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1 S.211
2 Introduced by Senators Lyons, Clarkson and Kitchel
3 Referred to Committee on
4 Date:
5 Subject: Health; health care reform; Director of Health Care Reform; Green
6 Mountain Care Board; hospitals
7 Statement of purpose of bill as introduced: This bill proposes to transfer
8 certain duties from the Green Mountain Care Board to the Director of Health
9 Care Reform in the Agency of Human Services and to modify or eliminate
10 other Board duties. It bill would specify that the Board’s review,
11 consideration, and approval of hospital budgets and of certification and
12 budgets of accountable care organizations (ACOs) are the deliberations of a
13 public body in connection with a quasi-judicial proceeding. The bill would
14 direct the Board to adopt rules to establish processes for certifying Medicare-
15 only ACOs and would direct the Board of Nursing to adopt rules establishing a
16 student nurse apprenticeship program. The bill would require insurers to
17 participate in multipayer alternative payment models and would require
18 nonbinding mediation conducted by the Green Mountain Care Board prior to
19 the termination of a contract between a health care provider and a health plan.
20 The bill would require alignment of certain health insurer credentialing
21 practices, quality measures, and data collection. It would revise aspects of the VT LEG #372557 v.2
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1 Green Mountain Care Board’s hospital budget review processes and require
2 the Secretary of State to provide training for the Board’s members and staff.
3 The bill also would require reports on population-based hospital budgeting; on
4 realignment of the timing of the Green Mountain Care Board’s regulatory
5 processes; on review and approval of mergers, affiliations, and divestments
6 involving Vermont-based health care providers; and on designating a single
7 State agency for coordination of clinical health care data.
8 An act relating to health care reform and to the regulatory duties of the
9 Green Mountain Care Board
10 It is hereby enacted by the General Assembly of the State of Vermont:
11 Sec. 1. 3 V.S.A. § 3027 is amended to read:
12 § 3027. HEALTH CARE SYSTEM REFORM; IMPROVING QUALITY
13 AND AFFORDABILITY
14 (a) The Director of Health Care Reform in the Agency of Human Services
15 shall be responsible for the coordination of health care system reform efforts
16 among Executive Branch agencies, departments, and offices, and for
17 coordinating with the Green Mountain Care Board established in 18 V.S.A.
18 chapter 220, including engaging in payment and delivery system reform to the
19 extent so directed by the General Assembly.
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1 (b) The Director of Health Care Reform, in consultation with the Green
2 Mountain Care Board and the Department of Health, shall develop and
3 maintain a method for evaluating systemwide performance and quality,
4 including identification of the appropriate process and outcome measures:
5 (1) for determining public and health care professional satisfaction with
6 the health system;
7 (2) for utilization of health services;
8 (3) also in consultation with the Director of the Blueprint for Health, for
9 quality of health services and the effectiveness of prevention and health
10 promotion programs;
11 (4) for cost-containment and limiting the growth in health care
12 expenditures;
13 (5) for determining the adequacy of the supply and distribution of health
14 care resources in this State;
15 (6) to address access to and quality of mental health and substance use
16 disorder treatment services;
17 (7) for including population-level clinical data to measure population
18 health improvements and for providing the information to the Green Mountain
19 Care Board to inform the Board’s decisions regarding health insurance rates,
20 hospital budgets, and accountable care organization certification and budgets;
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1 (8) for improving access to care through care coordination between
2 providers and services, such as between hospitals and residential or long-term
3 care services, between primary care and specialty care, between primary care
4 and access to mental health or substance use disorder treatment and recovery
5 services; and
6 (9) for other measures as determined by the Director.
7 Sec. 2. 18 V.S.A. chapter 13, subchapter 2 is added to read:
8 Subchapter 2. Payment Reform
9 § 721. INSURER PARTICIPATION IN MULTIPAYER ALTERNATIVE
10 PAYMENT MODELS
11 It is the intent of the General Assembly first to provide commercial health
12 insurers in the State with the opportunity to participate in Vermont’s
13 multipayer alternative payment model or models established pursuant to the
14 State’s agreement with the Center for Medicare and Medicaid Innovation. In
15 the event that no insurers elect to participate in Vermont’s multipayer
16 alternative payment model or models, the Department of Financial Regulation
17 shall require health insurers to participate in Vermont’s multipayer alternative
18 payment models as a condition of doing business in this State.
