Vermont 2025-2026 Regular Session

Vermont House Bill H0185 Compare Versions

Only one version of the bill is available at this time.

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1	1	BILL AS INTRODUCED H.185
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5	5	VT LEG #379757 v.1
6	6	H.185 1
7	7	Introduced by Representatives Olson of Starksboro, Carris-Duncan of 2
8	8	Whitingham, Chapin of East Montpelier, Cina of Burlington, 3
9	9	Cole of Hartford, Duke of Burlington, Graning of Jericho, 4
10	10	Kleppner of Burlington, Logan of Burlington, Masland of 5
11	11	Thetford, McGill of Bridport, Priestley of Bradford, Waszazak 6
12	12	of Barre City, Wells of Brownington, and White of Bethel 7
13	13	Referred to Committee on 8
14	14	Date: 9
15	15	Subject: Health; Green Mountain Care Board; universal primary care 10
16	16	Statement of purpose of bill as introduced: This bill proposes to direct the 11
17	17	Green Mountain Care Board to develop and implement a universal primary 12
18	18	care program. 13
19	19	An act relating to developing and implementing a universal primary care 14
20	20	program 15
21	21	It is hereby enacted by the General Assembly of the State of Vermont: 16
22	22	Sec. 1. FINDINGS; LEGISLATIVE INTENT 17
23	23	(a) The General Assembly finds that: 18 BILL AS INTRODUCED H.185
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28	28	(1) Good access to primary care is essential for the health of 1
29	29	Vermonters, but Vermont’s health care system currently does not provide 2
30	30	access to primary care with the timeliness and scope that Vermonters need. 3
31	31	(2) Primary care clinicians face significant administrative burdens 4
32	32	imposed by health networks and by both public and private insurance plans. 5
33	33	Primary care clinicians are also not compensated commensurate with their 6
34	34	value to the health care system. As a result, many primary care clinicians are 7
35	35	leaving their Vermont practices and too few new clinicians are replacing them. 8
36	36	(3) Good access to primary care saves health care system costs by 9
37	37	reducing the need for more costly services, but Vermont’s health care system is 10
38	38	in a state of crisis. Premiums in the commercial health insurance markets are 11
39	39	increasingly out of reach for individual Vermonters, their families, private 12
40	40	employers, and public employers such as schools and State and local 13
41	41	governments. Some hospital costs in particular are grossly excessive. Cost 14
42	42	containment efforts such as OneCare Vermont have failed to achieve their 15
43	43	desired goals. New initiatives such as the AHEAD model are limited in scope 16
44	44	and may take years before they achieve meaningful cost containment. 17
45	45	Universal primary care is Vermont’s best opportunity over the short term for 18
46	46	improvement in Vermont’s health care system. 19
47	47	(b) It is the intent of the General Assembly to establish a universal primary 20
48	48	care program that will promote the public good by increasing access to primary 21 BILL AS INTRODUCED H.185
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53	53	care, thereby improving the health of Vermonters and reducing health care 1
54	54	system costs. 2
55	55	Sec. 2. 18 V.S.A. § 9375(b) is amended to read: 3
56	56	(b) The Board shall have the following duties: 4
57	57	* * * 5
58	58	(16) Develop and implement a universal primary care program as set 6
59	59	forth in section 9384 of this chapter. 7
60	60	Sec. 3. 18 V.S.A. § 9384 is added to read: 8
61	61	§ 9384. UNIVERSAL PRIMARY CARE PROGRAM 9
62	62	(a) The Green Mountain Care Board, in consultation with interested 10
63	63	stakeholders, shall develop and implement by rule a universal primary care 11
64	64	program that will promote the public good by increasing access to primary care 12
65	65	and reducing health system costs. 13
66	66	(b) The universal health care program shall do all of the following: 14
67	67	(1) Reduce or eliminate hospital and health network administrative 15
68	68	burdens. 16
69	69	(2) Reduce or eliminate administrative burdens imposed by health 17
70	70	insurers, public programs, and other payors. 18
71	71	(3) Provide universal access to primary care services for all Vermonters 19
72	72	without the requirement of enrollment in an insured or self-insured plan or in a 20
73	73	public program. 21 BILL AS INTRODUCED H.185
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78	78	(4) Define primary care services to include primary care services, 1
