Senate Health and Welfare debates changes to statewide health‑care delivery bill, budgets and data rules

At a meeting of the Senate Health and Welfare Committee, staff and stakeholders reviewed and revised the committee’s draft health‑care delivery bill, focusing on hospital budget review, hospital network oversight, statewide health‑care delivery planning, data integration and proposed staffing and appropriations for implementation.

The discussion centered on how much authority the Green Mountain Care Board (the board) should retain; how hospital budgets and hospital‑network finances should be reviewed; whether global hospital budgets should begin in fiscal year 2028 or later; how Medicare and Medicaid should be carved out; and how to structure an advisory committee and data governance. Committee staff indicated they will produce a new draft for the committee’s next meeting.

Committee staff advised against broad statutory edits to the board’s general rate‑setting authority outside the bill’s reference‑based pricing context, saying such changes would be a “whole other discussion.” Members and staff debated whether language describing the board’s duties (including participation in federal programs) should be narrowed or left unchanged while the committee proceeds with the bill’s immediate reforms.

On budget review, staff proposed removing some prescriptive ‘‘uniform system of accounts’’ language and instead using less prescriptive, standardized approaches and a consultative review process for hospital budget data submissions. The committee discussed shifting provisions related to hospital networks to a separate section addressing network financial operations rather than treating them the same as individual hospital budgets.

The committee considered a set of proposed changes to incentives and revenue accounting. One option discussed was excluding revenue derived from community‑support programs from net patient revenue and total cost‑of‑care targets. Committee members discussed moving any requirement that hospitals develop incentives to the section that requires hospitals to propose ways to support community‑based, independent and non‑hospital providers.

Members debated how to handle variable executive compensation and incentive plans; the staff noted the board had asked to add review authority for such plans in a subsequent draft. The committee also discussed deleting a sentence that referenced national average staffing ratios and instead focusing the statute on the number of employees whose duties are administrative versus those who deliver direct patient care.

The bill’s global hospital budget provisions generated discussion about timing, scale and carve‑outs. Participants raised the option of beginning global budgets no earlier than hospital fiscal year 2028 and debated minimum thresholds for participation (for example whether to require a specific minimum number of remote hospitals or allow more flexibility). A carve‑out for critical‑access hospitals was discussed. Committee staff recommended explicit statutory language clarifying that the global‑budget provisions do not apply to Medicaid, and they suggested limiting any reference to Medicare to the extent permitted under federal law.

On outcome measurement, staff said the board and some stakeholders prefer that the board use existing measurement authority rather than creating new prescriptive measurement duties. One suggested formulation reported in committee materials would have the board, “in consultation with the Vermont Program for Quality in Health Care and in alignment with the statewide health‑care delivery plan,” establish or maintain measurements for hospital cost, quality and access.

The committee discussed procedures tied to service reductions (a so‑called reverse certificate‑of‑need process). Staff described proposals that would require hospitals proposing to reduce or eliminate services to explain how the proposal aligns with the statewide health‑care delivery plan and the hospital’s most recent community health needs assessment. Members discussed narrowing notice requirements where reductions result from previously directed transformation work, to avoid duplicative justification.

On the statewide health‑care delivery plan, staff and members debated which agency should lead the plan. Several participants recommended the Agency of Human Services (AHS) lead the plan, with the Office of the Health Care Advocate and other stakeholders consulted. The committee discussed advisory‑committee composition at length: options ranged from a smaller, 9–11‑member advisory group to a larger 14‑member model used for past rural‑health task forces. Suggested seats included a Green Mountain Care Board designee, an AHS designee, a Medicaid director, hospital and FQHC representatives, the health care advocate and commercial payers. Committee members discussed co‑chairs and staggered terms.

Data and interoperability were another major topic. AHS had submitted recommendations to limit prescriptive language and to prioritize collaboration with existing entities, including the state’s health information exchange steering committee (HIE steering committee). Staff said they would add HIE steering committee language while retaining consultation with other stakeholders such as FQHCs and the Blueprint for Health where appropriate. The committee debated whether to list many specific data sources (EMS, WIC, etc.) by name or to retain broader language allowing for future data‑type additions.

Section 9 (retaining certain capabilities) and related provisions drew comments about the roles of entities such as OneCare and the Blueprint; staff suggested clarifying which entity is responsible for particular reporting tasks. Several participants asked for follow‑up reports on ongoing work and recommended including OneCare and other private entities in implementation discussions without creating an automatic appropriation mechanism for private programs.

Members pressed for clarity about staffing and appropriations in Section 10. The draft currently establishes five new permanent positions for the board in the bill; staff said those five positions would cost roughly $802,500 (the board later provided an updated estimate of $802,500 for five positions). The draft also referenced a total appropriation package that committee staff summarized as roughly $2,050,000 when combining multiple line items: contract support for reference‑based pricing and transformation, grants for hospital transformation and data‑integration grants from the Health Information Technology fund. Staff said some amounts may shift between AHS and the board depending on which agency leads the statewide delivery plan and clarified they will prepare more specific fiscal language.

Reporting deadlines and follow‑up were discussed. AHS suggested providing an implementation update to the Health Care Oversight Committee in the fall; committee staff and members proposed a target reporting date of November 15 (with alternative language using a November/December timeframe discussed). Staff said they would draft language requiring periodic updates from AHS and the board on reference‑based pricing implementation and global budget pilots.

The chair directed staff to prepare a revised draft for the committee’s next meeting. Staff said they will circulate a new draft incorporating the committee’s choices on board duties, budget submission standardization, advisory‑committee composition, data‑integration language (including HIE steering‑committee collaboration), and updated appropriation language.

Ending: The committee adjourned after scheduling additional work on the bill and several other bills for the next day. Staff said they will have a new draft and supporting fiscal detail available at the next meeting.