Vermont H. 585: An act relating to management of records

Bill Text

BILLAS PASSED BY THE HOUSE H.585
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H.585
Introduced by Representatives McCoy of Poultney and McFaun of Barre
Town
Referred to Committee on
Date:
Subject: Health; health care reform; health insurers; health insurance; prior
authorization; site-neutral billing; reinsurance
Statement of purpose of bill as introduced: This bill proposes to modify the
governance and executive compensation requirements for certain health
insurance companies. It would allow limited age rating for health insurance
plans in the individual and small group markets and expand access to
association health plans and to short-term, limited duration health insurance.
The bill would define high-dollar claims for purposes of claims edits and
would limit the primary care provider exemption from prior authorization
requirements to apply to independent providers only. The bill would also
begin implementing site-neutral billing policies for certain health care services
and would authorize the State to pursue a federal waiver to establish a
reinsurance program.
An act relating to health insurance reforms
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BILLAS PASSED BY THE HOUSE H.585
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It is hereby enacted by the General Assembly of the State of Vermont:
* * * Health Insurer Governance and Executive Compensation * * *
Sec. 1. 8 V.S.A. chapter 123 is amended to read:
CHAPTER 123. NONPROFIT HOSPITALSERVICE CORPORATIONS
* * *
§ 4512. POWERS
(a) Such A hospital service corporation shall be a nonprofit sharing
corporation without capital stock. It shall be maintained and operated solely
for the benefit of the its subscribers thereof and shall ensure that benefits and
services are balanced with the efficient and economical management of the
corporation. A hospital service corporation shall not be authorized to pay
money in lieu of hospital service. A person, partnership, association, or
corporation shall not contract to furnish hospital service unless authorized so
to do so pursuant to the provisions of this chapter. Corporations formed under
the provisions of this chapter shall have the privileges and be subject to the
provisions of Title 11B as well as the applicable provisions of this chapter. In
the event of a conflict between the provisions of Title 11B and the provisions
of this chapter, the latter shall control.
* * *
§ 4513. PERMIT TO ENGAGE IN BUSINESS; FOREIGN
CORPORATIONS
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BILLAS PASSED BY THE HOUSE H.585
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(a) At least three-fourths of the board of directors of a corporation
organized under this chapter shall be composed of subscribers and members of
the public. The remainder may be providers. The subscriber members of the
board shall comprise at least a majority of the board. A corporation organized
under this chapter shall provide for the election of its board of directors at a
publicly announced meeting. As used in this section, “provider” means any
person who is a provider of hospital or medical services, or who is an
employee, director, trustee, or representative of a provider of such services.
[Repealed.]
* * *
§ 4513a. BOARD OF DIRECTORS
(a) Definitions. As used in this section:
(1) “Provider” means any person who is a provider of hospital or
medical services, or who is an employee, director, trustee, or representative of
a provider of such services.
(2) “Representative of the public” means any member of the board of
directors appointed by the Governor. A representative of the public may be a
member of the public, a subscriber, or a provider.
(b) Composition. At least three-fourths of the board of directors of a
corporation organized under this chapter shall be composed of subscribers and
members of the public. The remainder may be providers. The subscriber
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members of the board shall comprise at least a majority of the board. A
corporation organized under this chapter shall provide for the election of its
board of directors at a publicly announced meeting.
(c) Representatives of the public.
(1) Two voting members of the board, but in no event less than one-
sixth of the board of directors, shall be representatives of the public appointed
by the Governor. Unless otherwise specified in this chapter, a representative
of the public shall have the same rights and responsibilities as any other
member of the board of directors.
(2) The initial term of one representative of the public shall be two
years and the initial term of the other representative of the public shall be three
years. If there are more than two representatives of the public, their initial
terms shall be divided as equally as possible between the two initial term
lengths. Thereafter, each representative of the public appointed by the
Governor to succeed a representative of the public shall serve a three-year term
and shall serve until a successor is appointed.
(3) A re