9375(d)

February 1, 2012

• The Secretary of Administration will report on the potential impact of various Green Mountain Care financing sources on Vermont’s businesses and its economy. Sec. 9(c)

February 15, 2012

• The director of health care reform will provide the legislature with information relating to Vermont’s health benefit exchange. Sec. 2(a)(2)(A)

March 15, 2012

• The Green Mountain Care Board, in consultation with BISHCA and DVHA, will report on regulatory changes that may be necessary to align professional and managed care regulation with payment reform. Sec. 12

July 1, 2012

• The Green Mountain Care Board will begin reviewing recommendations on hospital budgets and certificates of need. Sec. 3; 18 V.S.A. § 9375(b)(6)(B)-(C)
• Two additional proposed payment reform pilot projects must be operational. Sec. 3c.; 18  V.S.A. § 722(e)
• The Medicaid Advisory Board is repealed. Sec. 32; 33 V.S.A. § 1901(c)