Vermont Republican state Reps. Patricia McCoy and Francis McFaun introduced a bill in January to shake up how payers operate in the state.
The proposed legislation grants the governor a greater say in the makeup of health insurance company boards. Subscribers and members of the public must comprise at least three-quarters of a corporation’s board, with two voting members (or at least one-sixth of the board) who are public representatives appointed by the governor.
Health insurer boards would need to file compensation benchmarks, bonus information and other pay-related data pertaining to executives with the commissioner of financial regulation.
Beginning in 2028, the bill would permit age-based premium variation, limited to no more than a 5% difference with the filed community rate.
For claims edits, the bill defined high-dollar claims as over $25,000 per episode of care. Prior authorization exemptions would be limited to independent primary care practices, excluding hospital-owned facilities, as well. Previously, BCBS Vermont President and CEO Beth Roberts told Becker’s that “the majority of the healthcare system is driven by the hospitals” in the state, affecting costs.
The bill would also expand access to association health plans and short-term, limited-duration health plans, often referred to as “junk” health plans due to reduced compliance standards. The state’s commissioner must approve insurer rates for short-term, limited-duration health plans. Healthcare organizations have urged caution with both types of coverage.
The Vermont Department of Financial Regulation and the healthcare regulatory body Green Mountain Care Board would be tasked with coming up with site-neutral, reference-based prices that insurers would not be allowed to exceed.
The bill would also allow the state to pursue a federal waiver to establish a reinsurance program.
