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S.126 1
Introduced by Committee on Health and Welfare 2
Date: 3
Subject: Health; health care reform; Green Mountain Care Board; Agency of 4
Human Services; Statewide Health Care Delivery Plan; health 5
information technology; hospitals 6
Statement of purpose of bill as introduced: This bill proposes to enact certain 7
health care payment and delivery system reforms. 8
An act relating to health care payment and delivery system reform 9
It is hereby enacted by the General Assembly of the State of Vermont: 10
* * * Purpose of the Act; Goals * * * 11
Sec. 1. PURPOSE; GOALS 12
The purpose of this act is to promote the transformation of Vermont’s 13
health care system. In enacting this legislation, the General Assembly intends 14
to advance the following goals: 15
(1) improvements in health outcomes, quality of care, and regional 16
access to services; 17
(2) an integrated system of care, with robust care coordination and 18
increased investments in primary care, home health care, and long-term care; 19 BILL AS INTRODUCED S.126
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(3) stabilizing health care providers, reducing commercial health 1
insurance premiums, and managing hospital costs based on the total cost of 2
care, beginning with reference-based pricing and continuing on to global 3
hospital budgets; and 4
(4) improving population health and increasing access to health 5
insurance coverage. 6
* * * Hospital Budgets and Payment Reform * * * 7
Sec. 2. 18 V.S.A. § 9375 is amended to read: 8
§ 9375. DUTIES 9
(a) The Board shall execute its duties consistent with the principles 10
expressed in section 9371 of this title. 11
(b) The Board shall have the following duties: 12
(1) Oversee the development and implementation, and evaluate the 13
effectiveness, of health care payment and delivery system reforms designed to 14
control the rate of growth in health care costs; promote seamless care, 15
administration, and service delivery; and maintain health care quality in 16
Vermont, including ensuring that the payment reform pilot projects set forth in 17
this chapter are consistent with such reforms. 18
(A) Implement by rule, pursuant to 3 V.S.A. chapter 25, 19
methodologies for achieving payment reform and containing costs that may 20
include the participation of Medicare and Medicaid, which may include the 21 BILL AS INTRODUCED S.126
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creation of health care professional cost-containment targets, reference-based 1
pricing, global payments, bundled payments, global budgets, risk-adjusted 2
capitated payments, or other uniform payment methods and amounts for 3
integrated delivery systems, health care professionals, or other provider 4
arrangements. 5
* * * 6
(5) Set rates for health care professionals pursuant to section 9376 of 7
this title, to be implemented over time beginning with reference-based pricing 8
as soon as practicable, but not later than 2027, and make adjustments to the 9
rules on reimbursement methodologies as needed. 10
(6) Approve, modify, or disapprove requests for health insurance rates 11
pursuant to 8 V.S.A. § 4062, taking into consideration the requirements in the 12
underlying statutes,; changes in health care delivery,; changes in payment 13
methods and amounts, including implementation of reference-based pricing; 14
protecting insurer solvency,; and other issues at the discretion of the Board. 15
(7) Review and establish hospital budgets pursuant to chapter 221, 16
subchapter 7 of this title, including establishing standards for global hospital 17
budgets that reflect the implementation of reference-based pricing and the total 18
cost of care targets determined in collaboration with federal partners and other 19
stakeholders or as set by the Statewide Health Care Delivery Plan developed 20
pursuant to section 9403 of this title, once established. Beginning not later 21 BILL AS INTRODUCED S.126
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than hospital fiscal year 2028, the Board shall establish global hospital budgets 1
for one or more Vermont hospitals that are not critical access hospitals. By 2
hospital fiscal year 2030, the Board shall establish global hospital budgets for 3
all Vermont hospitals. 4
* * * 5
Sec. 3. 18 V.S.A. § 9376 is amended to read: 6
§ 9376. PAYMENT AMOUNTS; METHODS 7
(a) Intent. It is the intent of the General Assembly to ensure payments to 8
health care professionals that are consistent with efficiency, economy, and 9
quality of care and will permit them to provide, on a solvent basis, effective 10
and efficient health services that are in the public interest. It is also the intent 11
of the General Assembly to eliminate the shift of costs between the payers of 12
health services to ensure that the amount paid to health care professionals is 13
sufficient to enlist enough providers to ensure that health services are available 14
to all Vermonters and are distributed equitably. 15
(b) Rate-setting. 16
(1) The Board shall set reasonable rates for health care professionals, 17
health care provider bargaining groups created pursuant to section 9409 of this 18
title, manufacturers of prescribed products, medical supply companies, and 19
other companies providing health services or health supplies based on 20
methodologies pursuant to section 9375 of this title, in order to have a 21 BILL AS INTRODUCED S.126
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consistent reimbursement amount accepted by these persons. In its discretion, 1
