S.63 would require ACO certification, change hospital budget appeals and limit some board reviews, Green Mountain Care Board staff say

Representatives of the Green Mountain Care Board told the Health & Welfare Committee Feb. 27 that S.63, a board‑requested bill, would change how the board regulates accountable care organizations and how hospital budget enforcement matters are appealed.

Michelle Sawyer, director at the Green Mountain Care Board, said the proposal makes certification mandatory for all ACOs that operate in Vermont — including Medicare‑only, multistate entities — so the board can decertify ACOs that do not meet state requirements. “The idea is that there's no model specific language in how the board would regulate ACOs,” Sawyer said, explaining the proposal seeks to make regulation agnostic to whatever payment model Vermont uses next.

Under current practice, Sawyer said, ACOs that contract with Medicaid or commercial payers must already submit an annual budget review to the board; Medicare‑only ACOs generally have not been subject to the same review. The bill would narrow the board’s full annual budget review to ACOs that contract with Vermont Medicaid or commercial payers — entities that bring Vermont‑dollar financial flows to the state — and instead place Medicare‑only ACOs under a certification process.

Sawyer told the committee that several Medicare‑only ACOs are multistate organizations that contract directly with the federal government and use national financial arrangements; because of that structure the board’s budget‑review authority is less effective for those entities.

Michael Barber, the board’s general counsel, reviewed additional sections of the bill that would amend several hospital budget statutes. Barber said S.63 would: change the timing mechanics for reviewing entities with calendar fiscal years (for example, the Retreat); move appeals of hospital budget enforcement orders from superior court directly to the Vermont Supreme Court; and specify that contested‑case procedures under the Administrative Procedure Act do not apply to proceedings to establish or enforce a hospital budget.

Barber also said the bill would limit the statute that governs governance and meeting rules for certain ACO governing bodies to ACOs that contract with Vermont Medicaid and repeal a statutory requirement that the board prepare an advisory opinion about population‑based Medicaid payment arrangements.

Several concrete fees and timelines were described for the proposal’s regulatory tools. The board’s presentation lists an initial certification fee of $10,000 for an ACO, an annual eligibility verification fee of $2,000, and a substantially larger regulatory fee for a full annual budget review of $125,000. Sawyer said Vermont currently has three ACOs operating in the state that warranted mention in testimony: Lower Health ACO (contracts with an FQHC in Springfield), Vitalize (a multistate organization with a Vermont presence) and Alidade (Richmond area). She also said the departure of OneCare has made up‑to‑date regulatory tools more important as other ACOs expand into Vermont.

Sawyer said the board supports making certification universal so it can remove or deny participation by “bad actors” if needed; she noted there are roughly 500 ACOs nationally and that many are private‑equity backed.

The board asked the committee to post written testimony to the bill on the committee’s web page and indicated it would return for additional questions.

No formal committee action or votes on S.63 were recorded during the session.

Details from the bill as presented to the committee reference 18 V.S.A. sections covering hospital budgets and ACO governance.