Vermont H 102: An act relating to reducing prior authorization requirements in health insurance plans

Bill Text

BILL AS INTRODUCED H.102
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VT LEG #378718 v.1
H.102 1
Introduced by Representatives Casey of Montpelier, Berbeco of Winooski, 2
Black of Essex, Burke of Brattleboro, Cordes of Bristol, 3
Headrick of Burlington, McGill of Bridport, and Priestley of 4
Bradford 5
Referred to Committee on 6
Date: 7
Subject: Health; health coverage; health care sharing plan or arrangement; 8
Department of Financial Regulation; reporting 9
Statement of purpose of bill as introduced: This bill proposes to require a 10
person who is not authorized to offer health insurance in Vermont and who 11
offers or intends to offer a health care sharing plan or arrangement to facilitate 12
payment or reimbursement of health care costs or services for Vermont 13
residents to report certain information annually to the Commissioner of 14
Financial Regulation and to certify the accuracy of the information. The bill 15
would direct the Commissioner of Financial Regulation to prepare an annual 16
report summarizing the information and post it on the Department of Financial 17
Regulation’s website. 18
An act relating to annual reporting on health care sharing plans and 19
arrangements 20

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VT LEG #378718 v.1
It is hereby enacted by the General Assembly of the State of Vermont: 1
Sec. 1. 8 V.S.A. § 4078 is added to read: 2
§ 4078. HEALTH CARE SHARING PLAN OR ARRANGEMENT; 3
REPORTING AND CERTIFICATION 4
(a) A person who is not authorized by the Commissioner under chapter 5
101, 123, 125, or 139 of this title to offer insurance in this State and who offers 6
or intends to offer a plan or arrangement to facilitate payment or 7
reimbursement of health care costs or services for residents of this State, 8
regardless of whether the person is domiciled in this State or another state, 9
shall submit to the Commissioner on or after October 1, 2025 and on or after 10
March 1 each year thereafter: 11
(1) the following information: 12
(A) the total number of individuals and households that participated 13
in the plan or arrangement in this State in the immediately preceding calendar 14
year; 15
(B) the total number of employer groups that participated in the plan 16
or arrangement in this State in the immediately preceding calendar year, 17
specifying the total number of participating individuals in each participating 18
employer group; 19
(C) if the person offers a plan or arrangement in other states, the total 20
number of participants in the plan or arrangement nationally; 21

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VT LEG #378718 v.1
(D) any contracts the person has entered into with providers in this 1
State who provide health care services to plan or arrangement participants; 2
(E) the total amount of fees, dues, or other payments collected by the 3
person in the immediately preceding calendar year from individuals, employer 4
groups, or others who participated in the plan or arrangement, specifying the 5
percentage of fees, dues, or other payments retained by the person for 6
administrative expenses; 7
(F) the total dollar amount of requests for reimbursement of health 8
care costs or services that were submitted in this State in the immediately 9
preceding calendar year by plan or arrangement participants or providers who 10
provided health care services to plan or arrangement participants; 11
(G) the total dollar amount of requests for reimbursement of health 12
care costs or services that were submitted in this State and were determined to 13
qualify for reimbursement under the plan or arrangement in the immediately 14
preceding calendar year; 15
(H) the total dollar amount of payments made to providers in this 16
State in the immediately preceding calendar year for health care services that 17
were provided to or received by plan or arrangement participants; 18
(I) the total dollar amount of reimbursements made to plan or 19
arrangement participants in this State in the immediately preceding calendar 20

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VT LEG #378718 v.1
year for health care services provided to or received by a plan or arrangement 1
participant; 2
(J) the total number of requests for reimbursement of health care 3
costs or services submitted in this State in the immediately preceding calendar 4
year that were denied, expressed as a percentage of total reimbursement 5
requests submitted in that calendar year, and the total number of 6
reimbursement request denials that were appealed; 7
(K) the total dollar amount of health care expenses submitted in this 8
State by plan or arrangement participants or providers in the immediately 9
preceding calendar year that qualify for reimbursement pursuant to the plan or 10
arrangement criteria but that, as of the end of that calendar year, have not been 11
reimbursed, excluding any amounts that the plan or arrangement participants 12
incurring the health care costs must pay before receiving reimbursement under 13
the plan or arrangement; 14
(