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Green Mountain Care Board requests staff for drug work, proposes fee reallocation as OneCare winds down
Summary
At the Feb. 20 hearing the Green Mountain Care Board asked the appropriation committee for three governor-funded positions and described separate Act 134 and AHEAD staffing needs; the board proposed statutory language reallocating existing fill-back fees (about $570,000) between hospitals and insurers following the end of OneCare Vermont.
The Green Mountain Care Board asked the Vermont House Appropriations Committee on Feb. 20 for staffing and a statutory change tied to the end of OneCare Vermont and to new work on prescription drugs.
Executive Director Susan Barrett said the board’s base request (as presented) adds three positions funded through the governor’s base initiatives — a $750,000 mixed package that includes $300,000 in general funds and bill-back authority to cover the rest. Barrett said separately authorized Act 134 funds already provided for two employees focused on prescription-drug work; those positions are dedicated to the drug-pricing work the legislature requested and are not available for other board duties.
Barrett told the committee the board’s hospital-budget staff currently totals three FTEs and that additional short-term data positions would help automate repetitive reporting tasks. She said the board has asked for more staff for the AHEAD model—an incoming federal/state transformation program—and that AHEAD’s approval includes a condition requiring five new positions by September; the board noted that if only the three governor-requested positions are funded, it will not meet the AHEAD staffing conditions.
On statutory language, Barrett explained the board’s proposed change to its fill-back statute (the 60% allocation language) to address the anticipated disappearance of the large, state-level Accountable Care Organization, OneCare Vermont. The board said roughly $570,000 that had been allocated from ACO fees last year should be reallocated between hospitals and insurers; the proposed language weights that share more heavily toward hospitals because hospitals had been paying ACO fees. Barrett said S.63 (pending legislation) could further change fee authority for Medicare-only ACOs and, if enacted, those fees would reduce the amount to be reallocated so the board is not “double dipping.”
Barrett described several uncertainties that affect the budget request: the future staffing of a federal AHEAD office, pending federal policy changes and system solvency risks. She said the Act 134 drug work is a separate, focused project and that the requested positions in the governor’s base initiative are intended to support core board functions and anticipated AHEAD conditions.
No formal committee votes were taken during the session. Committee members asked the board to provide written budget materials and additional detail on how the proposed fee reallocation and staffing would interact with pending legislation.
