Signed by Governor Peter Shumlin

Vote Smart's Synopsis:

Vote to adopt a conference report that establishes a publicly-funded health care system and health benefit exchange for Vermont residents.

Highlights:

• Establishes Green Mountain Care as a publicly-funded health care program for which all Vermont residents would be eligible and that provides benefits including, but not limited to, the following (Sec. 4):
• Primary care;
• Preventive care;
• Chronic care;
• Acute episodic care; and
• Hospital services.

• Prohibits Green Mountain Care from limiting coverage of preexisting conditions (Sec. 4).

• Authorizes individuals to maintain health coverage other than Green Mountain Care (Sec. 4).

• Establishes the Green Mountain Care Board, beginning July 1, 2011, to consist of a chair and 5 members with duties including, but not limited to, the following (Sec. 3):
• Oversee and evaluate the development and implementation of health care payment and delivery system changes;
• Enhance the patient experience of care, including quality, access, and reliability;
• Reduce or control the total cost of health services;
• Recommend the Green Mountain Care benefit package and budget; and
• Set "reasonable" rates for health care professionals, health care provider bargaining groups, manufacturers of prescribed medical products, and medical supply companies.

• Requires Green Mountain Care to take effect 90 days after certain conditions are met including, but not limited to, the following (Sec. 4):
• Receipt of a federal waiver authorizing the state to suspend the operations of the Vermont Health Benefit Exchange; and
• The Green Mountain Care Board makes a determination that certain conditions will be met including, but not limited to, the following:
• Green Mountain Care will not have a negative impact on the Vermont economy;
• The rate of growth of Vermont's per-capita health care expenses will be reduced;
• Each resident covered by Green Mountain Care will receive benefits that will cover at least 80 percent of the total average costs of covered benefits; and
• Health care professionals will be reimbursed at levels that will allow the state to recruit and retain "high-quality" individuals.

• Establishes the Vermont Health Benefit Exchange and requires it to provide "qualified individuals" with health benefit plans and to begin enrolling individuals by November 1, 2013 (Sec. 4).

• Authorizes the Vermont Health Benefit Exchange to provide health benefit plans to individuals including, but not limited to, the following (Sec. 4):
• Those people who are not "qualified individuals";
• Medicaid beneficiaries, provided that their enrollment would not reduce their Medicaid benefits;
• Medicare beneficiaries, provided that their enrollment would not reduce their Medicare benefits;
• State and municipal employees; and
• Injured employees, in lieu of medical benefits provided under workers' compensation laws.

• Defines a "qualified individual" as a Vermont resident who is not incarcerated and is a United States citizen or legal immigrant (Sec. 4).

• Requires the Vermont Health Benefit Exchange to meet several duties and responsibilities including, but not limited to, the following (Sec. 4):
• Creating a process for enrolling individuals in health benefit plans;
• Collecting premium payments from employers and individuals;
• Determining eligibility for and enrolling individuals in Medicaid;
• Assigning a "quality and wellness rating" to each health plan offered through the exchange; and
• Determining enrollee premiums and subsidies.

• Requires the Vermont Health Benefit Exchange to establish a navigator program to assist individuals and employers in enrolling in a health benefit plan offered under the exchange (Sec. 4).

Full Bill Text

Vote Smart's Synopsis:

Vote to adopt a conference report that establishes a publicly-funded health care system and health benefit exchange for Vermont residents.

Highlights:

• Establishes Green Mountain Care as a publicly-funded health care program for which all Vermont residents would be eligible and that provides benefits including, but not limited to, the following (Sec. 4):
• Primary care;
• Preventive care;
• Chronic care;
• Acute episodic care; and
• Hospital services.

• Prohibits Green Mountain Care from limiting coverage of preexisting conditions (Sec. 4).

• Authorizes individuals to maintain health coverage other than Green Mountain Care (Sec. 4).

