June 18, 2010
By Linda Cohen*
Vermont's multi-part healthcare bill, S.88, automatically became law at the beginning of last month. Pursuant to Act 128, Vermont will create a commission charged with providing several design options for a state healthcare system to support the goals of universal access to essential healthcare services through a regional, integrated care delivery service. The commission will work with consultants to design three different healthcare system options that could be ready to implement by July 2012. The commission is directed to consider both employment-and non-employment-based coverage systems that will include single payer, public option and a multi-payer option. The commission is also charged with evaluating a variety of provider payment mechanisms including an annual global budget, capitation, quality incentives, and fee for service. The cost of this study was one of the reasons Governor Douglas declined to sign the bill.
The Act also provides for mandatory disclosure by manufacturers of free samples of prescription drugs, biological products, and medical devices provided to Vermont healthcare providers. While free samples will remain legally permissible, beginning April 1, 2012, each manufacturer of prescribed products must disclose all free samples it has given to healthcare providers during the previous year. The disclosures must identify the product, recipient, number of units, and dosages for each sample. The disclosure data may be used for academic research and will also be publically reported in a deidentified manner. Vermont will not implement this program if the federal government collects and reports the data. The Act also limits net revenue increases to targets of 4.5% for 2011 and 4.0% for 2012 for all Vermont hospitals. These limited increases are an immediate cost containment measure and will be enforced by the Department of Banking, Insurance, Securities and Health Care Administration in the hospital budget setting process.
The state's Blueprint for Health pilot program, an integrated health system management initiative that focuses on chronic care issues was expanded by the Act. The Blueprint will now include initiatives for patient-centered medical homes, community health teams, adoption and maintenance of clinical quality and performance measures for treating chronic conditions, and expansion of the use of electronic medical records. Additionally, the Blueprint, which now resides in several pilot sites, will be expanded throughout the state.
Vermont will also implement pilot programs to test payment reform methodologies through its Medicaid agency. The Medicaid agency will appoint a director of payment reform to develop and implement pilot programs organized around primary care practitioners. The director of payment reform will present the legislature with a strategic plan for pilot projects by February 2011 with the goal of the first pilot being operational by January 2012.
*We would like to thank Linda J. Cohen, Esquire (Dinse Knapp & McAndrew, Burlington, VT) for providing this email alert.