BILL AS INTRODUCED S.63
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S.63 1
Introduced by Senators Lyons, Cummings and Gulick 2
Referred to Committee on 3
Date: 4
Subject: Health; Green Mountain Care Board; health information technology; 5
accountable care organizations; hospital budgets 6
Statement of purpose of bill as introduced: This bill proposes to eliminate the 7
Green Mountain Care Board’s responsibility for approving the State’s Health 8
Information Technology Plan, for reviewing the budget of the Vermont 9
Information Technology Leaders, and for conducting Medicaid advisory rate 10
cases. The bill would modify the scope of the Green Mountain Care Board’s 11
certification of accountable care organizations and its review of their budgets 12
and would limit the application of provisions regarding meetings of 13
accountable care organization governing bodies to only the accountable care 14
organizations that contract with Vermont Medicaid. The bill would establish 15
fees for accountable care board certification and budget review and would 16
remove accountable care organizations from the billback formula under which 17
Board expenses are allocated in part to other regulated entities. The bill would 18
also specify that the Board’s review, establishment, and enforcement of 19
hospital budgets includes the right to the Board’s appeals processes and does 20
not constitute a contested case under the Administrative Procedures Act. 21 BILL AS INTRODUCED S.63
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An act relating to modifying the regulatory duties of the Green Mountain 1
Care Board 2
It is hereby enacted by the General Assembly of the State of Vermont: 3
Sec. 1. 18 V.S.A. § 9351 is amended to read: 4
§ 9351. HEALTH INFORMATION TECHNOLOGY PLAN 5
(a)(1) The Department of Vermont Health Access, in consultation with the 6
Department’s Health Information Exchange Steering Committee, shall be 7
responsible for the overall coordination of Vermont’s statewide Health 8
Information Technology Plan. The Plan shall be revised annually and updated 9
comprehensively every five years to provide a strategic vision for clinical 10
health information technology. 11
(2) The Department shall submit the proposed Plan to the Green 12
Mountain Care Board annually on or before November 1. The Green Mountain 13
Care Board shall approve, reject, or request modifications to the Plan within 45 14
days following its submission; if the Board has taken no action after 45 days, 15
the Plan shall be deemed to have been approved. [Repealed.] 16
(3)(A) The Department, in consultation with the Steering Committee, 17
shall administer the Plan. 18
(B) The Plan shall include the implementation of an integrated 19
electronic health information infrastructure for the sharing of electronic health 20
information among health care facilities, health care professionals, public and 21
private payers, and patients. The Plan shall provide for each patient’s 22 BILL AS INTRODUCED S.63
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electronic health information that is contained in the Vermont Health 1
Information Exchange to be accessible to health care facilities, health care 2
professionals, and public and private payers to the extent permitted under 3
federal law unless the patient has affirmatively elected not to have the patient’s 4
electronic health information shared in that manner. 5
(C) The Plan shall include standards and protocols designed to 6
promote patient education, patient privacy, physician best practices, electronic 7
connectivity to health care data, access to advance care planning documents, 8
and, overall, a more efficient and less costly means of delivering quality health 9
care in Vermont. 10
(D) A representative of the Green Mountain Care Board shall be a 11
voting member of the Steering Committee. 12
* * * 13
(c) The Department of Vermont Health Access, in consultation with the 14
Steering Committee and subject to Green Mountain Care Board approval, may 15
propose updates to the Plan in addition to the annual updates as needed to 16
reflect emerging technologies, the State’s changing needs, and such other areas 17
as the Department deems appropriate. The Department shall solicit 18
recommendations from interested stakeholders in order to propose updates to 19
the Health Information Technology Plan pursuant to subsection (a) of this 20
section and to this subsection, including applicable standards, protocols, and 21 BILL AS INTRODUCED S.63
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pilot programs, and following approval of the proposed updates by the Green 1
Mountain Care Board, may enter into a contract or grant agreement with 2
appropriate entities to update some or all of the Plan. Upon approval of the 3
