BILLASINTRODUCEDANDPASSEDBYSENATE S.126
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S.126
IntroducedbyCommitteeonHealthandWelfare
Date:March18,2025
Subject:Health;healthcarereform;GreenMountainCareBoard;Agencyof
HumanServices;StatewideHealthCareDeliveryPlan;health
informationtechnology;hospitals
Statementofpurposeofbillasintroduced:Thisbillproposestoenactcertain
healthcarepaymentanddeliverysystemreforms.
Anactrelatingtohealthcarepaymentanddeliverysystemreform
ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
***PurposeoftheAct;Goals***
Sec.1.PURPOSE;GOALS
ThepurposeofthisactistopromotethetransformationofVermont’s
healthcaresystem.Inenactingthislegislation,theGeneralAssemblyintends
toadvancethefollowinggoals:
(1)improvementsinhealthoutcomes,qualityofcare,andregional
accesstoservices;
(2)anintegratedsystemofcare,withrobustcarecoordinationand
increasedinvestmentsinprimarycare,homehealthcare,andlong-termcare;
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19 BILLASINTRODUCEDANDPASSEDBYSENATE S.126
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(3)stabilizinghealthcareproviders,reducingcommercialhealth
insurancepremiums,andmanaginghospitalcostsbasedonthetotalcostof
care,beginningwithreference-basedpricingandcontinuingontoglobal
hospitalbudgets;and
(4)improvingpopulationhealthandincreasingaccesstohealth
insurancecoverage.
***HospitalBudgetsandPaymentReform***
Sec.2.18V.S.A.§ 9375isamendedtoread:
§9375.DUTIES
(a)TheBoardshallexecuteitsdutiesconsistentwiththeprinciples
expressedinsection9371ofthistitle.
(b)TheBoardshallhavethefollowingduties:
(1)Overseethedevelopmentandimplementation,andevaluatethe
effectiveness,ofhealthcarepaymentanddeliverysystemreformsdesignedto
controltherateofgrowthinhealthcarecosts;promoteseamlesscare,
administration,andservicedelivery;andmaintainhealthcarequalityin
Vermont,includingensuringthatthepaymentreformpilotprojectssetforthin
thischapterareconsistentwithsuchreforms.
(A)Implementbyrule,pursuantto3V.S.A.chapter25,
methodologiesforachievingpaymentreformandcontainingcoststhatmay
includetheparticipationofMedicareandMedicaid,whichmayincludethe
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creationofhealthcareprofessionalcost-containmenttargets,reference-based
pricing,globalpayments,bundledpayments,globalbudgets,risk-adjusted
capitatedpayments,orotheruniformpaymentmethodsandamountsfor
integrateddeliverysystems,healthcareprofessionals,orotherprovider
arrangements.
***
(5)Setratesforhealthcareprofessionalspursuanttosection9376of
thistitle,tobeimplementedovertimebeginningwithreference-basedpricing
assoonaspracticable,butnotlaterthan2027,andmakeadjustmentstothe
rulesonreimbursementmethodologiesasneeded.
(6)Approve,modify,ordisapproverequestsforhealthinsurancerates
pursuantto8V.S.A.§4062,takingintoconsiderationtherequirementsinthe
underlyingstatutes,;changesinhealthcaredelivery,;changesinpayment
methodsandamounts,includingimplementationofreference-basedpricing;
protectinginsurersolvency,;andotherissuesatthediscretionoftheBoard.
(7)Reviewandestablishhospitalbudgetspursuanttochapter221,
subchapter7ofthistitle,includingestablishingstandardsforglobalhospital
budgetsthatreflecttheimplementationofreference-basedpricingandthetotal
costofcaretargetsdeterminedincollaborationwithfederalpartnersandother
stakeholdersorassetbytheStatewideHealthCareDeliveryPlandeveloped
pursuanttosection9403ofthistitle,onceestablished.Beginningnotlater
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thanhospitalfiscalyear2028,theBoardshallestablishglobalhospitalbudgets
foroneormoreVermonthospitalsthatarenotcriticalaccesshospitals.By
hospitalfiscalyear2030,theBoardshallestablishglobalhospitalbudgetsfor
allVermonthospitals.
***
Sec.3.18V.S.A.§ 9376isamendedtoread:
§9376.PAYMENTAMOUNTS;METHODS
(a)Intent.ItistheintentoftheGeneralAssemblytoensurepaymentsto
healthcareprofessionalsthatareconsistentwithefficiency,economy,and
qualityofcareandwillpermitthemtoprovide,onasolventbasis,effective
andefficienthealthservicesthatareinthepublicinterest.Itisalsotheintent
oftheGeneralAssemblytoeliminatetheshiftofcostsbetweenthepayersof
healthservicestoensurethattheamountpaidtohealthcareprofessionalsis
sufficienttoenlistenoughproviderstoensurethathealthservicesareavailable
toallVermontersandaredistributedequitably.
(b)Rate-setting.
