Committee debates who should decide on hospital service closures as bill offers five options
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Summary
The committee discussed S.189, which outlines five options for handling hospital reductions or eliminations of services — from doing nothing to giving final authority to AHS or the Green Mountain Care Board — and agreed to take more testimony before choosing a path.
The Senate committee took up S.189, a bill addressing notice and review when hospitals propose reducing or eliminating services, and spent the session weighing five policy options ranging from keeping current practice to giving binding authority to a state agency.
Chair introduced the options: do nothing (retain current statute), adopt the senate-passed bill (with timing tweaks), preserve the public process but streamline agency interactions, require the Agency of Human Services (AHS) to make a binding recommendation, or give the Green Mountain Care Board authority to approve or deny service reductions. Committee members agreed that a public process and community notice should remain part of any approach.
"I think AHS should have to approve it," a committee member said, arguing AHS should lead hospital transformation because it has the most relevant knowledge and accountability. Other members pushed back with practical concerns: "If AHS says you can't close that service... who's going to fund the money that they are losing?" one member asked, noting that blocking a closure could require additional funding or rate adjustments by the Green Mountain Care Board.
Members cited recent local examples, including hospital decisions about birthing centers, to illustrate trade-offs among quality, access and cost. Some warned that local public hearings can produce powerful emotional testimony but do not always change a hospital's decision; others said public comment matters and the board should not eliminate community input.
Rather than adopt a final approach, the committee took a nonbinding sense of the room and directed staff to obtain additional testimony from AHS and the Green Mountain Care Board. Members signaled they preferred more evidence and a collaborative process before deciding whether to leave final authority with hospitals or to assign a state agency the ultimate decision-making power. No formal vote occurred; the committee will reconvene with further testimony.
Next steps: committee staff will schedule additional testimony from AHS and the Green Mountain Care Board and continue deliberations at a later date, with final action to follow further review.