updated Plan by the Green Mountain Care Board, the The Department of 4
Vermont Health Access shall distribute the updated Plan to the Secretary of 5
Administration; the Secretary of Digital Services; the Commissioner of 6
Financial Regulation; the Green Mountain Care Board; the Secretary of 7
Human Services; the Commissioner of Health; the Commissioner of Mental 8
Health; the Commissioner of Disabilities, Aging, and Independent Living; the 9
Senate Committee on Health and Welfare; the House Committee on Health 10
Care; affected parties; and interested stakeholders. Unless major modifications 11
are required, the Department may present updated information about the Plan 12
to the legislative committees of jurisdiction in lieu of creating a written report. 13
(d) The Health Information Technology Plan shall serve as the framework 14
within which the Green Mountain Care Board reviews certificate of need 15
applications for information technology under section 9440b of this title. In 16
addition, the Commissioner of Information and Innovation Secretary of Digital 17
Services shall use the Health Information Technology Plan as the basis for 18
independent review of State information technology procurements. 19
* * * 20 BILL AS INTRODUCED S.63
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Sec. 2. 18 V.S.A. § 9352 is amended to read: 1
§ 9352. VERMONT INFORMATION TECHNOLOGY LEADERS 2
* * * 3
(c) Health information exchange operation. 4
(1) VITL shall be designated in the Health Information Technology Plan 5
approved by the Green Mountain Care Board pursuant to section 9351 of this 6
title to operate the exclusive statewide health information exchange network 7
for this State. The Plan shall determine the manner in which Vermont’s health 8
information exchange network shall be managed. The Green Mountain Care 9
Board shall have the authority to approve VITL’s budget pursuant to chapter 10
220 of this title. Nothing in this chapter shall impede local community 11
providers from the exchange of electronic medical data. 12
* * * 13
(e) Report. On or before January 15 of each year, VITL shall file a report 14
with the Green Mountain Care Board; the Secretary of Administration; the 15
Secretary of Digital Services; the Commissioner of Financial Regulation; the 16
Commissioner of Vermont Health Access; the Secretary of Human Services; 17
the Commissioner of Health; the Commissioner of Mental Health; the 18
Commissioner of Disabilities, Aging, and Independent Living; the Senate 19
Committee on Health and Welfare; and the House Committee on Health Care. 20
The report shall include an assessment of progress in implementing health 21 BILL AS INTRODUCED S.63
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information technology in Vermont and recommendations for additional 1
funding and legislation required. In addition, VITL shall publish minutes of 2
VITL meetings and any other relevant information on a public website. The 3
provisions of 2 V.S.A. § 20(d) (expiration of required reports) shall not apply 4
to the report to be made under this subsection. 5
* * * 6
(i) Certification of meaningful use and connectivity. 7
(1) To the extent necessary to support Vermont’s health care reform 8
goals or as required by federal law, VITL shall be authorized to certify the 9
meaningful use of health information technology and electronic health records 10
by health care providers licensed in Vermont. 11
(2) VITL, in consultation with health care providers and health care 12
facilities, shall establish criteria for creating or maintaining connectivity to the 13
State’s health information exchange network. VITL shall provide the criteria 14
annually on or before March 1 to the Green Mountain Care Board established 15
pursuant to chapter 220 of this title. 16
* * * 17
Sec. 3. 18 V.S.A. § 9374(h) is amended to read: 18
(h)(1)(A) Except as otherwise provided in subdivisions (1)(C) and (2) of 19
this subsection (h), the expenses of the Board shall be borne as follows: 20
(i) 40.0 40 percent by the State from State monies; 21 BILL AS INTRODUCED S.63
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(ii) 28.8 36 percent by the hospitals; and 1
(iii) 23.2 24 percent by nonprofit hospital and medical service 2
corporations licensed under 8 V.S.A. chapter 123 or 125, health insurance 3
companies licensed under 8 V.S.A. chapter 101, and health maintenance 4
organizations licensed under 8 V.S.A. chapter 139; and 5
(iv) 8.0 percent by accountable care organizations. 6
(B) Expenses under subdivision (A)(iii) of this subdivision (1) shall 7
be allocated to persons licensed under Title 8 based on premiums paid for 8
health care coverage, which for the purposes of this subdivision (1) shall 9
include major medical, comprehensive medical, hospital or surgical coverage, 10