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1 Sec. 3. 18 V.S.A. § 9372 is amended to read:
2 § 9372. PURPOSE
3 It is the intent of the General Assembly to create an independent board to
4 promote the general good of the State by:
5 (1) improving the health of the population making decisions that
6 improve population health;
7 (2) reducing the per-capita rate of growth in expenditures for health
8 services in Vermont across all payers through regulation of health insurance
9 rates pursuant to 8 V.S.A. § 4062; establishment of hospital budgets, including
10 global hospital budgets, pursuant to chapter 221, subchapter 7 of this title; and
11 certification of accountable care organizations and regulation of accountable
12 care organization budgets pursuant to section 9382 of this title while ensuring
13 that access to care and quality of care are not compromised; and
14 (3) enhancing the patient and health care professional experience of
15 care;
16 (4) recruiting and retaining high-quality health care professionals; and
17 (5) achieving administrative simplification in health care financing and
18 delivery aligning payer policies, administrative obligations, and clinical
19 services to reduce administrative burdens, establish and improve equitable
20 reimbursements, and ensure clinically appropriate care coordination and
21 continuity of and access to high-quality care.
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1 Sec. 4. 18 V.S.A. § 9374(d) and (e) are amended to read:
2 (d)(1) The Chair shall have general charge of the offices and employees of
3 the Board but may hire a director to oversee the administration and operation.
4 (2)(A) Except for final decisions in regulatory matters over which the
5 Board has jurisdiction, a member of the Board, Board officer, or Board
6 employee may perform any service that is within the Board’s jurisdiction and
7 that the Board delegates to the member, officer, or employee.
8 (B) The Board shall establish procedures to ensure that Board
9 employees have appropriate supervision in their performance of delegated
10 activities and that the Board remains informed regarding these activities.
11 (e)(1) The Board shall establish a consumer, patient, business, and health
12 care professional advisory group to provide input and recommendations to the
13 Board. Members of such advisory group who are not State employees or
14 whose participation is not supported through their employment or association
15 shall receive per diem compensation and reimbursement of expenses pursuant
16 to 32 V.S.A. § 1010, provided that the total amount expended for such
17 compensation shall not exceed $5,000.00 per year.
18 (2) The Board may establish additional advisory groups and
19 subcommittees as needed to carry out its duties. The Board shall appoint
20 diverse health care professionals to the additional advisory groups and
21 subcommittees as appropriate.
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1 (3) To the extent funds are available, the Board may examine, on its
2 own or through collaboration or contracts with third parties, the effectiveness
3 of existing requirements for health care professionals, such as quality measures
4 and prior authorization, and evaluate alternatives that improve quality, reduce
5 costs, and reduce administrative burden.
6 Sec. 5. 18 V.S.A. § 9375 is amended to read:
7 § 9375. DUTIES
8 (a) The Board shall execute its duties consistent with the principles
9 expressed in section 9371 of this title.
10 (b) The Board shall have the following duties, in collaboration with the
11 Director of Health Care Reform in the Agency of Human Services:
12 (1) Oversee the development and implementation, and evaluate the
13 effectiveness, of health care payment and delivery system reforms designed to
14 control the rate of growth in health care costs; promote seamless care,
15 administration, and service delivery; and maintain health care quality in
16 Vermont, including ensuring that the payment reform pilot projects set forth in
17 this chapter are consistent with such reforms.
18 (A) Implement by rule, pursuant to 3 V.S.A. chapter 25,
19 methodologies for achieving payment reform and containing costs that may
20 include the participation of Medicare and, Medicaid, and commercial
21 insurance, which may include the creation of health care professional cost-
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1 containment targets, global payments, bundled payments, global budgets, risk-
2 adjusted capitated payments, or other uniform payment methods and amounts
3 for integrated delivery systems, health care professionals, or other provider
4 arrangements.
5 (i) The Board shall work in collaboration with the Director of
6 Health Care Reform in the Agency of Human Services and health care
7 providers to develop payment models that preserve access to care and quality
8 in each community and that provide for equitable reimbursements to providers.
