Senate Health & Welfare advances H.96 to raise CON threshold to $10 million, adds state-project notice

Montpelier — The Senate Health & Welfare Committee on April 8 voted to report H.96 favorably, advancing an amendment that raises the monetary threshold for certificate-of-need (CON) review to $10,000,000 and makes several structural changes to Vermonts CON law.

The amendment, offered as draft 1.3 by Jen Furby of the Office of Legislative Counsel, combines separate hospital and non-hospital provisions into a single definition so all "health care facilities" are treated the same under the monetary threshold. "We are looking at an amendment to H 96, which is an act relating to increasing the monetary thresholds for certificates of need," Furby said while walking the committee through the draft.

Under the amendment, ambulatory surgical centers would fall under the same $10,000,000 threshold that applies to other health care facilities after the stand-alone ambulatory-surgical provision is repealed. The bill also creates a new exclusion: facilities or services that are owned or operated by the State of Vermont, or are funded in whole or in substantial part by a state contract or grant, would not have to obtain a certificate of need. That exclusion is conditioned on a notice requirement: state agencies sponsoring such projects must inform the Green Mountain Care Board either prior to commencing the project or within 30 days following execution of the contract or grant.

The amendment sets the act to take effect on passage and applies to projects initiated on or after that date. Projects already in process on the date of passage for which an interested party has been granted would continue to operate under the existing rules; where no interested party has been granted, the applicant may withdraw.

Committee members discussed whether the Green Mountain Care Board should be required to "periodically adjust" monetary thresholds (language in current statute permits the board to do so). Some senators, and witness Mike Fisher, suggested stronger language such as "shall" or an annual requirement; others expressed concern that a mandatory schedule would be difficult to define. Furby noted the statute currently permits the board to make adjustments tied to the cumulative Consumer Price Index, and the committee left the permissive language in place.

A fiscal note presented to the committee said the board has collected about $50,000 per year over the past seven years in CON-related filing fees and estimated the bill could reduce revenue by roughly $20,000 per year on average. Fees are currently calculated at 0.125% of project costs and have ranged from a minimum of $250 to a maximum of $20,000. The Green Mountain Care Board told staff it could absorb the projected revenue loss and that fewer CON reviews would free staff time for other work.

On a motion to report draft 1.3 of H.96 favorably out of committee, the roll call recorded five affirmative votes: Senator Hart (yes); Senator Cummings (yes); Senator Douglas (yes); Senator Buick (yes); and Senator Hawkins (yes). The committee did not record a named mover or seconder in the transcript.

Why it matters: raising the CON threshold reduces the number of projects that must undergo formal state review and potential public hearings; including ambulatory surgical centers under the higher threshold and exempting state-sponsored projects narrows the scope of projects subject to board review while keeping the board informed through the notice requirement.

Votes at a glance: Motion to report H.96 (draft 1.3) favorably out of committee — outcome: approved. Recorded roll call: Hart, Cummings, Douglas, Buick, Hawkins — all "yes."