VT
Vermont House Bill H0080

Vermont 2025-2026 Regular Session

Vermont House Bill H0080 Compare Versions

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33 H.80
44 IntroducedbyRepresentativesCordesofBristol,BerbecoofWinooski,Black
55 ofEssex,CinaofBurlington,CritchlowofColchester,Demar
66 ofEnosburgh,GoldmanofRockingham,McFaunofBarre
77 Town,andPageofNewportCity
88 ReferredtoCommitteeon
99 Date:
1010 Subject:Health;healthinsurance;OfficeoftheHealthCareAdvocate;
1111 certificatesofneed
1212 Statementofpurposeofbillasintroduced:Thisbillproposestomodifythe
1313 roleanddutiesoftheOfficeoftheHealthCareAdvocateastheyrelateto
1414 healthcareregulatoryactivities,accesstoinformation,andproviding
1515 assistancetoVermonters.
1616 AnactrelatingtotheOfficeoftheHealthCareAdvocate
1717 ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
1818 Sec.1.8V.S.A.§ 4062isamendedtoread:
1919 §4062.FILINGANDAPPROVALOFPOLICYFORMSANDPREMIUMS
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4040 (c)(1)TheBoardshallprovideinformationtothepublicontheBoard’s
4141 websiteaboutthepublicavailabilityofthefilingsandsummariesrequired
4242 underthissection.
4343 ***
4444 (3)(A)Inadditiontothepubliccommentprovisionssetforthinthis
4545 subsection(c),theOfficeoftheHealthCareAdvocateestablishedin18V.S.A.
4646 chapter229,actingonbehalfofhealthinsuranceconsumersinthisState,may,
4747 within30calendardaysaftertheBoardreceivesaninsurer’sraterequest
4848 pursuanttothissection,submittotheBoard,inwriting,suggestedquestions
4949 regardingthefilingforthattheBoardtoprovidetoshallasktheinsurer,either
5050 directlyorthroughitscontractingactuary,ifany.
5151 (3)(A)Inadditiontothepubliccommentprovisionssetforthinthis
5252 subsection(c),theOfficeoftheHealthCareAdvocateestablishedin18V.S.A.
5353 chapter229,actingonbehalfofhealthinsuranceconsumersinthisState,may,
5454 within30calendardaysaftertheBoardreceivesaninsurer’sraterequest
5555 pursuanttothissection,submittotheBoard,inwriting,suggestedquestions
5656 regardingwithanarticulablenexustothefilingforthattheBoardtoprovide
5757 toshallasktheinsurer,eitherdirectlyorthroughitscontractingactuary,if
5858 any.
5959 (B)TheOfficeoftheHealthCareAdvocatemayalsosubmittothe
6060 Boardwrittencommentsonaninsurer’sraterequest.TheBoardshallpostthe
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7575 commentsonitswebsiteandshallconsiderthecommentspriortoissuingits
7676 decision.
7777 (d)(1)Nolaterthan60calendardaysafterreceivinganinsurer’srate
7878 requestpursuanttothissection,theGreenMountainCareBoardshallmake
7979 availabletothepublictheinsurer’sratefiling,theDepartment’sanalysisand
8080 opinionoftheeffectoftheproposedrateontheinsurer’ssolvency,andthe
8181 analysisandopinionoftheratefilingbytheBoard’scontractingactuary,if
8282 any.
8383 (2)TheBoardshallpostonitswebsite,afterredactinganyconfidential
8484 orproprietaryinformationrelatingtotheinsurerortotheinsurer’sratefiling:
8585 (A)allquestionstheBoardposestoitscontractingactuary,ifany,
8686 andtheactuary’sresponsestotheBoard’squestions;and
8787 (B)allquestionstheBoard,theBoard’scontractingactuary,ifany,
8888 ortheDepartmentposestotheinsurerandtheinsurer’sresponsestothose
8989 questionsTheGreenMountainCareBoardshallcontemporaneouslyposton
9090 itswebsiteorotherwisemakeavailabletothepublicthroughafile-sharing
9191 platformallmaterialsintherecordofaratereviewproceedingafterredacting
9292 anyinformationorothermaterialthattheBoarddeterminestobeconfidential
9393 orotherwisesubjecttoprotectionfromdisclosurebylaw.
9494 ***
9595 Sec.1.8V.S.A.§ 4062isamendedtoread:
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117117 §4062.FILINGANDAPPROVALOFPOLICYFORMSANDPREMIUMS
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119119 (c)(1)TheBoardshallprovideinformationtothepublicontheBoard’s
120120 websiteaboutthepublicavailabilityofthefilingsandsummariesrequired
121121 underthissection.