and comprehensive health care services plans, but shall not include long-term 11
care, limited benefits, disability, credit or stop loss, or excess loss insurance 12
coverage. 13
(C) Expenses Amounts assessed pursuant to the provisions of section 14
sections 9382 and 9441 of this title shall not be assessed in accordance with the 15
formula set forth in subdivision (A) of this subdivision (1). 16
(2) The Board may determine the scope of the incurred expenses to be 17
allocated pursuant to the formula set forth in subdivision (1) of this subsection 18
if, in the Board’s discretion, the expenses to be allocated are in the best 19
interests of the regulated entities and of the State. 20 BILL AS INTRODUCED S.63
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(3) If the amount of the proportional assessment to any entity calculated 1
in accordance with the formula set forth in subdivision (1)(A) of this 2
subsection would be less than $150.00, the Board shall assess the entity a 3
minimum fee of $150.00. The Board shall apply the amounts collected based 4
on the difference between each applicable entity’s proportional assessment 5
amount and $150.00 to reduce the total amount assessed to the regulated 6
entities pursuant to subdivisions (1)(A)(ii)–(iv) (1)(A)(ii) and (iii) of this 7
subsection. 8
* * * 9
Sec. 4. 18 V.S.A. § 9375 is amended to read: 10
§ 9375. DUTIES 11
* * * 12
(b) The Board shall have the following duties: 13
* * * 14
(2)(A) Review and approve Vermont’s statewide Health Information 15
Technology Plan pursuant to section 9351 of this title to ensure that the 16
necessary infrastructure is in place to enable the State to achieve the principles 17
expressed in section 9371 of this title. 18
(B) Review and approve the criteria required for health care 19
providers and health care facilities to create or maintain connectivity to the 20
State’s health information exchange as set forth in section 9352 of this title. 21 BILL AS INTRODUCED S.63
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Within 90 days following this approval, the Board shall issue an order 1
explaining its decision. 2
(C) Annually review and approve the budget, consistent with 3
available funds, of the Vermont Information Technology Leaders, Inc. (VITL). 4
This review shall take into account VITL’s responsibilities pursuant to section 5
9352 of this title and the availability of funds needed to support those 6
responsibilities. [Repealed.] 7
* * * 8
(12) Review data regarding mental health and substance abuse treatment 9
reported to the Department of Financial Regulation pursuant to 8 V.S.A. § 10
4089b(g)(1)(G) and discuss such information, as appropriate, with the Mental 11
Health Technical Advisory Group established pursuant to subdivision 12
9374(e)(2) of this title. [Repealed.] 13
(13) Adopt by rule pursuant to 3 V.S.A. chapter 25 such standards as the 14
Board deems necessary and appropriate to the operation and evaluation of 15
accountable care organizations pursuant to this chapter, including reporting 16
requirements, patient protections, and solvency and ability to assume financial 17
risk. 18
* * * 19
Sec. 5. 18 V.S.A. § 9382 is amended to read: 20
§ 9382. OVERSIGHT OF ACCOUNTABLE CARE ORGANIZATIONS 21 BILL AS INTRODUCED S.63
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(a)(1) In order to be eligible to receive payments from Medicaid or 1
commercial insurance through any payment reform program or initiative, 2
including an all-payer model operate in Vermont, each accountable care 3
organization shall obtain and maintain certification from the Green Mountain 4
Care Board. The Board shall adopt rules pursuant to 3 V.S.A. chapter 25 to 5
establish standards and processes for certifying accountable care organizations. 6
To the extent permitted under federal law, the Board shall ensure these rules 7
anticipate and accommodate a range of ACO models and sizes, balancing 8
oversight with support for innovation. In order to certify an ACO to operate in 9
this State, the Board shall ensure that the following criteria are met: 10
(1)(A) The ACO’s governance, leadership, and management structure is 11
transparent, reasonably and equitably represents the ACO’s participating 12
providers and its patients, and includes a consumer advisory board and other 13
processes for inviting and considering consumer input. 14
(2) The ACO has established appropriate mechanisms and care models 15
to provide, manage, and coordinate high-quality health care services for its 16
patients, including incorporating the Blueprint for Health, coordinating 17
services for complex high-need patients, and providing access to health care 18
providers who are not participants in the ACO. The ACO ensures equal access 19
