Committee reviews H.80 to expand Office of the Health Care Advocate’s access and role

A legislative committee heard testimony on H.80, an act relating to the Office of the Health Care Advocate, which would expand the office’s role in insurance rate reviews and certificate-of-need proceedings and update its statutory duties.

The bill would allow the Office of the Health Care Advocate (HCA) to submit written questions that the Green Mountain Care Board would be required to ask insurers during rate-review proceedings; broaden the office’s statutory scope from strictly health insurance matters to include access to health care; permit the office to be administered by more than one director (one of whom would be the chief health care advocate); strengthen agencies’ obligation to seek the office’s input on health‑care policy; and add confidentiality language that would limit information sharing "to the extent permitted by law." The act would take effect July 1.

The changes to rate-review procedures are concentrated in Title 8 provisions. Jen Harvey of the Office of Legislative Counsel said the bill changes the HCA’s role from submitting "suggested questions" for the board’s contracting actuary to submitting questions the board "shall ask the insurer either directly or through its contracting actuary, if any." Harvey also summarized a transparency change that would require the board to make the full record of a rate-review proceeding available to the public after redacting information the board determines to be confidential.

Charles Becker, staff attorney for the Office of the Health Care Advocate, told the committee the primary purpose of H.80 is to update statute "to make it reflect the work that we do and the ways we serve the public and the ways we interact with state agencies." Becker said HCA staff routinely participate in formal rate-review proceedings as a party and that the office needs the ability to pose pre‑hearing questions to develop its case. "We have to be able to develop the case and, if we can't ask questions, we can't develop our case, we can't argue the case," Becker said.

Michael Barber, general counsel for the Green Mountain Care Board, said the board supports the HCA’s meaningful participation but raised two operational concerns. First, Barber said the bill’s requirement that the board "contemporaneously" post all nonconfidential materials would be unworkable because the board lacks an electronic, publicly accessible filing system and posts documents manually; he asked that the word "contemporaneously" be removed. "Contemporaneously was problematic for us," Barber said. Second, Barber asked that a proposed right for intervening parties to ask questions of board employees in the certificate-of-need (CON) process be removed because board staff must remain neutral in proceedings where the HCA and long-term-care ombudsman are parties.

Agency of Human Services (AHS) representatives said they met with the HCA and Green Mountain Care Board and reached consensus on several edits. Ashley John Stafford of AHS described adding the phrase "to the extent permitted by law" in places to reflect existing constraints such as HIPAA, Part 2 confidentiality for substance-use treatment records and attorney‑client privilege. "The phrase 'to the extent permitted by law' got added in a few places," Stafford said, and AHS explained that some information will still require written consent under federal law.

Emily Brown, deputy commissioner at the Department of Financial Regulation, said the department supports adding DFR to the list of agencies with which the HCA can engage. Brown asked whether the confidentiality provision could be strengthened so that information the department considers confidential would be treated by the HCA the same way DFR treats it. "We were wondering if this language could be strengthened in any way to ensure that when the healthcare advocate was receiving confidential information it was required to treat it, as the agency does," Brown said.

Becker and other HCA witnesses described several statute-specific edits the bill makes: changing references from "consumers" to "Vermonters," permitting the office to pursue administrative and judicial remedies on behalf of individuals with problems relating to health insurance or access to health care, expanding the statutory duty to include facilitating public comment on health-care–related laws and rules, and changing the annual report date from Jan. 1 to Jan. 15. The bill also clarifies that state agencies should "seek input" from the HCA in developing health policy and, when appropriate and permitted by law, allow the HCA access to confidential or proprietary information and participation in meetings or deliberations where such information is discussed.

On conflicts of interest, the bill would require the HCA to report potential conflicts to the Agency of Human Services and would explicitly allow employees or contractors to serve without compensation on the board of a nonprofit health-care entity whose primary regulator is not an agency of the state. HCA witnesses said this change reflects practice and would remove a statutory barrier that had complicated service on nonprofit boards.

Committee members and witnesses indicated several near-term drafting changes and agreements: the Green Mountain Care Board and HCA agreed to remove the word "contemporaneously" from the posting requirement; the parties agreed to delete the HCA's proposed right to ask board employees questions in CON proceedings so as to preserve board staff neutrality; and AHS and HCA agreed to include "to the extent permitted by law" language to reflect HIPAA and other federal restrictions. The committee did not take a final vote on the bill during the hearing, and staff were asked to work on the confidentiality and drafting language in follow-up sessions.

H.80 contains several cross‑references to existing statutes and legal constraints, including provisions in Title 8 on health‑insurance rate review, certificate‑of‑need procedures in Title 18, the Public Records Act, HIPAA and federal 42 CFR Part 2 confidentiality protections. The bill as drafted sets an effective date of July 1.

The committee will continue work on H.80; witnesses said they would provide revised draft language to address the technical concerns raised during the hearing.