122122 ***
123123 (3)(A)Inadditiontothepubliccommentprovisionssetforthinthis
124124 subsection(c),theOfficeoftheHealthCareAdvocateestablishedin18V.S.A.
125125 chapter229,actingonbehalfofhealthinsuranceconsumersinthisState,may,
126126 within30calendardaysaftertheBoardreceivesaninsurer’sraterequest
127127 pursuanttothissection,submittotheBoard,inwriting,suggestedquestions
128128 regardingwithasubstantialrelationshiptotheratefilingforandreview
129129 criteriathattheBoardtoprovidetoshallasktheinsurer,eitherdirectlyor
130130 throughitscontractingactuary,ifany.
131131 (B)TheOfficeoftheHealthCareAdvocatemayalsosubmittothe
132132 Boardwrittencommentsonaninsurer’sraterequest.TheBoardshallpostthe
133133 commentsonitswebsiteandshallconsiderthecommentspriortoissuingits
134134 decision.
135135 (d)(1)Nolaterthan60calendardaysafterreceivinganinsurer’srate
136136 requestpursuanttothissection,theGreenMountainCareBoardshallmake
137-availabletothepublictheinsurer’sratefiling,theDepartment’sanalysisand BILLASPASSEDBYTHEHOUSEANDSENATE H.80
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139139 opinionoftheeffectoftheproposedrateontheinsurer’ssolvency,andthe
140140 analysisandopinionoftheratefilingbytheBoard’scontractingactuary,if
141141 any.
142142 (2)TheBoardshallpostonitswebsite,afterredactinganyconfidential
143143 orproprietaryinformationrelatingtotheinsurerortotheinsurer’sratefiling:
144144 (A)allquestionstheBoardposestoitscontractingactuary,ifany,
145145 andtheactuary’sresponsestotheBoard’squestions;and
146146 (B)allquestionstheBoard,theBoard’scontractingactuary,ifany,
147147 ortheDepartmentposestotheinsurerandtheinsurer’sresponsestothose
148148 questionsTheGreenMountainCareBoardshallpostonitswebsiteor
149149 otherwisemakeavailabletothepublicthroughafile-sharingplatformall
150150 materialsintherecordofaratereviewproceedingafterredactingany
151151 informationorothermaterialthattheBoarddeterminestobeconfidentialor
152152 otherwisesubjecttoprotectionfromdisclosurebylaw.
153153 ***
154154 Sec.2.18V.S.A.§ 9440(c)isamendedtoread:
155155 (c)Theapplicationprocessshallbeasfollows:
156156 ***
157157 (9)(A)TheOfficeoftheHealthCareAdvocateestablishedunder
158158 chapter229ofthistitleor,inthecaseofnursinghomes,theLong-TermCare
159159 Ombudsman’sOfficeestablishedunder33V.S.A.§7502,isauthorizedbutnot
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167167 requiredtoparticipateinanyadministrativeorjudicialreviewofan
168168 applicationunderthissubchapterandshallbeconsideredaninterestedpartyin
169169 suchproceedingsuponfilinganoticeofinterventionwiththeBoard.
170170 (B)Onceeitherofficefilesanoticeofinterventionpursuanttothis
171171 subchapter,theBoardshallprovidethatofficewiththeinformationnecessary
172172 toparticipateinthereviewprocess,includinginformationaboutprocedures,
173173 copiesofallwrittencorrespondence,andcopiesofallentriesintheapplication
174174 recordforallcertificateofneedproceedings,regardlessofwhetherexpedited
175175 statushasbeengrantedthatofficeshallhavetherighttoreceivecopiesofall
176176 materialsrelatedtothecertificateofneedapplicationreviewandmay:
177177 (i)askquestionsofemployeesoftheGreenMountainCareBoard
178178 relatedtotheBoard’sreviewofthecertificateofneedapplication;
179179 (ii)submitwrittenquestionstotheBoardthattheBoardwillask
180180 oftheapplicantinadvanceofanyhearingheldinconjunctionwiththeBoard’s
181181 reviewofthecertificateofneedapplication;
182182 (iii)submitwrittencommentsfortheBoard’sconsideration;and
183183 (iv)askquestionsandprovidetestimonyinanyhearingheldin
184184 conjunctionwiththeBoard’sreviewofthecertificateofneedapplication.
185185 (C)TheOfficeoftheHealthCareAdvocateandtheLong-TermCare
186186 Ombudsman’sOfficeshallnotfurtherdiscloseanyconfidentialorproprietary
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208208 informationprovidedtotheirrespectiveofficespursuanttothissubdivision
209209 (9).