the Board may implement rate-setting for different groups of health care 2
professionals over time and need not set rates for all types of health care 3
professionals. In establishing rates, the Board may consider legitimate 4
differences in costs among health care professionals, such as the cost of 5
providing a specific necessary service or services that may not be available 6
elsewhere in the State, and the need for health care professionals in particular 7
areas of the State, particularly in underserved geographic or practice shortage 8
areas. 9
(2) Nothing in this subsection shall be construed to: 10
(A) limit the ability of a health care professional to accept less than 11
the rate established in subdivision (1) of this subsection (b) from a patient 12
without health insurance or other coverage for the service or services received; 13
or 14
(B) reduce or limit the covered services offered by Medicare or 15
Medicaid. 16
(c) Methodologies. The Board shall approve payment methodologies that 17
encourage cost-containment; provision of high-quality, evidence-based health 18
services in an integrated setting; patient self-management; access to primary 19
care health services for underserved individuals, populations, and areas; and 20
healthy lifestyles. Such methodologies shall be consistent with payment 21 BILL AS INTRODUCED S.126
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reform and with evidence-based practices, and may include fee-for-service 1
payments if the Board determines such payments to be appropriate. 2
(d) Supervision. To the extent required to avoid federal antitrust violations 3
and in furtherance of the policy identified in subsection (a) of this section, the 4
Board shall facilitate and supervise the participation of health care 5
professionals and health care provider bargaining groups in the process 6
described in subsection (b) of this section. 7
(e) Reference-based pricing. 8
(1) The Board shall establish reference-based prices that represent the 9
amounts that health insurers in this State shall pay to hospitals for items 10
provided and services delivered in Vermont. The purposes of reference-based 11
pricing are to contain costs and to move health care professionals toward a site-12
neutral pricing structure while also allowing the Board to differentiate prices 13
among health care professionals based on factors such as demographics, 14
population health in a given hospital service area, payer mix, acuity, social risk 15
factors, and a specific health care professional’s role in Vermont’s health care 16
system. The Board shall consult with health insurers, hospitals, other health 17
care professionals as applicable, the Office of the Health Care Advocate, and 18
the Agency of Human Services on ways to approach reference-based pricing in 19
an effort to achieve all-payer alignment on design and implementation of the 20
program. 21 BILL AS INTRODUCED S.126
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(2)(A) Reference-based prices established pursuant to this subsection (e) 1
shall be based on a percentage of the Medicare reimbursement rate for the 2
same or a similar item or service, provided that after the Board establishes 3
initial prices that are referenced to Medicare, the Board may opt to update the 4
prices in the future based on a reasonable rate of growth that is separate from 5
Medicare rates, such as the Medicare Economic Index measure of inflation, in 6
order to provide predictability and consistency for health care professionals 7
and payers and to protect against federal funding pressures that may impact 8
Medicare rates in an unpredictable manner. 9
(B) In establishing reference-based prices pursuant to this subsection 10
(e), the Board shall consider the composition of the communities served by the 11
hospital, including the health of the population, demographic characteristics, 12
acuity, payer mix, labor costs, social risk factors, and other factors that may 13
affect the costs of providing care in the hospital service area. 14
(3)(A) The Board shall begin implementing reference-based pricing by 15
establishing the amounts that health insurers in this State shall pay to Vermont 16
hospitals for items provided and services delivered to individuals covered by 17
the health insurer’s plans as soon as practicable but not later than hospital 18
fiscal year 2027. 19
(B) The Board shall implement reference-based pricing in a manner 20
that does not allow hospitals to charge or collect from patients any amount in 21 BILL AS INTRODUCED S.126
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excess of the reference-based amount established by the Board for the item 1
provided or service delivered. 2
(C) The Board, in collaboration with the Department of Financial 3
Regulation, shall monitor the implementation of reference-based pricing to 4
ensure that any decreased prices paid to hospitals result in commensurate 5
decreases in health insurance premiums. The Board shall post its findings 6
regarding the alignment between price decreases and premium decreases 7
annually on its website. 8
(4) The Board shall identify factors that would necessitate terminating 9
the use of reference-based pricing in one or more hospitals, such as a reduction 10
in access to or quality of care. 11
(5) The Agency of Human Services, in consultation with the Green 12
Mountain Care Board, may implement reference-based pricing for services 13
