Lawmakers, hospitals spar over whether Green Mountain Care Board enforcement should be a 'contested case'

At a legislative committee hearing, hospital representatives, state advocates and members of the Green Mountain Care Board debated whether enforcement of hospital budget orders should be handled as formal “contested cases” under the Vermont Administrative Procedures Act or remain a less formal administrative process.

Devin Green, Vermont Association of Hospitals and Health Systems, told the committee, “The only thing we oppose is the recent proposal from the Green Mountain Care Board on Section 7 around the Vermont Administrative Procedures Act and the contested case language” and said hospitals want a formal notice-and-hearing process so they have “a notice and opportunity to present their case.”

The dispute centers on a provision the Green Mountain Care Board proposed that would clarify budget‑enforcement proceedings are not contested cases — a move the board and some legislators say preserves a quicker administrative remedy. Legal counsel for the committee told members that legislation generally applies prospectively and would not affect an active court case now scheduled for a May 12 hearing.

Why it matters: hospitals argue that as the Care Board moves from budget review toward rate‑setting and reference‑based pricing, enforcement decisions have higher stakes and should include the evidentiary protections of the Vermont Administrative Procedures Act (notice, evidentiary hearing, cross‑examination). Green Mountain Care Board representatives and some committee members said treating budget enforcement as contested cases would substantially increase the time and administrative burden of enforcement, potentially hindering the board’s ability to hold hospitals to their budgets.

Key details from the hearing: - Devin Green said the hospitals are contesting language in Section 7 because the current proposal would “not be considered a contested case, so it would not be formalized. There would be no hearing or evidence or cross examination.” - Multiple witnesses and committee members discussed that in recent enforcement matters the board has both taken enforcement action and that some enforcement matters became litigation. One witness said an enforcement action based on the 2023 fiscal year overage is already in court and has a May 12 hearing; another enforcement matter was dropped after a settlement. - Witnesses noted an unofficial tolerance range historically cited around 1% of net patient service revenue; speakers said the board has in some cases enforced orders and in others rebased budgets rather than penalizing over‑spending. - Several participants said the practical appeal route for disputed budget enforcement currently goes to the courts (Superior Court and then the Supreme Court) and that litigants have had difficulty in the past because a formal administrative record was not created at the board level.

Positions on whether to require a contested‑case process were split: - Hospitals and some advocates asked for a formal contested‑case option to create a clear record and permit evidentiary hearings before appeals to the courts. - The Green Mountain Care Board and some legislators argued that requiring contested cases would be lengthier and more resource‑intensive, potentially delaying enforcement and reducing the board’s ability to hold hospitals accountable.

Committee counsel explained that statutory change would generally apply prospectively and would not automatically alter active court cases, and several lawmakers urged the hospital association and the Care Board to continue negotiating language that could satisfy both parties.

The committee did not take a vote at the hearing; members asked staff and counsel for statutory clarifications and recommended further discussion between the affected parties and the committee as the bill moves forward.