210210 Sec.3.18V.S.A.chapter229isamendedtoread:
211211 CHAPTER229.OFFICEOFTHEHEALTHCAREADVOCATE
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213213 §9602.OFFICEOFTHEHEALTHCAREADVOCATE;COMPOSITION
214214 (a)TheOfficeoftheHealthCareAdvocateisestablishedasan
215215 independentvoiceforVermontersthatisdedicatedtopromotingaccessto
216216 high-quality,affordablehealthcareforall.
217217 (b)TheAgencyofHumanServicesshallmaintaintheOfficeoftheHealth
218218 CareAdvocatebycontractwithanynonprofitorganization.
219219 (b)(c)TheOfficeshallbeadministeredbyoneormoredirectors,oneof
220220 whomshallbetheChiefHealthCareAdvocate,whoshallbeanindividual
221221 withexpertiseandexperienceinthefieldsofhealthcareandadvocacy.The
222222 Advocatedirectorordirectorsmayemploylegalcounsel,administrativestaff,
223223 andotheremployeesandcontractorsasneededtocarryoutthedutiesofthe
224224 Office.
225225 §9603.DUTIESANDAUTHORITY
226226 (a)TheOfficeoftheHealthCareAdvocateshall:
227227 (1)AssisthealthinsuranceconsumersVermonterswithhealthinsurance
228228 planselectionbyprovidinginformation,referrals,andassistancetoindividuals
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251251 aboutmeansofobtainingandpayingforhealthinsurancecoverageand
252252 services.TheOfficeshallacceptreferralsfromtheVermontHealthBenefit
253253 ExchangeandExchangenavigatorscreatedpursuantto33V.S.A.chapter18,
254254 subchapter1,toassistconsumersindividualsexperiencingproblemsrelatedto
255255 theExchange.
256256 (2)AssisthealthinsuranceconsumersVermonterstounderstandtheir
257257 rightsandresponsibilitiesunderhealthinsuranceplans.
258258 (3)Provideinformationtothepublic,agencies,membersoftheGeneral
259259 Assembly,andothersregardingaboutVermonters’problemsandconcernsof
260260 regardinghealthinsuranceconsumersandaccesstohealthcare,aswellas
261261 recommendationsforresolvingthoseproblemsandconcerns.
262262 (4)Identify,investigate,andresolvecomplaints,questions,andinquiries
263263 onbehalfofindividualVermonterswithrespecttoissuesregardinghealth
264264 insuranceconsumersoraccesstohealthcare,andassistthoseconsumers
265265 Vermonterswithfilingandpursuitofpursuingcomplaintsandappeals.
266266 (5)Provideinformationtoindividualsconsumereducationto
267267 Vermontersregardingtheirobligationsrightsandresponsibilitiesunderthe
268268 PatientProtectionandAffordableCareAct(Pub.L.No.111-148)Stateand
269269 federallaws,rules,andregulations.
270270 (6)Analyzeandmonitorthedevelopmentandimplementationof
271271 federal,State,andlocallaws,rules,andpoliciesrelatingtopatientsandhealth
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294294 insuranceconsumershealthinsuranceandhealthcare,withaspecialfocuson
295295 patients’rightsandeligibilityforStateandfederalhealthcareprograms.
296296 (7)FacilitateEnsurepolicymakersheardirectlyfromVermontersby
297297 facilitatingpubliccommentonhealthcare-relatedlaws,rules,processes,and
298298 policies,includingpoliciesandactionsofhealthinsurers.
299299 (8)SuggesttotheGreenMountainCareBoard,theDepartmentof
300300 FinancialRegulation,andotherentitiesinStategovernmentpolicies,
301301 procedures,orrulestotheGreenMountainCareBoardinordertothatprotect
302302 patients’andconsumers’andpromotetheinterestsofVermontersinmatters
303303 relatedtohealthinsuranceandaccesstohealthcare.
304304 (9)PromotethedevelopmentofCollaboratewithotherhealthcare-and
305305 healthpolicy-relatedcitizenandconsumerorganizationstopromoteaffordable
306306 andaccessiblehealthcareforVermonters.
307307 (10)EnsurethatpatientsandhealthinsuranceconsumersallVermonters
308308 havetimelyaccesstotheservicesprovidedbytheOffice.
309309 (11)SubmittotheGovernor;theHouseCommitteesonHealthCare,on
310310 WaysandMeans,andonAppropriations;andtheSenateCommitteeson
311311 HealthandWelfare,onFinance,andonAppropriations,onorbeforeJanuary1
312312 15ofeachyear,areportontheactivities,performance,andfiscalaccountsof
313313 theOfficeduringtheprecedingcalendaryear.
