Senate Health and Welfare to present House amendment: hospital budget reviews not a 'contested case' and appeals routed to Vermont Supreme Court

The Senate Health and Welfare Committee on May 20 agreed to present a House amendment to S.63 that specifies the Green Mountain Care Board’s review, establishment and enforcement of hospital budgets “is not” a contested case and adjusts appeal procedures, while delaying parts of the bill that affect accountable care organization certification.

The amendment matters because it clarifies which procedural rules apply when the board sets or enforces hospital budgets, affect the route and timing for appeals by hospitals, and alters effective dates for certification of certain ACOs — changes that the board says are needed to preserve its public meeting-based budget process.

Jen Harvey, legislative counsel with the Office of Legislative Council, told the committee the House proposal contains two main amendments. First, language restored to section 7 would specify that the board’s review, establishment and enforcement of hospital budgets should not be treated as a contested case under the Administrative Procedures Act; instead, parties may appeal by the board’s general appeal statute (18 V.S.A. § 9381) after final board action. Second, the amendment staggers effective dates: certification rules for Medicare-only ACOs would take effect Jan. 1, 2027, while the other budget-review changes would take effect Jan. 1, 2026, to allow the board time to implement the changes.

“Every year the board establishes budgets for the hospitals. Hospitals are required to operate within those budgets,” said Michael Barber, general counsel for the Green Mountain Care Board. Barber described the existing practice as a public, transparent process in which the board hears from hospitals, the health care advocate and the public before deliberating in open session. He said the amendment would allow the board to continue that public process for both budget establishment and enforcement.

Committee members discussed the difference between a “contested case” — an adversarial hearing format with rules of evidence and cross-examination under the Administrative Procedures Act — and the board’s longstanding public meeting process. Harvey said the amendment makes the determination that the contested-case procedures are not the required mechanism for hospital budget review and enforcement going forward; she also cautioned the change would be prospective and would not resolve ongoing litigation that alleges contested-case procedures should have applied in past matters.

Barber said the amendment also moves the post-order appeal venue for enforcement from superior court to the Vermont Supreme Court under the board’s general appeal statute, a shift he said hospitals have not opposed. The committee did not record a formal roll-call vote; members were polled informally by hand-raise and the committee chair said she would present the concurrence on the Senate floor.

The committee’s action is procedural: it concurred with the House amendment language and will seek floor consideration. Ongoing litigation over whether contested-case procedures applied historically was discussed as unaffected by the committee’s prospective change.

The committee also discussed practical implementation timing for the ACO certification provisions and the board’s need for rollout time; no budgetary numbers or additional implementation dates beyond those in the amendment were provided in committee remarks.