Committee backs Agency of Human Services to lead statewide health-care delivery plan but funding, roles remain unresolved

Members of the committee reviewed language in S.27 establishing a statewide health-care delivery plan and indicated support for housing the work at the Agency of Human Services, while leaving funding and contractor roles unresolved.

Jen Carvey, Office of Legislative Counsel, opened the discussion on the bill and amendments and outlined the House proposal to delete a separate budget-moving section: "the house is proposing to concur in your house proposal of amendment with further proposal of amendment by striking out section 2," she said, and explained the deletion is tied to separate budget action downstairs.

The committee then turned to section 8, the statewide health-care delivery plan. Members repeatedly emphasized that the plan must be measurable and accountable. "I am fully in favor of it being housed in AHS," said a committee member, adding that the work should be "expedient and measurable, and accountability" must be written into the section. Several speakers pressed for language that requires performance metrics and clear reporting so the plan can inform other statutory duties.

Diane Greenberg, Green Mountain Care Board, told the committee she would check existing contracting relationships and cautioned that budget changes happening elsewhere could affect the resources available for the plan: "I can see if we have any contracting with them, but I would stress . . . that as live things are happening downstairs . . . all of that work will impact particularly this particular bill because of the resources that are in there."

Committee members discussed whether the plan should set annual targets for total cost of care. The Green Mountain Care Board urged limiting the Agency of Human Services' role on cost targets, and the committee agreed to strike language that would have had AHS set reasonable annual cost-growth rates, leaving the Board's participation and reporting duties intact. One committee member summarized the dispute: whether the statewide plan should recommend targets or have authority that other statutory actors must follow.

The committee also debated the role of the Vermont primary care body (referred to in testimony as BPQHC/VPQHC). BPQHC proposed language to embed quality-improvement methods and to serve as a technical/convening partner on measures and evaluation. Jessica Barnard, Vermont Medical Society, said the society proposed giving primary care an elevated, central role in the planning work so that issues like prior authorization and EMR interoperability do not remain siloed: "We really think primary care needs to have a central role in creating that plan."

Members discussed possible contracting structures and potential appropriation amounts raised in testimony. Speakers mentioned a $500,000 line envisioned for contracting in a Senate version, a separate request of $2,250,000 mentioned by AHS for broader planning work, and smaller sums discussed (for example, $50,000) to fund BPQHC contributions. Nolan, fiscal staff, reminded the committee that the bill's money is within the appropriations bill and that final funding and allocation would be negotiated in the budget process: "the money for this bill is in the appropriations bill, so it's gonna be within the context of that call."

On governance, several members proposed either formalizing the existing primary care advisory group or creating a new, statutorily recognized committee to give primary care providers a clearer seat at the table. Testimony said some primary-care advisory groups currently advise the Green Mountain Care Board but that many primary-care issues fall outside the Board's regulatory remit and instead involve AHS or the Legislature.

No formal vote was taken on section 8 during the discussion recorded in the transcript. Committee members asked staff to draft clarified language that integrates BPQHC recommendations on measurement and accountability and to circulate that language so fiscal offices and stakeholders can respond with more precise cost estimates before the bill is finalized.

The committee moved on after agreeing to refine the language and to seek prompt fiscal detail to support any contracting or appropriations requested.