(1)TheBoardshallsetreasonableratesforhealthcareprofessionals,
healthcareproviderbargaininggroupscreatedpursuanttosection9409ofthis
title,manufacturersofprescribedproducts,medicalsupplycompanies,and
othercompaniesprovidinghealthservicesorhealthsuppliesbasedon
methodologiespursuanttosection9375ofthistitle,inordertohavea
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21 BILLASINTRODUCEDANDPASSEDBYSENATE S.126
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consistentreimbursementamountacceptedbythesepersons.Initsdiscretion,
theBoardmayimplementrate-settingfordifferentgroupsofhealthcare
professionalsovertimeandneednotsetratesforalltypesofhealthcare
professionals.Inestablishingrates,theBoardmayconsiderlegitimate
differencesincostsamonghealthcareprofessionals,suchasthecostof
providingaspecificnecessaryserviceorservicesthatmaynotbeavailable
elsewhereintheState,andtheneedforhealthcareprofessionalsinparticular
areasoftheState,particularlyinunderservedgeographicorpracticeshortage
areas.
(2)Nothinginthissubsectionshallbeconstruedto:
(A)limittheabilityofahealthcareprofessionaltoacceptlessthan
therateestablishedinsubdivision(1)ofthissubsection(b)fromapatient
withouthealthinsuranceorothercoveragefortheserviceorservicesreceived;
or
(B)reduceorlimitthecoveredservicesofferedbyMedicareor
Medicaid.
(c)Methodologies.TheBoardshallapprovepaymentmethodologiesthat
encouragecost-containment;provisionofhigh-quality,evidence-basedhealth
servicesinanintegratedsetting;patientself-management;accesstoprimary
carehealthservicesforunderservedindividuals,populations,andareas;and
healthylifestyles.Suchmethodologiesshallbeconsistentwithpayment
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reformandwithevidence-basedpractices,andmayincludefee-for-service
paymentsiftheBoarddeterminessuchpaymentstobeappropriate.
(d)Supervision.Totheextentrequiredtoavoidfederalantitrustviolations
andinfurtheranceofthepolicyidentifiedinsubsection(a)ofthissection,the
Boardshallfacilitateandsupervisetheparticipationofhealthcare
professionalsandhealthcareproviderbargaininggroupsintheprocess
describedinsubsection(b)ofthissection.
(e)Reference-basedpricing.
(1)TheBoardshallestablishreference-basedpricesthatrepresentthe
amountsthathealthinsurersinthisStateshallpaytohospitalsforitems
providedandservicesdeliveredinVermont.Thepurposesofreference-based
pricingaretocontaincostsandtomovehealthcareprofessionalstowarda
site-neutralpricingstructurewhilealsoallowingtheBoardtodifferentiate
pricesamonghealthcareprofessionalsbasedonfactorssuchasdemographics,
populationhealthinagivenhospitalservicearea,payermix,acuity,socialrisk
factors,andaspecifichealthcareprofessional’sroleinVermont’shealthcare
system.TheBoardshallconsultwithhealthinsurers,hospitals,otherhealth
careprofessionalsasapplicable,theOfficeoftheHealthCareAdvocate,and
theAgencyofHumanServicesonwaystoapproachreference-basedpricingin
anefforttoachieveall-payeralignmentondesignandimplementationofthe
program.
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21 BILLASINTRODUCEDANDPASSEDBYSENATE S.126
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(2)(A)Reference-basedpricesestablishedpursuanttothissubsection(e)
shallbebasedonapercentageoftheMedicarereimbursementrateforthe
sameorasimilaritemorservice,providedthataftertheBoardestablishes
initialpricesthatarereferencedtoMedicare,theBoardmayopttoupdatethe
pricesinthefuturebasedonareasonablerateofgrowththatisseparatefrom
Medicarerates,suchastheMedicareEconomicIndexmeasureofinflation,in
ordertoprovidepredictabilityandconsistencyforhealthcareprofessionals
andpayersandtoprotectagainstfederalfundingpressuresthatmayimpact
Medicareratesinanunpredictablemanner.
(B)Inestablishingreference-basedpricespursuanttothissubsection
(e),theBoardshallconsiderthecompositionofthecommunitiesservedbythe
hospital,includingthehealthofthepopulation,demographiccharacteristics,
acuity,payermix,laborcosts,socialriskfactors,andotherfactorsthatmay
affectthecostsofprovidingcareinthehospitalservicearea.
(3)(A)TheBoardshallbeginimplementingreference-basedpricingby
establishingtheamountsthathealthinsurersinthisStateshallpaytoVermont
hospitalsforitemsprovidedandservicesdeliveredtoindividualscoveredby
thehealthinsurer’splansassoonaspracticablebutnotlaterthanhospital
fiscalyear2027.
(B)TheBoardshallimplementreference-basedpricinginamanner
thatdoesnotallowhospitalstochargeorcollectfrompatientsanyamountin
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excessofthereference-basedamountestablishedbytheBoardfortheitem
providedorservicedelivered.
(C)TheBoard,incollaborationwiththeDepartmentofFinancial
Regulation,shallmonitortheimplementationofreference-basedpricingto
ensurethatanydecreasedpricespaidtohospitalsresultincommensurate
decreasesinhealthinsurancepremiums.TheBoardshallpostitsfindings
regardingthealignmentbetweenpricedecreasesandpremiumdecreases
annuallyonitswebsite.
(4)TheBoardshallidentifyfactorsthatwouldnecessitateterminating
theuseofreference-basedpricinginoneormorehospitals,suchasareduction
inaccesstoorqualityofcare.
(5)TheAgencyofHumanServices,inconsultationwiththeGreen
MountainCareBoard,mayimplementreference-basedpricingforservices
deliveredoutsideahospital,suchasprimarycareservices,andmayincreaseor
decreasethepercentageofMedicareoranotherbenchmarkasappropriate,first
toenhanceaccesstoprimarycareandlaterforalignmentwiththeStatewide
HealthCareDeliveryPlanestablishedpursuanttosection9403ofthistitle,
onceestablished.
