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H.80 1
Introduced by Representatives Cordes of Lincoln, Berbeco of Winooski, Black 2
of Essex, Cina of Burlington, Critchlow of Colchester, Demar 3
of Enosburgh, Goldman of Rockingham, McFaun of Barre 4
Town, and Page of Newport City 5
Referred to Committee on 6
Date: 7
Subject: Health; health insurance; Office of the Health Care Advocate; 8
certificates of need 9
Statement of purpose of bill as introduced: This bill proposes to modify the 10
role and duties of the Office of the Health Care Advocate as they relate to 11
health care regulatory activities, access to information, and providing 12
assistance to Vermonters. 13
An act relating to the Office of the Health Care Advocate 14
It is hereby enacted by the General Assembly of the State of Vermont: 15
Sec. 1. 8 V.S.A. § 4062 is amended to read: 16
§ 4062. FILING AND APPROVAL OF POLICY FORMS AND PREMIUMS 17
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(c)(1) The Board shall provide information to the public on the Board’s 1
website about the public availability of the filings and summaries required 2
under this section. 3
* * * 4
(3)(A) In addition to the public comment provisions set forth in this 5
subsection (c), the Office of the Health Care Advocate established in 18 V.S.A. 6
chapter 229, acting on behalf of health insurance consumers in this State, may, 7
within 30 calendar days after the Board receives an insurer’s rate request 8
pursuant to this section, submit to the Board, in writing, suggested questions 9
regarding the filing for that the Board to provide to shall ask the insurer, either 10
directly or through its contracting actuary, if any. 11
(B) The Office of the Health Care Advocate may also submit to the 12
Board written comments on an insurer’s rate request. The Board shall post the 13
comments on its website and shall consider the comments prior to issuing its 14
decision. 15
(d)(1) No later than 60 calendar days after receiving an insurer’s rate 16
request pursuant to this section, the Green Mountain Care Board shall make 17
available to the public the insurer’s rate filing, the Department’s analysis and 18
opinion of the effect of the proposed rate on the insurer’s solvency, and the 19
analysis and opinion of the rate filing by the Board’s contracting actuary, if 20
any. 21 BILL AS INTRODUCED H.80
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(2) The Board shall post on its website, after redacting any confidential 1
or proprietary information relating to the insurer or to the insurer’s rate filing: 2
(A) all questions the Board poses to its contracting actuary, if any, 3
and the actuary’s responses to the Board’s questions; and 4
(B) all questions the Board, the Board’s contracting actuary, if any, 5
or the Department poses to the insurer and the insurer’s responses to those 6
questions The Green Mountain Care Board shall contemporaneously post on 7
its website or otherwise make available to the public through a file-sharing 8
platform all materials in the record of a rate review proceeding after redacting 9
any information or other material that the Board determines to be confidential 10
or otherwise subject to protection from disclosure by law. 11
* * * 12
Sec. 2. 18 V.S.A. § 9440(c) is amended to read: 13
(c) The application process shall be as follows: 14
* * * 15
(9)(A) The Office of the Health Care Advocate established under 16
chapter 229 of this title or, in the case of nursing homes, the Long-Term Care 17
Ombudsman’s Office established under 33 V.S.A. § 7502, is authorized but 18
not required to participate in any administrative or judicial review of an 19
application under this subchapter and shall be considered an interested party in 20
such proceedings upon filing a notice of intervention with the Board. 21 BILL AS INTRODUCED H.80
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(B) Once either office files a notice of intervention pursuant to this 1
subchapter, the Board shall provide that office with the information necessary 2
to participate in the review process, including information about procedures, 3
copies of all written correspondence, and copies of all entries in the application 4
record for all certificate of need proceedings, regardless of whether expedited 5
status has been granted that office shall have the right to receive copies of all 6
materials related to the certificate of need application review and may: 7
(i) ask questions of employees of the Green Mountain Care Board 8
related to the Board’s review of the certificate of need application; 9
(ii) submit written questions to the Board that the Board will ask 10
of the applicant in advance of any hearing health in conjunction with the 11
Board’s review of the certificate of need application; 12
(iii) submit written comments for the Board’s consideration; and 13
(iv) ask questions and provide testimony in any hearing held in 14