to appropriate mental health care that meets standards of quality, access, and 20
affordability equivalent to other components of health care as part of an 21 BILL AS INTRODUCED S.63
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integrated, holistic system of care , taken as a whole, support and do not hinder 1
the State’s principles for health care reform as set forth in section 9371 of this 2
title. 3
(B) The ACO’s financial incentives for providers and patients are 4
reasonably calculated to improve, or at a minimum, maintain, the quality of, 5
access to, and affordability of care. 6
(3)(C) The ACO has established appropriate mechanisms to receive and 7
distribute payments to its participating health care providers in a fair and 8
equitable manner. To the extent that the ACO has the authority and ability to 9
establish provider reimbursement rates, the ACO shall minimize differentials 10
in payment methodology and amounts among comparable participating 11
providers across all practice settings, as long as doing so is not inconsistent 12
with the ACO’s overall payment reform objectives. 13
(4)(D) The ACO has established appropriate mechanisms and criteria 14
for accepting health care providers to participate in the ACO that prevent 15
unreasonable discrimination and are related to the needs of the ACO and the 16
patient population served. 17
(5) The ACO has established mechanisms and care models to promote 18
evidence-based health care, patient engagement, coordination of care, use of 19
electronic health records, and other enabling technologies to promote 20 BILL AS INTRODUCED S.63
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integrated, efficient, seamless, and effective health care services across the 1
continuum of care, where feasible. 2
(6) The ACO’s participating providers have the capacity for meaningful 3
participation in health information exchanges. 4
(7)(E) The ACO has performance standards and measures to evaluate 5
the quality and utilization of care delivered by its participating health care 6
providers. 7
(8)(F) The ACO does not place any restrictions on the information its 8
participating health care providers may provide to patients about their health or 9
decisions regarding their health. 10
(9) The ACO’s participating health care providers engage their patients 11
in shared decision making to inform them of their treatment options and the 12
related risks and benefits of each. 13
(10)(G) The ACO offers assistance to health care consumers, including: 14
(A)(i) maintaining a consumer telephone line for questions, 15
complaints, and grievances from attributed patients; 16
(B)(ii) responding and making best efforts to resolve complaints and 17
grievances from attributed patients, including providing assistance in 18
identifying appropriate rights under a patient’s health plan; 19
(C)(iii) providing an accessible mechanism for explaining how ACOs 20
work; 21 BILL AS INTRODUCED S.63
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(D)(iv) providing contact information for the Office of the Health 1
Care Advocate; and 2
(E)(v) sharing deidentified complaint and grievance information with 3
the Office of the Health Care Advocate at least twice annually. 4
(11) The ACO collaborates with providers not included in its financial 5
model, including home- and community-based providers and dental health 6
providers. 7
(12) The ACO does not interfere with patients’ choice of their own 8
health care providers under their health plan, regardless of whether a provider 9
is participating in the ACO; does not reduce covered services; and does not 10
increase patient cost sharing. 11
(13) The meetings of the ACO’s governing body comply with the 12
provisions of section 9572 of this title. 13
(14) The impact of the ACO’s establishment and operation does not 14
diminish access to any health care or community-based service or increase 15
delays in access to care for the population and area it serves. 16
(15) The ACO has in place appropriate mechanisms to conduct ongoing 17
assessments of its legal and financial vulnerabilities. 18
(16)(H) The ACO has in place a financial guarantee sufficient to cover 19
its potential losses. 20 BILL AS INTRODUCED S.63
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(17) The ACO provides connections and incentives to existing 1
community services for preventing and addressing the impact of childhood 2
adversity. The ACO collaborates on the development of quality-outcome 3
measurements for use by primary care providers who work with children and 4
families and fosters collaboration among care coordinators, community service 5
providers, and families. 6
(2) Notwithstanding subdivision (1) of this subsection, the Green 7
Mountain Care Board may adopt rules in accordance with 3 V.S.A. chapter 25 8