314314 (b)TheOfficeoftheHealthCareAdvocatemay:
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337337 (1)Reviewthehealthinsurancerecordsofaconsumerwhohas
338338 providedwrittenconsent.Basedonthewrittenconsentoftheconsumerorhis
339339 orherguardianorlegalrepresentative,ahealthinsurershallprovidetheOffice
340340 withaccesstorecordsrelatingtothatconsumer.[Repealed.]
341341 (2)Pursueadministrative,judicial,andotherremediesonbehalfofany
342342 individualhealthinsuranceconsumerorgroupofconsumersindividuals
343343 experiencingproblemswithhealthinsuranceoraccesstohealthcare.
344344 (3)RepresenttheinterestsofthepeopleoftheStateincasesrequiringa
345345 hearingbeforeofVermontinmattersinvolvinghealthcareandhealth
346346 insuranceattheGreenMountainCareBoardestablishedinchapter220ofthis
347347 title,theDepartmentofFinancialRegulation,orotherStateagencies.
348348 (4)Adoptpoliciesandproceduresnecessarytocarryouttheprovisions
349349 ofthischapter.
350350 (5)Takeanyotheractionnecessarytofulfillthepurposesofthis
351351 chapter.
352352 (c)TheOfficeoftheHealthCareAdvocateshallbeabletospeakto
353353 VermontersandonbehalfoftheinterestsofVermontersinhealthcarecare-
354354 andhealthinsuranceconsumersinsurance-relatedmattersandtocarryoutall
355355 dutiesprescribedinthischapterwithoutbeingsubjecttoanyretaliatoryaction;
356356 provided,however,thatnothinginthissubsectionshalllimittheauthorityof
357357 theAgencyofHumanServicestoenforcethetermsofthecontract.
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380380 (d)Healthcareprovidersandhealthinsurersshallcooperatewiththe
381381 OfficeoftheHealthCareAdvocatebyprovidingrelevantrecordsand
382382 informationwhenanindividualortheindividual’sguardianorlegal
383383 representativehasauthorizedtheOfficetoactontheindividual’sbehalf.
384384 §9604.DUTIESOFSTATEAGENCIES
385385 (a)IndevelopingStatepolicyaffectinghealthcareaccessandaffordability,
386386 StateagenciesshallseekinputfromtheOfficeoftheHealthCareAdvocate.
387387 (b)AllStateagenciesshallcomplyfacilitatetheOffice’smeaningful
388388 participationinhealthcarepolicymakingbycomplyingwithreasonable
389389 requestsfromtheOfficeoftheHealthCareAdvocateforinformationand,
390390 assistance,andaccess.Arequestshallbeconsideredreasonableifitrelatesto
391391 theOffice’sstatutorydutiesandauthority.
392392 (1)Whenappropriate,StateagenciesshallallowtheOfficetoaccess
393393 confidentialorproprietaryinformationthatisotherwiseexemptfrompublic
394394 inspectionandcopyingunderthePublicRecordsActandtoparticipatein
395395 meetings,deliberations,andproceedingsinwhichconfidentialorproprietary
396396 informationisdiscussed.
397397 (1)Whenappropriate,StateagenciesshallallowtheOfficetoaccess
398398 confidentialorproprietaryinformationthatisotherwiseexemptfrompublic
399399 inspectionandcopyingunderthePublicRecordsActandtoparticipatein
400400 meetings,deliberations,andproceedingsinwhichconfidentialorproprietary
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419419 informationisdiscussed;provided,however,thatnothinginthissectionshall
420420 requireaStateagencytoprovideordiscloseinformationthatisprohibited
421421 fromdisclosurebyStateorfederallaworthatwouldcausetheprovideror
422422 disclosertoviolateanystatutoryorcommonlawprivilege.
423423 (2)TheOfficeshallnotfurtherdiscloseanyconfidentialorproprietary
424424 informationprovidedtotheOffice.
425425 (c)TheAgencyofHumanServicesmayadoptrulesnecessarytoensure
426426 thecooperationofStateagenciesunderthissection.
427427 §9605.CONFIDENTIALITY
428428 Intheabsenceofwrittenconsentbyacomplainantoranindividualusing
429429 theservicesoftheOfficeorbyhisorherguardianorlegalrepresentativeor
430430 theabsenceofacourtorder,theOfficeoftheHealthCareAdvocate,its
431431 employees,anditscontractorsshallnotdisclosetheidentityofthe
432432 complainantorindividualTheOfficeoftheHealthCareAdvocateshall
433433 maintaintheconfidentialityofinformationrelatedtoindividualsusingits
434434 servicesinaccordancewithallapplicableStateandfederallaws,rules,
435435 regulations,andpolicies.
