BILLASPASSEDBYTHEHOUSE H.80
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H.80
IntroducedbyRepresentativesCordesofBristol,BerbecoofWinooski,Black
ofEssex,CinaofBurlington,CritchlowofColchester,Demar
ofEnosburgh,GoldmanofRockingham,McFaunofBarre
Town,andPageofNewportCity
ReferredtoCommitteeon
Date:
Subject:Health;healthinsurance;OfficeoftheHealthCareAdvocate;
certificatesofneed
Statementofpurposeofbillasintroduced:Thisbillproposestomodifythe
roleanddutiesoftheOfficeoftheHealthCareAdvocateastheyrelateto
healthcareregulatoryactivities,accesstoinformation,andproviding
assistancetoVermonters.
AnactrelatingtotheOfficeoftheHealthCareAdvocate
ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
Sec.1.8V.S.A.§ 4062isamendedtoread:
§4062.FILINGANDAPPROVALOFPOLICYFORMSANDPREMIUMS
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(c)(1)TheBoardshallprovideinformationtothepublicontheBoard’s
websiteaboutthepublicavailabilityofthefilingsandsummariesrequired
underthissection.
***
(3)(A)Inadditiontothepubliccommentprovisionssetforthinthis
subsection(c),theOfficeoftheHealthCareAdvocateestablishedin18V.S.A.
chapter229,actingonbehalfofhealthinsuranceconsumersinthisState,may,
within30calendardaysaftertheBoardreceivesaninsurer’sraterequest
pursuanttothissection,submittotheBoard,inwriting,suggestedquestions
regardingthefilingforthattheBoardtoprovidetoshallasktheinsurer,either
directlyorthroughitscontractingactuary,ifany.
(3)(A)Inadditiontothepubliccommentprovisionssetforthinthis
subsection(c),theOfficeoftheHealthCareAdvocateestablishedin18V.S.A.
chapter229,actingonbehalfofhealthinsuranceconsumersinthisState,may,
within30calendardaysaftertheBoardreceivesaninsurer’sraterequest
pursuanttothissection,submittotheBoard,inwriting,suggestedquestions
regardingwithanarticulablenexustothefilingforthattheBoardtoprovide
toshallasktheinsurer,eitherdirectlyorthroughitscontractingactuary,if
any.
(B)TheOfficeoftheHealthCareAdvocatemayalsosubmittothe
Boardwrittencommentsonaninsurer’sraterequest.TheBoardshallpostthe
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commentsonitswebsiteandshallconsiderthecommentspriortoissuingits
decision.
(d)(1)Nolaterthan60calendardaysafterreceivinganinsurer’srate
requestpursuanttothissection,theGreenMountainCareBoardshallmake
availabletothepublictheinsurer’sratefiling,theDepartment’sanalysisand
opinionoftheeffectoftheproposedrateontheinsurer’ssolvency,andthe
analysisandopinionoftheratefilingbytheBoard’scontractingactuary,if
any.
(2)TheBoardshallpostonitswebsite,afterredactinganyconfidential
orproprietaryinformationrelatingtotheinsurerortotheinsurer’sratefiling:
(A)allquestionstheBoardposestoitscontractingactuary,ifany,
andtheactuary’sresponsestotheBoard’squestions;and
(B)allquestionstheBoard,theBoard’scontractingactuary,ifany,
ortheDepartmentposestotheinsurerandtheinsurer’sresponsestothose
questionsTheGreenMountainCareBoardshallcontemporaneouslyposton
itswebsiteorotherwisemakeavailabletothepublicthroughafile-sharing
platformallmaterialsintherecordofaratereviewproceedingafterredacting
anyinformationorothermaterialthattheBoarddeterminestobeconfidential
orotherwisesubjecttoprotectionfromdisclosurebylaw.
***
Sec.1.8V.S.A.§ 4062isamendedtoread:
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§4062.FILINGANDAPPROVALOFPOLICYFORMSANDPREMIUMS
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(c)(1)TheBoardshallprovideinformationtothepublicontheBoard’s
websiteaboutthepublicavailabilityofthefilingsandsummariesrequired
underthissection.
***
(3)(A)Inadditiontothepubliccommentprovisionssetforthinthis
subsection(c),theOfficeoftheHealthCareAdvocateestablishedin18V.S.A.
chapter229,actingonbehalfofhealthinsuranceconsumersinthisState,may,
within30calendardaysaftertheBoardreceivesaninsurer’sraterequest
pursuanttothissection,submittotheBoard,inwriting,suggestedquestions
regardingwithasubstantialrelationshiptotheratefilingforandreview
criteriathattheBoardtoprovidetoshallasktheinsurer,eitherdirectlyor
throughitscontractingactuary,ifany.
