Senate panel reviews bill to expand Office of the Health Care Advocate’s role and access to information

Jen Harvey of the Office of Legislative Council walked the Senate Health and Welfare Committee through the House bill that updates and broadens the Office of the Health Care Advocate’s statutory role.

“So now we will walk through the bill,” Harvey said at the start of her presentation.

The measure revises Title 18 statutory language to expand the office’s focus beyond health insurance to a broader charge on access to health care and affordability. At the hearing Harvey and other participants described changes that would strengthen the office’s ability to participate in rate review, certificate-of-need (CON) proceedings, and state policymaking that affects health care access.

Why it matters: the Office of the Health Care Advocate assists Vermonters with insurance and access problems, files public comments in regulatory proceedings and may intervene in CON cases. The bill would codify and expand that role, clarify confidentiality rules for sensitive materials, and require state agencies to facilitate meaningful participation by the office in matters of significant state policy.

Key changes noted by Legislative Council

- Rate review questions: Under current law the office may submit suggested questions to the GMCB for its contracting actuary; the bill would allow the office to submit questions “with a substantial relationship to the rate filing and review criteria” that the board shall ask the insurer directly or through a contracting actuary.

- Certificate-of-need participation: If the Office of the Health Care Advocate or the long-term care ombudsman files a notice of intervention in a CON application, the bill would give the office the right to receive copies of materials related to the application. Legislative Council said proposals remain under discussion about whether the office should be able to question GMCB staff directly; regulators have signaled concerns about that narrower proposal and a deletion is expected.

- Broader statutory mission and duties: The bill expands statutory language to refer to Vermonters generally and to matters of both health insurance and access to health care. It would allow the office to pursue administrative, judicial and other remedies on behalf of individuals experiencing problems with health insurance or access to health care and to represent interests before the GMCB, the Department of Financial Regulation (DFR), and other state agencies.

- Confidentiality and consent: The bill reinforces that the office must maintain confidentiality for information received and acknowledges that certain agencies—most notably the Agency of Human Services when acting in a Medicaid capacity—may require written consent from an individual or their legal representative before releasing protected records.

- Agency duties and access: The bill states legislative intent that state agencies consult the office on matters of significant state health policy and obliges agencies to comply with reasonable requests for information and assistance; it also provides a path for the office to access confidential or proprietary information when appropriate, subject to legal limits and non-disclosure obligations.

- Conflicts of interest and reporting: The bill would require the office to report potential conflicts of interest to the Agency of Human Services (which holds the contract with the office) and clarifies that unpaid service on certain nonprofit boards is not a per se conflict.

- Effective date: The bill would take effect July 1.

What committee members asked and next steps

Committee members asked whether the changes require additional appropriation; Legislative Council and the presenter said much of the work is already being done by the office and that the bill primarily codifies existing practice. Harvey noted there are pending technical edits and that stakeholders (GMCB, DFR, AHS, Vermont Legal Aid) are continuing discussions about specific wording, including narrow deletions related to questioning board staff.

Toward the end of the session Harvey summarized the bill’s practical effect: “It’s gonna be a really powerful health care advocate. Okay. It's a great help.”

Committee staff said they will schedule further briefings with the Office of the Health Care Advocate, GMCB and other affected agencies; no committee vote was recorded in the transcript.