436436 §9606.CONFLICTSOFINTEREST
437437 (a)TheOfficeoftheHealthCareAdvocate,itsemployees,andits
438438 contractorsshallnothaveanyconflictofinterestrelatingtotheperformance
439439 oftheirresponsibilitiesunderthischapter.Forthepurposesofthischapter,a
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458458 conflictofinterestexistswhenevertheOfficeoftheHealthCareAdvocate,its
459459 employees,oritscontractorsorapersonaffiliatedwiththeOffice,its
460460 employees,oritscontractors:
461461 (1)hasadirectinvolvementinthelicensing,certification,or
462462 accreditationofahealthcarefacility,healthinsurer,orhealthcareprovider;
463463 (2)hasadirectownershipinterestorinvestmentinterestinahealthcare
464464 facility,healthinsurer,orhealthcareprovider;
465465 (3)isemployedbyorparticipatinginthemanagementofahealthcare
466466 facility,healthinsurer,orhealthcareprovider;or
467467 (4)receivesorhastherighttoreceive,directlyorindirectly,
468468 remunerationunderacompensationarrangementwithahealthcarefacility,
469469 healthinsurer,orhealthcareprovider.
470470 (b)TheOfficeshallreportanypotentialconflictsofinteresttotheAgency
471471 ofHumanServices.
472472 (c)Itshallnotconstituteaconflictofinterestperseforanemployeeor
473473 contractoroftheOfficetoservewithoutcompensationontheboardof
474474 directorsofanonprofithealthcareentitywhoseprimaryregulatorisnotan
475475 agencyoftheStateofVermont.
476476 ***
477477 Sec.4.EFFECTIVEDATE
478478 ThisactshalltakeeffectonJuly1,2025.
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501-Sec.1.8V.S.A.§ 4062isamendedtoread:
502-§4062.FILINGANDAPPROVALOFPOLICYFORMSANDPREMIUMS
503-***
504-(c)(1)TheBoardshallprovideinformationtothepublicontheBoard’s
505-websiteaboutthepublicavailabilityofthefilingsandsummariesrequired
506-underthissection.
507-***
508-(3)(A)Inadditiontothepubliccommentprovisionssetforthinthis
509-subsection(c),theOfficeoftheHealthCareAdvocateestablishedin18V.S.A.
510-chapter229,actingonbehalfofhealthinsuranceconsumersinthisState,may,
511-within30calendardaysaftertheBoardreceivesaninsurer’sraterequest
512-pursuanttothissection,submittotheBoard,inwriting,suggestedquestions
513-regardingwithasubstantialrelationshiptotheratefilingforandreview
514-criteriathattheBoardtoprovidetoshallasktheinsurer,eitherdirectlyor
515-throughitscontractingactuary,ifany.
516-(B)TheOfficeoftheHealthCareAdvocatemayalsosubmittothe
517-Boardwrittencommentsonaninsurer’sraterequest.TheBoardshallpostthe
518-commentsonitswebsiteandshallconsiderthecommentspriortoissuingits
519-decision.
520-(d)(1)Nolaterthan60calendardaysafterreceivinganinsurer’srate
521-requestpursuanttothissection,theGreenMountainCareBoardshallmake BILLASPASSEDBYTHEHOUSEANDSENATE H.80
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523-availabletothepublictheinsurer’sratefiling,theDepartment’sanalysisand
524-opinionoftheeffectoftheproposedrateontheinsurer’ssolvency,andthe
525-analysisandopinionoftheratefilingbytheBoard’scontractingactuary,if
526-any.
527-(2)TheBoardshallpostonitswebsite,afterredactinganyconfidential
528-orproprietaryinformationrelatingtotheinsurerortotheinsurer’sratefiling:
529-(A)allquestionstheBoardposestoitscontractingactuary,ifany,
530-andtheactuary’sresponsestotheBoard’squestions;and
531-(B)allquestionstheBoard,theBoard’scontractingactuary,ifany,
532-ortheDepartmentposestotheinsurerandtheinsurer’sresponsestothose
533-questionsTheGreenMountainCareBoardshallpostonitswebsiteor
534-otherwisemakeavailabletothepublicthroughafile-sharingplatformall
535-materialsintherecordofaratereviewproceedingafterredactingany
536-informationorothermaterialthattheBoarddeterminestobeconfidentialor
537-otherwisesubjecttoprotectionfromdisclosurebylaw.
