[{"_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",6262595,"mediaKeyId","3114963-e272a760c6f65078f65c927cb649caff","parentId",3114963,"title","Senate panel reviews H.482 giving Green Mountain Care Board authority to cut hospital reimbursement rates and appoint independent observer","audioSeconds",3709,"startMs",1000,"endMs",3710000,"viewUrl","/Search/View?dp=1&key=3114963-e272a760c6f65078f65c927cb649caff&start=1&end=3710","thumbnailUrl","https://assets.pipeline.soar.com/3114963-e272a760c6f65078f65c927cb649caff/thumbnail_1000.jpg","articleUrl","/articles/6262595/Vermont/Senate-panel-reviews-H482-giving-Green-Mountain-Care-Board-authority-to-cut-hospital-reimbursement-rates-and-appoint-independent-observer","mediaUrl","https://secure.pipeline.soar.com/6262595-8a6389fb3313aa62993f04068e6cd03e/orig.mp4?Expires=1771170077&Signature=jJ~ipHLfjSQGCk0XPokJMSYD51Up8YIcpWeIOjdJ8gLiuVjJ7D4oq9etuWvuRaa6pZBUny~T4LfwszdvAqbNjkvZAKqkyCQYwXUI-Qy8NvV2VKLRwHkhAoOpiEaEPLi43pmhxxpv7KeFqylzWNbYg6aOzvoDOR3YrO-S4kmX2oekkUarp4xaqEAOUBQH6VGBP~FE3LIHrZI0SzPIvG6VZNYXb9R~LkHTgRYJhnKSumzQwqeLYxLigdzqfKWGPAOtQ8qzSF9rHVby1ZkQjQRPTVBZ2Ylzgz4pbwLR4Pe6TczTTujb2N~E0yjRTzuJv9UvQlV7mbWnHU0fBlBlhfjvtA__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-04-24T23:59:06.727Z","article","Senator Foster, chair of the Senate Health & Welfare Committee, opened the April 24 hearing on H.482, a bill that would allow the Green Mountain Care Board (GMCB) to reduce commercial reimbursement rates to one or more hospitals after consulting with the commissioner of the Department of Financial Regulation (DFR) if a domestic health insurer faces an acute and immediate threat to solvency.

The bill directs the GMCB to limit reductions to the amount necessary to remediate the insurer threat, and it sets eligibility and floor thresholds tied to hospitals' days cash on hand and operating margins. Under the draft language discussed, a hospital (or hospital network) would be eligible for a reduction only if it has more than 135 days cash on hand or had a positive operating margin in the previous fiscal year; and any ordered reduction could not lower a hospital or network’s projected days cash on hand below 125 days.

The proposal also expands the GMCB’s hospital budget-review authority. The bill would require hospital budgets to reconcile significant revenue deviations from prior years and would permit the GMCB to adjust insurance reimbursement rates during a hospital’s fiscal year to keep a hospital operating within the board-established budget. Separately, the bill would allow the board to appoint an independent observer if it finds that a hospital made a material misrepresentation in documents provided to the board or is materially noncompliant with the budget. The observer would have access to materials the GMCB reviews, could obtain additional information from the hospital (including about participation in a hospital network), report findings to the board and the Office of the Health Care Advocate, and the board could order the hospital to pay some or all observer costs.

\"We don't wanna lose sight of that at the same time. We wanna make sure that we have the appropriate guardrails and information in place,\" Senator Foster said, describing the committee's interest in balancing emergency actions to protect insurer solvency with safeguards for hospitals and their contractual obligations.

Representatives of stakeholders raised several concerns and questions. Sarah Teachout with Blue Cross Blue Shield of Vermont emphasized that the bill would not provide cash to the insurer but would reduce what the plan pays hospitals: \"This section is triggered when our finances are extremely, unstable,\" she said, and the mechanism reduces payout obligations rather than providing an infusion of funds. Evan Green with the Vermont Association of Hospitals and Health Systems and other hospital representatives questioned how the GMCB learned of the issues that prompted the board’s prior use of an independent observer and whether the statute’s finding threshold would be met in similar future circumstances. \"I just believe on the record, Chair Foster testified that it didn't quite meet the standard that is written here,\" Evan Green said of the earlier matter prompting an observer.

Staff and witnesses debated several technical issues the committee asked the GMCB and DFR to clarify before the bill moves forward: how \"materially noncompliant\" would be defined in practice; whether and how bond covenants and other contractual obligations (current and future) should be considered before a rate reduction; whether critical access hospitals should be excluded from eligibility in section 1(c); the appropriate metric to trigger board action (days cash on hand versus a less volatile metric such as net worth); and the appropriate duration for any emergency authority (several witnesses suggested a sunset or periodic review). Sam Pyesh of the Office of the Health Care Advocate questioned use of days cash on hand as the trigger, noting it is volatile and that, based on recent data, only three hospitals would meet a 135-day threshold.

Committee members also discussed process and scope for an independent observer: whether the observer would be a GMCB employee (staff said no), whether the observer would be onsite or perform more limited audit work, confidentiality limits, and the statutory effective dates. Committee members asked the GMCB to provide the written agreement used in the current observer arrangement as background for the committee's deliberations.