delivered outside a hospital, such as primary care services, and may increase or 14
decrease the percentage of Medicare or another benchmark as appropriate, first 15
to enhance access to primary care and later for alignment with the Statewide 16
Health Care Delivery Plan established pursuant to section 9403 of this title, 17
once established. 18 BILL AS INTRODUCED S.126
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Sec. 4. 18 V.S.A. § 9454 is amended to read: 1
§ 9454. HOSPITALS; DUTIES 2
(a) Hospitals shall file the following information at the time and place and 3
in the manner established by the Board: 4
* * * 5
(6) known depreciation schedules on existing buildings, a four-year 6
capital expenditure projection, and a one-year capital expenditure plan; and 7
(7) the number of employees of the hospital whose duties are primarily 8
administrative in nature, as defined by the Board, and the number of 9
employees whose duties primarily involve delivering health care services 10
directly to hospital patients; 11
(8) information regarding base salaries and total compensation for the 12
hospital’s executive and clinical leadership and for its employees who deliver 13
health care services directly to hospital patients; 14
(9) proposals for ways in which the hospital can support community-15
based, independent, and nonhospital providers, including mental health and 16
substance use disorder treatment providers, primary care providers, long-term 17
care providers, and physical therapists; services provided through the Blueprint 18
for Health, Choices for Care, and Support and Services at Home (SASH); 19
investments in the health care workforce; and other nonhospital aspects of 20 BILL AS INTRODUCED S.126
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Vermont’s health and human services systems that affect population health 1
outcomes, including the social drivers of health; and 2
(10) such other information as the Board may require. 3
(b) Hospitals shall submit information as directed by the Board in order to 4
maximize hospital budget data standardization and allow the Board to make 5
direct comparisons of hospital expenses across the health care system. 6
(c) Hospitals shall adopt a fiscal year that shall begin on October 1. 7
Sec. 5. 18 V.S.A. § 9456 is amended to read: 8
§ 9456. BUDGET REVIEW 9
(a) The Board shall conduct reviews of each hospital’s proposed budget 10
based on the information provided pursuant to this subchapter and in 11
accordance with a schedule established by the Board. 12
(b) In conjunction with budget reviews, the Board shall: 13
(1) review utilization information; 14
(2) consider the Statewide Health Care Delivery Plan developed 15
pursuant to section 9403 of this title, once established, including the total cost 16
of care targets, and consult with the Agency of Human Services to ensure 17
compliance with federal requirements regarding Medicare and Medicaid; 18
(3) consider the Health Resource Allocation Plan identifying Vermont’s 19
critical health needs, goods, services, and resources developed pursuant to 20
section 9405 of this title; 21 BILL AS INTRODUCED S.126
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(3)(4) consider the expenditure analysis for the previous year and the 1
proposed expenditure analysis for the year under review; 2
(4)(5) consider any reports from professional review organizations; 3
(6) for a hospital that operates within a hospital network, review the 4
hospital network’s financial operations as they relate to the budget of the 5
individual hospital; 6
(7) exclude revenue derived from primary care, mental health care, and 7
substance use disorder treatment services when determining a hospital’s net 8
patient revenue and any total cost of care targets; 9
(5)(8) solicit public comment on all aspects of hospital costs and use and 10
on the budgets proposed by individual hospitals; 11
(6)(9) meet with hospitals to review and discuss hospital budgets for the 12
forthcoming fiscal year; 13
(7)(10) give public notice of the meetings with hospitals, and invite the 14
public to attend and to comment on the proposed budgets; 15
(8)(11) consider the extent to which costs incurred by the hospital in 16
connection with services provided to Medicaid beneficiaries are being charged 17
to non-Medicaid health benefit plans and other non-Medicaid payers; 18
(9)(12) require each hospital to file an analysis that reflects a reduction 19
in net revenue needs from non-Medicaid payers equal to any anticipated 20
increase in Medicaid, Medicare, or another public health care program 21 BILL AS INTRODUCED S.126
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reimbursements, and to any reduction in bad debt or charity care due to an 1
increase in the number of insured individuals; 2
(10)(13) require each hospital to provide information on administrative 3
costs, as defined by the Board, including specific information on the amounts 4
spent on marketing and advertising costs; 5
(11)(14) require each hospital to create or maintain connectivity to the 6
State’s Health Information Exchange Network in accordance with the criteria 7
established by the Vermont Information Technology Leaders, Inc., pursuant to 8
subsection 9352(i) of this title, provided that the Board shall not require a 9
hospital to create a level of connectivity that the State’s Exchange is unable to 10
support; 11
(12)(15) review the hospital’s investments in workforce development 12
initiatives, including nursing workforce pipeline collaborations with nursing 13
