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Bill would scale back Green Mountain Care Board oversight, create ACO certification and fees
Summary
A bill reviewed by the House Health Care Committee would remove several Green Mountain Care Board duties, expand certification authority over some accountable care organizations and set initial and annual certification fees plus a budget-review fee.
A bill reviewed at the House Health Care Committee meeting on April 29 would remove several oversight duties from the Green Mountain Care Board and create a new certification-and-fee framework for accountable care organizations operating in Vermont. The bill, S.63 as passed by the Senate, would expand the types of ACOs the board can certify and set one-time and annual fees to support that work.
The bill would eliminate the board's statutory duty to review and approve the statewide health information technology plan and certain budget approvals for Vermont Information Technology Leaders (VITL, also referred to in testimony as VITAL). It would also change how the board's regulatory costs are allocated and create certification and budget-review fees for ACOs. Diane Lanfer, director of legislative affairs for the Green Mountain Care Board, said the proposals largely came from board staff as housekeeping and workload adjustments.
The measure would broaden the board's certification authority to include Medicare-only ACOs, while narrowing the scope of the board's detailed review for budgets tied to Vermont Medicaid or commercial payers. Michelle Sawyer, the board's policy project director, said the current statute requires all ACOs in Vermont to submit annual budgets but only required certification for ACOs that contract with Vermont Medicaid or commercial payers. Sawyer said the change is intended to create a better-fitting regulatory approach for Medicare-only, multistate ACOs that already operate under federal oversight and that can enter and leave the state quickly.
The bill also proposes fees the board would collect from ACOs: $10,000 for initial certification and $2,000 annually to maintain certification, plus a $125,000 fee for each ACO budget review when an ACO is operating under Vermont Medicaid or a Vermont commercial payer. Sawyer told the committee that the static fee amounts are intended to provide predictability for ACOs and to reflect the board's estimated staff effort for certification and, separately, for deep budget reviews.
Proponents told the committee that the fee schedule and certification approach would replace some of the current "bill back" mechanism that allocates the board's regulatory costs across state and regulated entities. Diane Lanfer summarized the billback adjustment as maintaining a 40 percent state share while redistributing the nonstate share—raising the hospital portion and slightly increasing nonprofit medical service corporations—to account for the winding down of OneCare's prior allocation share.
Committee members asked how the board would avoid duplicating federal oversight of Medicare-only ACOs. Sawyer said Medicare has its own vetting and monitoring for those ACOs, and the bill would allow Vermont to adopt a streamlined certification process for Medicare-only ACOs that relies where appropriate on federal authorizations. She added that the board would reserve full-budget reviews for any ACO that contracts with Vermont Medicaid or commercial payers, because the state has a particular interest in how Vermont dollars are used.
Several committee members pressed about the fiscal implications. Board staff said the board's current operating budget is composed of a general-fund portion (about $3.9 million) and bill-back recoveries (about $6.0 million) and that the proposed fees and bill-back adjustments were modeled to reflect likely workloads and to avoid enlarging the state's general-fund obligation.
No formal committee action or vote occurred during the hearing. Board staff also proposed a modification to the bill's timing: retain the board's existing oversight of OneCare through the end of 2025 and set an effective date in 2026 or 2027 for the new certification regime so that the board does not lose regulatory authority over an ACO that remains active through year-end.
The committee did not take immediate action; staff said they would circulate proposed amendments and fiscal analyses for further review.