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Sec.4.18V.S.A.§ 9454isamendedtoread:
§9454.HOSPITALS;DUTIES
(a)Hospitalsshallfilethefollowinginformationatthetimeandplaceand
inthemannerestablishedbytheBoard:
***
(6)knowndepreciationschedulesonexistingbuildings,afour-year
capitalexpenditureprojection,andaone-yearcapitalexpenditureplan;and
(7)thenumberofemployeesofthehospitalwhosedutiesareprimarily
administrativeinnature,asdefinedbytheBoard,andthenumberof
employeeswhosedutiesprimarilyinvolvedeliveringhealthcareservices
directlytohospitalpatients;
(8)informationregardingbasesalariesandtotalcompensationforthe
hospital’sexecutiveandclinicalleadershipandforitsemployeeswhodeliver
healthcareservicesdirectlytohospitalpatients;
(9)proposalsforwaysinwhichthehospitalcansupportcommunity-
based,independent,andnonhospitalproviders,includingmentalhealthand
substanceusedisordertreatmentproviders,primarycareproviders,long-term
careproviders,andphysicaltherapists;servicesprovidedthroughtheBlueprint
forHealth,ChoicesforCare,andSupportandServicesatHome(SASH);
investmentsinthehealthcareworkforce;andothernonhospitalaspectsof
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Vermont’shealthandhumanservicessystemsthataffectpopulationhealth
outcomes,includingthesocialdriversofhealth;and
(10)suchotherinformationastheBoardmayrequire.
(b)HospitalsshallsubmitinformationasdirectedbytheBoardinorderto
maximizehospitalbudgetdatastandardizationandallowtheBoardtomake
directcomparisonsofhospitalexpensesacrossthehealthcaresystem.
(c)HospitalsshalladoptafiscalyearthatshallbeginonOctober1.
Sec.5.18V.S.A.§ 9456isamendedtoread:
§9456.BUDGETREVIEW
(a)TheBoardshallconductreviewsofeachhospital’sproposedbudget
basedontheinformationprovidedpursuanttothissubchapterandin
accordancewithascheduleestablishedbytheBoard.
(b)Inconjunctionwithbudgetreviews,theBoardshall:
(1)reviewutilizationinformation;
(2)considertheStatewideHealthCareDeliveryPlandeveloped
pursuanttosection9403ofthistitle,onceestablished,includingthetotalcost
ofcaretargets,andconsultwiththeAgencyofHumanServicestoensure
compliancewithfederalrequirementsregardingMedicareandMedicaid;
(3)considertheHealthResourceAllocationPlanidentifyingVermont’s
criticalhealthneeds,goods,services,andresourcesdevelopedpursuantto
section9405ofthistitle;
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(3)(4)considertheexpenditureanalysisforthepreviousyearandthe
proposedexpenditureanalysisfortheyearunderreview;
(4)(5)consideranyreportsfromprofessionalrevieworganizations;
(6)forahospitalthatoperateswithinahospitalnetwork,reviewthe
hospitalnetwork’sfinancialoperationsastheyrelatetothebudgetofthe
individualhospital;
(7)excluderevenuederivedfromprimarycare,mentalhealthcare,and
substanceusedisordertreatmentserviceswhendeterminingahospital’snet
patientrevenueandanytotalcostofcaretargets;
(5)(8)solicitpubliccommentonallaspectsofhospitalcostsanduse
andonthebudgetsproposedbyindividualhospitals;
(6)(9)meetwithhospitalstoreviewanddiscusshospitalbudgetsforthe
forthcomingfiscalyear;
(7)(10)givepublicnoticeofthemeetingswithhospitals,andinvitethe
publictoattendandtocommentontheproposedbudgets;
(8)(11)considertheextenttowhichcostsincurredbythehospitalin
connectionwithservicesprovidedtoMedicaidbeneficiariesarebeingcharged
tonon-Medicaidhealthbenefitplansandothernon-Medicaidpayers;
(9)(12)requireeachhospitaltofileananalysisthatreflectsareduction
innetrevenueneedsfromnon-Medicaidpayersequaltoanyanticipated
increaseinMedicaid,Medicare,oranotherpublichealthcareprogram
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reimbursements,andtoanyreductioninbaddebtorcharitycareduetoan
increaseinthenumberofinsuredindividuals;
(10)(13)requireeachhospitaltoprovideinformationonadministrative
costs,asdefinedbytheBoard,includingspecificinformationontheamounts
spentonmarketingandadvertisingcosts;
(11)(14)requireeachhospitaltocreateormaintainconnectivitytothe
State’sHealthInformationExchangeNetworkinaccordancewiththecriteria
establishedbytheVermontInformationTechnologyLeaders,Inc.,pursuantto
subsection9352(i)ofthistitle,providedthattheBoardshallnotrequirea
hospitaltocreatealevelofconnectivitythattheState’sExchangeisunableto
support;
(12)(15)reviewthehospital’sinvestmentsinworkforcedevelopment
initiatives,includingnursingworkforcepipelinecollaborationswithnursing
schoolsandcompensationandothersupportfornursepreceptors;and
(13)(16)considerthesalariesforthehospital’sexecutiveandclinical
leadership,includingvariablepaymentsandincentiveplans,andthehospital’s
salaryspread,includingacomparisonofmediansalariestothemediansof
northernNewEnglandstatesandacomparisonofthebasesalariesandtotal
compensationforthehospital’sexecutiveandclinicleadershipwiththoseof
thehospital’slowest-paidemployeeswhodeliverhealthcareservicesdirectly
tohospitalpatients;and
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(17)considerthenumberofemployeesofthehospitalwhosedutiesare
primarilyadministrativeinnature,asdefinedbytheBoard,comparedwiththe
numberofemployeeswhosedutiesprimarilyinvolvedeliveringhealthcare
servicesdirectlytohospitalpatients.
