Vermont Healthcare Reform Update 

Email Alert

By Linda Cohen and Sarah Curry*

June 25, 2009

The 2009 Vermont Legislature completed its year with few healthcare reform efforts, as it focused its attention squarely on the budget crisis. That said, there were several significant enactments:

• Act 49, An Act Relating to Containing Health Care Costs by Decreasing Variability in Health Care Spending & Utilization requires an analysis by the Vermont Department of Banking, Insurance, Securities and Health Care Administration to identify variations in the use of healthcare provided by both hospitals and physicians, and to determine the causes and reasons for the variations across different regions of the state. Recommendations for reducing healthcare-related costs will follow based on the findings.
  
  
• Act 59, An Act Relating to the Marketing of Prescribed Drugs establishes a ban on the giving of gifts to healthcare professionals by pharmaceutical, biological product, and medical-device manufacturers, but carves out limited allowable gifts such as genuine educational expenses, items related to clinical trials, and research expenditures. The Act also requires disclosure to the attorney general of all allowable gifts and eliminates the trade-secret protection found in Vermont's earlier gift-disclosure law such that the identity of the receiving healthcare professionals should be disclosed. All pharmaceutical, biological product, and medical-device manufacturers doing business in Vermont should pay close attention to this Act, as each unlawful gift is subject to a $10,000 penalty.
  
  
• Act 61, An Act Relating to Health Care Reform enacted a number of changes to Vermont's healthcare reform efforts. First, the Act furthers Vermont's healthcare information technology plan with the goal of taking advantage of federal stimulus funds available for electronic medical record systems. The Act also encompasses provider fair-contracting standards that require all state-regulated insurers: (1) to adhere to claims editing standards no less restrictive than NCCI; (2) to disclose fully to providers how they will be paid both with summary disclosures and required responses to inquiries from providers; (3) to provide prior notice and explanations of proposed contract amendments; (4) to disclose all parties with access to any rental networks; and (5) not to use most favored-nations clauses. The Act changes the Timely Payment law to require payment of uncontested claims or notice that the claim is incomplete or contested within thirty days of receipt. The Act also makes modifications to Catamount Health, an insurance product for low-income Vermonters, such as eliminating the pre-existing condition exclusion for qualified enrollees and allowing enrollment for families with high-deductible health plans.

*AHLA wishes to thank Linda Cohen, Esquire, and Sarah Curry, Legal Intern (Dinse Knapp & McAndrew, Burlington, VT) for providing this email alert.

For summaries of other state healthcare initiatives, please visit the Healthcare Reform Educational Task Force's website and click on Email Alerts in the left-hand navigation menu.