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H.185 1
Introduced by Representatives Olson of Starksboro, Carris-Duncan of 2
Whitingham, Chapin of East Montpelier, Cina of Burlington, 3
Cole of Hartford, Duke of Burlington, Graning of Jericho, 4
Kleppner of Burlington, Logan of Burlington, Masland of 5
Thetford, McGill of Bridport, Priestley of Bradford, Waszazak 6
of Barre City, Wells of Brownington, and White of Bethel 7
Referred to Committee on 8
Date: 9
Subject: Health; Green Mountain Care Board; universal primary care 10
Statement of purpose of bill as introduced: This bill proposes to direct the 11
Green Mountain Care Board to develop and implement a universal primary 12
care program. 13
An act relating to developing and implementing a universal primary care 14
program 15
It is hereby enacted by the General Assembly of the State of Vermont: 16
Sec. 1. FINDINGS; LEGISLATIVE INTENT 17
(a) The General Assembly finds that: 18 BILL AS INTRODUCED H.185
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(1) Good access to primary care is essential for the health of 1
Vermonters, but Vermont’s health care system currently does not provide 2
access to primary care with the timeliness and scope that Vermonters need. 3
(2) Primary care clinicians face significant administrative burdens 4
imposed by health networks and by both public and private insurance plans. 5
Primary care clinicians are also not compensated commensurate with their 6
value to the health care system. As a result, many primary care clinicians are 7
leaving their Vermont practices and too few new clinicians are replacing them. 8
(3) Good access to primary care saves health care system costs by 9
reducing the need for more costly services, but Vermont’s health care system is 10
in a state of crisis. Premiums in the commercial health insurance markets are 11
increasingly out of reach for individual Vermonters, their families, private 12
employers, and public employers such as schools and State and local 13
governments. Some hospital costs in particular are grossly excessive. Cost 14
containment efforts such as OneCare Vermont have failed to achieve their 15
desired goals. New initiatives such as the AHEAD model are limited in scope 16
and may take years before they achieve meaningful cost containment. 17
Universal primary care is Vermont’s best opportunity over the short term for 18
improvement in Vermont’s health care system. 19
(b) It is the intent of the General Assembly to establish a universal primary 20
care program that will promote the public good by increasing access to primary 21 BILL AS INTRODUCED H.185
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care, thereby improving the health of Vermonters and reducing health care 1
system costs. 2
Sec. 2. 18 V.S.A. § 9375(b) is amended to read: 3
(b) The Board shall have the following duties: 4
* * * 5
(16) Develop and implement a universal primary care program as set 6
forth in section 9384 of this chapter. 7
Sec. 3. 18 V.S.A. § 9384 is added to read: 8
§ 9384. UNIVERSAL PRIMARY CARE PROGRAM 9
(a) The Green Mountain Care Board, in consultation with interested 10
stakeholders, shall develop and implement by rule a universal primary care 11
program that will promote the public good by increasing access to primary care 12
and reducing health system costs. 13
(b) The universal health care program shall do all of the following: 14
(1) Reduce or eliminate hospital and health network administrative 15
burdens. 16
(2) Reduce or eliminate administrative burdens imposed by health 17
insurers, public programs, and other payors. 18
(3) Provide universal access to primary care services for all Vermonters 19
without the requirement of enrollment in an insured or self-insured plan or in a 20
public program. 21 BILL AS INTRODUCED H.185
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(4) Define primary care services to include primary care services, 1
outpatient mental health services, outpatient substance use disorder treatment 2
services, communicable disease testing, and vaccines. 3
(5) Eliminate health insurance cost-sharing for primary care services. 4
(6) Divest primary care practices from the controlling interests of 5
hospitals and health networks. 6
(7) Be funded by an allocation of premiums, premium equivalents, and, 7
to the extent permitted by federal law and federal initiatives such as the 8
AHEAD model, public program funds from Medicare and Medicaid. The 9
allocation shall be an appropriate percentage of premiums, premium 10
equivalents, and public program funds reflecting historical trends in 11
expenditures for primary care, with an additional increment of compensation if 12
warranted in order to increase access to primary care and reduce overall 13
Vermont health system costs. 14
(c) The Board may assess to Vermont hospitals and health networks its 15
reasonable and necessary expenses in developing, implementing, and 16
administering the universal primary care program, in proportion to the relative 17
annual operating expenses of the hospitals and health networks; provided, 18
however, that the Board may waive or reduce charges for one or more 19
hospitals or health networks if necessary given the financial condition of the 20
entity or entities. 21 BILL AS INTRODUCED H.185
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(d) The Board may contract with a private entity or enter into an agreement 1
with the Vermont Medicaid program for the operation of a virtual payment 2
pool to collect the primary care allocation of premiums, premium equivalents, 3
and public program funds and to transmit per capita payments or another cost-4
effective payment mechanism to primary care practices and practitioners. 5
(e) A primary care practice or practitioner under a universal primary care 6
program, or Vermont Medicaid or a private entity designated by the Board to 7
operate the virtual payment pool, may negotiate agreements with private, self-8
insured plans for an appropriate allocation of premium equivalents to be paid 9
into the virtual payment pool, in amounts that do not unfairly disadvantage the 10
beneficiaries of insured plans, self-insured plans of public employees, and 11
public programs. In the absence of an appropriate agreement, a primary care 12
practice or practitioner may decline to participate in the private, self-insured 13
plan’s primary care network. 14
(f) The Green Mountain Care Board shall adopt rules in accordance with 15
3 V.S.A. chapter 25 to implement the program set forth in this section. 16
(g) It is the intent of the General Assembly to provide funding to support an 17
increase in the number of medical school slots and residency slots for primary 18
care practitioners at the University of Vermont College of Medicine in order to 19
increase the supply of primary care practitioners in this State. It is the intent of 20
the General Assembly that the funding for these slots shall be derived by 21 BILL AS INTRODUCED H.185
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annual appropriation, by an annual charge imposed by the Board on hospitals 1
and health systems, or by a combination of revenue sources. The Board shall 2
coordinate with the Office of Primary Care and Area Health Education Centers 3
Program (AHEC) at the University of Vermont College of Medicine to 4
establish the appropriate conditions on the use of the medical school or 5
residency funds in order to benefit Vermonters and Vermont’s health care 6
system. 7
Sec. 4. DEVELOPMENT AND IMPLEMENTATION REPORTS 8
On or before January 15, 2026 and January 15, 2027, the Green Mountain 9
Care Board shall report to the General Assembly on the status of its 10
rulemaking and on the development and implementation of the universal 11
primary care program set forth in Sec. 3 of this act. 12
Sec. 5. EFFECTIVE DATE 13
This act shall take effect on passage, with the universal primary care 14
program beginning operation not later than January 1, 2028. 15