Vermont 2025-2026 Regular Session

Vermont House Bill H0267 Compare Versions

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

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1	1	BILL AS INTRODUCED H.267
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6	6	H.267 1
7	7	Introduced by Representative McFaun of Barre Town 2
8	8	Referred to Committee on 3
9	9	Date: 4
10	10	Subject: Health; hospitals; Vermont Hospital Security Plan 5
11	11	Statement of purpose of bill as introduced: This bill proposes to establish the 6
12	12	Vermont Hospital Security Plan, which would provide Vermont residents with 7
13	13	coverage for health care services received in a hospital and would provide 8
14	14	payments to hospitals for health care services delivered. The Plan would 9
15	15	include the annual development of a global hospital budget for the State and 10
16	16	individual hospital budgets for each hospital located in Vermont. 11
17	17	An act relating to the Vermont Hospital Security Plan 12
18	18	It is hereby enacted by the General Assembly of the State of Vermont: 13
19	19	Sec. 1. 33 V.S.A. chapter 18, subchapter 3 is added to read: 14
20	20	Subchapter 3. Vermont Hospital Security Plan 15
21	21	§ 1841. PURPOSE 16
22	22	The purposes of this subchapter are to provide all Vermonters with access 17
23	23	to and coverage for health care services delivered in hospitals and to provide 18
24	24	an opportunity to reduce hospital billing processes and other unnecessary 19
25	25	administrative costs. The General Assembly recognizes that the health care 20 BILL AS INTRODUCED H.267
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30	30	system is in crisis and that most Vermonters do not have the financial ability to 1
31	31	pay for increasing health insurance premiums or for the rising costs of health 2
32	32	care. Vermonters need access to hospital care, regardless of insurance 3
33	33	coverage or ability to pay. In addition, the State must seek the financial 4
34	34	sustainability of the health care system, including reducing health care 5
35	35	spending and transaction costs. The General Assembly recognizes that health 6
36	36	care reform is needed to provide coverage of essential health care services to 7
37	37	Vermonters. 8
38	38	§ 1842. DEFINITIONS 9
39	39	As used in this subchapter: 10
40	40	(1) “Agency” means the Agency of Human Services. 11
41	41	(2) “Board” means the Green Mountain Care Board. 12
42	42	(3) “Health care services” means services for the diagnosis, prevention, 13
43	43	treatment, cure, or relief of a physical or mental health condition, including 14
44	44	counseling, procedures, products, devices, and medications. 15
45	45	(4) “Hospital” has the same meaning as in 18 V.S.A. § 1902 and may 16
46	46	also include hospitals located outside Vermont. 17
47	47	(5) “Secretary” means the Secretary of Human Services. 18
48	48	(6) “Vermont resident” means an individual who is domiciled in 19
49	49	Vermont as evidenced by an intent to maintain a permanent dwelling place in 20 BILL AS INTRODUCED H.267
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54	54	Vermont indefinitely and to return to Vermont if temporarily absent, coupled 1
55	55	with an act or acts consistent with that intent. 2
56	56	§ 1843. VERMONT HOSPITAL SECURITY PLAN 3
57	57	(a)(1) The Agency of Human Services or designee shall administer the 4
58	58	Vermont Hospital Security Plan to provide Vermont residents with access to 5
59	59	and coverage for health care services received in a hospital and for payments to 6
60	60	hospitals for health care services provided. 7
61	61	(2) Vermonters who are eligible for or are enrolled in a publicly funded 8
62	62	health care program shall be eligible for coverage of any benefits provided by 9
63	63	the Vermont Hospital Security Plan that are not covered by the publicly funded 10
64	64	health care program. As used in this subdivision, “publicly funded health care 11
65	65	program” means Medicare, Medicaid, Dr. Dynasaur, VPharm, another 12
66	66	Medicaid-waiver program, or any other program providing health benefits that 13
67	67	is funded in whole or in part with federal funds. 14
68	68	(b) The Vermont Hospital Security Plan shall: 15
69	69	(1) provide each hospital in this State with a negotiated annual payment 16
70	70	based on the budget of the individual hospital for health care services provided 17
71	71	by that hospital to all patients, including patients who are not Vermont 18
72	72	residents; 19
73	73	(2) provide for the collection of payments for health care services 20
74	74	provided by hospitals in this State to patients who are not Vermont residents, 21 BILL AS INTRODUCED H.267
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79	79	which may be carried out by the Agency or by a third-party administrator 1
80	80	under contract with the Agency for this purpose; and 2
81	81	(3) provide for payments to out-of-state hospitals for health care 3
82	82	services delivered to Vermont residents. 4
83	83	(c) The Agency shall establish by rule income-sensitized deductibles, co-5
84	84	payments, an annual hospital care fee, or other cost-sharing amounts and 6
85	85	mechanisms applicable to the Vermont Hospital Security Plan established by 7
86	86	this subchapter. 8
87	87	(d) A beneficiary aggrieved by an adverse decision of the Agency may 9
88	88	appeal to the Human Services Board pursuant to 3 V.S.A. § 3090. 10