• Establishes the Green Mountain Care Board, beginning July 1, 2011, to consist of a chair and 5 members with duties including, but not limited to, the following (Sec. 3):
• Oversee and evaluate the development and implementation of health care payment and delivery system changes;
• Enhance the patient experience of care, including quality, access, and reliability;
• Reduce or control the total cost of health services;
• Recommend the Green Mountain Care benefit package and budget; and
• Set "reasonable" rates for health care professionals, health care provider bargaining groups, manufacturers of prescribed medical products, and medical supply companies.

• Requires Green Mountain Care to take effect 90 days after certain conditions are met including, but not limited to, the following (Sec. 4):
• Receipt of a federal waiver authorizing the state to suspend the operations of the Vermont Health Benefit Exchange; and
• The Green Mountain Care Board makes a determination that certain conditions will be met including, but not limited to, the following:
• Green Mountain Care will not have a negative impact on the Vermont economy;
• The rate of growth of Vermont's per-capita health care expenses will be reduced;
• Each resident covered by Green Mountain Care will receive benefits that will cover at least 80 percent of the total average costs of covered benefits; and
• Health care professionals will be reimbursed at levels that will allow the state to recruit and retain "high-quality" individuals.

• Establishes the Vermont Health Benefit Exchange and requires it to provide "qualified individuals" with health benefit plans and to begin enrolling individuals by November 1, 2013 (Sec. 4).

• Authorizes the Vermont Health Benefit Exchange to provide health benefit plans to individuals including, but not limited to, the following (Sec. 4):
• Those people who are not "qualified individuals";
• Medicaid beneficiaries, provided that their enrollment would not reduce their Medicaid benefits;
• Medicare beneficiaries, provided that their enrollment would not reduce their Medicare benefits;
• State and municipal employees; and
• Injured employees, in lieu of medical benefits provided under workers' compensation laws.

• Defines a "qualified individual" as a Vermont resident who is not incarcerated and is a United States citizen or legal immigrant (Sec. 4).

• Requires the Vermont Health Benefit Exchange to meet several duties and responsibilities including, but not limited to, the following (Sec. 4):
• Creating a process for enrolling individuals in health benefit plans;
• Collecting premium payments from employers and individuals;
• Determining eligibility for and enrolling individuals in Medicaid;
• Assigning a "quality and wellness rating" to each health plan offered through the exchange; and
• Determining enrollee premiums and subsidies.

• Requires the Vermont Health Benefit Exchange to establish a navigator program to assist individuals and employers in enrolling in a health benefit plan offered under the exchange (Sec. 4).

Full Bill Text

Vote Smart's Synopsis:

Vote to adopt a conference report that establishes a publicly-funded health care system and health benefit exchange for Vermont residents.

Highlights:

• Establishes Green Mountain Care, a universal health care program that will provide health benefits through a single payment system and of which all Vermont residents shall be eligible (Sec. 2).

• Establishes the Green Mountain Care Board to develop mechanisms to reduce the per capita rate of growth in health care expenditures across all payers for health services, and whose objectives include, but are not limited to, the following (Sec. 3):
• Enhance the patient experience of care, including quality, access, and reliability;
• Reduce or control the total cost of health; and
• Develop and approve payment pilot projects to manage total health care costs, improve health care outcomes, and provide a positive health care experience for patients and health care professionals.

• Establishes the Vermont Health Benefit Exchange with the following duties and responsibilities consistent with the Patient Protection and Affordable Care Act, including, but not limited to, the following (Sec. 4):
• Enrolling individuals in qualified health benefit plans and ensuring that individuals may transfer coverage between qualified health benefit plans and other sources of coverage;
• Determining eligibility for and enrolling individuals in Medicaid;
• Assigning a quality and wellness rating to each qualified health plan offered through the exchange and determining each qualified health plan's level of coverage;
• Determining enrollee premiums and subsidies.

• Requires the Vermont Health Benefit Exchange to establish a navigator program to assist individuals and employers in enrolling in a qualified health benefit plan offered under the exchange (Sec. 4).

Full Bill Text