(c)Individualhospitalbudgetsestablishedunderthissectionshall:
(1)beconsistent,totheextentpracticable,withtheStatewideHealth
CareDeliveryPlan,onceestablished,includingthetotalcostofcaretargets,
andwiththeHealthResourceAllocationPlan;
(2)reflectthereference-basedpricesestablishedbytheBoardpursuant
tosection9376ofthistitle;
(3)takeintoconsiderationnational,regional,orin-statepeergroup
norms,accordingtoindicators,ratios,andstatisticsestablishedbytheBoard;
(3)(4)promoteefficientandeconomicoperationofthehospital;
(4)(5)reflectbudgetperformancesforprioryears;
(5)(6)includeafindingthattheanalysisprovidedinsubdivision(b)(9)
(b)(12)ofthissectionisareasonablemethodologyforreflectingareductionin
netrevenuesfornon-Medicaidpayers;and
(6)(7)demonstratethattheysupportequalaccesstoappropriatemental
healthcarethatmeetsstandardsofquality,access,andaffordabilityequivalent
toothercomponentsofhealthcareaspartofanintegrated,holisticsystemof
care;and
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(8)includemeaningfulvariablepaymentsandincentiveplansfor
hospitalsthatareconsistentwiththissectionandwiththeprinciplesforhealth
carereformexpressedinsection9371ofthistitle.
(d)(1)(A)Annually,theBoardshallestablishabudgetforeachhospitalon
orbeforeSeptember15,followedbyawrittendecisionbyOctober1.Each
hospitalshalloperatewithinthebudgetestablishedunderthissection.
(B)(i)Beginningnotlaterthanhospitalfiscalyear2028,theBoard
shallestablishglobalhospitalbudgetsforoneormoreVermonthospitalsthat
arenotcriticalaccesshospitals.Notlaterthanhospitalfiscalyear2030,the
BoardshallestablishglobalhospitalbudgetsforallVermonthospitals.
(ii)Globalhospitalbudgetsestablishedpursuanttothissection
shallincludeMedicaretotheextentpermittedunderfederallawbutshallnot
includeMedicaid.
***
(e)(1)TheBoard,inconsultationwiththeVermontProgramforQualityin
HealthCare,shallutilizemechanismstomeasurehospitalcosts,quality,and
accessandalignmentwiththeStatewideHealthCareDeliveryPlan,once
established.
(2)(A)Exceptasprovidedinsubdivision(D)ofthissubdivision(2),a
hospitalthatproposestoreduceoreliminateanyserviceinordertocomply
withabudgetestablishedunderthissectionshallprovideanoticeofintentto
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theBoard,theAgencyofHumanServices,theOfficeoftheHealthCare
Advocate,andthemembersoftheGeneralAssemblywhorepresentthe
hospitalserviceareanotlessthan90dayspriortotheproposedreductionor
elimination.
(B)Thenoticeshallexplaintherationalefortheproposedreduction
oreliminationanddescribehowitisconsistentwiththeStatewideHealthCare
DeliveryPlan,onceestablished,andthehospital’smostrecentcommunity
healthneedsassessmentconductedpursuanttosection9405aofthistitleand
26U.S.C.§ 501(r)(3).
(C)TheBoardmayevaluatetheproposedreductionorelimination
forconsistencywiththeStatewideHealthCareDeliveryPlan,onceestablished
andthecommunityhealthneedsassessment,andmaymodifythehospital’s
budgetortakesuchadditionalactionsastheBoarddeemsappropriateto
preserveaccesstonecessaryservices.
(D)Aservicethathasbeenidentifiedforreductionoreliminationin
connectionwiththetransformationeffortsundertakenbytheBoardandthe
AgencyofHumanServicespursuantto2022ActsandResolvesNo.167does
notneedtocomplywithsubdivisions(A)–(C)ofthissubdivision(2).
(3)TheBoard,incollaborationwiththeDepartmentofFinancial
Regulation,shallmonitortheimplementationofanyauthorizeddecreasein
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hospitalservicestodetermineitsbenefitstoVermontersortoVermont’shealth
caresystem,orboth.
(4)TheBoardmayestablishaprocesstodefine,onanannualbasis,
criteriaforhospitalstomeet,suchasutilizationandinflationbenchmarks.
(5)TheBoardmaywaiveoneormoreofthereviewprocesseslistedin
subsection(b)ofthissection.
***
Sec.6.18V.S.A.§ 9458isaddedtoread:
§ 9458.HOSPITALNETWORKS;STRUCTURE;FINANCIAL
OPERATIONS
(a)Asusedinthissection,“hospitalnetwork”meansasystemcomprising
twoormoreaffiliatedhospitals,andmayincludeotherhealthcare
professionalsandfacilities,thatderives50percentormoreofitsoperating
revenue,attheconsolidatednetworklevel,fromVermonthospitalsandin
whichtheaffiliatedhospitalsdeliverhealthcareservicesinacoordinated
mannerusinganintegratedfinancialandgovernancestructure.