(B)TheOfficeoftheHealthCareAdvocatemayalsosubmittothe
Boardwrittencommentsonaninsurer’sraterequest.TheBoardshallpostthe
commentsonitswebsiteandshallconsiderthecommentspriortoissuingits
decision.
(d)(1)Nolaterthan60calendardaysafterreceivinganinsurer’srate
requestpursuanttothissection,theGreenMountainCareBoardshallmake
availabletothepublictheinsurer’sratefiling,theDepartment’sanalysisand BILLASPASSEDBYTHEHOUSE H.80
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opinionoftheeffectoftheproposedrateontheinsurer’ssolvency,andthe
analysisandopinionoftheratefilingbytheBoard’scontractingactuary,if
any.
(2)TheBoardshallpostonitswebsite,afterredactinganyconfidential
orproprietaryinformationrelatingtotheinsurerortotheinsurer’sratefiling:
(A)allquestionstheBoardposestoitscontractingactuary,ifany,
andtheactuary’sresponsestotheBoard’squestions;and
(B)allquestionstheBoard,theBoard’scontractingactuary,ifany,
ortheDepartmentposestotheinsurerandtheinsurer’sresponsestothose
questionsTheGreenMountainCareBoardshallpostonitswebsiteor
otherwisemakeavailabletothepublicthroughafile-sharingplatformall
materialsintherecordofaratereviewproceedingafterredactingany
informationorothermaterialthattheBoarddeterminestobeconfidentialor
otherwisesubjecttoprotectionfromdisclosurebylaw.
***
Sec.2.18V.S.A.§ 9440(c)isamendedtoread:
(c)Theapplicationprocessshallbeasfollows:
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(9)(A)TheOfficeoftheHealthCareAdvocateestablishedunder
chapter229ofthistitleor,inthecaseofnursinghomes,theLong-TermCare
Ombudsman’sOfficeestablishedunder33V.S.A.§7502,isauthorizedbutnot
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requiredtoparticipateinanyadministrativeorjudicialreviewofan
applicationunderthissubchapterandshallbeconsideredaninterestedpartyin
suchproceedingsuponfilinganoticeofinterventionwiththeBoard.
(B)Onceeitherofficefilesanoticeofinterventionpursuanttothis
subchapter,theBoardshallprovidethatofficewiththeinformationnecessary
toparticipateinthereviewprocess,includinginformationaboutprocedures,
copiesofallwrittencorrespondence,andcopiesofallentriesintheapplication
recordforallcertificateofneedproceedings,regardlessofwhetherexpedited
statushasbeengrantedthatofficeshallhavetherighttoreceivecopiesofall
materialsrelatedtothecertificateofneedapplicationreviewandmay:
(i)askquestionsofemployeesoftheGreenMountainCareBoard
relatedtotheBoard’sreviewofthecertificateofneedapplication;
(ii)submitwrittenquestionstotheBoardthattheBoardwillask
oftheapplicantinadvanceofanyhearingheldinconjunctionwiththeBoard’s
reviewofthecertificateofneedapplication;
(iii)submitwrittencommentsfortheBoard’sconsideration;and
(iv)askquestionsandprovidetestimonyinanyhearingheldin
conjunctionwiththeBoard’sreviewofthecertificateofneedapplication.
(C)TheOfficeoftheHealthCareAdvocateandtheLong-TermCare
Ombudsman’sOfficeshallnotfurtherdiscloseanyconfidentialorproprietary
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informationprovidedtotheirrespectiveofficespursuanttothissubdivision
(9).
Sec.3.18V.S.A.chapter229isamendedtoread:
CHAPTER229.OFFICEOFTHEHEALTHCAREADVOCATE
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§9602.OFFICEOFTHEHEALTHCAREADVOCATE;COMPOSITION
(a)TheOfficeoftheHealthCareAdvocateisestablishedasan
independentvoiceforVermontersthatisdedicatedtopromotingaccessto
high-quality,affordablehealthcareforall.
(b)TheAgencyofHumanServicesshallmaintaintheOfficeoftheHealth
CareAdvocatebycontractwithanynonprofitorganization.
(b)(c)TheOfficeshallbeadministeredbyoneormoredirectors,oneof
whomshallbetheChiefHealthCareAdvocate,whoshallbeanindividual
withexpertiseandexperienceinthefieldsofhealthcareandadvocacy.The
Advocatedirectorordirectorsmayemploylegalcounsel,administrativestaff,
andotheremployeesandcontractorsasneededtocarryoutthedutiesofthe
Office.
