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Senate reviews S.197 to expand Blueprint payments and set primary care spending targets
Summary
In markup of S.197 lawmakers discussed aligning the state's primary care payment reforms with the Blueprint for Health, directing per‑person‑per‑month spending targets, requiring payer data for fiscal analysis, and setting reporting deadlines for 2027–2028.
The committee reviewed proposed revisions to S.197 that would build primary care payment reform on Vermont’s existing Blueprint for Health. The amendment would direct the Agency of Human Services to establish per‑person‑per‑month (PMPM) primary care spending targets, develop a transitional schedule to increase that target over time, and require payers to submit data needed for a comprehensive fiscal analysis.
Jessa Barard (Vermont Medical Society) said the approach is intentionally transitional, aiming first to bring more payers into a common PMPM payment and then to broaden the payment to cover more routine primary care services. She said bringing all payers into the funding approach is payer‑agnostic and could increase payments to practices without adding burden to regulated QHPs.
The amendment would require the Blueprint director, in consultation with the Blueprint executive committee and the Vermont steering committee for comprehensive primary healthcare, to report to the Senate Health and Welfare and House Health Care committees by January 1, 2027 on payment amounts and recommendations to transition PMPM payments. A further report with proposed spending targets and an implementation schedule would be due January 1, 2028.
Mara Krauss Donahghue (assistant director, Blueprint for Health) supported aligning incremental changes with existing Blueprint infrastructure and flagged remaining language the agency needs to review, especially around state‑directed payments and annual updates. Committee members sought fiscal estimates for the budgetary cost of increasing primary care payments (for example, 1–5%) and raised resourcing concerns for stakeholder engagement and data collection.
The committee agreed to continue markup and to request baseline and target reports from AHS. Members also discussed removing a sunset on an education scholarship program for primary care students and asked staff to coordinate statutory and budget language so that existing funding is preserved.