to establish a streamlined process for certification as a Medicare-only ACO for 9
an entity authorized by the Centers for Medicare and Medicaid Services to act 10
as an accountable care organization under the Medicare program. The 11
streamlined process may require a Medicare-only ACO to meet one or more of 12
the criteria set forth in subdivision (1) of this subsection. Certification 13
obtained pursuant to the streamlined process shall apply to the Medicare-only 14
ACO’s actions only as they relate to Medicare beneficiaries and only to the 15
extent that the federal authorization allows. 16
(b)(1) The Green Mountain Care Board shall adopt rules pursuant to in 17
accordance with 3 V.S.A. chapter 25 to establish standards and processes for 18
reviewing, modifying, and approving the budgets of ACOs with 10,000 or 19
more that receive payments from Medicaid or commercial insurers, or both, on 20
behalf of attributed lives in Vermont. To the extent permitted under federal 21 BILL AS INTRODUCED S.63
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law, the Board shall ensure the rules anticipate and accommodate a range of 1
ACO models and sizes, balancing oversight with support for innovation. In its 2
review, the Board shall review and consider: 3
(A) information regarding utilization of the health care services 4
delivered by health care providers participating in the ACO and the effects of 5
care models on appropriate utilization, including the provision of innovative 6
services; 7
(B) the Health Resource Allocation Plan identifying Vermont’s 8
critical health needs, goods, services, and resources as identified pursuant to 9
section 9405 of this title; 10
(C) the expenditure analysis for the previous year and the proposed 11
expenditure analysis for the year under review by payer; 12
(D) the character, competence, fiscal responsibility, and soundness of 13
the ACO and its principals; 14
(E) any reports from professional review organizations; 15
(F) the ACO’s efforts to prevent duplication of high-quality services 16
being provided efficiently and effectively by existing community-based 17
providers in the same geographic area, as well as its integration of efforts with 18
the Blueprint for Health and its regional care collaboratives; 19
(G) the extent to which the ACO provides incentives for systemic 20
health care investments to strengthen primary care, including strategies for 21 BILL AS INTRODUCED S.63
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recruiting additional primary care providers, providing resources to expand 1
capacity in existing primary care practices, and reducing the administrative 2
burden of reporting requirements for providers while balancing the need to 3
have sufficient measures to evaluate adequately the quality of and access to 4
care; 5
(H) the extent to which the ACO provides incentives for systemic 6
integration of community-based providers in its care model or investments to 7
expand capacity in existing community-based providers, in order to promote 8
seamless coordination of care across the care continuum; 9
(I) the extent to which the ACO provides incentives for systemic 10
health care investments in social determinants of health, such as developing 11
support capacities that prevent hospital admissions and readmissions, reduce 12
length of hospital stays, improve population health outcomes, reward healthy 13
lifestyle choices, and improve the solvency of and address the financial risk to 14
community-based providers that are participating providers of an accountable 15
care organization; 16
(J) the extent to which the ACO provides incentives for preventing 17
and addressing the impacts of adverse childhood experiences (ACEs) and other 18
traumas, such as developing quality outcome measures for use by primary care 19
providers working with children and families, developing partnerships between 20
nurses and families, providing opportunities for home visits, and including 21 BILL AS INTRODUCED S.63
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parent-child centers and designated agencies as participating providers in the 1
ACO; 2
(K) public comment on all aspects of the ACO’s costs and use and on 3
the ACO’s proposed budget; 4
(L) information gathered from meetings with the ACO to review and 5
discuss its proposed budget for the forthcoming fiscal year; 6
(M) information on the ACO’s administrative costs, as defined by the 7
Board; 8
(N) the effect, if any, of Medicaid reimbursement rates on the rates 9
for other payers; 10
(O) the extent to which the ACO makes its costs transparent and easy 11
to understand so that patients are aware of the costs of the health care services 12
they receive; and 13
(P) the extent to which the ACO provides resources to primary care 14