schools and compensation and other support for nurse preceptors; and 14
(13)(16) consider the salaries for the hospital’s executive and clinical 15
leadership, including variable payments and incentive plans, and the hospital’s 16
salary spread, including a comparison of median salaries to the medians of 17
northern New England states and a comparison of the base salaries and total 18
compensation for the hospital’s executive and clinic leadership with those of 19
the hospital’s lowest-paid employees who deliver health care services directly 20
to hospital patients; and 21 BILL AS INTRODUCED S.126
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(17) consider the number of employees of the hospital whose duties are 1
primarily administrative in nature, as defined by the Board, compared with the 2
number of employees whose duties primarily involve delivering health care 3
services directly to hospital patients. 4
(c) Individual hospital budgets established under this section shall: 5
(1) be consistent, to the extent practicable, with the Statewide Health 6
Care Delivery Plan, once established, including the total cost of care targets, 7
and with the Health Resource Allocation Plan; 8
(2) reflect the reference-based prices established by the Board pursuant 9
to section 9376 of this title; 10
(3) take into consideration national, regional, or in-state peer group 11
norms, according to indicators, ratios, and statistics established by the Board; 12
(3)(4) promote efficient and economic operation of the hospital; 13
(4)(5) reflect budget performances for prior years; 14
(5)(6) include a finding that the analysis provided in subdivision (b)(9) 15
(b)(12) of this section is a reasonable methodology for reflecting a reduction in 16
net revenues for non-Medicaid payers; and 17
(6)(7) demonstrate that they support equal access to appropriate mental 18
health care that meets standards of quality, access, and affordability equivalent 19
to other components of health care as part of an integrated, holistic system of 20
care; and 21 BILL AS INTRODUCED S.126
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(8) include meaningful variable payments and incentive plans for 1
hospitals that are consistent with this section and with the principles for health 2
care reform expressed in section 9371 of this title. 3
(d)(1)(A) Annually, the Board shall establish a budget for each hospital on 4
or before September 15, followed by a written decision by October 1. Each 5
hospital shall operate within the budget established under this section. 6
(B)(i) Beginning not later than hospital fiscal year 2028, the Board 7
shall establish global hospital budgets for one or more Vermont hospitals that 8
are not critical access hospitals. Not later than hospital fiscal year 2030, the 9
Board shall establish global hospital budgets for all Vermont hospitals. 10
(ii) Global hospital budgets established pursuant to this section 11
shall include Medicare to the extent permitted under federal law but shall not 12
include Medicaid. 13
* * * 14
(e)(1) The Board, in consultation with the Vermont Program for Quality in 15
Health Care, shall utilize mechanisms to measure hospital costs, quality, and 16
access and alignment with the Statewide Health Care Delivery Plan, once 17
established. 18
(2)(A) Except as provided in subdivision (D) of this subdivision (2), a 19
hospital that proposes to reduce or eliminate any service in order to comply 20
with a budget established under this section shall provide a notice of intent to 21 BILL AS INTRODUCED S.126
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the Board, the Agency of Human Services, the Office of the Health Care 1
Advocate, and the members of the General Assembly who represent the 2
hospital service area not less than 90 days prior to the proposed reduction or 3
elimination. 4
(B) The notice shall explain the rationale for the proposed reduction 5
or elimination and describe how it is consistent with the Statewide Health Care 6
Delivery Plan, once established, and the hospital’s most recent community 7
health needs assessment conducted pursuant to section 9405a of this title and 8
26 U.S.C. § 501(r)(3). 9
(C) The Board may evaluate the proposed reduction or elimination 10
for consistency with the Statewide Health Care Delivery Plan, once established 11
and the community health needs assessment, and may modify the hospital’s 12
budget or take such additional actions as the Board deems appropriate to 13
preserve access to necessary services. 14
(D) A service that has been identified for reduction or elimination in 15
connection with the transformation efforts undertaken by the Board and the 16
Agency of Human Services pursuant to 2022 Acts and Resolves No. 167 does 17
not need to comply with subdivisions (A)–(C) of this subdivision (2). 18
(3) The Board, in collaboration with the Department of Financial 19
Regulation, shall monitor the implementation of any authorized decrease in 20 BILL AS INTRODUCED S.126
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hospital services to determine its benefits to Vermonters or to Vermont’s 1
health care system, or both. 2
(4) The Board may establish a process to define, on an annual basis, 3
criteria for hospitals to meet, such as utilization and inflation benchmarks. 4
(5) The Board may waive one or more of the review processes listed in 5
subsection (b) of this section. 6
* * * 7
Sec. 6. 18 V.S.A. § 9458 is added to read: 8
§ 9458. HOSPITAL NETWORKS; STRUCTURE; FINANCIAL 9
