AHS and Green Mountain Care Board debate roles, sequencing in proposed statewide health care delivery plan

Agency of Human Services officials and the Green Mountain Care Board told the Vermont Senate Health & Welfare Committee on Feb. 20 that they support creating a statewide health care delivery plan but urged clearer definitions of roles, sequencing and oversight before language is finalized.

At a committee hearing, Brandon Krause, director of health care reform at the Agency of Human Services, said AHS wants the plan to “include those other community-based providers” and to reflect regulatory roles so that sections tied to hospital regulation align with the Green Mountain Care Board’s responsibilities while AHS covers nonhospital providers.

The nut of the discussion centered on how to align ongoing hospital transformation work with a new strategic planning requirement. Senators and agency officials raised sequencing concerns: hospitals are already preparing transformation plans under recent initiatives, which multiple speakers said could overwhelm volunteer hospital boards if they are asked to produce parallel strategic plans.

Green Mountain Care Board Chair Oliver Foster told the committee the board “is very supportive” of a statewide delivery plan but urged specificity on what would happen if the care board found a hospital strategic plan out of alignment. Foster warned that directing the care board to “review and approve hospital strategic plans” requires thought about consequences for budgets and operations.

Committee members repeatedly asked for a short-term timeline and near-term actions to stabilize finances while planning longer-term transformation. Krause and other agency witnesses described immediate work with hospitals — sending project managers and financial analysts to support transformation — and said the next six months would be “very intense.”

Committee members and witnesses also discussed whether the Department of Financial Regulation should be named in the statute; AHS, GMCB and DFR were repeatedly mentioned as the three entities with key regulatory levers on hospitals, payers and rates. Krause said AHS recommends “acknowledg[ing] and consider[ing] the role of the Department of Financial Regulation,” particularly for rate review and premium growth oversight.

Several senators pressed for a timeline and clearer leadership assignments, and Foster and other witnesses urged that oversight remain independent where appropriate. Foster recommended reporting and transparency to the legislature and public rather than direct political oversight by the executive branch.

Ending: Committee members asked AHS and the care board to submit written comments and suggested convening follow-up sessions to draft specific statutory language, timelines and advisory committee membership rules. Several witnesses agreed to return with written recommendations and more detailed sequencing proposals for how hospital transformation and community-based planning would be integrated.