(b)TheBoardmayreviewandevaluatethestructureofahospitalnetwork
todetermine:
(1)whetheranynetworkoperationsshouldbeorganizedandoperated
outofahospitalinsteadofatthenetwork;and
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(2)whethertheexistenceandoperationofanetworkprovidesvalueto
Vermonters,isinthepublicinterest,andisconsistentwiththeprinciplesfor
healthcarereformexpressedinsection9371ofthistitleandwiththe
StatewideHealthCareDeliveryPlan,onceestablished.
(c)Inordertoprotectthepublicinterest,theBoardmay,onitsown
initiative,investigatethefinancialoperationsofahospitalnetwork,including
compensationofthenetwork’semployeesandexecutiveleadership.
(d)TheBoardmayrecommendortakeappropriateactionasnecessaryto
correctanyaspectofthestructureofahospitalnetworkoritsfinancial
operationsthatareinconsistentwiththeprinciplesforhealthcarereform
expressedinsection9371ofthistitleorwiththeStatewideHealthCare
DeliveryPlan,onceestablished.
(e)Anyfinalaction,order,orotherdeterminationbytheBoardpursuantto
thissectionshallbesubjecttoappealinaccordancewiththeprovisionsof
section9381ofthistitle.
***HealthCareContracts***
Sec.7.18V.S.A.§ 9418cisamendedtoread:
§9418c.FAIRCONTRACTSTANDARDS
***
(e)Therequirementsofsubdivision(b)(5)ofthissectiondonotprohibita
contractingentityfromrequiringareasonableconfidentialityagreement
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betweentheproviderandthecontractingentityregardingthetermsofthe
proposedhealthcarecontract.Uponrequest,acontractingentityorprovider
shallprovideanunredactedcopyofanexecutedorproposedhealthcare
contracttotheDepartmentofFinancialRegulationortheGreenMountain
CareBoard,orboth.
***StatewideHealthCareDeliveryPlan;HealthCareDelivery
AdvisoryCommittee***
Sec.8.18V.S.A.§ 9403isaddedtoread:
§ 9403.STATEWIDEHEALTHCAREDELIVERYPLAN
(a)TheAgencyofHumanServices,incollaborationwiththeGreen
MountainCareBoard,theDepartmentofFinancialRegulation,theVermont
ProgramforQualityinHealthCare,theOfficeoftheHealthCareAdvocate,
theHealthCareDeliveryAdvisoryCommitteeestablishedinsection9403aof
thistitle,andotherinterestedstakeholders,shallleaddevelopmentofan
integratedStatewideHealthCareDeliveryPlanassetforthinthissection.
(b)ThePlanshall:
(1)Alignwiththeprinciplesforhealthcarereformexpressedinsection
9371ofthistitle.
(2)Promoteaccesstohigh-quality,cost-effectiveacutecare,primary
care,chroniccare,long-termcare,andhospital-based,independent,and
community-basedservicesacrossVermont.
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(3)Strivetomakementalhealthservices,substanceusedisorder
treatmentservices,emergencymedicalservices,nonemergencymedical
services,andnonmedicalservicesandsupportsavailableineachregionof
Vermont.
(4)ProvideannualtargetsforthetotalcostofcareacrossVermont’s
healthcaresystemandincludereasonableannualcostgrowthrateswhile
excludingfromhospitaltotalcostofcaretargetsallrevenuederivedfroma
hospital’sinvestmentsinprimarycare,mentalhealthcare,andsubstanceuse
disordertreatmentservices.Usingthesetotalcostofcaretargets,thePlan
shallidentifyappropriateallocationsofhealthcareresourcesandservices
acrosstheStatethatbalancequality,access,andcostcontainment.ThePlan
shallalsoestablishtargetsforthepercentagesofoverallhealthcarespending
thatshouldreflectspendingonprimarycareservices,includingmentalhealth
services,andpreventivecareservices,whichtargetsshallbealignedwiththe
totalcostofcaretargets.
(5)Buildondataandinformationfrom:
(A)thetransformationplanningresultingfrom2022Actsand
ResolvesNo.167,Secs.1and2;
(B)theexpenditureanalysisandhealthcarespendingestimate
developedpursuanttosection9383ofthistitle;
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(C)theStateHealthImprovementPlanadoptedpursuantto
subsection9405(a)ofthistitle;
(D)theHealthResourceAllocationPlanpublishedbytheGreen
MountainCareBoardinaccordancewithsubsection9405(b)ofthistitle;
(E)hospitals’communityhealthneedsassessmentsandstrategic
planningconductedinaccordancewithsection9405aofthistitle;
(F)hospitalandambulatorysurgicalcenterqualityinformation
publishedbytheDepartmentofHealthpursuanttosection9405bofthistitle;
(G)thestatewidequalityassuranceprogrammaintainedbythe
VermontProgramforQualityinHealthCarepursuanttosection9416ofthis
title;and
(H)suchadditionalsourcesofdataandinformationastheBoard,
Agency,andDepartmentdeemappropriate.