OPERATIONS 10
(a) As used in this section, “hospital network” means a system comprising 11
two or more affiliated hospitals, and may include other health care 12
professionals and facilities, that derives 50 percent or more of its operating 13
revenue, at the consolidated network level, from Vermont hospitals and in 14
which the affiliated hospitals deliver health care services in a coordinated 15
manner using an integrated financial and governance structure. 16
(b) The Board may review and evaluate the structure of a hospital network 17
to determine: 18
(1) whether any network operations should be organized and operated 19
out of a hospital instead of at the network; and 20 BILL AS INTRODUCED S.126
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(2) whether the existence and operation of a network provides value to 1
Vermonters, is in the public interest, and is consistent with the principles for 2
health care reform expressed in section 9371 of this title and with the 3
Statewide Health Care Delivery Plan, once established. 4
(c) In order to protect the public interest, the Board may, on its own 5
initiative, investigate the financial operations of a hospital network, including 6
compensation of the network’s employees and executive leadership. 7
(d) The Board may recommend or take appropriate action as necessary to 8
correct any aspect of the structure of a hospital network or its financial 9
operations that are inconsistent with the principles for health care reform 10
expressed in section 9371 of this title or with the Statewide Health Care 11
Delivery Plan, once established. 12
(e) Any final action, order, or other determination by the Board pursuant to 13
this section shall be subject to appeal in accordance with the provisions of 14
section 9381 of this title. 15
* * * Health Care Contracts * * * 16
Sec. 7. 18 V.S.A. § 9418c is amended to read: 17
§ 9418c. FAIR CONTRACT STANDARDS 18
* * * 19
(e) The requirements of subdivision (b)(5) of this section do not prohibit a 20
contracting entity from requiring a reasonable confidentiality agreement 21 BILL AS INTRODUCED S.126
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between the provider and the contracting entity regarding the terms of the 1
proposed health care contract. Upon request, a contracting entity or provider 2
shall provide an unredacted copy of an executed or proposed health care 3
contract to the Department of Financial Regulation or the Green Mountain 4
Care Board, or both. 5
* * * Statewide Health Care Delivery Plan; Health Care Delivery 6
Advisory Committee * * * 7
Sec. 8. 18 V.S.A. § 9403 is added to read: 8
§ 9403. STATEWIDE HEALTH CARE DELIVERY PLAN 9
(a) The Agency of Human Services, in collaboration with the Green 10
Mountain Care Board, the Department of Financial Regulation, the Vermont 11
Program for Quality in Health Care, the Office of the Health Care Advocate, 12
the Health Care Delivery Advisory Committee established in section 9403a of 13
this title, and other interested stakeholders, shall lead development of an 14
integrated Statewide Health Care Delivery Plan as set forth in this section. 15
(b) The Plan shall: 16
(1) Align with the principles for health care reform expressed in section 17
9371 of this title. 18
(2) Promote access to high-quality, cost-effective acute care, primary 19
care, chronic care, long-term care, and hospital-based, independent, and 20
community-based services across Vermont. 21 BILL AS INTRODUCED S.126
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(3) Strive to make mental health services, substance use disorder 1
treatment services, emergency medical services, nonemergency medical 2
services, and nonmedical services and supports available in each region of 3
Vermont. 4
(4) Provide annual targets for the total cost of care across Vermont’s 5
health care system and include reasonable annual cost growth rates while 6
excluding from hospital total cost of care targets all revenue derived from a 7
hospital’s investments in primary care, mental health care, and substance use 8
disorder treatment services. Using these total cost of care targets, the Plan 9
shall identify appropriate allocations of health care resources and services 10
across the State that balance quality, access, and cost containment. The Plan 11
shall also establish targets for the percentages of overall health care spending 12
that should reflect spending on primary care services, including mental health 13
services, and preventive care services, which targets shall be aligned with the 14
total cost of care targets. 15
(5) Build on data and information from: 16
(A) the transformation planning resulting from 2022 Acts and 17
Resolves No. 167, Secs. 1 and 2; 18
(B) the expenditure analysis and health care spending estimate 19
developed pursuant to section 9383 of this title; 20 BILL AS INTRODUCED S.126
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(C) the State Health Improvement Plan adopted pursuant to 1
subsection 9405(a) of this title; 2
(D) the Health Resource Allocation Plan published by the Green 3
Mountain Care Board in accordance with subsection 9405(b) of this title; 4
(E) hospitals’ community health needs assessments and strategic 5
planning conducted in accordance with section 9405a of this title; 6
(F) hospital and ambulatory surgical center quality information 7
published by the Department of Health pursuant to section 9405b of this title; 8
(G) the statewide quality assurance program maintained by the 9