practices to ensure that care coordination and community services, such as 15
mental health and substance use disorder counseling that are provided by 16
community health teams, are available to patients without imposing 17
unreasonable burdens on primary care providers or on ACO member 18
organizations. 19
(2) The Green Mountain Care Board shall adopt rules pursuant to 3 20
V.S.A. chapter 25 to establish standards and processes for reviewing, 21 BILL AS INTRODUCED S.63
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modifying, and approving the budgets of ACOs with fewer than 10,000 1
attributed lives in Vermont. In its review, the Board may consider as many of 2
the factors described in subdivision (1) of this subsection as the Board deems 3
appropriate to a specific ACO’s size and scope 4
(1) information gathered from meetings with the ACO to review and 5
discuss its proposed budget for the forthcoming fiscal year; 6
(2) the efficacy with which the ACO uses funds from Medicaid and 7
commercial insurers, as applicable, to enhance and expedite the State’s health 8
care system transformation efforts; 9
(3) the ACO’s reasonable use of State and commercial insurance funds 10
for its own administrative costs, as defined by the Board; 11
(4) the ACO’s collaboration with a range of provider types, such as 12
home- and community-based providers, dental health providers, and mental 13
health and substance use disorder treatment providers; 14
(5) the ACO’s use of a consumer advisory board and other mechanisms 15
for inviting and considering consumer input; and 16
(6) public comment on all aspects of the ACO’s costs, operations, and 17
proposed budget. 18
(3)(A)(c)(1) The Office of the Health Care Advocate shall have the right 19
to receive copies of all materials related to any ACO certification or budget 20
review and may: 21 BILL AS INTRODUCED S.63
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(i)(A) ask questions of employees of the Green Mountain Care Board 1
related to the Board’s ACO budget review; 2
(ii)(B) submit written questions to the Board that the Board will ask 3
of the ACO in advance of any hearing held in conjunction with the Board’s 4
ACO review; 5
(iii)(C) submit written comments for the Board’s consideration; and 6
(iv)(D) ask questions and provide testimony in any hearing held in 7
conjunction with the Board’s ACO budget review. 8
(B)(2) The Office of the Health Care Advocate shall not disclose 9
further any confidential or proprietary information provided to the Office 10
pursuant to this subdivision (3) subsection. 11
(c)(d) The Board’s rules shall include requirements for submission of 12
information and data by ACOs and their participating providers as needed to 13
evaluate an ACO’s success. They The rules may also establish standards as 14
appropriate to promote an ACO’s ability to participate in applicable federal 15
programs for ACOs. 16
(d)(e) All information required to be filed by an ACO pursuant to this 17
section or to rules adopted pursuant to this section shall be made available to 18
the public upon request in accordance with 1 V.S.A. chapter 5, subchapter 3 19
(Public Records Act), provided that individual patients or health care providers 20
shall not be directly or indirectly identifiable. 21 BILL AS INTRODUCED S.63
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(e)(f) To the extent required to avoid federal antitrust violations, the Board 1
shall supervise the participation of health care professionals, health care 2
facilities, and other persons operating or participating in an accountable care 3
organization. The Board shall ensure that its certification and oversight 4
processes constitute sufficient State supervision over these entities to comply 5
with federal antitrust provisions and shall refer to the Attorney General for 6
appropriate action the activities of any individual or entity that the Board 7
determines, after notice and an opportunity to be heard, may be in violation of 8
State or federal antitrust laws without a countervailing benefit of improving 9
patient care, improving access to health care, increasing efficiency, or reducing 10
costs by modifying payment methods. 11
(g) The Board shall collect the following amounts from an accountable care 12
organization: 13
(1) $10,000.00 for initial certification in accordance with subsection (a) 14
of this section; 15
(2) $2,000.00 annually following initial certification to maintain 16
certification; and 17
(3) $125,000.00 for each review of the accountable care organization’s 18
budget in accordance with subsection (b) of this section. 19 BILL AS INTRODUCED S.63
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Sec. 6. 18 V.S.A. § 9454 is amended to read: 1
§ 9454. HOSPITALS; DUTIES 2
* * * 3
(b)(1) Hospitals General hospitals, as defined in section 1902 of this title, 4