§9603.DUTIESANDAUTHORITY
(a)TheOfficeoftheHealthCareAdvocateshall:
(1)AssisthealthinsuranceconsumersVermonterswithhealthinsurance
planselectionbyprovidinginformation,referrals,andassistancetoindividuals
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aboutmeansofobtainingandpayingforhealthinsurancecoverageand
services.TheOfficeshallacceptreferralsfromtheVermontHealthBenefit
ExchangeandExchangenavigatorscreatedpursuantto33V.S.A.chapter18,
subchapter1,toassistconsumersindividualsexperiencingproblemsrelatedto
theExchange.
(2)AssisthealthinsuranceconsumersVermonterstounderstandtheir
rightsandresponsibilitiesunderhealthinsuranceplans.
(3)Provideinformationtothepublic,agencies,membersoftheGeneral
Assembly,andothersregardingaboutVermonters’problemsandconcernsof
regardinghealthinsuranceconsumersandaccesstohealthcare,aswellas
recommendationsforresolvingthoseproblemsandconcerns.
(4)Identify,investigate,andresolvecomplaints,questions,andinquiries
onbehalfofindividualVermonterswithrespecttoissuesregardinghealth
insuranceconsumersoraccesstohealthcare,andassistthoseconsumers
Vermonterswithfilingandpursuitofpursuingcomplaintsandappeals.
(5)Provideinformationtoindividualsconsumereducationto
Vermontersregardingtheirobligationsrightsandresponsibilitiesunderthe
PatientProtectionandAffordableCareAct(Pub.L.No.111-148)Stateand
federallaws,rules,andregulations.
(6)Analyzeandmonitorthedevelopmentandimplementationof
federal,State,andlocallaws,rules,andpoliciesrelatingtopatientsandhealth
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insuranceconsumershealthinsuranceandhealthcare,withaspecialfocuson
patients’rightsandeligibilityforStateandfederalhealthcareprograms.
(7)FacilitateEnsurepolicymakersheardirectlyfromVermontersby
facilitatingpubliccommentonhealthcare-relatedlaws,rules,processes,and
policies,includingpoliciesandactionsofhealthinsurers.
(8)SuggesttotheGreenMountainCareBoard,theDepartmentof
FinancialRegulation,andotherentitiesinStategovernmentpolicies,
procedures,orrulestotheGreenMountainCareBoardinordertothatprotect
patients’andconsumers’andpromotetheinterestsofVermontersinmatters
relatedtohealthinsuranceandaccesstohealthcare.
(9)PromotethedevelopmentofCollaboratewithotherhealthcare-and
healthpolicy-relatedcitizenandconsumerorganizationstopromoteaffordable
andaccessiblehealthcareforVermonters.
(10)EnsurethatpatientsandhealthinsuranceconsumersallVermonters
havetimelyaccesstotheservicesprovidedbytheOffice.
(11)SubmittotheGovernor;theHouseCommitteesonHealthCare,on
WaysandMeans,andonAppropriations;andtheSenateCommitteeson
HealthandWelfare,onFinance,andonAppropriations,onorbeforeJanuary1
15ofeachyear,areportontheactivities,performance,andfiscalaccountsof
theOfficeduringtheprecedingcalendaryear.
(b)TheOfficeoftheHealthCareAdvocatemay:
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(1)Reviewthehealthinsurancerecordsofaconsumerwhohas
providedwrittenconsent.Basedonthewrittenconsentoftheconsumerorhis
orherguardianorlegalrepresentative,ahealthinsurershallprovidetheOffice
withaccesstorecordsrelatingtothatconsumer.[Repealed.]
(2)Pursueadministrative,judicial,andotherremediesonbehalfofany
individualhealthinsuranceconsumerorgroupofconsumersindividuals
experiencingproblemswithhealthinsuranceoraccesstohealthcare.
(3)RepresenttheinterestsofthepeopleoftheStateincasesrequiringa
hearingbeforeofVermontinmattersinvolvinghealthcareandhealth
insuranceattheGreenMountainCareBoardestablishedinchapter220ofthis
title,theDepartmentofFinancialRegulation,orotherStateagencies.
(4)Adoptpoliciesandproceduresnecessarytocarryouttheprovisions
ofthischapter.
(5)Takeanyotheractionnecessarytofulfillthepurposesofthis
chapter.