538-***
539-Sec.2.18V.S.A.§ 9440(c)isamendedtoread:
540-(c)Theapplicationprocessshallbeasfollows:
541-***
542-(9)(A)TheOfficeoftheHealthCareAdvocateestablishedunder
543-chapter229ofthistitleor,inthecaseofnursinghomes,theLong-TermCare BILLASPASSEDBYTHEHOUSEANDSENATE H.80
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545-Ombudsman’sOfficeestablishedunder33V.S.A.§7502,isauthorizedbutnot
546-requiredtoparticipateinanyadministrativeorjudicialreviewofan
547-applicationunderthissubchapterandshallbeconsideredaninterestedparty
548-insuchproceedingsuponfilinganoticeofinterventionwiththeBoard.
549-(B)Onceeitherofficefilesanoticeofinterventionpursuanttothis
550-subchapter,theBoardshallprovidethatofficewiththeinformationnecessary
551-toparticipateinthereviewprocess,includinginformationaboutprocedures,
552-copiesofallwrittencorrespondence,andcopiesofallentriesinthe
553-applicationrecordforallcertificateofneedproceedings,regardlessofwhether
554-expeditedstatushasbeengrantedthatofficeshallhavetherighttoreceive
555-copiesofallmaterialsrelatedtothecertificateofneedapplicationreviewand
556-may:
557-(i)submitwrittenquestionstotheBoardthattheBoardwillaskof
558-theapplicantinadvanceofanyhearingheldinconjunctionwiththeBoard’s
559-reviewofthecertificateofneedapplication;
560-(ii)submitwrittencommentsfortheBoard’sconsideration;and
561-(iii)askquestionsandprovidetestimonyinanyhearingheldin
562-conjunctionwiththeBoard’sreviewofthecertificateofneedapplication.
563-(C)TheOfficeoftheHealthCareAdvocateandtheLong-TermCare
564-Ombudsman’sOfficeshallnotfurtherdiscloseanyconfidentialorproprietary
565-informationprovidedtotheirrespectiveofficespursuanttothissubdivision(9). BILLASPASSEDBYTHEHOUSEANDSENATE H.80
566-2025 Page17of24
567-Sec.3.18V.S.A.chapter229isamendedtoread:
568-CHAPTER229.OFFICEOFTHEHEALTHCAREADVOCATE
569-***
570-§9602.OFFICEOFTHEHEALTHCAREADVOCATE;COMPOSITION
571-(a)TheOfficeoftheHealthCareAdvocateisestablishedasan
572-independentvoiceforVermontersthatisdedicatedtopromotingaccessto
573-high-quality,affordablehealthcareforall.
574-(b)TheAgencyofHumanServicesshallmaintaintheOfficeoftheHealth
575-CareAdvocatebycontractwithanynonprofitorganization.
576-(b)(c)TheOfficeshallbeadministeredbyoneormoredirectors,oneof
577-whomshallbetheChiefHealthCareAdvocate,whoshallbeanindividual
578-withexpertiseandexperienceinthefieldsofhealthcareandadvocacy.The
579-Advocatedirectorordirectorsmayemploylegalcounsel,administrativestaff,
580-andotheremployeesandcontractorsasneededtocarryoutthedutiesofthe
581-Office.
582-§9603.DUTIESANDAUTHORITY
583-(a)TheOfficeoftheHealthCareAdvocateshall:
584-(1)AssisthealthinsuranceconsumersVermonterswithhealthinsurance
585-planselectionbyprovidinginformation,referrals,andassistanceto
586-individualsaboutmeansofobtainingandpayingforhealthinsurance
587-coverageandservices.TheOfficeshallacceptreferralsfromtheVermont BILLASPASSEDBYTHEHOUSEANDSENATE H.80
588-2025 Page18of24
589-HealthBenefitExchangeandExchangenavigatorscreatedpursuantto33
590-V.S.A.chapter18,subchapter1,toassistconsumersindividualsexperiencing
591-problemsrelatedtotheExchange.
592-(2)AssisthealthinsuranceconsumersVermonterstounderstandtheir
593-rightsandresponsibilitiesunderhealthinsuranceplans.
594-(3)Provideinformationtothepublic,agencies,membersoftheGeneral
595-Assembly,andothersregardingaboutVermonters’problemsandconcernsof
596-regardinghealthinsuranceconsumersandaccesstohealthcare,aswellas
597-recommendationsforresolvingthoseproblemsandconcerns.