Vermont Program for Quality in Health Care pursuant to section 9416 of this 10
title; and 11
(H) such additional sources of data and information as the Board, 12
Agency, and Department deem appropriate. 13
(6) Identify: 14
(A) gaps in access to care, as well as circumstances in which service 15
closures or consolidations could result in improvements in quality, access, and 16
affordability; 17
(B) opportunities to reduce administrative burdens, such as 18
complexities in contracting and payment terms and duplicative quality 19
reporting requirements; and 20 BILL AS INTRODUCED S.126
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(C) federal, State, and other barriers to achieving the Plan’s goals 1
and, to the extent feasible, how those barriers can be removed or mitigated. 2
(c) The Green Mountain Care Board shall contribute data and expertise 3
related to its regulatory duties and its efforts pursuant to 2022 Acts and 4
Resolves No. 167. The Agency of Human Services shall contribute data and 5
expertise related to its role as the State Medicaid agency, its work with 6
community-based providers, and its efforts pursuant to 2022 Acts and Resolves 7
No. 167. 8
(d)(1) From 2025 through 2027, the Agency of Human Services shall 9
engage with stakeholders; collect and analyze data; gather information 10
obtained through the processes established in 2022 Acts and Resolves No. 167, 11
Secs. 1 and 2; and solicit input from the public. 12
(2) In 2028, the Agency shall prepare the Plan. 13
(3) On or before January 15, 2029, the Agency shall present the Plan to 14
the House Committees on Health Care and on Human Services and the Senate 15
Committee on Health and Welfare. 16
(4) The Agency shall prepare an updated Plan every three years and 17
shall present it to the General Assembly on or before January 15 every third 18
year after 2029. 19
Sec. 9. 18 V.S.A. § 9403a is added to read: 20
§ 9403a. HEALTH CARE DELIVERY ADVISOR Y COMMITTEE 21 BILL AS INTRODUCED S.126
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(a) There is created the Health Care Delivery Advisory Committee to: 1
(1) establish affordability benchmarks, including for affordability of 2
commercial health insurance; 3
(2) evaluate and monitor the performance of Vermont’s health care 4
system and its impacts on population health outcomes; 5
(3) collaborate with the Green Mountain Care Board, the Agency of 6
Human Services, the Department of Financial Regulation, and other interested 7
stakeholders in the development and maintenance of the Statewide Health Care 8
Delivery Plan developed pursuant to section 9403 of this title; 9
(4) advise the Green Mountain Care Board on the design and 10
implementation of an ongoing evaluation process to continuously monitor 11
current performance in the health care delivery system; and 12
(5) provide coordinated and consensus recommendations to the General 13
Assembly on issues related to health care delivery and population health. 14
(b)(1) The Advisory Committee shall be composed of the following 14 15
members: 16
(A) the Secretary of Human Services or designee; 17
(B) the Chair of the Green Mountain Care Board or designee; 18
(C) the Chief Health Care Advocate from the Office of the Health 19
Care Advocate or designee; 20 BILL AS INTRODUCED S.126
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(D) one representative of commercial health insurers offering major 1
medical health insurance plans in Vermont, selected by the Commissioner of 2
Financial Regulation; 3
(E) two representatives of Vermont hospitals, selected by the 4
Vermont Association of Hospitals and Health Systems, who shall represent 5
hospitals that are located in different regions of the State and that face different 6
levels of financial stability; 7
(F) one representative of Vermont’s federally qualified health 8
centers, selected by Bi-State Primary Care Association; 9
(G) one representative of independent physician practices, selected 10
jointly by the Vermont Medical Society and HealthFirst; 11
(H) one representative of Vermont’s free clinic programs, selected by 12
Vermont’s Free & Referral Clinics; 13
(I) one representative of Vermont’s designated and specialized 14
service agencies, selected by Vermont Care Partners; 15
(J) one preferred provider from outside the designated and 16
specialized service agency system, selected by the Commissioner of Health; 17
(K) one Vermont-licensed mental health professional from an 18
independent practice, selected by the Commissioner of Mental Health; 19
(L) one representative of Vermont’s home health agencies, selected 20
jointly by the VNAs of Vermont and Bayada Home Health Care; and 21 BILL AS INTRODUCED S.126
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(M) one representative of long-term care facilities, selected by the 1
Vermont Health Care Association. 2
(2) The Secretary of Human Services or designee shall be the Chair of 3
the Advisory Committee. 4
(3) The Agency of Human Services shall provide administrative and 5
technical assistance to the Advisory Committee. 6
* * * Data Integration; Data Sharing * * * 7
Sec. 10. 18 V.S.A. § 9353 is added to read: 8
§ 9353. INTEGRATION OF HEALTH CARE DATA 9
(a) The Agency of Human Services shall collaborate with the Health 10
Information Exchange Steering Committee in the development of an integrated 11
system of clinical and claims data in order to improve patient, provider, and 12
payer access to relevant information and reduce administrative burdens on 13
providers. 14