9 (ii) The rule shall take into consideration current Medicare
10 designations and payment methodologies, including critical access hospitals,
11 prospective payment system hospitals, graduate medical education payments,
12 Medicare dependent hospitals, and federally qualified health centers.
13 (iii) The payment reform methodologies developed by the Board
14 shall encourage coordination and planning on a regional basis, taking into
15 account existing local relationships between providers and human services
16 organizations.
17 (B) Prior to the initial adoption of the rules described in subdivision
18 (A) of this subdivision (1), report the Board’s proposed methodologies to the
19 House Committee on Health Care and the Senate Committee on Health and
20 Welfare.
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1 (C) In developing methodologies pursuant to subdivision (A) of this
2 subdivision (1), engage Vermonters in seeking ways to equitably distribute
3 health services while acknowledging the connection between fair and
4 sustainable payment and access to health care.
5 (D) Nothing in this subdivision (1) shall be construed to limit the
6 authority of other agencies or departments of State government to engage in
7 additional cost-containment activities to the extent permitted by State and
8 federal law.
9 (2)(A) Review and approve Vermont’s statewide Health Information
10 Technology Plan pursuant to section 9351 of this title to ensure that the
11 necessary infrastructure is in place to enable the State to achieve the principles
12 expressed in section 9371 of this title.
13 (B) Review and approve the criteria required for health care
14 providers and health care facilities to create or maintain connectivity to the
15 State’s health information exchange as set forth in section 9352 of this title.
16 Within 90 days following this approval, the Board shall issue an order
17 explaining its decision.
18 (C) Annually review and approve the budget, consistent with
19 available funds, of the Vermont Information Technology Leaders, Inc. (VITL).
20 This review shall take into account VITL’s responsibilities pursuant to
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1 section 9352 of this title and the availability of funds needed to support those
2 responsibilities.
3 (3) Review and approve the Health Care Workforce Development
4 Strategic Plan created in chapter 222 of this title. [Repealed.]
5 (4) Publish on its website the Health Resource Allocation Plan
6 identifying Vermont’s critical health needs, goods, services, and resources in
7 accordance with section 9405 of this title.
8 (5) Set rates for health care professionals pursuant to section 9376 of
9 this title, to be implemented over time, and make adjustments to the rules on
10 reimbursement methodologies as needed.
11 (6) Approve, modify, or disapprove requests for health insurance rates
12 pursuant to 8 V.S.A. § 4062, taking into consideration the requirements in the
13 underlying statutes, changes in health care delivery, changes in payment
14 methods and amounts, protecting insurer solvency, and other issues at the
15 discretion of the Board.
16 (7) Review and establish hospital budgets, including global budgets,
17 pursuant to chapter 221, subchapter 7 of this title.
18 (8) Review and approve, approve with conditions, or deny applications
19 for certificates of need pursuant to chapter 221, subchapter 5 of this title.
20 (9) Review and approve, with recommendations from the Commissioner
21 of Vermont Health Access, the benefit package or packages for qualified VT LEG #372557 v.2
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1 health benefit plans and reflective health benefit plans pursuant to 33 V.S.A.
2 chapter 18, subchapter 1. The Board shall report to the House Committee on
3 Health Care and the Senate Committee on Health and Welfare within 15 days
4 following its approval of any substantive changes to the benefit packages.
5 (10) Develop and maintain a method for evaluating systemwide
6 performance and quality, including identification of the appropriate process
7 and outcome measures:
8 (A) for determining public and health care professional satisfaction
9 with the health system;
10 (B) for utilization of health services;
11 (C) in consultation with the Department of Health and the Director of
12 the Blueprint for Health, for quality of health services and the effectiveness of
13 prevention and health promotion programs;
14 (D) for cost-containment and limiting the growth in health care
15 expenditures;
16 (E) for determining the adequacy of the supply and distribution of
17 health care resources in this State;
18 (F) to address access to and quality of mental health and substance
19 abuse services; and
20 (G) for other measures as determined by the Board.
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1 Engage in payment and delivery system reform to the extent so directed
2