For the Week Ending January 6, 2012

Lawmakers returned to Montpelier Tuesday to convene for the 2012 session of the Vermont General Assembly. The legislature this year will grapple with a wide variety of challenges, including budget and revenue issues lingering from a slowly recovering economy and fallout from last fall’s Hurricane Irene.

Governor Peter Shumlin applauded Vermont’s response to the hurricane in his annual state of the state address Thursday, devoting more than half his speech to highlight the efforts of state agencies, businesses and individual citizens in response to the catastrophic storm. The Governor will unveil his policy agenda this week when he delivers his annual budget address listing his priorities for the coming year.

Health care remains a critical area of legislative focus this year as the state constructs a health insurance exchange required by federal law by 2014, and plans for replacement of the state psychiatric hospital facility compromised by flooding in last fall’s devastating storm.

The House Health Care Committee will take the lead on the legislative sequel to Act 48, last year’s reform legislation. The committee is awaiting more than a dozen studies, reports and recommendations required by Act 48 that are expected to be completed and delivered to legislative committees the week of January 17th. Those studies and recommendations will provide the committees with the administration’s position on key issues for the design of the insurance exchange, Green Mountain Care, and information and data necessary for the legislative committees to make decisions.

Among the critical decisions that must be decided for the design of the exchange this year are: whether to allow an off-exchange market for the individual and small group markets, whether small groups should be defined as groups of less than 50 employees or to expand the size to less than 100 employees, whether to impose a moratorium on the provision of new “association” policies, and whether to allow supplemental insurance to be sold to small businesses and individuals.

The House Committee spent time last week hearing updates on the status of ongoing activities, introductions to the new Green Mountain Care board appointed by Governor Shumlin late last summer, and new executive branch appointments in the department of Vermont health access and the department of banking, insurance and health care administration. The committee has scheduled time this week for briefings from BISHCA about the insurance market and from Vermont Information Technology Leaders (VITL) about its activities.

They also will continue discussions began last week around health care related-topics included in the annual budget adjustment bill around the administration’s recommendations for new positions in DVHA and a Green Mountain Care Board request for emergency rulemaking powers to allow them to bypass the normal process to enable them to enact rules governing their authority to regulate insurer rate requests, hospital budgets, and certificate of need requests.

The Senate Health and Welfare Committee joined their House counterparts in joint sessions for part of the week’s updates, and met separately to consider confirmation of the Green Mountain Care appointees as well as the state hospital developments.

Meanwhile, the Green Mountain Care Board is quickly moving forward on its agenda to address health care costs and oversee development of the universal coverage system envisioned in Act 48. Their website and public meeting calendar is available at: http://healthcare.vermont.gov/

New Bills of Interest:

S.163 Introduced by Senator Brock
This bill proposes to move from January 15, 2013 to September 15, 2012 the due date for the administration’s recommendations for financing Green Mountain Care and the Vermont health benefit exchange.

S.190 Introduced by Senators Miller and Mullin
This bill proposes to expand the role of behavioral and mental health providers on community care teams in the Blueprint for Health to include facilitating patient engagement in healthy behaviors.

S.191 Introduced by Senators Miller and Mullin
This bill proposes to create a commission on rational treatment of chronic pain to develop training programs for health care and human services professionals. The bill would also require health care and human services professionals to receive training.

S.197 Introduced by Senator Mullin
This bill proposes to prohibit hospital-owned medical practices from imposing a hospital-based outpatient charge for nonemergency visits.

S.199 Introduced by Senator Mullin
This bill proposes to extend the termination date of the immunization pilot program and remove the exemption from immunization on philosophical grounds.

S.200 Introduced by Senators Pollina, Doyle and Illuzzi
This bill proposes to expand health insurers’ reporting obligations in their annual reports and under the Vermont healthcare claims uniform reporting and evaluation system (VHCURES).

S.207 Introduced by Senators Miller and Mullin
This bill proposes to expand the conditions that must be met before the implementation of Green Mountain Care.

S.208 Introduced by Senators Illuzzi and Miller
This bill proposes to define a small employer for purposes of Vermont’s health benefit exchange as an employer with 50 or fewer employees in 2014 and 2015, as an employer with 100 or fewer employees in 2016, and as an employer of any size in 2017 and subsequent years. The bill would direct employers offering exchange plans to their employees to contribute a defined amount toward the cost of the employee’s plan and would require the employee to pay the difference. It would require health insurance be available for purchase in the individual and small group markets both inside and outside the exchange and would direct BISHCA to propose a mechanism for merging the individual and small group markets. The bill would also require the secretary of administration to provide an estimate of the cost of providing an additional state subsidy on a sliding scale to individuals eligible for federal premium tax credits and cost-sharing subsidies.

S.209 Introduced by Senators Miller and Snelling
This bill proposes to require health insurers to include naturopathic physicians as primary care providers, include naturopathic physicians as medical homes under the Blueprint for Health, specify that naturopathic physicians may practice independently and without supervision, and allow naturopathic physicians to apply for loans and grants from the state’s health information technology fund to enable them to purchase electronic health record programs.

S.210 Introduced by Senators Miller and Snelling
This bill proposes to tighten insurance coverage requirements for home births and other services provided by licensed midwives and certified nurse midwives; to ensure that all midwives submit data to a nationwide database; and to require the midwife appointees to the office of professional regulation’s advisory board, not the commissioner of health, to access the database to obtain relevant data.

S.221 Introduced by Senators Fox and Mullin
This bill proposes to restrict the amount of an insured’s out-of-pocket expenditures for prescription drugs.

S.222 Introduced by Senators Fox and Mullin
This bill proposes to limit cost-sharing exposure for individuals eligible for Catamount Health who are on an employer-sponsored insurance assistance plan.

S.223 Introduced by Senators Pollina, Baruth, Lyons, McCormack and Westman
This bill proposes to require health insurers to cover the diagnosis and treatment of autism spectrum disorders in individuals six years of age and above.

S.236 Introduced by Senator Kittell
This bill proposes to allow the signature of an advanced practice nurse (APRN) certified as a nurse practitioner to be used whenever the signature of a physician is required.

H.492 Introduced by Representatives Mook, Edwards, Botzow, Burke, Klein, Lenes and Stuart
This bill proposes to require health insurers to provide coverage for hearing aids and to direct the Green Mountain Care board to consider including coverage for hearing aids as part of Green Mountain Care.

H.494 Introduced by Representative Klein of East Montpelier
This bill proposes to require health care professionals to identify their title and license, certification, or registration type in advertisements, handouts, and identification tags.

H.495 Introduced by Representative Till of Jericho
This bill proposes to allow health care provider bargaining groups to negotiate with the secretary of administration and the Green Mountain Care board in addition to the officials already listed in statute and expands the list of topics about which they may negotiate.

H.512 Introduced by Representative Botzow and others
This bill proposes to make technical and miscellaneous amendments to various statutes pertaining to banking, insurance, securities, and health care administration.

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://www.leg.state.vt.us/Committee01.cfm 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 Leigh Tofferi at (802) 223-6131 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 webmail@bcbsvt.com