598-(4)Identify,investigate,andresolvecomplaints,questions,andinquiries
599-onbehalfofindividualVermonterswithrespecttoissuesregardinghealth
600-insuranceconsumersoraccesstohealthcare,andassistthoseconsumers
601-Vermonterswithfilingandpursuitofpursuingcomplaintsandappeals.
602-(5)Provideinformationtoindividualsconsumereducationto
603-Vermontersregardingtheirobligationsrightsandresponsibilitiesunderthe
604-PatientProtectionandAffordableCareAct(Pub.L.No.111-148)Stateand
605-federallaws,rules,andregulations.
606-(6)Analyzeandmonitorthedevelopmentandimplementationof
607-federal,State,andlocallaws,rules,andpoliciesrelatingtopatientsand
608-healthinsuranceconsumershealthinsuranceandhealthcare,withaspecial BILLASPASSEDBYTHEHOUSEANDSENATE H.80
609-2025 Page19of24
610-focusonpatients’rightsandeligibilityforStateandfederalhealthcare
611-programs.
612-(7)FacilitateEnsurepolicymakersheardirectlyfromVermontersby
613-facilitatingpubliccommentonhealthcare-relatedlaws,rules,processes,and
614-policies,includingpoliciesandactionsofhealthinsurers.
615-(8)SuggesttotheGreenMountainCareBoard,theDepartmentof
616-FinancialRegulation,andotherentitiesinStategovernmentpolicies,
617-procedures,orrulestotheGreenMountainCareBoardinordertothatprotect
618-patients’andconsumers’andpromotetheinterestsofVermontersinmatters
619-relatedtohealthinsuranceandaccesstohealthcare.
620-(9)PromotethedevelopmentofCollaboratewithotherhealthcare-and
621-healthpolicy-relatedcitizenandconsumerorganizationstopromoteaffordable
622-andaccessiblehealthcareforVermonters.
623-(10)Ensurethatpatientsandhealthinsuranceconsumersall
624-VermontershavetimelyaccesstotheservicesprovidedbytheOffice.
625-(11)SubmittotheGovernor;theHouseCommitteesonHealthCare,on
626-WaysandMeans,andonAppropriations;andtheSenateCommitteeson
627-HealthandWelfare,onFinance,andonAppropriations,onorbeforeJanuary
628-115ofeachyear,areportontheactivities,performance,andfiscalaccounts
629-oftheOfficeduringtheprecedingcalendaryear.
630-(b)TheOfficeoftheHealthCareAdvocatemay: BILLASPASSEDBYTHEHOUSEANDSENATE H.80
631-2025 Page20of24
632-(1)Reviewthehealthinsurancerecordsofaconsumerwhohas
633-providedwrittenconsent.Basedonthewrittenconsentoftheconsumerorhis
634-orherguardianorlegalrepresentative,ahealthinsurershallprovidethe
635-Officewithaccesstorecordsrelatingtothatconsumer.[Repealed.]
636-(2)Pursueadministrative,judicial,andotherremediesonbehalfofany
637-individualhealthinsuranceconsumerorgroupofconsumersindividuals
638-experiencingproblemswithhealthinsuranceoraccesstohealthcare.
639-(3)RepresenttheinterestsofthepeopleoftheStateincasesrequiringa
640-hearingbeforeofVermontinmattersinvolvinghealthcareandhealth
641-insuranceattheGreenMountainCareBoardestablishedinchapter220ofthis
642-title,theDepartmentofFinancialRegulation,orotherStateagencies.
643-(4)Adoptpoliciesandproceduresnecessarytocarryouttheprovisions
644-ofthischapter.
645-(5)Takeanyotheractionnecessarytofulfillthepurposesofthis
646-chapter.
647-(c)TheOfficeoftheHealthCareAdvocateshallbeabletospeakto
648-VermontersandonbehalfoftheinterestsofVermontersinhealthcarecare-
649-andhealthinsuranceconsumersinsurance-relatedmattersandtocarryoutall
650-dutiesprescribedinthischapterwithoutbeingsubjecttoanyretaliatory
651-action;provided,however,thatnothinginthissubsectionshalllimitthe
652-authorityoftheAgencyofHumanServicestoenforcethetermsofthecontract. BILLASPASSEDBYTHEHOUSEANDSENATE H.80
653-2025 Page21of24
654-(d)Healthcareprovidersandhealthinsurersshallcooperatewiththe
655-OfficeoftheHealthCareAdvocatebyprovidingrelevantrecordsand
656-informationwhenanindividualortheindividual’sguardianorlegal
657-representativehasauthorizedtheOfficetoactontheindividual’sbehalf.A
658-healthcareproviderorhealthinsurermayrequirethewrittenconsentofthe
659-individualortheindividual’sguardianorlegalrepresentativepriorto
660-providingtherecordsorinformationtotheOffice.