(6)Identify:
(A)gapsinaccesstocare,aswellascircumstancesinwhichservice
closuresorconsolidationscouldresultinimprovementsinquality,access,and
affordability;
(B)opportunitiestoreduceadministrativeburdens,suchas
complexitiesincontractingandpaymenttermsandduplicativequality
reportingrequirements;and
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(C)federal,State,andotherbarrierstoachievingthePlan’sgoals
and,totheextentfeasible,howthosebarrierscanberemovedormitigated.
(c)TheGreenMountainCareBoardshallcontributedataandexpertise
relatedtoitsregulatorydutiesanditseffortspursuantto2022Actsand
ResolvesNo.167.TheAgencyofHumanServicesshallcontributedataand
expertiserelatedtoitsroleastheStateMedicaidagency,itsworkwith
community-basedproviders,anditseffortspursuantto2022Actsand
ResolvesNo.167.
(d)(1)From2025through2027,theAgencyofHumanServicesshall
engagewithstakeholders;collectandanalyzedata;gatherinformation
obtainedthroughtheprocessesestablishedin2022ActsandResolvesNo.167,
Secs.1and2;andsolicitinputfromthepublic.
(2)In2028,theAgencyshallpreparethePlan.
(3)OnorbeforeJanuary15,2029,theAgencyshallpresentthePlanto
theHouseCommitteesonHealthCareandonHumanServicesandtheSenate
CommitteeonHealthandWelfare.
(4)TheAgencyshallprepareanupdatedPlaneverythreeyearsand
shallpresentittotheGeneralAssemblyonorbeforeJanuary15everythird
yearafter2029.
Sec.9.18V.S.A.§ 9403aisaddedtoread:
§ 9403a.HEALTHCAREDELIVERYADVISORYCOMMITTEE
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(a)ThereiscreatedtheHealthCareDeliveryAdvisoryCommitteeto:
(1)establishaffordabilitybenchmarks,includingforaffordabilityof
commercialhealthinsurance;
(2)evaluateandmonitortheperformanceofVermont’shealthcare
systemanditsimpactsonpopulationhealthoutcomes;
(3)collaboratewiththeGreenMountainCareBoard,theAgencyof
HumanServices,theDepartmentofFinancialRegulation,andotherinterested
stakeholdersinthedevelopmentandmaintenanceoftheStatewideHealthCare
DeliveryPlandevelopedpursuanttosection9403ofthistitle;
(4)advisetheGreenMountainCareBoardonthedesignand
implementationofanongoingevaluationprocesstocontinuouslymonitor
currentperformanceinthehealthcaredeliverysystem;and
(5)providecoordinatedandconsensusrecommendationstotheGeneral
Assemblyonissuesrelatedtohealthcaredeliveryandpopulationhealth.
(b)(1)TheAdvisoryCommitteeshallbecomposedofthefollowing14
members:
(A)theSecretaryofHumanServicesordesignee;
(B)theChairoftheGreenMountainCareBoardordesignee;
(C)theChiefHealthCareAdvocatefromtheOfficeoftheHealth
CareAdvocateordesignee;
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(D)onerepresentativeofcommercialhealthinsurersofferingmajor
medicalhealthinsuranceplansinVermont,selectedbytheCommissionerof
FinancialRegulation;
(E)tworepresentativesofVermonthospitals,selectedbythe
VermontAssociationofHospitalsandHealthSystems,whoshallrepresent
hospitalsthatarelocatedindifferentregionsoftheStateandthatfacedifferent
levelsoffinancialstability;
(F)onerepresentativeofVermont’sfederallyqualifiedhealth
centers,selectedbyBi-StatePrimaryCareAssociation;
(G)onerepresentativeofindependentphysicianpractices,selected
jointlybytheVermontMedicalSocietyandHealthFirst;
(H)onerepresentativeofVermont’sfreeclinicprograms,selectedby
Vermont’sFree&ReferralClinics;
(I)onerepresentativeofVermont’sdesignatedandspecialized
serviceagencies,selectedbyVermontCarePartners;
(J)onepreferredproviderfromoutsidethedesignatedand
specializedserviceagencysystem,selectedbytheCommissionerofHealth;
(K)oneVermont-licensedmentalhealthprofessionalfroman
independentpractice,selectedbytheCommissionerofMentalHealth;
(L)onerepresentativeofVermont’shomehealthagencies,selected
jointlybytheVNAsofVermontandBayadaHomeHealthCare;and
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(M)onerepresentativeoflong-termcarefacilities,selectedbythe
VermontHealthCareAssociation.
(2)TheSecretaryofHumanServicesordesigneeshallbetheChairof
theAdvisoryCommittee.
(3)TheAgencyofHumanServicesshallprovideadministrativeand
technicalassistancetotheAdvisoryCommittee.
***DataIntegration;DataSharing***
Sec.10.18V.S.A.§ 9353isaddedtoread:
§ 9353.INTEGRATIONOFHEALTHCAREDATA
(a)TheAgencyofHumanServicesshallcollaboratewiththeHealth
InformationExchangeSteeringCommitteeinthedevelopmentofanintegrated
systemofclinicalandclaimsdatainordertoimprovepatient,provider,and
payeraccesstorelevantinformationandreduceadministrativeburdenson
providers.
