Senate committee reviews bill to raise Vermont certificate-of-need thresholds

Representative Marie Flores introduced H.96 to the Senate Health & Welfare Committee on March 26, asking lawmakers to raise monetary thresholds that trigger Vermont’s certificate-of-need (CON) review and to add several targeted exclusions.

The bill would increase several dollar thresholds that determine when health-care projects must obtain a CON from the Green Mountain Care Board, Representative Marie Flores said. Flores said the intent is to reduce ‘‘regulatory burden’’ on providers and help the board focus on larger reviews while speeding projects that affect rural access to care.

Jen Harvey of the Office of Legislative Counsel walked the committee through the bill’s statutory changes and transitional rules. Harvey said the bill converts the statutory thresholds into a mandatory indexed standard and described how applications already in process would be handled after the bill’s July 1, 2025 effective date: ‘‘If one or more persons have been granted interested party status, then the jurisdictional thresholds and exclusions in place at the time the application was filed will continue to apply until a final decision is made on the application.’’

Key changes described to the committee include (numbers and language as presented in committee): - For health-care facilities other than hospitals, the capital-expenditure trigger would increase from $1,500,000 to $10,000,000. - Purchase, lease or comparable acquisition of a single piece of diagnostic or therapeutic equipment would increase from $1,000,000 to $5,000,000. - For hospitals, the capital-expenditure trigger would increase from $3,000,000 to $10,000,000; the threshold for diagnostic and therapeutic equipment would move from $1,500,000 to $5,000,000; and operating-expense triggers discussed in the bill text move toward higher thresholds (transcript discussion referenced a change using $1,000,000 and $3,000,000 figures). - The bill would establish a $10,000,000 monetary threshold for ambulatory surgical centers (statutory language previously had no dollar trigger for those centers). - The conceptual development phase CON threshold would rise from $30,000,000 to $50,000,000, allowing applicants to pursue preliminary architectural and planning expenditures before a full CON.

The bill also adds or clarifies exclusions: routine replacement of fully depreciated medical equipment would be excluded from CON jurisdiction; nonmedical equipment and fixtures would be excluded regardless of remaining useful life; and emergency and nonemergency ground ambulance services, affiliated agencies, equipment and supplies used by emergency personnel would be excluded using definitions from municipal statutes.

Flores and others said the proposal has support from the Green Mountain Care Board and from a range of stakeholders who participated in drafting. Committee members discussed how the bill should align with S.18, the separate birth-center carve-out being considered in the Senate. Jen Harvey cautioned that duplicate or inconsistent drafting across bills could cause confusion and recommended coordination so the statutory exclusions interact as intended.

Harvey also reminded the committee that the board currently indexes thresholds in practice under existing law and the bill would make indexing mandatory (limited to adjustments tied to the consumer price index as already permitted in statute).

Committee process and next steps: bill text shown to the committee would take effect July 1, 2025; for CON applications pending as of that date, applications for which an interested party has been granted would remain subject to the thresholds in place when filed, while applicants for which no interested party has been granted could withdraw and proceed under the new thresholds. Committee members said they will take testimony and coordinate with the House and the separate S.18 birth-center bill as the measure moves forward.

Ending — The committee scheduled further consideration and public testimony; sponsors and legal staff said they will provide requested clarifications and conforming language on birth-center carve-outs, indexing mechanics and application-transition language before the committee’s next formal action.