661-§9604.DUTIESOFSTATEAGENCIES
662-(a)ItistheintentoftheGeneralAssemblythatStateagenciesshallseek
663-inputfromtheOfficeoftheHealthCareAdvocatewhendevelopingorrevising
664-significantmattersofStatepolicyaffectinghealthcareaccessandaffordability
665-inordertoensurethatVermonters’perspectivesareheardandconsidered
666-throughthevoiceoftheirindependentadvocate.
667-(b)AllStateagenciesshallcomplyfacilitatetheOffice’smeaningful
668-participationinhealthcarepolicymakingbycomplyingwithreasonable
669-requestsfromtheOfficeoftheHealthCareAdvocateforinformationand,
670-assistance,andaccess.Arequestshallbeconsideredreasonableifitrelatesto
671-theOffice’sstatutorydutiesandauthority.
672-(1)Whenappropriate,StateagenciesshallallowtheOfficetoaccess
673-confidentialorproprietaryinformationthatisotherwiseexemptfrompublic
674-inspectionandcopyingunderthePublicRecordsActandtoparticipatein BILLASPASSEDBYTHEHOUSEANDSENATE H.80
675-2025 Page22of24
676-meetings,deliberations,andproceedingsinwhichconfidentialorproprietary
677-informationisdiscussed;provided,however,thatnothinginthissectionshall
678-requireaStateagencytoprovideordiscloseinformationthatisprohibited
679-fromdisclosurebyStateorfederallaworthatwouldcausetheprovideror
680-disclosertoviolateanystatutoryorcommonlawprivilege.
681-(2)TheOfficeshallnotfurtherdiscloseanyconfidentialorproprietary
682-informationprovidedtotheOffice.
683-(c)TheAgencyofHumanServicesmayadoptrulesnecessarytoensurethe
684-cooperationofStateagenciesunderthissection.
685-§9605.CONFIDENTIALITY
686-Intheabsenceofwrittenconsentbyacomplainantoranindividualusing
687-theservicesoftheOfficeorbyhisorherguardianorlegalrepresentativeor
688-theabsenceofacourtorder,theOfficeoftheHealthCareAdvocate,its
689-employees,anditscontractorsshallnotdisclosetheidentityofthe
690-complainantorindividualTheOfficeoftheHealthCareAdvocateshall
691-maintaintheconfidentialityofinformationrelatedtoindividualsusingits
692-servicesinaccordancewithallapplicableStateandfederallaws,rules,
693-regulations,andpolicies.
694-§9606.CONFLICTSOFINTEREST
695-(a)TheOfficeoftheHealthCareAdvocate,itsemployees,andits
696-contractorsshallnothaveanyconflictofinterestrelatingtotheperformance BILLASPASSEDBYTHEHOUSEANDSENATE H.80
697-2025 Page23of24
698-oftheirresponsibilitiesunderthischapter.Forthepurposesofthischapter,a
699-conflictofinterestexistswhenevertheOfficeoftheHealthCareAdvocate,its
700-employees,oritscontractorsorapersonaffiliatedwiththeOffice,its
701-employees,oritscontractors:
702-(1)hasadirectinvolvementinthelicensing,certification,or
703-accreditationofahealthcarefacility,healthinsurer,orhealthcareprovider;
704-(2)hasadirectownershipinterestorinvestmentinterestinahealthcare
705-facility,healthinsurer,orhealthcareprovider;
706-(3)isemployedbyorparticipatinginthemanagementofahealthcare
707-facility,healthinsurer,orhealthcareprovider;or
708-(4)receivesorhastherighttoreceive,directlyorindirectly,
709-remunerationunderacompensationarrangementwithahealthcarefacility,
710-healthinsurer,orhealthcareprovider.
711-(b)TheOfficeshallreportanypotentialconflictsofinteresttotheAgency
712-ofHumanServices.
713-(c)Itshallnotconstituteaconflictofinterestperseforanemployeeor
714-contractoroftheOfficetoservewithoutcompensationontheboardof
715-directorsofanonprofithealthcareentitywhoseprimaryregulatorisnotan
716-agencyoftheStateofVermont.
717-*** BILLASPASSEDBYTHEHOUSEANDSENATE H.80
718-2025 Page24of24
719-Sec.4.EFFECTIVEDATE
720-ThisactshalltakeeffectonJuly1,2025.
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