(b) The Agency’s process shall: 15
(1) align with the statewide Health Information Technology Plan 16
established pursuant to section 9351 of this title; 17
(2) utilize the expertise of the Health Information Exchange Steering 18
Committee; 19
(3) incorporate appropriate privacy and security standards; 20 BILL AS INTRODUCED S.126
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(4) determine how best to integrate clinical data, claims data, and data 1
regarding social drivers of health and health-related social needs; 2
(5) ensure interoperability among contributing data sources and 3
applications to enable a Unified Health Data Space that is usable by all 4
stakeholders; 5
(6) identify the resources necessary to complete data linkages for 6
clinical and research usage; 7
(7) establish a timeline for setup and access to the integrated system; 8
(8) develop and implement a system that ensures rapid access for 9
patients, providers, and payers; and 10
(9) identify additional opportunities for future development, including 11
incorporating new data types and larger populations. 12
(c) Health insurers, as defined in section 9402 of this title, shall provide 13
clinical and claims data to the Agency of Human Services as directed by the 14
Agency in order to facilitate the integrated system of clinical and claims data 15
as set forth in this section. 16
(d) The Agency shall provide access to data to State agencies and health 17
care providers as needed to support the goals of the Statewide Health Care 18
Delivery Plan established pursuant to section 9403 of this title, once 19
established, to the extent permitted by the data use agreements in place for 20
each data set. 21 BILL AS INTRODUCED S.126
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(e) On or before January 15 annually, the Agency of Human Services shall 1
provide an update to the House Committees on Health Care and on Human 2
Services and the Senate Committee on Health and Welfare regarding the 3
development and implementation of the integrated system of clinical and 4
claims data in accordance with this section. 5
Sec. 11. 18 V.S.A. § 9374 is amended to read: 6
§ 9374. BOARD MEMBERSHIP; AUTHORITY 7
* * * 8
(i)(1) In addition to any other penalties and in order to enforce the 9
provisions of this chapter and empower the Board to perform its duties, the 10
Chair of the Board may issue subpoenas, examine persons, administer oaths, 11
and require production of papers and records. Any subpoena or notice to 12
produce may be served by registered or certified mail or in person by an agent 13
of the Chair. Service by registered or certified mail shall be effective three 14
business days after mailing. Any subpoena or notice to produce shall provide 15
at least six business days’ time from service within which to comply, except 16
that the Chair may shorten the time for compliance for good cause shown. 17
Any subpoena or notice to produce sent by registered or certified mail, postage 18
prepaid, shall constitute service on the person to whom it is addressed. 19
(2) Each witness who appears before the Chair under subpoena shall 20
receive a fee and mileage as provided for witnesses in civil cases in Superior 21 BILL AS INTRODUCED S.126
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Courts; provided, however, any person subject to the Board’s authority shall 1
not be eligible to receive fees or mileage under this section. 2
(3) The Board may share any information, papers, or records it receives 3
pursuant to a subpoena or notice to produce issued under this section with 4
another State agency as appropriate to the work of that agency, provided that 5
the receiving agency agrees to maintain the confidentiality of any information, 6
papers, or records that are exempt from public inspection and copying under 7
the Public Records Act. 8
* * * 9
* * * Retaining Accountable Care Organization Capabilities * * * 10
Sec. 12. RETAINING ACCOUNTABLE CARE ORGANIZATION 11
CAPABILITIES; GREEN MOUNTAIN CARE BOARD; 12
BLUEPRINT FOR HEALTH; REPORT 13
The Agency of Human Services shall explore opportunities to retain 14
capabilities developed by or on behalf of a certified accountable care 15
organization that were funded in whole or in part using State or federal monies, 16
or both, and that have the potential to make beneficial contributions to 17
Vermont’s health care system, such as capabilities related to comprehensive 18
payment reform and quality data measurement and reporting. On or before 19
November 1, 2025, the Agency of Human Services shall report its findings and 20
recommendations to the Health Reform Oversight Committee. 21 BILL AS INTRODUCED S.126
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* * * Implementation Updates * * * 1
Sec. 13. AGENCY OF HUMAN SERVICES; IMPLEMENTATION; 2
REPORT 3
On or before November 15, 2025, the Agency of Human Services shall 4
provide an update to the Health Reform Oversight Committee regarding the 5
Agency’s implementation of this act, including the status of its efforts to 6
develop the Statewide Health Care Delivery Plan, advance health care data 7
integration, and explore opportunities to retain accountable care organization 8
capabilities, as well as on its hospital transformation activities pursuant to 2022 9
Acts and Resolves No. 167 and the effects of these efforts and activities on 10
Vermonters and on Vermont’s health care system. 11
Sec. 14. GREEN MOUNTAIN CARE BOARD; IMPLEMENTATION; 12
REPORT 13
On or before February 15, 2026, the Green Mountain Care Board shall 14
