[{"_1":2,"_87":-5,"_88":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},"mediaId",6324350,"mediaKeyId","2338480-1bafb3a27e260b6a78bd339796ed9607","parentId",2338480,"title","Committee debates freestanding birth-center licensure; health department warns rules and inspections will take time","audioSeconds",4486,"startMs",2356000,"endMs",6842000,"viewUrl","/Search/View?dp=1&key=2338480-1bafb3a27e260b6a78bd339796ed9607&start=2356&end=6842","thumbnailUrl","https://assets.pipeline.soar.com/2338480-1bafb3a27e260b6a78bd339796ed9607/thumbnail_2356000.jpg","articleUrl","/articles/6324350/Vermont/Committee-debates-freestanding-birth-center-licensure-health-department-warns-rules-and-inspections-will-take-time","mediaUrl","https://secure.pipeline.soar.com/6324350-a6216eaab693543523256ed563c2e669/orig.mp4?Expires=1777742947&Signature=XIGzKAjT0nunP5M3MwC1cBpPQETdUpQf5~BoS5NP7Bt63bLmfCXYeq2RuuOesiYNEa07fMJXiBS1FikFxdMZh3V0Lj8Ww~0~oevDYhS4I0MmrAz~gKDjgGzxWbra6ha3RuEEew5nyWrQxi79LeCBuCVhVxSVF59UAWc3cu7UpQREIxqAfOtBk9TcI-NfOGZuuo4XtJO95TzD1TnaVl4kf~HHY2LwRb~SZQZO37qwzUfrcl171n-9hgpsWxxTNtOTc0ETygi2uU0iLg6Cw5hKdhfBieEg0PM9G4exReyjxt-rW-Y~2kjZ9MjLjtciKiauOPifPWo8JthxgLayeVvb2Q__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-02-19T08:59:22.213Z","article","The Vermont Senate Health & Welfare Committee took testimony Feb. 18 on S.18, a bill to license freestanding birth centers in Vermont, a measure supporters said would expand birthsetting options and produce better outcomes for low-risk pregnancies.

Lauren Raymond, general counsel for the Vermont Department of Health, told the committee the agency “is very supportive of increasing access to choice for birthing individuals” but warned that licensing will require detailed rulemaking, inspection protocols and enforcement resources. “A licensing program is more than just issuing a license,” Raymond said; the department wants authority to adapt national guidelines to Vermont practice and to clarify how a facility’s permitted scope will be defined and inspected.

Dr. Peter Stewart, a board-certified OB-GYN at North Country Hospital in Newport, said he supports reproductive choice but urged caution on how licensing might affect rural hospitals and regionalized maternal care. Stewart said some provisions in the house version of the bill referenced standards he did not find in national guidance and stressed the need for strong transfer agreements and hospital relationships in areas where tertiary care is distant. “A low-risk patient can very quickly move into a high-risk patient,” Stewart said, urging clear plans for rapid transport and hospital backup.

Laurie Foster, a midwife and legislative liaison for the Vermont affiliate of the American College of Nurse-Midwives, said birth centers produce better outcomes for many low-risk families and are in statewide demand. “I strongly support S.18, and I encourage the committee to pass it as it's written,” Foster said, citing lower cesarean rates in birth-center settings and community survey results showing broad public support. Witnesses for the birth-center coalition emphasized that most birth-center births represent care that otherwise would be provided out-of-area or as home births, and that centers typically collaborate with local hospitals for laboratory, imaging and transfer services.

Committee members pressed to quantify rural transport and capacity concerns. Dr. Stewart said rapid obstetric emergencies can unfold in minutes and suggested 15–20 minutes as a practical limit for emergency access to higher-level care; committee members asked the Department of Health and advocates to identify specific guardrails and data the panel can use during markup.

The Department of Health asked for time to work with bill sponsors on language to: specify rulemaking authority; define the facility scope of practice apart from provider scope; set inspection and enforcement expectations; and resolve whether existing licensure fees and a $250 license fee in the draft will fund administration and inspections. Raymond said some inspection standards typically rely on federal CMS rules (not applicable to birth centers), so Vermont will need to develop state rules, training and inspection procedures.

Committee members acknowledged the role of broader hospital transformation work and recommended collecting and sharing regional birth-location data — for example, how many local births occur in hospitals versus out-of-area facilities — to better estimate the potential effect of licensure on rural hospital maternity volumes. The committee did not vote; sponsors and agencies were asked to submit written recommendations and data before a scheduled markup.