(c)TheOfficeoftheHealthCareAdvocateshallbeabletospeakto
VermontersandonbehalfoftheinterestsofVermontersinhealthcarecare-
andhealthinsuranceconsumersinsurance-relatedmattersandtocarryoutall
dutiesprescribedinthischapterwithoutbeingsubjecttoanyretaliatoryaction;
provided,however,thatnothinginthissubsectionshalllimittheauthorityof
theAgencyofHumanServicestoenforcethetermsofthecontract.
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(d)Healthcareprovidersandhealthinsurersshallcooperatewiththe
OfficeoftheHealthCareAdvocatebyprovidingrelevantrecordsand
informationwhenanindividualortheindividual’sguardianorlegal
representativehasauthorizedtheOfficetoactontheindividual’sbehalf.
§9604.DUTIESOFSTATEAGENCIES
(a)IndevelopingStatepolicyaffectinghealthcareaccessandaffordability,
StateagenciesshallseekinputfromtheOfficeoftheHealthCareAdvocate.
(b)AllStateagenciesshallcomplyfacilitatetheOffice’smeaningful
participationinhealthcarepolicymakingbycomplyingwithreasonable
requestsfromtheOfficeoftheHealthCareAdvocateforinformationand,
assistance,andaccess.Arequestshallbeconsideredreasonableifitrelatesto
theOffice’sstatutorydutiesandauthority.
(1)Whenappropriate,StateagenciesshallallowtheOfficetoaccess
confidentialorproprietaryinformationthatisotherwiseexemptfrompublic
inspectionandcopyingunderthePublicRecordsActandtoparticipatein
meetings,deliberations,andproceedingsinwhichconfidentialorproprietary
informationisdiscussed.
(1)Whenappropriate,StateagenciesshallallowtheOfficetoaccess
confidentialorproprietaryinformationthatisotherwiseexemptfrompublic
inspectionandcopyingunderthePublicRecordsActandtoparticipatein
meetings,deliberations,andproceedingsinwhichconfidentialorproprietary
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informationisdiscussed;provided,however,thatnothinginthissectionshall
requireaStateagencytoprovideordiscloseinformationthatisprohibited
fromdisclosurebyStateorfederallaworthatwouldcausetheprovideror
disclosertoviolateanystatutoryorcommonlawprivilege.
(2)TheOfficeshallnotfurtherdiscloseanyconfidentialorproprietary
informationprovidedtotheOffice.
(c)TheAgencyofHumanServicesmayadoptrulesnecessarytoensure
thecooperationofStateagenciesunderthissection.
§9605.CONFIDENTIALITY
Intheabsenceofwrittenconsentbyacomplainantoranindividualusing
theservicesoftheOfficeorbyhisorherguardianorlegalrepresentativeor
theabsenceofacourtorder,theOfficeoftheHealthCareAdvocate,its
employees,anditscontractorsshallnotdisclosetheidentityofthe
complainantorindividualTheOfficeoftheHealthCareAdvocateshall
maintaintheconfidentialityofinformationrelatedtoindividualsusingits
servicesinaccordancewithallapplicableStateandfederallaws,rules,
regulations,andpolicies.
§9606.CONFLICTSOFINTEREST
(a)TheOfficeoftheHealthCareAdvocate,itsemployees,andits
contractorsshallnothaveanyconflictofinterestrelatingtotheperformance
oftheirresponsibilitiesunderthischapter.Forthepurposesofthischapter,a
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conflictofinterestexistswhenevertheOfficeoftheHealthCareAdvocate,its
employees,oritscontractorsorapersonaffiliatedwiththeOffice,its
employees,oritscontractors:
(1)hasadirectinvolvementinthelicensing,certification,or
accreditationofahealthcarefacility,healthinsurer,orhealthcareprovider;
(2)hasadirectownershipinterestorinvestmentinterestinahealthcare
facility,healthinsurer,orhealthcareprovider;
(3)isemployedbyorparticipatinginthemanagementofahealthcare
facility,healthinsurer,orhealthcareprovider;or
(4)receivesorhastherighttoreceive,directlyorindirectly,
remunerationunderacompensationarrangementwithahealthcarefacility,
healthinsurer,orhealthcareprovider.
(b)TheOfficeshallreportanypotentialconflictsofinteresttotheAgency
ofHumanServices.
(c)Itshallnotconstituteaconflictofinterestperseforanemployeeor
contractoroftheOfficetoservewithoutcompensationontheboardof
directorsofanonprofithealthcareentitywhoseprimaryregulatorisnotan
agencyoftheStateofVermont.
***
Sec.4.EFFECTIVEDATE
ThisactshalltakeeffectonJuly1,2025.
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