VT
Vermont House Bill H0482

Vermont 2025-2026 Regular Session

Vermont House Bill H0482 Compare Versions

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1-BILLASPASSEDBYTHEHOUSE H.482
1+BILL AS INTRODUCED H.482
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3-H.482
4-IntroducedbyCommitteeonHealthCare
5-Date:
6-Subject:Health;hospitals;healthinsurers;GreenMountainCareBoard;
7-hospitalobserver
8-Statementofpurposeofbillasintroduced:Thisbillproposestoauthorizethe
9-GreenMountainCareBoardtoreduceahealthinsurer’sreimbursementrates
10-tooneormorehospitalsifthehealthinsurerisatimminentriskofinsolvency.
11-ThebillwouldpermittheBoardtoreduceahospital’sbudgetforthe
12-forthcomingfiscalyeartoaccountforthehospital’sbudgetoverageinthe
13-previousfiscalyear.ThebillwouldalsoallowtheBoardtoappointan
14-independentobservertooverseeahospitalanditsoperationsiftheBoardfinds
15-thehospitalhasmadeamaterialmisrepresentationorisoutofcompliancewith
16-itsbudgetandtheBoardbelievesthatappointinganindependentobserverisin
17-thepublicinterest.
18-AnactrelatingtoGreenMountainCareBoardauthoritytoadjusta
19-hospital’sreimbursementratesandtoappointahospitalobserver
20-ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
21-Sec.1.18V.S.A.§ 9384isaddedtoread:
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40-19 BILLASPASSEDBYTHEHOUSE H.482
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5+VT LEG #381367 v.1
6+H.482 1
7+Introduced by Committee on Health Care 2
8+Date: 3
9+Subject: Health; hospitals; health insurers; Green Mountain Care Board; 4
10+hospital observer 5
11+Statement of purpose of bill as introduced: This bill proposes to authorize the 6
12+Green Mountain Care Board to reduce a health insurer’s reimbursement rates 7
13+to one or more hospitals if the health insurer is at imminent risk of insolvency. 8
14+The bill would permit the Board to reduce a hospital’s budget for the 9
15+forthcoming fiscal year to account for the hospital’s budget overage in the 10
16+previous fiscal year. The bill would also allow the Board to appoint an 11
17+independent observer to oversee a hospital and its operations if the Board finds 12
18+the hospital has made a material misrepresentation or is out of compliance with 13
19+its budget and the Board believes that appointing an independent observer is in 14
20+the public interest. 15
21+An act relating to Green Mountain Care Board authority to adjust a 16
22+hospital’s reimbursement rates and to appoint a hospital observer 17
23+It is hereby enacted by the General Assembly of the State of Vermont: 18
24+Sec. 1. 18 V.S.A. § 9384 is added to read: 19 BILL AS INTRODUCED H.482
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42-§ 9384.REDUCTIONORREALLOCATIONOFREIMBURSEMENT
43-RATES;RISKSTOHEALTHINSURERSOLVENCY
44-(a)Asusedinthissection:
45-(1)“Hospital”hasthesamemeaningasinsection9451ofthistitle.
46-(2)“Hospitalnetwork”meansasystemcomprisingtwoormore
47-affiliatedhospitals,andmayincludeotherhealthcareprofessionalsand
48-facilities,thatderives50percentormoreofitsoperatingrevenue,atthe
49-consolidatednetworklevel,fromVermonthospitalsandinwhichtheaffiliated
50-hospitalsdeliverhealthcareservicesinacoordinatedmannerusingan
51-integratedfinancialandgovernancestructure.
52-(b)IftheGreenMountainCareBoarddetermines,afterconsultationwith
53-theCommissionerofFinancialRegulation,thatadomestichealthinsurerfaces
54-anacuteandimmediatethreattoitssolvencybecauseitsrisk-basedcapital
55-levelhastriggeredaregulatoryactionleveleventpursuantto8V.S.A.§ 8304,
56-theBoardmayorderareductionoftheinsurer’sreimbursementratestooneor
57-moreVermonthospitalsassetforthinsubsection(c)ofthissectionuntilsuch
58-timeastheamountoftheinsurer’srisk-basedcapitalexceedsthecompany
59-actionlevelrisk-basedcapitalthresholddefinedin8V.S.A.§8301.