conjunction with the Board’s review of the certificate of need application. 15
(C) The Office of the Health Care Advocate and the Long-Term Care 16
Ombudsman’s Office shall not further disclose any confidential or proprietary 17
information provided to their respective offices pursuant to this subdivision 18
(9). 19 BILL AS INTRODUCED H.80
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Sec. 3. 18 V.S.A. chapter 229 is amended to read: 1
CHAPTER 229. OFFICE OF THE HEALTH CARE ADVOCATE 2
* * * 3
§ 9602. OFFICE OF THE HEALTH CARE ADVOCATE; COMPOSITION 4
(a) The Office of the Health Care Advocate is established as an 5
independent voice for Vermonters that is dedicated to promoting access to 6
high-quality, affordable health care for all. 7
(b) The Agency of Human Services shall maintain the Office of the Health 8
Care Advocate by contract with any nonprofit organization. 9
(b)(c) The Office shall be administered by one or more directors, one of 10
whom shall be the Chief Health Care Advocate, who shall be an individual 11
with expertise and experience in the fields of health care and advocacy. The 12
Advocate director or directors may employ legal counsel, administrative staff, 13
and other employees and contractors as needed to carry out the duties of the 14
Office. 15
§ 9603. DUTIES AND AUTHORITY 16
(a) The Office of the Health Care Advocate shall: 17
(1) Assist health insurance consumers Vermonters with health insurance 18
plan selection by providing information, referrals, and assistance to individuals 19
about means of obtaining and paying for health insurance coverage and 20
services. The Office shall accept referrals from the Vermont Health Benefit 21 BILL AS INTRODUCED H.80
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Exchange and Exchange navigators created pursuant to 33 V.S.A. chapter 18, 1
subchapter 1, to assist consumers individuals experiencing problems related to 2
the Exchange. 3
(2) Assist health insurance consumers Vermonters to understand their 4
rights and responsibilities under health insurance plans. 5
(3) Provide information to the public, agencies, members of the General 6
Assembly, and others regarding about Vermonters’ problems and concerns of 7
regarding health insurance consumers and access to health care, as well as 8
recommendations for resolving those problems and concerns. 9
(4) Identify, investigate, and resolve complaints, questions, and inquiries 10
on behalf of individual Vermonters with respect to issues regarding health 11
insurance consumers or access to health care, and assist those consumers 12
Vermonters with filing and pursuit of pursuing complaints and appeals. 13
(5) Provide information to individuals consumer education to 14
Vermonters regarding their obligations rights and responsibilities under the 15
Patient Protection and Affordable Care Act (Pub. L. No. 111-148) State and 16
federal laws, rules, and regulations. 17
(6) Analyze and monitor the development and implementation of 18
federal, State, and local laws, rules, and policies relating to patients and health 19
insurance consumers health insurance and health care, with a special focus on 20
patients’ rights and eligibility for State and federal health care programs. 21 BILL AS INTRODUCED H.80
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(7) Facilitate Ensure policymakers hear directly from Vermonters by 1
facilitating public comment on health care-related laws, rules, processes, and 2
policies, including policies and actions of health insurers. 3
(8) Suggest to the Green Mountain Care Board, the Department of 4
Financial Regulation, and other entities in State government policies, 5
procedures, or rules to the Green Mountain Care Board in order to that protect 6
patients’ and consumers’ and promote the interests of Vermonters in matters 7
related to health insurance and access to health care. 8
(9) Promote the development of Collaborate with other health care- and 9
health policy-related citizen and consumer organizations to promote affordable 10
and accessible health care for Vermonters. 11
(10) Ensure that patients and health insurance consumers all Vermonters 12
have timely access to the services provided by the Office. 13
(11) Submit to the Governor; the House Committees on Health Care, on 14
Ways and Means, and on Appropriations; and the Senate Committees on 15
Health and Welfare, on Finance, and on Appropriations, on or before January 1 16
15 of each year, a report on the activities, performance, and fiscal accounts of 17
the Office during the preceding calendar year. 18
(b) The Office of the Health Care Advocate may: 19
(1) Review the health insurance records of a consumer who has 20
provided written consent. Based on the written consent of the consumer or his 21 BILL AS INTRODUCED H.80
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or her guardian or legal representative, a health insurer shall provide the Office 1
with access to records relating to that consumer. [Repealed.] 2