(b)TheAgency’sprocessshall:
(1)alignwiththestatewideHealthInformationTechnologyPlan
establishedpursuanttosection9351ofthistitle;
(2)utilizetheexpertiseoftheHealthInformationExchangeSteering
Committee;
(3)incorporateappropriateprivacyandsecuritystandards;
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(4)determinehowbesttointegrateclinicaldata,claimsdata,anddata
regardingsocialdriversofhealthandhealth-relatedsocialneeds;
(5)ensureinteroperabilityamongcontributingdatasourcesand
applicationstoenableaUnifiedHealthDataSpacethatisusablebyall
stakeholders;
(6)identifytheresourcesnecessarytocompletedatalinkagesfor
clinicalandresearchusage;
(7)establishatimelineforsetupandaccesstotheintegratedsystem;
(8)developandimplementasystemthatensuresrapidaccessfor
patients,providers,andpayers;and
(9)identifyadditionalopportunitiesforfuturedevelopment,including
incorporatingnewdatatypesandlargerpopulations.
(c)Healthinsurers,asdefinedinsection9402ofthistitle,shallprovide
clinicalandclaimsdatatotheAgencyofHumanServicesasdirectedbythe
Agencyinordertofacilitatetheintegratedsystemofclinicalandclaimsdata
assetforthinthissection.
(d)TheAgencyshallprovideaccesstodatatoStateagenciesandhealth
careprovidersasneededtosupportthegoalsoftheStatewideHealthCare
DeliveryPlanestablishedpursuanttosection9403ofthistitle,once
established,totheextentpermittedbythedatauseagreementsinplacefor
eachdataset.
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(e)OnorbeforeJanuary15annually,theAgencyofHumanServicesshall
provideanupdatetotheHouseCommitteesonHealthCareandonHuman
ServicesandtheSenateCommitteeonHealthandWelfareregardingthe
developmentandimplementationoftheintegratedsystemofclinicaland
claimsdatainaccordancewiththissection.
Sec.11.18V.S.A.§ 9374isamendedtoread:
§9374.BOARDMEMBERSHIP;AUTHORITY
***
(i)(1)Inadditiontoanyotherpenaltiesandinordertoenforcethe
provisionsofthischapterandempowertheBoardtoperformitsduties,the
ChairoftheBoardmayissuesubpoenas,examinepersons,administeroaths,
andrequireproductionofpapersandrecords.Anysubpoenaornoticeto
producemaybeservedbyregisteredorcertifiedmailorinpersonbyanagent
oftheChair.Servicebyregisteredorcertifiedmailshallbeeffectivethree
businessdaysaftermailing.Anysubpoenaornoticetoproduceshallprovide
atleastsixbusinessdays’timefromservicewithinwhichtocomply,except
thattheChairmayshortenthetimeforcomplianceforgoodcauseshown.
Anysubpoenaornoticetoproducesentbyregisteredorcertifiedmail,postage
prepaid,shallconstituteserviceonthepersontowhomitisaddressed.
(2)EachwitnesswhoappearsbeforetheChairundersubpoenashall
receiveafeeandmileageasprovidedforwitnessesincivilcasesinSuperior
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Courts;provided,however,anypersonsubjecttotheBoard’sauthorityshall
notbeeligibletoreceivefeesormileageunderthissection.
(3)TheBoardmayshareanyinformation,papers,orrecordsitreceives
pursuanttoasubpoenaornoticetoproduceissuedunderthissectionwith
anotherStateagencyasappropriatetotheworkofthatagency,providedthat
thereceivingagencyagreestomaintaintheconfidentialityofanyinformation,
papers,orrecordsthatareexemptfrompublicinspectionandcopyingunder
thePublicRecordsAct.
***
***RetainingAccountableCareOrganizationCapabilities***
Sec.12.RETAININGACCOUNTABLE CAREORGANIZATION
CAPABILITIES;GREENMOUNTAINCAREBOARD;
BLUEPRINTFORHEALTH;REPORT
TheAgencyofHumanServicesshallexploreopportunitiestoretain
capabilitiesdevelopedbyoronbehalfofacertifiedaccountablecare
organizationthatwerefundedinwholeorinpartusingStateorfederal
monies,orboth,andthathavethepotentialtomakebeneficialcontributionsto
Vermont’shealthcaresystem,suchascapabilitiesrelatedtocomprehensive
paymentreformandqualitydatameasurementandreporting.Onorbefore
November1,2025,theAgencyofHumanServicesshallreportitsfindingsand
recommendationstotheHealthReformOversightCommittee.
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***ImplementationUpdates***
Sec.13.AGENCYOFHUMANSERVICES;IMPLEMENTATION;
REPORT
OnorbeforeNovember15,2025,theAgencyofHumanServicesshall
provideanupdatetotheHealthReformOversightCommitteeregardingthe
Agency’simplementationofthisact,includingthestatusofitseffortsto
developtheStatewideHealthCareDeliveryPlan,advancehealthcaredata
integration,andexploreopportunitiestoretainaccountablecareorganization
capabilities,aswellasonitshospitaltransformationactivitiespursuantto
2022ActsandResolvesNo.167andtheeffectsoftheseeffortsandactivities
onVermontersandonVermont’shealthcaresystem.
Sec.14.GREENMOUNTAINCAREBOARD;IMPLEMENTATION;
REPORT
OnorbeforeFebruary15,2026,theGreenMountainCareBoardshall
provideanupdatetotheHouseCommitteeonHealthCareandtheSenate
CommitteeonHealthandWelfareregardingtheBoard’simplementationof
thisact,includingthestatusofitseffortstoestablishmethodologiesforand
beginimplementationofreference-basedpricinganddevelopmentofglobal
hospitalbudgets,andtheeffectsoftheseeffortsandactivitiesonVermonters
andonVermont’shealthcaresystem.
