For the Week Ending January 27, 2012

 The House Health Care Committee last week focused on specific sections contained in a health care reform bill (H.559) to create the final framework for a federally required health insurance exchange and for fine-tuning the state’s reform path toward a universal coverage, single-payer system in 2017. The committee is hearing testimony and marking up the bill as it tries to meet its February 10th target date for moving it to the full House for passage.

An administration proposal in one of those sections would allow the state to consider a “basic health plan” to enroll Vermonters whose incomes fall between 133 percent and 200 percent of the federal poverty level within the state’s Medicaid program rather than the new health insurance exchange. The proposal also allows the administration, without further legislative review, to implement the basic health plan. The administration is unsure if the state’s Medicaid plan would be allowed by the federal government to offer a basic health plan which would be necessary, according to administration officials. BCBSVT pointed out that the administration’s own report to the legislature cited disadvantages for a basic health plan: (1) thousands of potential enrollees in the exchange necessary for sustainability would instead be permanently segregated outside the exchange, and (2) lower Medicaid provider reimbursement rates would aggravate an already problematic shift of health care costs onto private payers due to underpayment from government plans. The Vermont Medical Society reinforced those points and also called the request an “extraordinary delegation” of legislative authority.

The committee will decide on the basic health plan issue early this week along with sections of the bill transferring bill-back authority for hospital and insurer regulatory functions from BISHCA to the new Green Mountain Care board. The authority to bill hospitals and insurers prompted significant discussion as lawmakers tried to sort out the bill-back methodology and the specific functions being funded through the bill-back provisions.

The House Human Services Committee completed its work on a restructuring of the state’s community mental health system, agreeing in concept with an administration proposal to not reopen the state hospital in Waterbury and instead build a smaller acute behavioral health hospital in central Vermont, fund additional beds at the Brattleboro Retreat and the Rutland Medical Center, and bolster the state’s community-based system.

Meanwhile, the Senate Health and Welfare Committee heard from nearly a dozen witnesses Tuesday on a bill (S.199) intended to stem the slide in child vaccination rates in Vermont. The bill would remove an exemption from the state’s requirement that children receive their scheduled vaccinations before enrolling in a Vermont school. The exemption allows parents to avoid the requirement for “philosophical” reasons. The bill would retain an exemption for religious reasons. Most witnesses expressed support for the bill, citing the troublesome decline in vaccination rates. Others, however, opposed the proposal as unwarranted and based on false evidence.

The Senate committee also began reviews of prescription drug abuse proposals (S.242), treatment of chronic pain (S.191), and hospital-based outpatient fees (S.197).

This week, the House Health Care Committee will complete its discussion on sections of H.559 held over from last week and take additional testimony on provisions prohibiting insurer discretionary clauses, provider bargaining groups, and a limit on out-of-pocket expenses for prescription drug benefits. The Senate committee will consider bills designating naturopaths as primary care physicians (S.209), expanding an autism mandate passed last year for children between 18 months and six years of age to cover anyone over 18 months (S.223), allow advanced practice nurses signature authority (S.236), and a bill greatly expanding the reporting requirements of health insurers (S.200).

New Bills of Interest:

H.534 Introduced by Representative Poirier of Barre City

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).

H.539 Introduced by Representative Eckhardt of Chittenden and others

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.

H.549 Introduced by Representative Wizowaty of Burlington and others

This bill proposes to limit state funding to profit and nonprofit corporations that meet an 8:1 compensation ratio between the highest and lowest paid employees.

H.559 Introduced by Representatives Fisher of Lincoln and Pugh of South Burlington

This bill proposes to implement a number of changes to Vermont’s health insurance, health coverage, and health care provider regulatory frameworks, including: (1) defining a small employer for the first three years of the Vermont health benefit exchange as an employer with 100 employees or fewer; (2) merging the individual and small group insurance markets; (3) expanding the duties and clarifying the role of the Green Mountain Care board; (4) giving the Green Mountain Care board authority over the health insurer rate review, hospital budget review, and certificate of need processes; (5) banning discretionary clauses in health insurance contracts; (6) restricting the amount of an insured’s out-of-pocket expenditures for prescription drugs; (7) authorizing the agency of human services to seek certain waivers from the Centers of Medicare and Medicaid Services; and (8) repealing Catamount Health and the Vermont health access plan upon implementation of the Vermont health benefit exchange.

H.572 Introduced by Representatives Heath of Westford and Wizowaty of Burlington

This bill proposes to expand health-related privacy protections and health insurance coverage to parties to a final divorce, dissolution, or legal separation decree.

H.573 Introduced by Representative Dakin of Chester and others

This bill proposes to allow the signature of an advanced practice registered nurse (APRN) certified as a nurse practitioner to be used whenever the signature of a physician is required.

H.578 Introduced by Representative Poirier of Barre City

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.

H.601 Introduced by Representative Kitzmiller of Montpelier

This bill proposes to prohibit health insurers from imposing cost-sharing requirements or other charges for colorectal cancer screenings and mammograms.

H.602 Introduced by Representative Till of Jericho and others

This bill proposes to eliminate a requirement that health insurers provide coverage for prostate cancer screenings.

H.631 Introduced by Representative Koch of Barre Town and others

This bill proposes to require that insurers directly reimburse ambulance and EMS providers.

H.646 Introduced by Representative Browning of Arlington and others

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 the department of banking, insurance, securities, and health care administration to propose a mechanism for merging the individual and small group markets.  The bill would 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.  The bill would require Green Mountain Care to provide cost-sharing incentives to individuals willing to commit to health behaviors.  It would establish a medical debt loan fund for individuals experiencing extreme financial hardship as the direct result of medical debt, and would require the legislative joint fiscal office to propose by September 1, 2012 possible financing systems for Green Mountain Care.

H.658 Introduced by Representatives Savage of Swanton and Bouchard of Colchester

This bill proposes to require a parent or legal guardian, but not a minor, to consent to the examination of the minor under 18 years of age by a physician for the purpose of determining whether the minor is in need of involuntary mental health treatment, and it provides for a judicial review process.

H. 665 Introduced by Representative Marcotte of Coventry and others

This bill proposes to require that the naturopathic physician formulary be approved by a pharmacologist and to require that the director of the office of professional regulation remove any substance on the formulary found to be illegal or unsafe.  This bill also seeks to ban the sale or use of dietary supplements containing silver and to require that promotional material used by naturopathic physicians state that the naturopath is not a medical doctor.

H.666 Introduced by Representative Pearson of Burlington and others

This bill proposes to increase the health insurer claims assessment in order to increase Medicaid reimbursement rates and reduce the cost shift.  The bill would require the department of banking, insurance, securities, and health care administration to ensure that the health insurance premiums reflect corresponding reductions in the cost shift.

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