[{"_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",6261801,"mediaKeyId","3117611-be6fcc7f86053b2e687e40a939bc21b2","parentId",3117611,"title","DVHA outlines Medicaid path toward hospital global budgets as OneCare winds down","audioSeconds",993,"startMs",2994000,"endMs",3987000,"viewUrl","/Search/View?dp=1&key=3117611-be6fcc7f86053b2e687e40a939bc21b2&start=2994&end=3987","thumbnailUrl","https://assets.pipeline.soar.com/3117611-be6fcc7f86053b2e687e40a939bc21b2/thumbnail_2994000.jpg","articleUrl","/articles/6261801/Vermont/DVHA-outlines-Medicaid-path-toward-hospital-global-budgets-as-OneCare-winds-down","mediaUrl","https://secure.pipeline.soar.com/6261801-f8b03691e773468b41d42e0ee5cd2e92/orig.mp4?Expires=1775400409&Signature=Da0EIG~1KVz42fo4MPvD4hHDWJq6YaDFOygzFPTZgYWcbGCHesQz70kaH4w3cWGLr04q9x2PzSfLKXD6mAlEdFkpmRzxcHGjQvRhGgCuenUKQq4v6s2Op8duS2viaohX6d6cRpX28ytEJ~9dpvmZEq-J6VppQ6MYMRpZ8NYE-pOmppWb82KnZ~IoWCXbgn8aNN-oKgyiDwuQ1ArT1NI0zyi6gZy-adBaMjT7PV~sDIb3-wp3aagodF1eG9QP-xJvaMtkpcfjum~EKvGiIr4yKYWH7ZNU7CY~xbE6laoaAtB3WVaddvbRQ-BcmMe6WV05T0sNzcMDE1UmocDsiV5rKw__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-04-25T03:45:56.723Z","article","Alicia Cooper, director of Managed Care Operations at the Department of Vermont Health Access, told the House Committee on Health Care that DVHA has implemented fixed prospective payments for hospitals through its Vermont Medicaid Next Generation ACO program and began a complementary Global Payment Program pilot in 2024. \"We began our thinking about hospital global budget methodologies in tandem with the state's negotiations for the AHEAD model,\" Cooper said, noting the department is developing a Medicaid hospital global budget methodology to align with Medicare requirements for hospital global budgets.

Cooper said the department views hospital global budgets as an evolution of the fixed-payment approach that will preserve revenue predictability for hospitals, continue incentives for value and population health, and offer budget predictability for Medicaid. \"Hospital global budgets represent an evolution of fixed payments for hospitals from where we have been to date with our ACO program,\" she said.

She told lawmakers that a small number of hospitals — \"I believe 4 or 5\" — are participating in the Global Payment Program pilot and that, for participating hospitals, DVHA and OneCare are delivering fixed payments that cover the vast majority of Medicaid revenue for those hospitals. For those hospitals, Cooper said, fee-for-service payments largely cease for included services and fixed payments are intended to cover total cost of care aside from specific exclusions (for example, retail pharmacy services remain on fee-for-service in many cases because they are not included in the department's total cost definition).

Committee members asked how the global payments are calculated and how outlier high-cost cases are handled. Cooper said the fixed payments derive from historic expenditure analysis and the Medicaid program's rate-setting work with OneCare: DVHA estimates projected spending for an attributed population and issues fixed monthly payments to the ACO, which then distributes funds to participating hospitals and providers under its contractual arrangements. Cooper said the current ACO framework includes mechanisms to shield participants from exceptionally high-cost individuals by using thresholds and protections baked into historical experience; hospital global budget methodologies include different adjustment approaches to reflect population risk and other factors.

DVHA staff disclosed that they have requested $250,000 over two years to support development of Medicaid hospital global budgets and alternative payment models; Cooper said DVHA plans to implement a Medicaid hospital global budget in January 2026 and intends to align Medicaid methodology with commercial hospital global budgets proposed in S.126 where feasible. \"DIVA intends to implement a Medicaid hospital global budget in January 26, aligning both the requirements of the AHEAD model and the commercial hospital global budgets proposed in this legislation,\" Cooper said.

No formal committee vote was held. Committee members asked for more detail on the number of participating hospitals, the treatment of outlier cases, and whether appropriations are needed for work DVHA is already conducting; Cooper said DVHA will provide follow-up documentation, and the agency will coordinate with AHS on budgetary components and fiscal notes.

Why this matters: As OneCare winds down and the ACO model changes, DVHA is planning to preserve certain fixed-payment functions and to expand a hospital global budget approach for Medicaid. That shift could affect how Medicaid pays hospitals, the predictability of hospital revenue, and state budget forecasting.