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Sec.15.3V.S.A.§ 3027isamendedtoread:
§3027.HEALTHCARESYSTEMREFORM;IMPROVINGQUALITY
ANDAFFORDABILITY;REPORT
(a)TheDirectorofHealthCareReformintheAgencyofHumanServices
shallberesponsibleforthecoordinationofhealthcaresystemreformefforts
amongExecutiveBranchagencies,departments,andoffices,andfor
coordinatingwiththeGreenMountainCareBoardestablishedin18V.S.A.
chapter220.
(b)OnorbeforeFebruary15annually,theAgencyofHumanServices
shallprovideanupdatetotheHouseCommitteeonHealthCareandtheSenate
CommitteeonHealthandWelfareregardingthestatusofitseffortstodevelop
andmaintaintheStatewideHealthCareDeliveryPlaninaccordancewith18
V.S.A.§ 9403,advancehealthcaredataintegrationassetforthin18V.S.A.
§ 9353,andcoordinatehospitaltransformationactivitiespursuantto2022
ActsandResolvesNo.167,andtheeffectsoftheseeffortsandactivitieson
VermontersandonVermont’shealthcaresystem.
Sec.16.18V.S.A.§ 9375(d)isamendedtoread:
(d)AnnuallyonorbeforeJanuary15,theBoardshallsubmitareportofits
activitiesfortheprecedingcalendaryeartotheHouseCommitteeonHealth
CareandtheSenateCommitteeonHealthandWelfare.
(1)Thereportshallinclude:
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***
(G)thestatusofitseffortstoestablishmethodologiesforandbegin
implementationofreference-basedpricinganddevelopmentofglobalhospital
budgets,andtheeffectsoftheseeffortsandactivitiesonVermontersandon
Vermont’shealthcaresystem;
(H)anyrecommendationsformodificationstoVermontstatutes;and
(H)(I)anyactualoranticipatedimpactsontheworkoftheBoardas
aresultofmodificationstofederallaws,regulations,orprograms.
***
***Positions;Appropriations***
Sec.17.GREENMOUNTAINCAREBOARD;AGENCYOFHUMAN
SERVICES;POSITIONS
(a)(1)Theestablishmentofthefollowingfivenewpermanentclassified
positionsisauthorizedattheGreenMountainCareBoardinfiscalyear2026:
(A)oneDirector,GlobalBudgets;
(B)oneProjectManager,GlobalBudgets;
(C)oneDirector,Reference-BasedPricing;
(D)oneProjectManager,Reference-BasedPricing;and
(E)oneStaffAttorney.
(2)Theestablishmentofthefollowingtwoclassifiedlimited-service
positionsisauthorizedattheAgencyofHumanServicesinfiscalyear2026:
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(A)oneHealthCareReform(HCR)IntegrationManager;and
(B)oneAdministrativeServicesDirectorII.
(3)Thesepositionsshallbetransferredandconvertedfromexisting
vacantpositionsintheExecutiveBranch.
(b)ItistheintentoftheGeneralAssemblytoauthorizetheestablishment
ofanadditionalfivenewpermanentpositionsattheGreenMountainCare
Boardinfiscalyear2027andanotherfivenewpermanentpositionsinfiscal
year2028.
Sec.18.APPROPRIATIONS
(a)Thesumof$1,525,000.00isappropriatedfromtheGeneralFundtothe
AgencyofHumanServicesinfiscalyear2026foruseasfollows:
(1)$250,000.00forgrantstohospitalsasneededfortransformation
effortsinitiatedpursuantto2022ActsandResolvesNo.167andtotransition
theirsystemstoimplementreference-basedpricing;
(2)$100,000.00forexpensesassociatedwithdevelopmentofthe
StatewideHealthCareDeliveryPlan;
(3)$1,000,000.00forcontractsforconsultantsandotherexpenses
associatedwithimplementationofthisact;and
(4)$175,000.00forthepositionsauthorizedinSec.17(a)(2)ofthisact.
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(b)Thesumof$250,000.00isappropriatedfromtheHealthIT-Fundtothe
AgencyofHumanServicesinfiscalyear2026forgrantstohealthcare
providersfordataintegrationinaccordancewithSec.10ofthisact.
(c)Thesumof$1,350,000.00isappropriatedfromtheGeneralFundtothe
GreenMountainCareBoardinfiscalyear2026foruseasfollows:
(1)$850,000.00forthepositionsauthorizedinSec.17(a)(1)ofthisact;
and
(2)$500,000.00forcontracts,includingcontractsforassistancewith
implementingreference-basedpricinginaccordancewiththisact.
(d)Notwithstandinganyprovisionof32V.S.A.§ 10301tothecontrary,
thesumof$150,000.00isappropriatedfromtheHealthIT-FundtotheGreen
MountainCareBoardinfiscalyear2026forexpensesassociatedwith
increasedstandardizationofelectronichospitalbudgetdatasubmissionsin
accordancewithSec.4ofthisact.
***EffectiveDates***
Sec.19.EFFECTIVEDATES
(a)Secs.17(positions)and18(appropriations)shalltakeeffectonJuly1,
2025.
(b)Theremainingsectionsshalltakeeffectonpassage.
***EffectiveDate***
Sec.17.EFFECTIVEDATE
Thisactshalltakeeffectonpassage.
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