89	89	(e) Vermont residents receiving health care services at a hospital shall not 11
90	90	be balance billed or otherwise charged for receiving the services except to the 12
91	91	extent of any applicable cost-sharing amounts established by the Agency by 13
92	92	rule. 14
93	93	§ 1844. GLOBAL HOSPITAL BUDGETS 15
94	94	(a)(1) Annually, the Green Mountain Care Board, in collaboration with the 16
95	95	Secretary of Human Services, shall develop a global hospital budget for the 17
96	96	State and individual hospital budgets for each hospital located in Vermont. In 18
97	97	developing the global hospital budget, the Board shall consider the Health 19
98	98	Resource Allocation Plan developed pursuant to 18 V.S.A. § 9405, the hospital 20
99	99	budget review process set forth in 18 V.S.A. § 9456, the negotiated global 21 BILL AS INTRODUCED H.267
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104	104	hospital payments established under section 1845 of this title, and all other 1
105	105	revenue received by Vermont hospitals. 2
106	106	(2) The Board shall report its recommended global hospital budget for 3
107	107	the State to the General Assembly on or before January 15 for the following 4
108	108	fiscal year. The global hospital budget shall not take effect until it has been 5
109	109	approved or modified by an act of the General Assembly. 6
110	110	(b)(1) The global hospital budget for the State shall serve as a spending cap 7
111	111	within which hospital costs may be controlled, resources directed, and quality 8
112	112	and access assured. The global hospital budget shall limit the total annual 9
113	113	growth of hospital costs to the Consumer Price Index plus 3.5 percent. 10
114	114	(2) The Board shall ensure that its review of individual hospital budgets 11
115	115	under 18 V.S.A. chapter 221, subchapter 7 and its review of certificate of need 12
116	116	requests under 18 V.S.A. chapter 221, subchapter 5 are consistent with the 13
117	117	global hospital budget. 14
118	118	(c) The Board shall adopt rules establishing the standards and procedures 15
119	119	necessary to implement this section. 16
120	120	§ 1845. NEGOTIATED GLOBAL HOSPITAL PAYMENTS 17
121	121	(a) The Secretary shall negotiate with hospitals for a global hospital 18
122	122	payment for health care services provided by the Vermont Hospital Security 19
123	123	Plan. The payment amount shall be based on the global hospital budget 20
124	124	developed pursuant to section 1844 of this title and other information 21 BILL AS INTRODUCED H.267
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129	129	necessary to the determination of the appropriate payment amount, including 1
130	130	all other revenue received by a hospital from other sources. 2
131	131	(b) The Secretary shall adopt rules establishing the standards and 3
132	132	procedures necessary to implement this section. 4
133	133	§ 1846. VERMONT HOSPITAL SECURITY TRUST FUND 5
134	134	(a) The Vermont Hospital Security Trust Fund is established as a special 6
135	135	fund for the purpose of financing health care services provided by hospitals to 7
136	136	beneficiaries of the Vermont Hospital Security Plan. 8
137	137	(b) Into the Fund shall be deposited: 9
138	138	(1) transfers from the General Fund authorized by the General 10
139	139	Assembly; 11
140	140	(2) proceeds from grants, donations, contributions, taxes, and any other 12
141	141	sources of revenue as may be provided by statute or rule; 13
142	142	(3) transfers of all federal receipts related to health care services 14
143	143	provided by hospitals, including all Medicaid receipts and, upon federal 15
144	144	approval, all Medicare receipts; and 16
145	145	(4) revenue for the sources established to fund the Vermont Hospital 17
146	146	Security Plan established in this subchapter. 18
147	147	(c) The Secretary shall administer the Fund in accordance with 32 V.S.A. 19
148	148	chapter 7, subchapter 5, except that all interest earned on Fund balances shall 20 BILL AS INTRODUCED H.267
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153	153	be credited to the Fund. The Secretary shall maintain records indicating the 1
154	154	amount of money in the Fund at any time. 2
155	155	(d) All monies received by or generated to the Fund shall be used only for 3
156	156	the administration and delivery of health care services provided by hospitals 4
157	157	participating in State health care assistance programs administered by the 5
158	158	Agency, including the Vermont Hospital Security Plan. 6
159	159	Sec. 2. 18 V.S.A. § 9437 is amended to read: 7
160	160	§ 9437. CRITERIA 8
161	161	A certificate of need shall be granted if the applicant demonstrates that the 9
162	162	project serves the public good and the Board finds: 10
163	163	(1) The proposed project aligns with statewide health care reform goals 11
164	164	and principles because the project: 12
165	165	(A) takes into consideration health care payment and delivery system 13
166	166	reform initiatives; 14
167	167	(B) addresses current and future community needs in a manner that 15
168	168	balances statewide needs, if applicable; and 16
169	169	(C) is consistent with appropriate allocation of health care resources, 17
170	170	including appropriate utilization of services, as identified in the Health 18
171	171	Resource Allocation Plan developed pursuant to section 9405 of this title; and 19 BILL AS INTRODUCED H.267