Ending: DVHA agreed to provide additional written materials and to confer with AHS and legislative fiscal staff to clarify how the requested $250,000 will be used and which hospitals are currently participating in the pilot.","mediaType","Video","parentTitle","House Healthcare - 2025-04-24 - 1:50 PM","oneSentenceSummary","Alicia Cooper, director of Managed Care Operations at the Department of Vermont Health Access, told the House Committee on Health Care that DVHA has implemented fixed prospective payments through its Next Generation ACO work and a Global Payment Program pilot and is developing a Medicaid hospital global budget methodology.","taxTitle","Health Care, HOUSE OF REPRESENTATIVES, Committees, Legislative , Vermont","taxId",30956,"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},6261806,"Green Mountain Care Board urges one consolidated report, requests staff and contractor funding tied to S.126",2674,141000,2815000,"/Search/View?dp=1&key=3117611-be6fcc7f86053b2e687e40a939bc21b2&start=141&end=2815","https://assets.pipeline.soar.com/3117611-be6fcc7f86053b2e687e40a939bc21b2/thumbnail_141000.jpg","/articles/6261806/Vermont/Green-Mountain-Care-Board-urges-one-consolidated-report-requests-staff-and-contractor-funding-tied-to-S126","https://secure.pipeline.soar.com/6261806-1ee146ab5e09f85c8f3836185eeb9622/orig.mp4?Expires=1775400409&Signature=CDYwRWEDc-HSln13P5qA-mDZ90WoycfFVU0W6lPvP4jIsG7iqLndfl~R61neYkXRGy1KoBTDs1ug1fBiJ73cznfY4KX5y9GAKz-xYRbNksLXytBfH86F1kS~poZXj4ILe8PvxPg3IPVuzkOTVle3avBEWgVaBOCDSutFhbgsX9T2Hm4~Od62oAaviwr6SVDbMFvzZQmZ~LVcpZgYQt83hp~06cSd6iP6PHG7-7Ul2DSVA7tDK8yAWsPThnM0tCSPnwUI4kks3DnT8y9buJtR55J9GyrHgNtClNsg8zRXKEiplRsDlDVyBd92FH7u3jJOae8PVvJ67Ex-K2XHMd~gLg__&Key-Pair-Id=KUT5TJCACFTXG","Susan Barrett, executive director of the Green Mountain Care Board, told the House Committee on Health Care on April 15 that sections of S.126 create overlapping reporting deadlines and suggested consolidating them to make the information more useful to lawmakers. \"The annual report every year is released on January 15, so this report would come out on 01/15/2026,\" Barrett said, noting section 16 would produce a January report while section 14 would require a separate February 15, 2026, update.

Barrett said the board prefers using the February 15 date for an initial implementation report and then adding an annual reference-based pricing update to the board's January annual report starting in 2027. \"We could take the G in section 16 and just have that begin on January,\" she said in discussion with committee members and counsel. The proposal would avoid duplicative reporting in the first year while establishing an ongoing annual entry point.

The board described staffing and contracting resources it says are necessary to support the statute's work if S.126 advances. Barrett said the governor's recommended budget already includes three general positions for the board — a financial analyst, a quality position and an access position — that are intended to support current board responsibilities but are not targeted to S.126 work. For S.126 specifically, the board said it is seeking three positions: a director of reference-based pricing, a project manager for reference-based pricing, and a procurement/operations position to handle contracting and administrative requirements. \"The director will lead the work building the methodology for reference based pricing... the project manager will assist the director in all of those layers of work,\" Barrett said.

Jean Setter, administrative services director at the board, told the committee the board currently has 33 positions including five board members (28 staff) and an operating budget that Barrett characterized as roughly $10 million. Barrett said a substantial portion of the board's budget supports two databases the board stewards — the health care claims database and the hospital discharge database — and that the board also contributes $510,000 annually toward funding the Office of the Health Care Advocate via the Agency of Human Services contract process.

On contracts, board staff described two line items that have been moved into the fiscal budget: roughly $500,001 for a contractor to help set up reference-based pricing methodology and a $150,000 appropriation from the Health IT Fund to support standardization of electronic hospital budget data submissions. Barrett said the $150,000 would be used to hire a contractor to transform and normalize hospital-submitted budget data so the board can make more consistent, automated apples-to-apples comparisons across hospitals during budget review. \"We would hire a contractor to work on our system so that that information would be more apples to apples,\" she said.

Michael Barber, general counsel for the Green Mountain Care Board, described section 11 of S.126, which would amend 18 V.S.A. § 9374 to make explicit the board's ability to share subpoenaed or produced records with other state entities. \"We support this section,\" Barber said, and asked a minor expansion in draft language to allow sharing not only with state agencies but also with state officers (for example, the state auditor), provided the receiving party agrees to maintain confidentiality.

No formal vote was taken during the committee hearing. Committee members asked clarifying questions about staffing numbers, the scope of contractor work, and whether the reporting changes would create duplicative annual filings; board staff proposed technical drafting fixes and an initial one-month extension for the first-year implementation report followed by annual reporting in the board's January report thereafter.

Why this matters: The board regulates hospital budgets and stewards statewide health data. Lawmakers must balance timetables for receiving implementation information with the board's capacity to build methodologies, hire technical staff, and procure contractor support without duplicative reporting. The committee indicated willingness to coordinate draft language with legislative counsel to avoid redundancy.

Ending: The committee accepted the board's recommendation to coordinate with legislative counsel on drafting the reporting language and to consider the board's staffing and contracting requests as the budget process continues. Board staff said they will work with counsel and the committee on revised statutory language and timing.","Board staff recommended merging overlapping reporting deadlines in S.126, outlined three planned reference-based pricing positions, and described two contract requests — one roughly $500,001 for reference-based pricing support and $150,000 from the Health IT Fund to standardize hospital budget data submissions.","actionData","errors"]

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DVHA outlines Medicaid path toward hospital global budgets as OneCare winds down

Green Mountain Care Board urges one consolidated report, requests staff and contractor funding tied to S.126