60-(c)(1)TheBoardshallonlyorderareductioninthereimbursementratesto
61-ahospitalthatmeetsoneorbothofthefollowingcriteria:
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28+VT LEG #381367 v.1
29+§ 9384. REDUCTION OR REALLOCATION OF REIMBURSEMENT 1
30+ RATES; RISKS TO HEALTH INSURER SOLVENCY 2
31+(a) As used in this section: 3
32+(1) “Hospital” has the same meaning as in section 9451 of this title. 4
33+(2) “Hospital network” means a system comprising two or more 5
34+affiliated hospitals, and may include other health care professionals and 6
35+facilities, that derives 50 percent or more of its operating revenue, at the 7
36+consolidated network level, from Vermont hospitals and in which the affiliated 8
37+hospitals deliver health care services in a coordinated manner using an 9
38+integrated financial and governance structure. 10
39+(b) If the Green Mountain Care Board determines, after consultation with 11
40+the Commissioner of Financial Regulation, that a domestic health insurer faces 12
41+an acute and immediate threat to its solvency because its risk-based capital 13
42+level has triggered a regulatory action level event pursuant to 8 V.S.A. § 8304, 14
43+the Board may order a reduction of the insurer’s reimbursement rates to one or 15
44+more Vermont hospitals as set forth in subsection (c) of this section until such 16
45+time as the amount of the insurer’s risk-based capital exceeds the company 17
46+action level risk-based capital threshold defined in 8 V.S.A. § 8301. 18
47+(c)(1) The Board shall only order a reduction in the reimbursement rates to 19
48+a hospital that meets one or both of the following criteria: 20 BILL AS INTRODUCED H.482
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83-(A)thehospitalhasmorethan135days’cashonhandandhada
84-positiveoperatingmargininthepreviousfiscalyear;or
85-(B)thehospitalisamemberofahospitalnetworkthat,atthe
86-consolidatednetworklevel,hasmorethan135days’cashonhandorhada
87-positiveoperatingmargininthepreviousfiscalyear,orboth.
88-(2)TheBoardshallorderareductioninreimbursementratestoa
89-hospitalpursuanttothissubsectiononlytotheextentnecessarytoremediate
90-thethreattothedomestichealthinsurer’ssolvency.
91-(3)InnoeventshallareductionorderedbytheBoardpursuanttothis
92-sectionresultinadecreasetoahospital’sorhospitalnetwork’sprojecteddays’
93-cashonhandtobelow125days.
94-Sec.2.18V.S.A.§ 9456isamendedtoread:
95-§9456.BUDGETREVIEW
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97-(c)Individualhospitalbudgetsestablishedunderthissectionshall:
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99-(4)reflectbudgetperformancesforprioryearsreconcileanysignificant
100-deviationinrevenueduringthepreviousfiscalyearinexcessofthebudget
101-establishedforthehospitalpursuanttothissection,usingamethodology
102-establishedbytheBoard;
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53+(A) the hospital has more than 135 days’ cash on hand and had a 1
54+positive operating margin in the previous fiscal year; or 2
55+(B) the hospital is a member of a hospital network that, at the 3
56+consolidated network level, has more than 135 days’ cash on hand or had a 4
57+positive operating margin in the previous fiscal year, or both. 5
58+(2) The Board shall order a reduction in reimbursement rates to a 6
59+hospital pursuant to this subsection only to the extent necessary to remediate 7
60+the threat to the domestic health insurer’s solvency. 8
61+(3) In no event shall a reduction ordered by the Board pursuant to this 9
62+section result in a decrease to a hospital’s or hospital network’s projected days’ 10
63+cash on hand to below 125 days. 11
64+Sec. 2. 18 V.S.A. § 9456 is amended to read: 12
65+§ 9456. BUDGET REVIEW 13
66+* * * 14
67+(c) Individual hospital budgets established under this section shall: 15
68+* * * 16
69+(4) reflect budget performances for prior years reconcile any significant 17
70+deviation in revenue during the previous fiscal year in excess of the budget 18
71+established for the hospital pursuant to this section, using a methodology 19
72+established by the Board; 20 BILL AS INTRODUCED H.482
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125-(f)(1)TheBoardmay,uponapplication,adjustabudgetestablishedunder
126-thissectionuponashowingofneedbaseduponexceptionalorunforeseen
127-circumstancesinaccordancewiththecriteriaandprocessesestablishedunder
128-section9405ofthistitle.
129-(2)TheBoardmay,onitsowninitiative,adjustthecommercialhealth
130-insurancereimbursementratespayabletoahospitalatanytimeduringthe
131-hospital’sfiscalyearinordertoensurethatthehospitaloperateswithinthe
132-budgetestablishedunderthissection.
