S 63 — An act relating to modifying the regulatory duties of the Green Mountain Care Board

BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 1 of 2225 S.63 AnIntroduced actby relatingSenators toLyons, modifyingCummings theand regulatoryGulick dutiesReferred ofto theCommittee Greenon MountainHealth Careand BoardWelfare ItDate: is hereby enacted by the General Assembly of the State of Vermont:

February 11, 2025 Subject:

Health;

Green Mountain Care Board;

health information technology;

accountable care organizations;

hospital budgets Statement of purpose of bill as introduced:

This bill proposes to eliminate the Green Mountain Care Board’s responsibility for approving the State’s Health Information Technology Plan, for reviewing the budget of the Vermont Information Technology Leaders, and for conducting Medicaid advisory rate cases.

The bill would modify the scope of the Green Mountain Care Board’s certification of accountable care organizations and its review of their budgets and would limit the application of provisions regarding meetings of accountable care organization governing bodies to only the accountable care organizations that contract with Vermont Medicaid.

The bill would establish fees for accountable care board certification and budget review and would remove accountable care organizations from the billback formula under which Board expenses are allocated in part to other regulated entities.

The bill would also specify that the Board’s review, establishment, and enforcement of hospital budgets includes the right to the Board’s appeals processes and does not constitute a contested case under the Administrative Procedures Act.

BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 2 of 25 An act relating to modifying the regulatory duties of the Green Mountain Care Board It is hereby enacted by the General Assembly of the State of Vermont:

§§ 9351 9351 is amended to read:

(B) The Plan shall include the implementation of an integrated electronic health information infrastructure for the sharing of electronic health VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 2 of 22 information among health care facilities, health care professionals, public and private payers, and patients.

The Plan shall provide for each patient’s BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 3 of 25 electronic health information that is contained in the Vermont Health Information Exchange to be accessible to health care facilities, health care professionals, and public and private payers to the extent permitted under federal law unless the patient has affirmatively elected not to have the patient’s electronic health information shared in that manner.

The Department shall solicit recommendations from interested stakeholders in order to propose updates to VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 3 of 22 the Health Information Technology Plan pursuant to subsection (a) of this section and to this subsection, including applicable standards, protocols, and BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 4 of 25 pilot programs, and following approval of the proposed updates by the Green Mountain Care Board, may enter into a contract or grant agreement with appropriate entities to update some or all of the Plan.

VT* LEG* #382101* v.1BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 45 of 2225 * * * Sec.

§§ 9352 9352 is amended to read:

VTThe LEGreport #382101shall v.1include ASan PASSEDassessment BYof SENATEprogress S.63in Pageimplementing 5health ofBILL 22AS TheINTRODUCED reportAND shallPASSED includeBY anSENATE assessmentS.63 ofPage progress6 inof implementing25 health information technology in Vermont and recommendations for additional funding and legislation required.

§§ 9374(h) 9374(h) is amended to read:

VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 6 of 22 (i) 40.0 40 percent by the State from State monies;

BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 7 of 25 (ii) 28.8 36 percent by the hospitals;

VTBILL LEGAS #382101INTRODUCED v.1AND AS PASSED BY SENATE S.63 Page 78 of 2225 (3) If the amount of the proportional assessment to any entity calculated in accordance with the formula set forth in subdivision (1)(A) of this subsection would be less than $150.00, the Board shall assess the entity a minimum fee of $150.00.

§§ 9375 9375 is amended to read:

VTBILL LEGAS #382101INTRODUCED v.1AND AS PASSED BY SENATE S.63 Page 89 of 2225 Within 90 days following this approval, the Board shall issue an order explaining its decision.

* * * VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 9 of 22 Sec.

§§ 9382 9382 is amended to read:

OVERSIGHT OF ACCOUNTABLE CARE ORGANIZATIONS BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 10 of 25 (a)(1) In order to be eligible to receive payments from Medicaid or commercial insurance through any payment reform program or initiative, including an all-payer model operate in Vermont, each accountable care organization shall obtain and maintain certification from the Green Mountain Care Board.

The ACO ensures equal access VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 10 of 22 to appropriate mental health care that meets standards of quality, access, and affordability equivalent to other components of health care as part of an BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 11 of 25 integrated, holistic system of care , taken as a whole, support and do not hinder the State’s principles for health care reform as set forth in section 9371 of this title.

(5) The ACO has established mechanisms and care models to promote evidence-based health care, patient engagement, coordination of care, use of VTelectronic LEGhealth #382101records, v.1and ASother PASSEDenabling BYtechnologies SENATEto S.63promote PageBILL 11AS ofINTRODUCED 22AND electronicPASSED healthBY records,SENATE andS.63 otherPage enabling12 technologiesof to25 promote integrated, efficient, seamless, and effective health care services across the continuum of care, where feasible.

VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 12 of 22 (C)(iii) providing an accessible mechanism for explaining how ACOs work;

BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 13 of 25 (D)(iv) providing contact information for the Office of the Health Care Advocate;

VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 13 of 22 (16)(H) The ACO has in place a financial guarantee sufficient to cover its potential losses.

BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 14 of 25 (17) The ACO provides connections and incentives to existing community services for preventing and addressing the impact of childhood adversity.

chapter 25 to establish standards and processes for reviewing, modifying, and approving the budgets of ACOs with 10,000 or VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 14 of 22 more that receive payments from Medicaid or commercial insurers, or both, on behalf of attributed lives in Vermont.

To the extent permitted under federal BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 15 of 25 law, the Board shall ensure the rules anticipate and accommodate a range of ACO models and sizes, balancing oversight with support for innovation.

VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 15 of 22 (G) the extent to which the ACO provides incentives for systemic health care investments to strengthen primary care, including strategies for BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 16 of 25 recruiting additional primary care providers, providing resources to expand capacity in existing primary care practices, and reducing the administrative burden of reporting requirements for providers while balancing the need to have sufficient measures to evaluate adequately the quality of and access to care;

(J) the extent to which the ACO provides incentives for preventing and addressing the impacts of adverse childhood experiences (ACEs) and other traumas, such as developing quality outcome measures for use by primary care VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 16 of 22 providers working with children and families, developing partnerships between nurses and families, providing opportunities for home visits, and BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 17 of 25 including parent-child centers and designated agencies as participating providers in the ACO;

VT LEG #382101 v.1 AS PASSED BY SENATE S.63 Page 17 of 22 (2) The Green Mountain Care Board shall adopt rules pursuant to 3 V.S.A.

chapter 25 to establish standards and processes for reviewing, BILL AS INTRODUCED AND PASSED BY SENATE S.63 Page 18 of 25 modifying, and approving the budgets of ACOs with fewer than 10,000 attributed lives in Vermont.