provide an update to the House Committee on Health Care and the Senate 15
Committee on Health and Welfare regarding the Board’s implementation of 16
this act, including the status of its efforts to establish methodologies for and 17
begin implementation of reference-based pricing and development of global 18
hospital budgets, and the effects of these efforts and activities on Vermonters 19
and on Vermont’s health care system. 20 BILL AS INTRODUCED S.126
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Sec. 15. 3 V.S.A. § 3027 is amended to read: 1
§ 3027. HEALTH CARE SYSTEM REFORM; IMPROVING QUALITY 2
AND AFFORDABILITY; REPORT 3
(a) The Director of Health Care Reform in the Agency of Human Services 4
shall be responsible for the coordination of health care system reform efforts 5
among Executive Branch agencies, departments, and offices, and for 6
coordinating with the Green Mountain Care Board established in 18 V.S.A. 7
chapter 220. 8
(b) On or before February 15 annually, the Agency of Human Services 9
shall provide an update to the House Committee on Health Care and the Senate 10
Committee on Health and Welfare regarding the status of its efforts to develop 11
and maintain the Statewide Health Care Delivery Plan in accordance with 18 12
V.S.A. § 9403, advance health care data integration as set forth in 18 V.S.A. 13
§ 9353, and coordinate hospital transformation activities pursuant to 2022 14
Acts and Resolves No. 167, and the effects of these efforts and activities on 15
Vermonters and on Vermont’s health care system. 16
Sec. 16. 18 V.S.A. § 9375(d) is amended to read: 17
(d) Annually on or before January 15, the Board shall submit a report of its 18
activities for the preceding calendar year to the House Committee on Health 19
Care and the Senate Committee on Health and Welfare. 20
(1) The report shall include: 21 BILL AS INTRODUCED S.126
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* * * 1
(G) the status of its efforts to establish methodologies for and begin 2
implementation of reference-based pricing and development of global hospital 3
budgets, and the effects of these efforts and activities on Vermonters and on 4
Vermont’s health care system; 5
(H) any recommendations for modifications to Vermont statutes; and 6
(H)(I) any actual or anticipated impacts on the work of the Board as a 7
result of modifications to federal laws, regulations, or programs. 8
* * * 9
* * * Positions; Appropriations * * * 10
Sec. 17. GREEN MOUNTAIN CARE BOARD; AGENCY OF HUMAN 11
SERVICES; POSITIONS 12
(a)(1) The establishment of the following five new permanent classified 13
positions is authorized at the Green Mountain Care Board in fiscal year 2026: 14
(A) one Director, Global Budgets; 15
(B) one Project Manager, Global Budgets; 16
(C) one Director, Reference-Based Pricing; 17
(D) one Project Manager, Reference-Based Pricing; and 18
(E) one Staff Attorney. 19
(2) The establishment of the following two classified limited-service 20
positions is authorized at the Agency of Human Services in fiscal year 2026: 21 BILL AS INTRODUCED S.126
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(A) one Health Care Reform (HCR) Integration Manager; and 1
(B) one Administrative Services Director II. 2
(3) These positions shall be transferred and converted from existing 3
vacant positions in the Executive Branch. 4
(b) It is the intent of the General Assembly to authorize the establishment 5
of an additional five new permanent positions at the Green Mountain Care 6
Board in fiscal year 2027 and another five new permanent positions in fiscal 7
year 2028. 8
Sec. 18. APPROPRIATIONS 9
(a) The sum of $1,525,000.00 is appropriated from the General Fund to the 10
Agency of Human Services in fiscal year 2026 for use as follows: 11
(1) $250,000.00 for grants to hospitals as needed for transformation 12
efforts initiated pursuant to 2022 Acts and Resolves No. 167 and to transition 13
their systems to implement reference-based pricing; 14
(2) $100,000.00 for expenses associated with development of the 15
Statewide Health Care Delivery Plan; 16
(3) $1,000,000.00 for contracts for consultants and other expenses 17
associated with implementation of this act; and 18
(4) $175,000.00 for the positions authorized in Sec. 17(a)(2) of this act. 19 BILL AS INTRODUCED S.126
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(b) The sum of $250,000.00 is appropriated from the Health IT-Fund to the 1
Agency of Human Services in fiscal year 2026 for grants to health care 2
providers for data integration in accordance with Sec. 10 of this act. 3
(c) The sum of $1,350,000.00 is appropriated from the General Fund to the 4
Green Mountain Care Board in fiscal year 2026 for use as follows: 5
(1) $850,000.00 for the positions authorized in Sec. 17(a)(1) of this act; 6
and 7
(2) $500,000.00 for contracts, including contracts for assistance with 8
implementing reference-based pricing in accordance with this act. 9
(d) Notwithstanding any provision of 32 V.S.A. § 10301 to the contrary, 10
the sum of $150,000.00 is appropriated from the Health IT-Fund to the Green 11
Mountain Care Board in fiscal year 2026 for expenses associated with 12
increased standardization of electronic hospital budget data submissions in 13
accordance with Sec. 4 of this act. 14
* * * Effective Dates * * * 15
Sec. 19. EFFECTIVE DATES 16
(a) Secs. 17 (positions) and 18 (appropriations) shall take effect on July 1, 17
2025. 18
(b) The remaining sections shall take effect on passage. 19