The committee requested follow-up information from the GMCB and DFR on the 135-day threshold, the definition of \"materially noncompliant,\" the observer agreement used previously, and whether language is needed to protect hospitals' existing bond covenants. Senators and stakeholders also discussed possible sunset language for the emergency rate-reduction authority and options other than rate reduction, including lump-sum payments, though witnesses characterized lump sums as a less durable remedy.

No formal vote or final action on H.482 was taken at the hearing; the committee recessed the item pending additional testimony and requested materials from the GMCB, the Department of Financial Regulation, the Office of the Health Care Advocate, and outside experts.

The committee said it would reconvene consideration of H.482 after receiving those materials and testimony.","mediaType","Video","parentTitle","Senate Health and Welfare - 2025-04-24- 9:00 AM","oneSentenceSummary","Senator Foster, chair of the Senate Health & Welfare Committee, opened the April 24 hearing on H.482, a bill that would allow the Green Mountain Care Board to reduce hospital reimbursement rates to protect a domestic insurer facing an acute solvency threat and to appoint an independent observer if a hospital materially misrepresented information or was materially noncompliant with a board-established budget.","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},6262590,"Senate panel reviews house changes to S.18, clarifies licensure and coverage for freestanding birth centers",55,3670000,3725000,"/Search/View?dp=1&key=3114963-e272a760c6f65078f65c927cb649caff&start=3670&end=3725","https://assets.pipeline.soar.com/3114963-e272a760c6f65078f65c927cb649caff/thumbnail_3670000.jpg","/articles/6262590/Vermont/Senate-panel-reviews-house-changes-to-S18-clarifies-licensure-and-coverage-for-freestanding-birth-centers","https://secure.pipeline.soar.com/6262590-876bac2ffcba5fb23958889578e3914f/orig.mp4?Expires=1771170077&Signature=Dmc9ZNufVbehKUeX6QGLRl~s05k8kGhaZisbaVi6AEWkrEQHlTFaFrTKsU8THELqqmA3fXJGmWahSyc7-85rym2OP1M4M6izj0Jwp1gq1QPaxZBjJ9JWIRea-Wz0ZwwMbyiTWiqYNNAkn9KEos34oKKoS5naoZLxcFCRcdWBsDrMsNXwyLsN4LIKYFp8b3ci8D3EwiyedJ-p0H4GRLMkF~fo0HDVDaU3rtMe7r1Blxp~2q-9olBaG9FPHh4nuGfq34njiT2b3dlS-~9EsBcWqBcaScHcjTxkAr25k-1pXM6VBBPLLii9DiK678orw2oaw~ZKKJ3pAiZriokHrrynnQ__&Key-Pair-Id=KUT5TJCACFTXG","The Senate Health & Welfare Committee considered House amendments to S.18 on April 24, which would create a licensing framework for freestanding birth centers and clarify what services licensed centers may provide.

Jen Cardi of the Office of Legislative Council summarized the changes the House proposed and the committee considered. The bill establishes a new chapter for birth center licensure and tightens definitions: a certified nurse midwife is defined as an advanced practice registered nurse (APRN) licensed under the APRN subchapter who has specialized training in childbirth, newborn care and reproductive health services. The draft removes a reference to \"doctor of nursing practice\" as a licensure description and clarifies that a birth center may be independently owned by a licensed maternity-care provider or another person who meets the chapter's requirements.

The bill explicitly prohibits birth centers from providing epidural anesthesia or cesarean delivery, aligning the statute with the intended scope of \"low-risk\" birth-center care. The proposed rules would require written policies and procedures for collaboration with hospitals and other providers (including lab and diagnostic services, obstetric and pediatric consultation services, transport procedures, childbirth education, and home health services). The bill would also require a birth center to provide a patient’s or newborn’s health record to receiving providers upon transfer in accordance with privacy law.

S.18 keeps birth centers exempt from the state certificate-of-need process if they are licensed under the new chapter and would add \"birth center\" to the list of settings where midwifery services must be covered by health insurance, while removing a statutory cross-reference that appeared to single out facility fees. The bill delays Medicaid enrollment and coverage for birth-center services until federal approvals are obtained and ties the state effective date to federal timing as requested by the Department of Vermont Health Access.

Committee members noted broad stakeholder consensus reflected in the draft language. \"I have thoughts on it. My understanding is that there was broad consensus among all the various parties,\" said Senator Kulik. After brief questions and a request to carry a one-page summary of agreed changes forward to the floor, the committee signaled concurrence with the House edits and planned to advance the language.

No roll-call vote on S.18 was recorded during the hearing; the committee indicated it would carry the agreed language forward for the committee report and subsequent floor action.","The Senate Health & Welfare Committee reviewed the House's amendments to S.18, which establishes licensing for freestanding birth centers, clarifies midwife definitions and permitted services, requires written collaboration and transfer policies, and preserves Medicaid coverage contingent on federal approval.","actionData","errors"]

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Senate panel reviews H.482 giving Green Mountain Care Board authority to cut hospital reimbursement rates and appoint independent observer

Senate panel reviews house changes to S.18, clarifies licensure and coverage for freestanding birth centers