Act No. 61

(H.444)

Health; health care reform; health insurance; health information technology; electronic health record; Blueprint for Health; Catamount Health; Vermont health access plan; employer-sponsored insurance assistance; workers' compensation; contract standard; rental network contract; chlamydia; stroke treatment; vaccine; immunization; Healthy Workers Program; agricultural workers; brominated flame retardant; orally administered chemotherapy----

This act:

1. Reassigns the Vermont Information Technology Leaders' (VITL) administrative duties for the administration and operation of the statewide health information technology plan to the secretary of administration or designee;

2. Positions Vermont to apply for and receive federal stimulus money to further health information technology in this state, including directing the secretary of administration and others to apply for federal grant opportunities created by the American Recovery and Reinvestment Act of 2009 (ARRA);

3. Expands continuation of group health insurance under the state's VIPER program to align with changes made to COBRA under federal law, including adding dental coverage and creating a special enrollment period;

4. Modifies the calculation, assessment, and payment of the Health Information Technology Reinvestment Fee;

5. Makes several modest changes to Catamount Health, including:

a. Reducing from $10,000.00 to $7,500.00 for an individual and from $20,000.00 to $15,000.00 for a family the threshold for qualifying for the high-deductible exemption from the 12-month waiting period for eligibility;

b. Subject to approval of a waiver amendment from the Centers for Medicare and Medicaid Services (CMS), exempting self-employed individuals who lose their business from the 12-month waiting period for eligibility;

c. Exempting certain individuals who dropped insurance in the nongroup market from the preexisting condition exclusion upon their timely entry into Catamount Health; and

d. Subject to CMS approval of a waiver amendment, designating depreciation as an allowable business expense for purposes of income calculation under Catamount Health, the Vermont health access plan, and the employer-sponsored insurance assistance programs;

6. Modifies the focus of the commission on health care reform's evaluation of the cost-effectiveness of Catamount Health and directs the commission also to study the cost-effectiveness of the employer-sponsored insurance assistance program;

7. Creates a process for health care providers to submit, dispute, and collect payment on bills for medical treatment provided to an injured employee eligible for workers' compensation;

8. Establishes standards for processing claims for health care services submitted to health plans by health care providers, establishes standards for disclosure of payment methodologies, and prohibits the use of "most favored nation" clauses in health care provider contracts;

9. Regulates the circumstances and conditions under which a contracting entity can grant access to a provider's health care services and contractual discounts under a provider network contract;

10. Enables health care providers to treat without examination the partner of a patient diagnosed with chlamydia;

11. Requests a study recommending ways to implement timely, effective stroke treatment in Vermont;

12. Establishes a vaccine purchasing pool pilot program through the department of health;

13. Establishes a pilot Healthy Workers Program to provide health services to agricultural workers statewide, beginning with Addison and Franklin Counties;

14. Bans the manufacture, sale, and distribution of certain products containing brominated flame retardants; and

15. Requires health insurers that cover chemotherapy to provide coverage for oral chemotherapy that is at least as financially favorable as the coverage provided for IV or injected chemotherapy under the insured's plan, and directs the department of banking, insurance, securities, and health care administration (BISHCA) to study the impact of the requirement prior to the requirement taking effect.

Date Signed by the Governor: June 2, 2009

Effective Date: July 1, 2009, except:

1. The changes to the calculation, assessment, and payment of the Health Information Technology Reinvestment Fee take effect October 1, 2009;

2. The changes to Catamount Health take effect April 1, 2010;

3. The section directing the agency of human services to adopt rules making depreciation an allowable business expense takes effect July 1, 2009, but the rules do not take effect until the later of approval by CMS or February 1, 2010;

4. Health plans, contracting entities, and payers must comply with certain provisions on timely payment for health care services no later than July 1, 2010;

5. The provisions on edit standards take effect July 1, 2011;

6. The provision on disclosure of payment information takes effect according to a specific schedule detailed in the act;

7. The summary disclosure form required by the fair contract standards section must be included in all contracts entered into or renewed on or after July 1, 2009 and provided for all other existing contracts by July 1, 2014;

8. Contracting entities and covered entities must comply with the rental network contracts provisions by January 1, 2010;

9. The effective dates section, the section making a new subchapter on claims processing and contract standards, and the stroke treatment study take effect on passage (Passage was June 2, 2009, the date on which the governor signed the bill); and

10. The oral chemotherapy insurance coverage requirement takes effect April 1, 2010 and applies to health plans offered, issued, or renewed after that date. All plans must include the coverage by April 1, 2011.