(2) Pursue administrative, judicial, and other remedies on behalf of any 3
individual health insurance consumer or group of consumers individuals 4
experiencing problems with health insurance or access to health care. 5
(3) Represent the interests of the people of the State in cases requiring a 6
hearing before of Vermont in matters involving health care and health 7
insurance at the Green Mountain Care Board established in chapter 220 of this 8
title, the Department of Financial Regulation, or other State agencies. 9
(4) Adopt policies and procedures necessary to carry out the provisions 10
of this chapter. 11
(5) Take any other action necessary to fulfill the purposes of this 12
chapter. 13
(c) The Office of the Health Care Advocate shall be able to speak to 14
Vermonters and on behalf of the interests of Vermonters in health care care- 15
and health insurance consumers insurance-related matters and to carry out all 16
duties prescribed in this chapter without being subject to any retaliatory action; 17
provided, however, that nothing in this subsection shall limit the authority of 18
the Agency of Human Services to enforce the terms of the contract. 19
(d) Health care providers and health insurers shall cooperate with the 20
Office of the Health Care Advocate by providing relevant records and 21 BILL AS INTRODUCED H.80
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information when an individual or the individual’s guardian or legal 1
representative has authorized the Office to act on the individual’s behalf. 2
§ 9604. DUTIES OF STATE AGENCIES 3
(a) In developing State policy affecting health care access and affordability, 4
State agencies shall seek input from the Office of the Health Care Advocate. 5
(b) All State agencies shall comply facilitate the Office’s meaningful 6
participation in health care policymaking by complying with reasonable 7
requests from the Office of the Health Care Advocate for information and, 8
assistance, and access. A request shall be considered reasonable if it relates to 9
the Office’s statutory duties and authority. 10
(1) When appropriate, State agencies shall allow the Office to access 11
confidential or proprietary information that is otherwise exempt from public 12
inspection and copying under the Public Records Act and to participate in 13
meetings, deliberations, and proceedings in which confidential or proprietary 14
information is discussed. 15
(2) The Office shall not further disclose any confidential or proprietary 16
information provided to the Office. 17
(c) The Agency of Human Services may adopt rules necessary to ensure the 18
cooperation of State agencies under this section. 19 BILL AS INTRODUCED H.80
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§ 9605. CONFIDENTIALITY 1
In the absence of written consent by a complainant or an individual using 2
the services of the Office or by his or her guardian or legal representative or 3
the absence of a court order, the Office of the Health Care Advocate, its 4
employees, and its contractors shall not disclose the identity of the complainant 5
or individual The Office of the Health Care Advocate shall maintain the 6
confidentiality of information related to individuals using its services in 7
accordance with all applicable State and federal laws, rules, regulations, and 8
policies. 9
§ 9606. CONFLICTS OF INTEREST 10
(a) The Office of the Health Care Advocate, its employees, and its 11
contractors shall not have any conflict of interest relating to the performance of 12
their responsibilities under this chapter. For the purposes of this chapter, a 13
conflict of interest exists whenever the Office of the Health Care Advocate, its 14
employees, or its contractors or a person affiliated with the Office, its 15
employees, or its contractors: 16
(1) has a direct involvement in the licensing, certification, or 17
accreditation of a health care facility, health insurer, or health care provider; 18
(2) has a direct ownership interest or investment interest in a health care 19
facility, health insurer, or health care provider; 20 BILL AS INTRODUCED H.80
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(3) is employed by or participating in the management of a health care 1
facility, health insurer, or health care provider; or 2
(4) receives or has the right to receive, directly or indirectly, 3
remuneration under a compensation arrangement with a health care facility, 4
health insurer, or health care provider. 5
(b) The Office shall report any potential conflicts of interest to the Agency 6
of Human Services. 7
(c) It shall not constitute a conflict of interest per se for an employee or 8
contractor of the Office to serve without compensation on the board of 9
directors of a nonprofit health care entity whose primary regulator is not an 10
agency of the State of Vermont. 11
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Sec. 4. EFFECTIVE DATE 13
This act shall take effect on July 1, 2025. 14