Act No. 49
(S.129)
Health; utilization; health insurers; administrative costs; patient education; health care quality; VPQHC; accountable care organization; certificate of need
This act directs the department of banking, insurance, securities, and health care administration (BISHCA) to contract with the Vermont program for quality health care (VPQHC) and other qualified professionals or entities to study health care utilization and to create a plan to address high or low utilization if it is inappropriate. The study and plan are due January 15, 2010. (Secs. 1 and 2)
BISHCA will also work with the agency of human services and the department of human resources to provide an administrative cost report across all payers to legislative committees no later than December 15, 2009. (Sec. 3)
The secretary of administration or designee shall present a plan to create a shared decision-making pilot program to legislative committees no later than January 15, 2010. Shared decision-making is a process between a health care professional and a patient to discuss the patient's condition, treatment options, benefits and harms, and other information available. (Sec. 4)
BISHCA, in collaboration with VPQHC, will evaluate quality initiatives in other states and countries to determine current "best practice" and report before January 15, 2010 to legislative committees. (Sec. 5)
The commission on health care reform will convene a broad work group to facilitate the development of an application to participate in a national learning collaborative sponsored by Dartmouth Institute and the Brookings Institute to create an accountable care organization (ACO). An accountable care organization is an entity that enables networks of community health care providers (primary care providers, specialists, hospitals, etc.) to be accountable for overall costs and quality. This section also allows the commission to approve the office of Vermont health access' plan to request a Medicaid waiver amendment in order to participate in the ACO pilot program. BISHCA is directed to supervise the activities to the extent necessary to avoid federal anti-trust problems. The commission shall report back to legislative committees by January 15, 2010. (Secs. 6 and 7)
The act also amends existing law regarding the certificate of need (CON) process to provide for some clarifications, including:
· Clarifying jurisdictional issues when a piece of equipment goes from being fixed to mobile (or vice versa).
· Removing the requirement of filing a letter of intent if the applicant agrees he, she, or it needs a CON for a project, but retains public notice requirement.
· Adding criteria for the expirations of CONs.
· Defining "material change" as a change which meets requirements for a "new health care project" or total cost increase by more than 10 percent and "nonmaterial change" as a modification that is not as substantial as a "material change" but still modifies the kind, scope, or capacity of the project.
· Adding a process for reviewing nonmaterial change on a case-by-case basis (Secs. 8-14).
The act requires the secretary of administration to add a link to the BISHCA quality information on the Vermont.gov website. (Sec. 15)
Date Signed by the Governor: May 28, 2009
Effective Date: July 1, 2009, but Sec. 12 of this act, amending section 9443 of Title 18, shall apply to certificates of need issued on or after July 1, 2009.