H 185

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1H.185
2 Introduced by Representatives Olson of Starksboro, Carris-Duncan of
3Whitingham, Chapin of East Montpelier, Cina of Burlington,
4Cole of Hartford, Duke of Burlington, Graning of Jericho,
5Kleppner of Burlington, Logan of Burlington, Masland of
6Thetford, McGill of Bridport, Priestley of Bradford, Waszazak
7of Barre City, Wells of Brownington, and White of Bethel
8 Referred to Committee on
9 Date:
10 Subject: Health; Green Mountain Care Board; universal primary care
11 Statement of purpose of bill as introduced: This bill proposes to direct the
12 Green Mountain Care Board to develop and implement a universal primary
13 care program.
14    An act relating to developing and implementing a universal primary care
15    program
16 It is hereby enacted by the General Assembly of the State of Vermont:
17 Sec. 1. FINDINGS; LEGISLATIVE INTENT
18    (a) The General Assembly finds that:
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1(1) Good access to primary care is essential for the health of
2 Vermonters, but Vermont’s health care system currently does not provide
3 access to primary care with the timeliness and scope that Vermonters need.
4(2) Primary care clinicians face significant administrative burdens
5 imposed by health networks and by both public and private insurance plans.
6 Primary care clinicians are also not compensated commensurate with their
7 value to the health care system. As a result, many primary care clinicians are
8 leaving their Vermont practices and too few new clinicians are replacing them.
9(3) Good access to primary care saves health care system costs by
10 reducing the need for more costly services, but Vermont’s health care system is
11 in a state of crisis. Premiums in the commercial health insurance markets are
12 increasingly out of reach for individual Vermonters, their families, private
13 employers, and public employers such as schools and State and local
14 governments. Some hospital costs in particular are grossly excessive. Cost
15 containment efforts such as OneCare Vermont have failed to achieve their
16 desired goals. New initiatives such as the AHEAD model are limited in scope
17 and may take years before they achieve meaningful cost containment.
18 Universal primary care is Vermont’s best opportunity over the short term for
19 improvement in Vermont’s health care system.
20    (b) It is the intent of the General Assembly to establish a universal primary
21 care program that will promote the public good by increasing access to primary
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1 care, thereby improving the health of Vermonters and reducing health care
2 system costs.
3 Sec. 2. 18 V.S.A. § 9375(b) is amended to read:
4    (b) The Board shall have the following duties:
5***
6(16) Develop and implement a universal primary care program as set
7 forth in section 9384 of this chapter.
8 Sec. 3. 18 V.S.A. § 9384 is added to read:
9 § 9384. UNIVERSAL PRIMARY CARE PROGRAM
10    (a) The Green Mountain Care Board, in consultation with interested
11 stakeholders, shall develop and implement by rule a universal primary care
12 program that will promote the public good by increasing access to primary care
13 and reducing health system costs.
14    (b) The universal health care program shall do all of the following:
15(1) Reduce or eliminate hospital and health network administrative
16 burdens.
17(2) Reduce or eliminate administrative burdens imposed by health
18 insurers, public programs, and other payors.
19(3) Provide universal access to primary care services for all Vermonters
20 without the requirement of enrollment in an insured or self-insured plan or in a
21 public program.
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1(4) Define primary care services to include primary care services,
2 outpatient mental health services, outpatient substance use disorder treatment
3 services, communicable disease testing, and vaccines.
4(5) Eliminate health insurance cost-sharing for primary care services.
5(6) Divest primary care practices from the controlling interests of
6 hospitals and health networks.
7(7) Be funded by an allocation of premiums, premium equivalents, and,
8 to the extent permitted by federal law and federal initiatives such as the
9 AHEAD model, public program funds from Medicare and Medicaid. The
10 allocation shall be an appropriate percentage of premiums, premium
11 equivalents, and public program funds reflecting historical trends in
12 expenditures for primary care, with an additional increment of compensation if
13 warranted in order to increase access to primary care and reduce overall
14 Vermont health system costs.
15    (c) The Board may assess to Vermont hospitals and health networks its
16 reasonable and necessary expenses in developing, implementing, and
17 administering the universal primary care program, in proportion to the relative
18 annual operating expenses of the hospitals and health networks; provided,
19 however, that the Board may waive or reduce charges for one or more
20 hospitals or health networks if necessary given the financial condition of the
21 entity or entities.
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1    (d) The Board may contract with a private entity or enter into an agreement
2 with the Vermont Medicaid program for the operation of a virtual payment
3 pool to collect the primary care allocation of premiums, premium equivalents,
4 and public program funds and to transmit per capita payments or another cost-
5 effective payment mechanism to primary care practices and practitioners.
6    (e) A primary care practice or practitioner under a universal primary care
7 program, or Vermont Medicaid or a private entity designated by the Board to
8 operate the virtual payment pool, may negotiate agreements with private, self-
9 insured plans for an appropriate allocation of premium equivalents to be paid
10 into the virtual payment pool, in amounts that do not unfairly disadvantage the
11 beneficiaries of insured plans, self-insured plans of public employees, and
12 public programs. In the absence of an appropriate agreement, a primary care
13 practice or practitioner may decline to participate in the private, self-insured
14 plan’s primary care network.
15    (f) The Green Mountain Care Board shall adopt rules in accordance with
16 3 V.S.A. chapter 25 to implement the program set forth in this section.
17    (g) It is the intent of the General Assembly to provide funding to support an
18 increase in the number of medical school slots and residency slots for primary
19 care practitioners at the University of Vermont College of Medicine in order to
20 increase the supply of primary care practitioners in this State. It is the intent of
21 the General Assembly that the funding for these slots shall be derived by
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1 annual appropriation, by an annual charge imposed by the Board on hospitals
2 and health systems, or by a combination of revenue sources. The Board shall
3 coordinate with the Office of Primary Care and Area Health Education Centers
4 Program (AHEC) at the University of Vermont College of Medicine to
5 establish the appropriate conditions on the use of the medical school or
6 residency funds in order to benefit Vermonters and Vermont’s health care
7 system.
8 Sec. 4. DEVELOPMENT AND IMPLEMENTATION REPORTS
9    On or before January 15, 2026 and January 15, 2027, the Green Mountain
10 Care Board shall report to the General Assembly on the status of its
11 rulemaking and on the development and implementation of the universal
12 primary care program set forth in Sec. 3 of this act.
13 Sec. 5. EFFECTIVE DATE
14    This act shall take effect on passage, with the universal primary care
15 program beginning operation not later than January 1, 2028.
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