The following overview of H.202 was developed by the Vermont Medical Society and contains three sections:

Green Mountain Care Board
Green Mountain Care
Mandated Studies

Green Mountain Care Board
 
The bill creates the Green Mountain Care Board with a chair and four other members to take office on Oct. 1, 2011. The Board’s duties will include:

• Develop, implement and evaluate payment reform pilots (the first pilot is scheduled for
• Jan. 1, 2012and two more pilot would begin on July 1, 2012);
• Develop payment reform methodologies, which may include global payments, bundled payments, and risk-adjusted capitated payments;
• Review and approve Vermont’s Health Information Technology Plan;
• Review and approve the health care workforce development strategic plan;
• Set reasonable rates for health care professionals in order to have a consistent and acceptable reimbursement amounts;
• Review and approve recommendations from BISHCA on insurance rate increases, hospital budgets and CONs;
• Review and approve the benefit package for qualified health benefit plans offered by the health benefit exchange;
• Develop and maintain a method for evaluating system-wide performance and quality;
• Define the Green Mountain Care benefit package; and,
• Recommend a three-year Green Mountain Care budget.

The bill establishes the Vermont Health Benefit Exchange as a division of Department of Vermont Health Access (DHVA).
 
Beginning on Jan. 1, 2014, the exchange will provide qualified health benefit plans to eligible individuals and small businesses.
 
The commissioner of DHVA is required to make a reasonable effort to maintain contracts with at least two health insurers to provide qualified health benefit plans, in addition to the multi-state plans required by the ACA.
 
Federal premium credits and cost-sharing subsidies will be available to individuals who enroll in health benefit exchange plans – provided that their income is generally above 133 percent ($29,861 annually for a family of four) and no more than 400 percent ($89,808 annually for a family of four) of the Federal Poverty Level (FPL). Dr. Hsiao’s report estimates that under the ACA $240 million in new federal funds will flow into the exchange in the form of premium subsidies for individuals in 2015 and $420 million in new federal funds in 2019. It is also anticipated that the individuals currently covered under VHAP would receive their insurance through the exchange beginning Jan. 1, 2014.
 
The duties and responsibilities of the exchange are drafted to comply with the ACA and these include: offering coverage for health services through qualified health benefit plans; enrolling individuals in a qualified health benefit plan; collecting premium payments made for qualified health benefit plans from employers and individuals on a pretax basis, and, informing enrollees of their eligibility for premiums and subsidies. The section also establishes broad “quality and wellness” standards for qualified plans that include participation in the Blueprint for Health.
 

Green Mountain Care
 
The purpose of Green Mountain Care – the bill’s conditional universal publicly-financed health care system – is to provide, as a public good, comprehensive, affordable, high-quality health care coverage for all Vermontresidents. The bill authorizes the Agency of Human Services to solicit bids from private insurers for the administration of Green Mountain Care with preference being given to Vermont-based businesses. Individuals would be allowed to maintain coverage they may have other than Green Mountain Care or elect supplemental coverage. The Agency of Human Services is directed to seek permission from CMS to administer the Medicare program in Vermontand to include Medicaid and SCHIP in Green Mountain Care.
 
The implementation date of Green Mountain Care would be 90 days following the last to occur of the following conditions:
 

• Enactment of a law by the General Assembly establishing the public financing for Green Mountain Care;
• The Green Mountain Care Board’s approval of an initial benefit package;
• Enactment of an appropriation by the General Assembly for the benefit package; and,
• Receipt of a waiver to allow Green Mountain Care to receive federal individual premium subsidies and small business tax credits provided through the health benefit exchange by the ACA (under current law, the state cannot apply for these waivers until 2017).

Mandated Studies
 
Reforms to the Medical Malpractice System
 
On Jan. 15, 2012, the Secretary of Administration is required to submit reforms to the medical malpractice system for Vermont. The proposal shall be designed to address any findings of defensive medicine and shall include the consideration of a no-fault system and confidential pre-suit mediation.
 
Integration Plan
 
The Secretary of Administration is required to make recommendations by Jan. 15, 2012, on how to fully integrate or align Medicaid, Medicare, private insurance, associations, state employees, and municipal employees with the Vermont health benefit exchange and Green Mountain Care and whether it is advisable to establish a basic health program for individuals above 133 percent of the federal poverty level (FPL) and at or below 200 percent of FPL, as provided under the ACA.
 
Aligning the Workers’ Compensation System
 
No later than Jan. 15, 2012, the Commissioner of Labor is required to evaluate the feasibility of integrating or aligning Vermont’s workers’ compensation system with Green Mountain Care.
 
Universal Coverage
By Jan. 15, 2012, the Commissioner of DHVA is required to review the requirements for maintaining minimum essential coverage under the ACA and recommend any additional mechanisms to ensure that all Vermonters will obtain health insurance coverage.
 
Financing Plans
 
By Jan. 15, 2013, the Secretary of Administration is required to recommend two plans for sustainable financing. One plan will recommend financing for the Vermonthealth benefit exchange which must be implemented by Jan. 1, 2014, in order to provide coverage to all Vermonters in the absence of a waiver under the ACA. The second plan shall recommend mechanisms to finance Green Mountain Care to achieve a public-private universal health care system.
 
 
Health System Planning, Regulation, and Public Health
 
The Secretary of Administration is required to report by Jan. 15, 2012, on how to unify Vermont’s current efforts around health system planning, regulation and public health.
 
Payment Reform and Regulatory Processes
 
The Green Mountain Care Board is required to recommend by March 15, 2012, any necessary changes to regulatory processes to align them with the payment reform strategic plan. By Jan. 15, 2012, the commissioner of BISHCA shall review the hospital budget review process and the certificate of need process and recommend modifications needed to enable the participation of the Green Mountain Care board.
 
Health Care Workforce Strategic Plan
 
The Director of Health Care Reform is required to oversee the development of a health care workforce development strategic plan to ensure that Vermonthas necessary health care workforce to provide care to all Vermonters and provide the plan by Jan. 15, 2013.
 
Workforce Issues
 
The Board of Nursing, Board of Medical Practice, and Office of Professional Regulation are required to review licensure issues and make joint recommendations by Jan. 15, 2012, on ways to improve the primary care workforce.
 
Prior Authorizations
 
The Green Mountain Care Board is required to consider paying health care providers for completing requests for prior authorization and exempting health care professionals from prior authorization requirements for specific services in Green Mountain Care.
 
Single Formulary Recommendations
 
The Commissioner of DVHA is required to report by Jan. 15, 2012, on the feasibility of using a single prescription drug formulary.