§ 903 - Catamount health; employer-sponsored insurance assistance; request for proposals
§ 903. Catamount health; employer-sponsored insurance assistance; request for proposals
(a) Private carrier assumption of risk option. It is the intent of the general assembly first to provide to carriers and insurers in the private market the opportunity to offer Catamount Health with the assumption of risk. In the event that no private carriers or insurers elect to offer Catamount Health, the commissioner of banking, insurance, securities, and health care administration shall require hospital and medical service corporations and nonprofit health maintenance organizations to offer Catamount Health under section 4080f of Title 8.
(b)(1) Program evaluation. No earlier than October 1, 2009, the commission on health care reform, in consultation with the secretary of administration or designee, shall:
(A) Compare the cost-effectiveness of the Catamount Health program with other available alternative methods of providing health care coverage to uninsured Vermonters, taking into consideration the rates and forms approved by the department of banking, insurance, securities, and health care administration; the costs of administration and reserves, including the extent to which the program's administrative complexity affects progress toward the goal of insuring 96 percent of Vermonters by 2010; the amount of Catamount Health assistance provided to individuals; whether the Catamount Health assistance is sufficient to make Catamount Health affordable to those individuals; the number of individuals for whom assistance is available given the appropriated amount; and the potential impacts on Vermont's programs of health care reform at the federal level. The commission shall review, in consultation with the joint fiscal office, the sustainability of the Catamount Fund and impacts on the general fund, both under the current mode of operation and under any alternatives considered. Prior to making its determination, the commission shall consider the recommendations of a health care and health insurance consultant selected jointly by the commission and the secretary of administration.
(B) Evaluate the cost-effectiveness of the employer-sponsored insurance assistance program established in section 1974 of Title 33. The commission shall:
(i) conduct a thorough review of the administrative costs of Vermont's state-sponsored health assistance programs, including program-specific figures for Catamount Health premium assistance, the employer-sponsored insurance assistance program for those eligible for Catamount Health, the Vermont health access plan (VHAP), and the employer-sponsored insurance assistance program for those eligible for VHAP;
(ii) recommend a method and format for reporting employer costs in the monthly financial reports submitted to the general assembly by the office of Vermont health access;
(iii) perform a historical analysis comparing the monthly costs for VHAP enrollees with access to employer-sponsored insurance to those without;
(iv) analyze why many potential applicants for state-sponsored health assistance programs do not complete the enrollment process, with a focus on what role, if any, the employer-sponsored insurance assistance program plays in the failure to enroll;
(v) assess the extent to which the agency of human services' engagement in a cost-benefit analysis of an applicant's employer-sponsored insurance results in a delay in the applicant's enrollment in a health plan; and
(vi) evaluate the health insurance costs of employers in this state and survey whether the employer-sponsored insurance assistance program has or may have any impact on the likelihood that they will continue to offer health insurance.
(C) The office of Vermont health access shall provide the commission with access to any information requested in order to conduct the activities specified in subdivision (B) of this subdivision (1), except the following:
(i) Names, addresses, and Social Security numbers of recipients of and applicants for services administered by the office.
(ii) Medical services provided to recipients.
(iii) Social and economic conditions or circumstances, except such de-identified information as the office may compile in the aggregate.
(iv) Agency evaluation of personal information.
(v) Medical data, including diagnosis and past history of disease or disability.
(vi) Information received for verifying income eligibility and amount of medical assistance payments, except such de-identified information as the office may compile in the aggregate.
(vii) Any additional types of information the office has identified for safeguarding pursuant to the requirements of 42 C.F.R. § 431.305.
(D) No later than January 15, 2010, the commission on health care reform shall report its findings and recommendations for the future of the employer-sponsored insurance assistance programs pursuant to subdivision (B) of this subdivision (1) to the house committee on health care and the senate committee on health and welfare.
(2) If the commission determines that the market is not cost-effective, the agency of administration shall issue a request for proposals for the administration only of Catamount Health as described in section 4080f of Title 8. A contract entered into under this subsection shall not include the assumption of risk. If Catamount Health is administered under this subsection, the agency shall purchase a stop-loss policy for an aggregate claims amount for Catamount Health as a method of managing the state's financial risk. The agency shall determine the amount of aggregate stop-loss reinsurance and may purchase additional types of reinsurance if prudent and cost-effective. The agency may include in the contract the chronic care management program established under section 1903a of Title 33.
(3) If Catamount Health is offered as a self-insured product, the requirements of section 4080f of Title 8 and subchapter 3a of chapter 19 of Title 33 shall apply to the extent feasible. The individual contributions set in subchapter 3a of chapter 19 of Title 33 shall be the premium amounts charged to individuals. (Added 2005, No. 190 (Adj. Sess.), § 2; No. 191 (Adj. Sess.), § 21; amended 2009, No. 61, § 24.)