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Senate Health & Welfare reviews bills to raise Vermont certificate-of-need thresholds
Summary
The Senate Health & Welfare Committee on Jan. 29 reviewed two bills, S10 and S20, that would raise the monetary thresholds that trigger Vermont's certificate-of-need review for health facility projects and would add or change several exclusions; committee counsel said the panel will take stakeholder testimony before deciding what to advance.
The Senate Health & Welfare Committee on Jan. 29 reviewed two competing bills (S10 and S20) that would raise the dollar thresholds at which health facility projects must obtain a certificate of need from the Green Mountain Care Board and would add or change several exclusions and procedural thresholds. Committee members and legislative counsel said the committee will take testimony from hospitals, insurers, the Health Care Advocate, independent physicians and other stakeholders before deciding what language to advance.
The bills are tied to a larger health-care transformation effort and follow recommendations in a report commissioned by the Green Mountain Care Board from the Oliver Wyman Group. Committee counsel Jen Harvey, Office of Legislative Council, opened the committee's review by placing the CON statutes in context: "We are in title 18 ... in a subchapter on health facility planning" and explained that the CON regime was enacted to "avoid unnecessary duplication and contain or reduce increases in the cost of delivering services," while maintaining access and quality.
Both bills change the monetary triggers in 18 V.S.A. a7 9434 but differ in the specific amounts and in proposed exclusions. Key differences the committee identified include:
- Non-hospital capital cost threshold: Existing law sets the trigger at $1,500,000 (indexed). S10 would raise that trigger to $5,000,000; S20 would raise it to $10,000,000.
- Hospital capital cost threshold: Existing law sets the trigger at $3,000,000 (indexed). Both bills raise that to $10,000,000.
- Purchase, lease or comparable arrangement for a single piece of diagnostic/therapeutic equipment: Existing statutory triggers are $1,000,000 (non-hospital) and $1,500,000 (hospital). S10 would move the non-hospital threshold to $3,000,000 and the hospital threshold to $5,000,000 (and S10 lists $5,000,000 for hospitals' equipment); S20 would raise the equipment threshold in several places to $10,000,000.
- Offering a health-care service or technology (operating-expense trigger): Existing law uses $500,000 (non-hospital) and $1,000,000 (hospital) as statutory reference points (subject to indexing). S10 would increase those to $1,500,000 (non-hospital) and $3,000,000 (hospital); S20 would increase them to $10,000,000.
- Conceptual development-phase CON (very large projects): Existing law triggers at $30,000,000. S10 would raise that trigger to $100,000,000; S20 would raise it to $50,000,000.
- Ambulatory surgical centers: S20 would remove the automatic CON trigger for ambulatory surgical centers below a $10,000,000 construction/expansion cost; under current law ambulatory surgical centers require CON regardless of amount.
- Exclusions: S10 would add an exclusion for routine replacement of fully depreciated medical equipment and would explicitly exclude emergency and nonemergency ground ambulance services and affiliated agencies. S20 does not add the fully depreciated-equipment exclusion; instead S20 would add an exclusion for facility projects or services that result from a contract awarded by the state of Vermont.
- Indexing and implementation: Both bills would keep the statutory mechanism for periodic adjustment of thresholds and would take effect July 1, 2025; S10 also streamlines the statute language to make annual CPI indexing explicit.
Committee members framed the bills as part of a broader effort to address rising health-care costs and access. "We're all here to solve problems. We have a ... health care cost crisis," said Sen. Gulick during the discussion, urging the committee to consider Oliver Wyman's recommendations and to weigh access and hospital viability.
Committee staff and sponsors said the next steps are to bring in witnesses, including representatives of the Green Mountain Care Board and the Agency of Human Services, and to gather data on likely impacts. Members asked for comparative evidence about whether loosening CON jurisdiction reduces costs or increases utilization and whether particular dollar amounts (for example, whether $10 million buys an MRI suite or a robotic surgery suite) would meaningfully change local access.
No formal votes or committee decisions were taken during the Jan. 29 walkthrough; sponsors and counsel said the committee will schedule testimony and may harmonize the two bills before taking action. The chair and sponsors acknowledged differing preferences for specific dollar amounts and asked for more information before advancing either bill.
Votes at the meeting: none recorded.
What happens next: Committee staff will post Act 167 background materials and arrange testimony from the Green Mountain Care Board, Agency of Human Services, hospitals, insurers, the health-care advocate and independent physicians to inform the committee's choice of thresholds and exclusions. Both bills list an effective date of July 1, 2025.