shall adopt a fiscal year that shall begin on October 1. 5
(2) Psychiatric hospitals, as defined in section 1902 of this title but 6
excluding those conducted, maintained, or operated by the State of Vermont, 7
shall adopt a fiscal year that shall begin on January 1. 8
Sec. 7. 18 V.S.A. § 9456 is amended to read: 9
§ 9456. BUDGET REVIEW 10
(a) The Board shall conduct reviews of each hospital’s proposed budget 11
based on the information provided pursuant to this subchapter and in 12
accordance with a schedule established by the Board. Notwithstanding any 13
provision of 3 V.S.A. chapter 25 to the contrary, the Board’s review, 14
establishment, and enforcement of hospital budgets under this section shall not 15
be construed to be a contested case. Any person aggrieved by a Board action, 16
order, or determination under this section may appeal as set forth in section 17
9381 of this title. 18
* * * 19 BILL AS INTRODUCED S.63
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(d)(1)(A) Annually, the Board shall establish a budget for each general 1
hospital, as defined in section 1902 of this title, on or before September 15, 2
followed by a written decision by on or before October 1. 3
(B) Annually, the Board shall establish a budget for each psychiatric 4
hospital, as defined in section 1902 of this title but excluding those conducted, 5
maintained, or operated by the State of Vermont, on or before December 15, 6
followed by a written decision on or before December 31. 7
(C) Each hospital shall operate within the budget established under 8
this section. 9
* * * 10
(h)(1) If a hospital violates a provision of this section, the Board may 11
maintain an action in the Superior Court of the county in which the hospital is 12
located to enjoin, restrain, or prevent such violation. 13
(2)(A) After notice and an opportunity for hearing, the Board may 14
impose on a person who knowingly violates a provision of this subchapter, or a 15
rule adopted pursuant to this subchapter, a civil administrative penalty of no 16
not more than $40,000.00, or in the case of a continuing violation, a civil 17
administrative penalty of no not more than $100,000.00 or one-tenth of one 18
percent of the gross annual revenues of the hospital, whichever is greater. This 19
subdivision shall not apply to violations of subsection (d) of this section caused 20
by exceptional or unforeseen circumstances. 21 BILL AS INTRODUCED S.63
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(B)(i) The Board may order a hospital to: 1
* * * 2
(ii) Orders issued under this subdivision (2)(B) shall be issued 3
after notice and an opportunity to be heard, except where the Board finds that a 4
hospital’s financial or other emergency circumstances pose an immediate 5
threat of harm to the public or to the financial condition of the hospital. Where 6
there is an immediate threat, the Board may issue orders under this subdivision 7
(2)(B) without written or oral notice to the hospital. Where an order is issued 8
without notice, the hospital shall be notified of the right to a hearing at the time 9
the order is issued. The hearing shall be held within 30 days after receipt of 10
the hospital’s request for a hearing, and a decision shall be issued within 30 11
days after conclusion of the hearing. The Board may increase the time to hold 12
the hearing or to render the decision for good cause shown. Hospitals may 13
appeal any decision in this subsection to Superior Court. Appeal shall be on 14
the record as developed by the Board in the administrative proceeding and the 15
standard of review shall be as provided in 8 V.S.A. § 16. 16
* * * 17
Sec. 8. 18 V.S.A. § 9572 is amended to read: 18
§ 9572. MEETINGS OF AN ACCOUNTABLE CARE ORGANIZATION ’S 19
GOVERNING BODY 20 BILL AS INTRODUCED S.63
2025 Page 24 of 24
VT LEG #379230 v.1
(a) Application. This section shall apply to all regular, special, and 1
emergency meetings of the governing board of an accountable care 2
organization’s governing body organization that contracts with the Vermont 3
Medicaid program, whether the meeting is held in person or by electronic 4
means, as well as to any other assemblage of members of the ACO’s governing 5
body at which binding action is taken on behalf of the ACO. For purposes of 6
this section, the term “ACO’s governing body” shall also include the 7
governing body of any organization acting as a coordinating entity for two or 8
more ACOs that contract with Vermont Medicaid. 9
* * * 10
Sec. 9. REPEAL 11
18 V.S.A. § 9573 (Medicaid advisory rate case) is repealed. 12
Sec. 10. EFFECTIVE DATES 13
(a) Secs. 6 (18 V.S.A. § 9454) and 7 (18 V.S.A. § 9456) and this section 14
shall take effect on passage. 15
(b) The remaining sections shall take effect on July 1, 2025. 16