Senate Health & Welfare explores law change to give board access to hospital network records

Senators on the Senate Health & Welfare Committee heard from Vermont State Auditor Doug Hoffer and Chief Auditor Tanya Morehouse during a committee meeting about possible legislation to give the Green Mountain Care Board access to records held by hospital networks so regulators can trace financial flows between Vermont and out‑of‑state hospitals.

Hoffer said state financial audits exist for individual hospitals but that digging into transfers between hospitals and a related network will require records held by the network itself. "You can't go anywhere until you address the question of access to records from the network itself," Hoffer said. He told the committee the network is not currently covered by authority granted to the Green Mountain Care Board and recommended amending the statute if the board needs broader access or budget‑approval authority over the network.

Tanya Morehouse, chief auditor with the Vermont State Auditor's Office, recommended working with the Green Mountain Care Board to determine what records the board can currently access and what additional authority would be needed. "The best way for us, I think, to be able to provide you with some advice is, to work with the Green Mountain Care Board because they'll be the ones that that have the answers about what they currently do have the right to access in terms of records," Morehouse said. She outlined the types of questions auditors would pursue, including governance structure, whether money can be shifted across member hospitals, and whether Vermont hospitals are obliged to support debt of out‑of‑state members.

Committee members cited testimony from an outside presenter that suggested $271,000,000 moved from New York to the UVM Medical Center and asked whether that value could be confirmed or explained without the network's records. Hoffer and Morehouse said some aggregate or hospital‑level financial data already exist, but the full picture of transfers and whether the network delivers added value would require cooperation from the network or a change in state authority to compel production of records. Hoffer also noted that the network's inclusion of out‑of‑state hospitals has at times affected the network's debt rating, which can raise borrowing costs for the entire system.

Neither Hoffer nor Morehouse recommended a single mandatory solution; they outlined two paths the committee could consider: 1) give the Green Mountain Care Board explicit authority to obtain or compel production of network records and, separately, to review or approve a network budget; or 2) authorize the board to obtain records and then validate those records (including by contracting for audits or using the State Auditor's Office) without granting budget‑approval authority. Morehouse said the auditor's office could assist the board and that the office has audit experience and the questions to ask but that a statutory change would be the predicate for compelled access.

Committee members also raised data and transparency gaps in statewide program reporting. Hoffer said his audit team "spent a great deal of time asking for data about statewide results and came up empty." The committee noted prior testimony about performance data from the Vermont program named in testimony as LEAP BQHC and commentary by presenters Foster King and Craig Jones; senators said those materials would be reviewed alongside any audit planning.

Hoffer told the committee the State Auditor's Office can help develop questions and work with the Green Mountain Care Board and offered to contact the board chair to begin a preliminary conversation. The auditors said they could return to the committee with findings or recommendations after consulting with the board.

No formal vote or ordinance was taken during the discussion; senators sought guidance for bill language and next steps.