","mediaType","Video","parentTitle","Senate Health and Welfare - 2025-02-18 - 10:00AM","oneSentenceSummary","The Senate Health & Welfare Committee heard testimony Feb. 18 on S.18, legislation that would license freestanding birth centers in Vermont, drawing support from midwives and caution from the Department of Health and hospital clinicians about rulemaking, inspections and rural transfers.","taxTitle","Health & Welfare, SENATE, Committees, Legislative , Vermont","taxId",38585,"location","Vermont","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6324356,"Senate Health & Welfare reviews medical-debt bill; lenders raise concerns about broad definition",2157,85000,2242000,"/Search/View?dp=1&key=2338480-1bafb3a27e260b6a78bd339796ed9607&start=85&end=2242","https://assets.pipeline.soar.com/2338480-1bafb3a27e260b6a78bd339796ed9607/thumbnail_85000.jpg","/articles/6324356/Vermont/Senate-Health-Welfare-reviews-medical-debt-bill-lenders-raise-concerns-about-broad-definition","https://secure.pipeline.soar.com/6324356-53b463a6d86fb046bf9368c3e1a21b2a/orig.mp4?Expires=1777742947&Signature=KWPkPHfTV9JowTsbiotGQkszdZGOwQZ27DX050DeFapLTwAMPB1UIu~LWNQ3ILwynx8cILx3Mbg-ct-N-1mU7tDcXqNWNntqV7QfmOdhYp0GW06Ola45J~XX50sPUewYCj0XPEVaaHxrYMrZ7tmrodOj~ZkRbPT~cOhwjNcz3xUp2FpZs6dRvDrXeB2TPls3Sz9fSHKwzkNcyLYXpF8ASVLLmUkOvX1erNJbtOmcujNWv~tBu7BfpfhJnNNo1oKuu2Wmj2fd87CvdBy5-SKeFvM~GdJH0jJCNhKFNjNjrshy~SunujM-FFBh-ROcvRmZBMUU2n321tUcBlkyKHZeMQ__&Key-Pair-Id=KUT5TJCACFTXG","The Vermont Senate Health & Welfare Committee heard extended testimony Feb. 18 on S.27, legislation that would allow a nonprofit to forgive medical debt and create reporting and notice procedures aimed at giving relief to Vermonters with unpaid hospital and provider bills.

Supporters, including the Office of the Health Care Advocate and hospital representatives, told the committee the proposal could provide meaningful relief to people saddled by hospital bills and urged the committee to consider related state actions to draw down federal funds. Critics including the Vermont Bankers Association warned the bill’s current wording could sweep in consumer debt not directly owed to medical providers.

Mike Fisher, the state’s health care advocate, described ACT 119 of 2022 — the patient financial assistance and medical debt protections law that took effect July 1, 2022 — as groundwork that standardized hospitals’ financial assistance eligibility and discount levels. “Act 119 … prohibited the sale of medical debt by large health care facilities and set minimum standards for financial assistance programs,” Fisher said, noting hospitals must now offer a range of discounts tied to federal poverty levels.

Chris Delia, president of the Vermont Bankers Association, said he supports the bill’s first section — money that the treasurer would administer to reduce outstanding provider-consumer debts — but raised concerns about the bill’s later sections that define which obligations qualify. “If a consumer uses a credit card or a home-equity loan to pay a medical expense, that credit or loan could be swept up into this,” Delia said, arguing that lenders could not reliably distinguish medical from nonmedical uses of general-purpose credit and that reporting requirements could create unintended credit-reporting consequences.

A representative of the Vermont Association of Hospitals and Health Systems told the committee hospitals back the concept and urged full funding for measures that would reduce uncompensated care. The witness said the state’s Disproportionate Share Hospital (DSH) match is underfunded: “There’s a special fund … our limit is $44,000,000. We only fund up to $22,000,000 for that, so we are leaving federal dollars on the table,” the witness said, summarizing hospital finance concerns and the size of uncompensated care documented in regulated hospital reports.

Office of the Health Care Advocate witnesses recommended several technical changes to S.27 to improve outreach and reduce unintended consequences. Their suggestions included requiring notice to individuals whose debt is forgiven about existing hospital financial assistance programs and clarifying that large health care facilities should not pull consumer credit reports to determine eligibility for financial assistance. They also asked the committee to consider whether the program should include non-hospital medical debts that enter collection and whether the treasurer’s nonprofit partner should be structured to identify debts originated by ambulance services, dental offices or independent provider practices.

The committee did not take formal votes on S.27 at the hearing. Members said they will use the testimony and follow-up hallway discussions with the treasurer’s office and stakeholders to refine language ahead of a scheduled markup.

Evidence in the hearing showed broad agreement on the bill’s intent but varied views on implementation details: hospital and consumer-advocate witnesses urged steps that would increase access to financial assistance and screen patients earlier, while bankers and lenders asked the committee to narrow statutory definitions to avoid capturing general secured or unsecured consumer credit tied to nonmedical purchases.

Committee leadership closed testimony by asking advocates and agencies to supply written language and data for the mark-up session, and to identify whether funding increases (for example to the DSH match or Medicaid rates) would be needed to preserve hospital capacity while expanding consumer protections.

Votes at the hearing: none recorded. The committee scheduled further work and a markup when members will incorporate the technical clarifications and any statutory language changes suggested by stakeholders.","The Senate Health & Welfare Committee took testimony on S.27, a bill to allow a nonprofit to forgive certain medical debt and to set notice/reporting requirements. Supporters said it could relieve Vermonters while hospital and banking representatives urged narrowing the bill’s definition of “medical debt” and raised implementation questions.","actionData","errors"]

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Committee debates freestanding birth-center licensure; health department warns rules and inspections will take time

Senate Health & Welfare reviews medical-debt bill; lenders raise concerns about broad definition