By Linda J. Cohen*
November 26, 2008
Through a collaborative effort in 2006 between Governor Douglas, the Vermont legislature, and stakeholders, Vermont enacted the legislation that laid the foundation for sweeping healthcare reform. The legislation focused on the core values of universal access, comprehensive and continuous coverage, quality and safety, and the engagement of the citizenry to adopt healthy lifestyles. These reform programs are overseen by the Health Care Reform Commission and a legislative oversight committee.
The cornerstone of these reforms was the creation of Catamount Health, an insurance plan offered by private carriers to previously uninsured Vermonters, with premiums paid on a sliding scale for those with incomes up to 300% of the federal poverty level and the full premium above that income. Those eligible for Medicaid programs or subsidized Catamount Health coverage may also receive premium assistance to purchase employer-sponsored coverage at the State's discretion. The plan is funded through an assessment on employers for each uninsured employee, an increase in the cigarette tax, and Medicaid savings through employer-sponsored coverage and federal matching dollars under Vermont's Global Commitment Medicaid Wavier Program. The goal of Catamount Health is to achieve 96% coverage by 2010; if not, mandatory universal health coverage may be enacted in 2011.
The 2006 reforms also include the establishment of an infrastructure and program for chronic care management in the form of the Blueprint for Health, development of information technology, the creation of a multi-payer database, a workgroup to reduce administrative costs, and a supervised system of consumer price and quality disclosures. One additional enactment of note was establishing a pilot program for SorryWorks, allowing healthcare professionals to apologize for certain events with immunity from use of those statements in subsequent litigation.
The next half of the biennium session saw minor modifications made to shore up the foundations established in the 2006 healthcare reform acts. Those adjustments included modifying the employer assessment for Catamount Health, changing Certificate of Need jurisdiction, and authorizing nurses and physicians to jointly form professional corporations. Also of significance was an act barring the sale of individual prescriber data for use in detailing by pharmaceutical manufacturers.
The last legislative session that ended in May 2008 saw a heightened level of activity on the healthcare front with expansions of prior reforms and new enactments. Enhanced prior reforms include:
- Building upon the 2006 Health Care Reform Acts through:
- Directing the Health Care Reform Commission to study the feasibility of payment reform, integration of care, merging several insurance group markets, and a variety of financing mechanisms;
- Authorizing split benefits design for commercial insurers to reward healthy lifestyle choices and expediting rulemaking for those products;
- Seeking a federal waiver to reduce qualification for Catamount Health to six months of being uninsured from the current twelve-month requirement;
- Modifying the pre-existing conditions limitations within Catamount Health to provide greater coverage;
- Directing a variety of studies and workgroups to investigate best options for promoting healthy lifestyle choices such as good nutrition and exercise as well as best practices for workplace wellness;
- Changing the funding for the Vermont Information Technology Leaders and requiring annual updating of its health information technology plan;
- Appropriating additional funding for nurse educator loan repayment; and
- Implementing fair standards for provider contracting, including a prohibition of retroactive claims denials more than twelve months post-adjudication, prohibitions on downcodes and denials, and requiring speedy credentialing.
- Furthering mental health parity through:
- Imposing full responsibility for the acts and omissions of managed care organizations for mental health services on the health insurers that contract with those organizations;
- Rulemaking to create additional oversight of utilization review, premiums for mental health services, quality improvement, and dissemination of information about participating providers by managed care organizations; and
- Enhancing the authority of the Commissioner to remedy and/or punish violations of the law.
- New enactments include:
- Requiring employers to provide reasonable time and space for nursing mothers to express breast milk.
- Establishing coverage mandates for:
- Naturopathic physicians;
- Athletic trainers; and
- Mammograms with co-payments not to exceed $25.
- Eliminating reimbursement for never events;
- Protecting healthcare and public safety personnel from communicable diseases;
- Regulating sexual assault nurse examiners through a newly created board;
- Creating a public inebriates task force to evaluate options to increase treatment and training, reduce recidivism, increase public safety, and reduce corrections costs; and
- Requiring commercial insurers to offer chronic care programs consistent with the state's Blueprint for Health, together with a requirement that children enrolled in licensed child-care facilities receive age appropriate immunizations.
*We would like to thank Linda J. Cohen, Esquire (Dinse Knapp & McAndrew PC, Burlington, VT) for providing this email alert.