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176	176	(D) is consistent with the financial parameters set by the global 1
177	177	hospital budget established pursuant to 33 V.S.A. § 1844, to the extent 2
178	178	applicable. 3
179	179	* * * 4
180	180	Sec. 3. 18 V.S.A. § 9456(c) is amended to read: 5
181	181	(c) Individual hospital budgets established under this section shall: 6
182	182	(1) be consistent with the Health Resource Allocation Plan; 7
183	183	(2) take into consideration national, regional, or in-state peer group 8
184	184	norms, according to indicators, ratios, and statistics established by the Board; 9
185	185	(3) promote efficient and economic operation of the hospital; 10
186	186	(4) reflect budget performances for prior years; 11
187	187	(5) include a finding that the analysis provided in subdivision (b)(9) of 12
188	188	this section is a reasonable methodology for reflecting a reduction in net 13
189	189	revenues for non-Medicaid payers; and 14
190	190	(6) demonstrate that they support equal access to appropriate mental 15
191	191	health care that meets standards of quality, access, and affordability equivalent 16
192	192	to other components of health care as part of an integrated, holistic system of 17
193	193	care; and 18
194	194	(7) be consistent with the global hospital budget established pursuant to 19
195	195	33 V.S.A. § 1844. 20 BILL AS INTRODUCED H.267
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200	200	Sec. 4. VERMONT HOSPITAL SECURITY PLAN SPECIAL 1
201	201	COMMITTEE; FUNDING MECHANISMS; REPORT 2
202	202	(a) There is created the Vermont Hospital Security Plan Special Committee 3
203	203	to recommend to the General Assembly appropriate funding mechanisms for 4
204	204	the Vermont Hospital Security Plan. 5
205	205	(b) The Special Committee shall be composed of the following members: 6
206	206	(1) two members of the House of Representatives, one from the House 7
207	207	Committee on Health Care and one from the House Committee on Ways and 8
208	208	Means, appointed by the Speaker of the House; 9
209	209	(2) two members of the Senate, one from the Senate Committee on 10
210	210	Health and Welfare and one from the Senate Committee on Finance, appointed 11
211	211	by the President Pro Tempore; 12
212	212	(3) the Secretary of Human Services or designee; 13
213	213	(4) the Chair of the Green Mountain Care Board or designee; and 14
214	214	(5) the Commissioner of Taxes or designee. 15
215	215	(c) Powers and duties. The Special Committee shall consider how to fund 16
216	216	the Vermont Hospital Security Plan with and without federal waivers to secure 17
217	217	the participation of Medicaid and Medicare, including at least the following 18
218	218	funding sources: 19
219	219	(1) an income tax; 20
220	220	(2) a payroll tax; 21 BILL AS INTRODUCED H.267
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225	225	(3) premiums or cost-sharing mechanisms; 1
226	226	(4) a value-added tax; and 2
227	227	(5) an annual hospital care fee or other consumption tax. 3
228	228	(d) Assistance. For purposes of scheduling meetings and preparing 4
229	229	recommended legislation, the Special Committee shall have the assistance of 5
230	230	the Office of Legislative Operations, the Office of Legislative Counsel, and the 6
231	231	Joint Fiscal Office. 7
232	232	(e) Report. On or before January 15, 2026, the Special Committee shall 8
233	233	provide its recommendation on funding the Vermont Hospital Security Plan to 9
234	234	the General Assembly. 10
235	235	(f) Meetings. 11
236	236	(1) The member of the House Committee on Health Care shall call the 12
237	237	first meeting of the Special Committee to occur on or before July 1, 2025. 13
238	238	(2) The Special Committee shall select a chair from among its members 14
239	239	at the first meeting. 15
240	240	(3) A majority of the membership shall constitute a quorum. 16
241	241	(4) The Special Committee shall cease to exist on January 15, 2026. 17
242	242	(g) Compensation and reimbursement. For attendance at meetings during 18
243	243	adjournment of the General Assembly, the legislative members of the Special 19
244	244	Committee shall be entitled to per diem compensation and reimbursement of 20 BILL AS INTRODUCED H.267
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249	249	expenses pursuant to 2 V.S.A. § 23 for not more than six meetings. These 1
250	250	payments shall be made from monies appropriated to the General Assembly 2
251	251	Sec. 5. FEDERAL WAIVERS 3
252	252	(a) Not later than July 1, 2025, the Secretary of Human Services shall apply 4
253	253	for a federal Medicare waiver to allow the State to include Medicare funds for 5
254	254	hospital services in the Vermont Hospital Security Trust Fund established by 6
255	255	33 V.S.A. § 1846 and to modify the payment standards or amounts in order to 7
256	256	include Medicare funds in the global hospital budget established pursuant to 33 8
257	257	V.S.A. § 1844. 9
258	258	(b) Not later than July 1, 2025, the Secretary of Human Services shall 10
259	259	apply for a federal Medicaid waiver to allow the State to modify the payment 11
260	260	standards or amounts in order to include Medicare funds in the global hospital 12
261	261	budget established pursuant to 33 V.S.A. § 1844. 13
262	262	Sec. 6. EFFECTIVE DATES 14
263	263	This act shall take effect on passage, with the Vermont Hospital Security 15
264	264	Plan implemented not later than January 1, 2027. 16