133-(g)(1)TheBoardmayrequest,andahospitalshallprovide,information
134-determinedbytheBoardtobenecessarytodeterminewhetherthehospitalis
135-operatingwithinabudgetestablishedunderthissection.Forpurposesofthis
136-subsection,subsection(h)ofthissection,andsubdivision9454(a)(7)ofthis
137-title,theBoard’sauthorityshallextendtoanaffiliatedcorporationorother
138-personinthecontroloforcontrolledbythehospitaltotheextentthatsuch
139-authorityisnecessarytocarryoutthepurposesofthissubsection,subsection
140-(h)ofthissection,orsubdivision9454(a)(7)ofthistitle.Asusedinthis
141-subsection,arebuttablepresumptionof“control”iscreatediftheentity,
142-hospital,orotherperson,directlyorindirectly,owns,controls,holdswiththe
143-powertovote,orholdsproxiesrepresenting20percentormoreofthevoting
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76+VT LEG #381367 v.1
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78+(f)(1) The Board may, upon application, adjust a budget established under 2
79+this section upon a showing of need based upon exceptional or unforeseen 3
80+circumstances in accordance with the criteria and processes established under 4
81+section 9405 of this title. 5
82+(2) The Board may, on its own initiative, adjust the commercial health 6
83+insurance reimbursement rates payable to a hospital at any time during the 7
84+hospital’s fiscal year in order to ensure that the hospital operates within the 8
85+budget established under this section. 9
86+(g)(1) The Board may request, and a hospital shall provide, information 10
87+determined by the Board to be necessary to determine whether the hospital is 11
88+operating within a budget established under this section. For purposes of this 12
89+subsection, subsection (h) of this section, and subdivision 9454(a)(7) of this 13
90+title, the Board’s authority shall extend to an affiliated corporation or other 14
91+person in the control of or controlled by the hospital to the extent that such 15
92+authority is necessary to carry out the purposes of this subsection, subsection 16
93+(h) of this section, or subdivision 9454(a)(7) of this title. As used in this 17
94+subsection, a rebuttable presumption of “control” is created if the entity, 18
95+hospital, or other person, directly or indirectly, owns, controls, holds with the 19
96+power to vote, or holds proxies representing 20 percent or more of the voting 20 BILL AS INTRODUCED H.482
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165-securitiesormembershipinterestorothergoverninginterestofthehospitalor
166-othercontrolledentity.
167-(2)(A)TheBoardmay,uponfindingthatahospitalhasmadeamaterial
168-misrepresentationininformationordocumentsprovidedtotheBoardorthata
169-hospitalismateriallynoncompliantwiththebudgetestablishedbytheBoard
170-pursuanttothissection,appointanindependentobserverwithrespecttoany
171-matterrelatedtotheBoard’srevieworenforcementunderthissectionifthe
172-Boardbelievesthatdoingsoisinthepublicinterest.Atthedirectionofthe
173-Board,theindependentobservermaymonitorthehospital’soperations,obtain
174-informationfromthehospital,andreportfindingsandrecommendationstothe
175-Board.
176-(B)Anindependentobserverappointedpursuanttothissubdivision
177-(2)shallhavetherighttoreceivecopiesofallmaterialsrelatedtotheBoard’s
178-reviewunderthissectionandthehospitalshallprovideanyinformation
179-requestedbytheindependentobserver,includinganyinformationregarding
180-thehospital’sparticipationinahospitalnetwork.Theindependentobserver
181-shallshareinformationprovidedbythehospitalwiththeBoardandwiththe
182-OfficeoftheHealthCareAdvocateinaccordancewithsubdivision(d)(3)of
183-thissectionbutshallnototherwisediscloseanyconfidentialorproprietary
184-informationthattheindependentobserverobtainedfromthehospital.
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101+securities or membership interest or other governing interest of the hospital or 1
102+other controlled entity. 2
103+(2)(A) The Board may, upon finding that a hospital has made a material 3
104+misrepresentation in information or documents provided to the Board or that a 4
105+hospital is materially noncompliant with the budget established by the Board 5
106+pursuant to this section, appoint an independent observer with respect to any 6
107+matter related to the Board’s review or enforcement under this section if the 7
108+Board believes that doing so is in the public interest. At the direction of the 8
109+Board, the independent observer may monitor the hospital’s operations, obtain 9
110+information from the hospital, and report findings and recommendations to the 10
111+Board. 11
112+(B) An independent observer appointed pursuant to this subdivision 12
113+(2) shall have the right to receive copies of all materials related to the Board’s 13
114+review under this section and the hospital shall provide any information 14
115+requested by the independent observer, including any information regarding 15
116+the hospital’s participation in a hospital network. The independent observer 16
117+shall share information provided by the hospital with the Board and with the 17
118+Office of the Health Care Advocate in accordance with subdivision (d)(3) of 18
119+this section but shall not otherwise disclose any confidential or proprietary 19
120+information that the independent observer obtained from the hospital. 20 BILL AS INTRODUCED H.482
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206-(C)TheBoardmayorderahospitaltopayforalloraportionofthe
207-costsofanindependentobserverappointedforthehospitalpursuanttothis
208-subdivision(2).
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210-Sec.3.INDEPENDENTHOSPITALOBSERVERAUTHORITY;
211-PROSPECTIVEREPEAL
212-18V.S.A.§ 9456(g)(2)(authoritytoappointindependenthospitalobserver)
213-isrepealedonJanuary1,2030.
214-Sec.4.EFFECTIVEDATE
215-Thisactshalltakeeffectonpassage.
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125+(C) The Board may order a hospital to pay for all or a portion of the 1
126+costs of an independent observer appointed for the hospital pursuant to this 2
127+subdivision (2). 3
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129+Sec. 3. INDEPENDENT HOSPITAL OBSERVER AUTHORITY; 5
130+ PROSPECTIVE REPEAL 6
131+18 V.S.A. § 9456(g)(2) (authority to appoint independent hospital observer) 7
132+is repealed on January 1, 2030. 8
133+Sec. 4. EFFECTIVE DATE 9
134+This act shall take effect on passage. 10