House amends H.96 to raise certificate-of-need monetary thresholds; third reading ordered

Representative Cortez of Bristol, speaking for the House Committee on Health Care, presented a strike-all amendment to H.96 on the House floor and described it as a package of changes to Vermont's certificate-of-need (CON) rules designed to reduce regulatory burden and increase access to health care services.

The amendment raises several monetary thresholds that trigger the CON review overseen by the Green Mountain Care Board. Under the amendment, thresholds for nonhospital health care facilities would increase, including a construction/development/renovation threshold raised to $10,000,000 from $1,500,000; the single-piece diagnostic or therapeutic equipment threshold to $5,000,000 from $1,000,000; an annual operating expense trigger to $3,000,000 from $500,000; and an ambulatory surgery center project threshold to $10,000,000. For hospitals, comparable thresholds were raised, including a construction/development threshold to $10,000,000 (from $3,000,000) and the conceptual development-phase CON threshold to $50,000,000 (from $30,000,000). The amendment also raises the limits on preparatory expenditures tied to conceptual-phase filings (the prior lower limits for non‑hospital and hospital preparatory expenditures were raised in the bill).

"H.96 is a strike all amendment about the certificate of need process," Representative Cortez said, and told the chamber the health care committee heard testimony arguing Vermont's CON rules can increase costs and limit access, particularly in rural areas. Cortez said witnesses included the executive director of the Vermont Medical Society, the chief legal officer of Rutland Regional Medical Center, representatives of Vermont Legal Aid, the chair of the Green Mountain Care Board, the Vermont Association of Hospitals and Health Services, and others who supported raising monetary thresholds and exempting certain routine equipment replacements.

Representative Brannigan of Georgia, speaking for the Committee on Ways and Means, summarized the fiscal effect: the Green Mountain Care Board typically collects about $50,000 a year in CON fees, and H.96 would reduce that by an estimated $20,000 annually. "There will be a slight reduction in state revenue," Brannigan said, and the committee verified the estimate before recommending passage. Ways and Means reported a committee vote of 9-0-2 in favor of the bill as amended; the House Health Care Committee reported a strike-all vote of 10-0-1.

The amendment includes a transition provision for CON applications already pending: if an applicant has parties with approved interested-party status before the Green Mountain Care Board at the time of filing, the thresholds and exclusions in effect when the application was filed continue to apply until final decision. If there are no approved interested-party statuses, an applicant may withdraw under board rules and would not be required to proceed under the new threshold triggers.

The bill's effective date is set to take effect on July 1 and will apply to new health care projects initiated on or after that date, the committee report stated. The Ways and Means committee also noted the Green Mountain Care Board supported the changes because they would allow the board to focus on larger projects with greater systemwide impact and because the proposal aligns CON exemptions with practices in other New England states.

On the floor the question was called on adopting the committee amendment. The amendment was approved on a voice vote; the House then ordered third reading by voice vote.

The House action completes the orders of the day for H.96; third reading was ordered and the bill will return to the calendar for further consideration.