79	79	outpatient mental health services, outpatient substance use disorder treatment 2
80	80	services, communicable disease testing, and vaccines. 3
81	81	(5) Eliminate health insurance cost-sharing for primary care services. 4
82	82	(6) Divest primary care practices from the controlling interests of 5
83	83	hospitals and health networks. 6
84	84	(7) Be funded by an allocation of premiums, premium equivalents, and, 7
85	85	to the extent permitted by federal law and federal initiatives such as the 8
86	86	AHEAD model, public program funds from Medicare and Medicaid. The 9
87	87	allocation shall be an appropriate percentage of premiums, premium 10
88	88	equivalents, and public program funds reflecting historical trends in 11
89	89	expenditures for primary care, with an additional increment of compensation if 12
90	90	warranted in order to increase access to primary care and reduce overall 13
91	91	Vermont health system costs. 14
92	92	(c) The Board may assess to Vermont hospitals and health networks its 15
93	93	reasonable and necessary expenses in developing, implementing, and 16
94	94	administering the universal primary care program, in proportion to the relative 17
95	95	annual operating expenses of the hospitals and health networks; provided, 18
96	96	however, that the Board may waive or reduce charges for one or more 19
97	97	hospitals or health networks if necessary given the financial condition of the 20
98	98	entity or entities. 21 BILL AS INTRODUCED H.185
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103	103	(d) The Board may contract with a private entity or enter into an agreement 1
104	104	with the Vermont Medicaid program for the operation of a virtual payment 2
105	105	pool to collect the primary care allocation of premiums, premium equivalents, 3
106	106	and public program funds and to transmit per capita payments or another cost-4
107	107	effective payment mechanism to primary care practices and practitioners. 5
108	108	(e) A primary care practice or practitioner under a universal primary care 6
109	109	program, or Vermont Medicaid or a private entity designated by the Board to 7
110	110	operate the virtual payment pool, may negotiate agreements with private, self-8
111	111	insured plans for an appropriate allocation of premium equivalents to be paid 9
112	112	into the virtual payment pool, in amounts that do not unfairly disadvantage the 10
113	113	beneficiaries of insured plans, self-insured plans of public employees, and 11
114	114	public programs. In the absence of an appropriate agreement, a primary care 12
115	115	practice or practitioner may decline to participate in the private, self-insured 13
116	116	plan’s primary care network. 14
117	117	(f) The Green Mountain Care Board shall adopt rules in accordance with 15
118	118	3 V.S.A. chapter 25 to implement the program set forth in this section. 16
119	119	(g) It is the intent of the General Assembly to provide funding to support an 17
120	120	increase in the number of medical school slots and residency slots for primary 18
121	121	care practitioners at the University of Vermont College of Medicine in order to 19
122	122	increase the supply of primary care practitioners in this State. It is the intent of 20
123	123	the General Assembly that the funding for these slots shall be derived by 21 BILL AS INTRODUCED H.185
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128	128	annual appropriation, by an annual charge imposed by the Board on hospitals 1
129	129	and health systems, or by a combination of revenue sources. The Board shall 2
130	130	coordinate with the Office of Primary Care and Area Health Education Centers 3
131	131	Program (AHEC) at the University of Vermont College of Medicine to 4
132	132	establish the appropriate conditions on the use of the medical school or 5
133	133	residency funds in order to benefit Vermonters and Vermont’s health care 6
134	134	system. 7
135	135	Sec. 4. DEVELOPMENT AND IMPLEMENTATION REPORTS 8
136	136	On or before January 15, 2026 and January 15, 2027, the Green Mountain 9
137	137	Care Board shall report to the General Assembly on the status of its 10
138	138	rulemaking and on the development and implementation of the universal 11
139	139	primary care program set forth in Sec. 3 of this act. 12
140	140	Sec. 5. EFFECTIVE DATE 13
141	141	This act shall take effect on passage, with the universal primary care 14
142	142	program beginning operation not later than January 1, 2028. 15