§ 9375 — Duties

Vermont § 9375

• Jurisdiction: Vermont
• Title 18: Title 18: Health
• Ch. 220: Chapter 220: Green Mountain Care Board

Text

(a) The Board shall execute its duties consistent with the principles expressed in section 9371 of this title.
(b) The Board shall have the following duties:
(1) Oversee the development and implementation, and evaluate the effectiveness, of health care payment and delivery system reforms designed to control the rate of growth in health care costs; promote seamless care, administration, and service delivery; and maintain health care quality in Vermont, including ensuring that the payment reform pilot projects set forth in this chapter are consistent with such reforms.
(A) Implement by rule, pursuant to 3 V.S.A. chapter 25, methodologies for achieving payment reform and containing costs that may include the participation of Medicare and Medicaid, which may include the creation of health care professional cost-containment targets, reference-based pricing, global payments, bundled payments, global budgets, risk-adjusted capitated payments, or other uniform payment methods and amounts for integrated delivery systems, health care professionals, or other provider arrangements.
(i) The Board shall work in collaboration with providers to develop payment models that preserve access to care and quality in each community.
(ii) The rule shall take into consideration current Medicare designations and payment methodologies, including critical access hospitals, prospective payment system hospitals, graduate medical education payments, Medicare dependent hospitals, and federally qualified health centers.
(iii) The payment reform methodologies developed by the Board shall encourage coordination and planning on a regional basis, taking into account existing local relationships between providers and human services organizations.
(B) Prior to the initial adoption of the rules described in subdivision (A) of this subdivision (1), report the Board’s proposed methodologies to the House Committee on Health Care and the Senate Committee on Health and Welfare.
(C) In developing methodologies pursuant to subdivision (A) of this subdivision (1), engage Vermonters in seeking ways to equitably distribute health services while acknowledging the connection between fair and sustainable payment and access to health care.
(D) Nothing in this subdivision (1) shall be construed to limit the authority of other agencies or departments of State government to engage in additional cost-containment activities to the extent permitted by State and federal law.
(2) [Repealed.]
(3) Review and approve the Health Care Workforce Development Strategic Plan created in chapter 222 of this title.
(4) Publish on its website the Health Resource Allocation Plan identifying Vermont’s critical health needs, goods, services, and resources in accordance with section 9405 of this title.
(5) Set rates for health care professionals pursuant to section 9376 of this title, to be implemented over time beginning with reference-based pricing as soon as practicable, but not later than hospital fiscal year 2027, and make adjustments to the rules on reimbursement methodologies as needed.
(6) Approve, modify, or disapprove requests for health insurance rates pursuant to 8 V.S.A. § 4026, taking into consideration the requirements in the underlying statutes; changes in health care delivery; changes in payment methods and amounts, including implementation of reference-based pricing; protecting insurer solvency; and other issues at the discretion of the Board.
(7) Review and establish hospital budgets pursuant to chapter 221, subchapter 7 of this title, including establishing standards for global hospital budgets that reflect the implementation of reference-based pricing and the total cost of care targets determined in collaboration with federal partners and other stakeholders or as set by the Statewide Health Care Delivery Plan developed pursuant to section 9403 of this title, once established. Beginning not later than hospital fiscal year 2028, to the extent that resources are available, the Board shall establish global hospital budgets for one or more Vermont hospitals that are not critical access hospitals. By hospital fiscal year 2030, to the extent that resources are available, the Board shall establish global hospital budgets for all Vermont hospitals.
(8) Review and approve, approve with conditions, or deny applications for certificates of need pursuant to chapter 221, subchapter 5 of this title.
(9) Review and approve, with recommendations from the Commissioner of Vermont Health Access, the benefit package or packages for qualified health benefit plans and reflective health benefit plans pursuant to 33 V.S.A. chapter 18, subchapter 1. The Board shall report to the House Committee on Health Care and the Senate Committee on Health and Welfare within 15 days following its approval of any substantive changes to the benefit packages.
(10) Develop and maintain a method for evaluating systemwide performance and quality, including identification of the appropriate process and outcome measures:
(A) for determining public and health care professional satisfaction with the health system;
(B) for utilization of health services;
(C) in consultation with the Department of Health and the Director of the Blueprint for Health, for quality of health services and the effectiveness of prevention and health promotion programs;
(D) for cost-containment and limiting the growth in health care expenditures;
(E) for determining the adequacy of the supply and distribution of health care resources in this State;
(F) to address access to and quality of mental health and substance abuse services; and
(G) for other measures as determined by the Board.
(11) Develop the health care spending estimate pursuant to section 9383 of this title.
(12) [Repealed.]
(13) Adopt by rule pursuant to 3 V.S.A. chapter 25 such standards as the Board deems necessary and appropriate to the operation and evaluation of accountable care organizations pursuant to this chapter, including reporting requirements, patient protections, and solvency and ability to assume financial risk.
[Subdivision (b)(14) repealed effective January 16, 2026.]
(14)(A) Collect and review annualized data from ambulatory surgical centers licensed pursuant to chapter 49 of this title, which shall include net patient revenues and which may include data on an ambulatory surgical center’s scope of services, volume, payer mix, and coordination with other aspects of the health care system. The Board’s processes shall be appropriate to ambulatory surgical centers’ scale, their role in Vermont’s health care system, and their administrative capacity, and the Board shall seek to minimize the administrative burden of data collection on ambulatory surgical centers. The Board shall also consider ways in which ambulatory surgical centers can be integrated into systemwide payment and delivery system reform.
(B) In its annual report pursuant to subsection (d) of this section, the Board shall describe its oversight of ambulatory surgical centers pursuant to subdivision (A) of this subdivision (14) for the most recently concluded 12-month period of the Board’s review, including the amount of each ambulatory surgical center’s net patient revenues and, using claims data from the Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES), information regarding high-volume outpatient surgeries and procedures performed in ambulatory surgical center and hospital settings in Vermont, any changes in utilization over time, and a comparison of the commercial insurance rates paid for the same surgeries and procedures performed in ambulatory surgical centers and in hospitals in Vermont.
(15) Collect and review data from each community mental health and developmental disability agency designated by the Commissioner of Mental Health or of Disabilities, Aging, and Independent Living pursuant to chapter 207 of this title, which may include data regarding a designated or specialized service agency’s scope of services, volume, utilization, payer mix, quality, coordination with other aspects of the health care system, and financial condition, including solvency. The Board’s processes shall be appropriate to the designated and specialized service agencies’ scale and their role in Vermont’s health care system, and the Board shall consider ways in which the designated and specialized service agencies can be integrated fully into systemwide payment and delivery system reform.
(c) The Board shall have the following duties related to Green Mountain Care:
(1) Prior to implementing Green Mountain Care, consider recommendations from the Agency of Human Services, and define the Green Mountain Care benefit package within the parameters established in 33 V.S.A. chapter 18, subchapter 2, to be adopted by the Agency by rule.
(2) When providing its recommendations for the benefit package pursuant to subdivision (1) of this subsection, the Agency of Human Services shall present a report on the benefit package proposal to the House Committee on Health Care and the Senate Committee on Health and Welfare. The report shall describe the covered services to be included in the Green Mountain Care benefit package and any cost-sharing requirements. If the General Assembly is not in session at the time that the Agency makes its recommendations, the Agency shall send its report electronically or by first-class mail to each member of the House Committee on Health Care and the Senate Committee on Health and Welfare.
(3) Prior to implementing Green Mountain Care and annually after implementation, recommend to the Governor a three-year Green Mountain Care budget pursuant to 32 V.S.A. chapter 5, to be adjusted annually in response to realized revenues and expenditures, that reflects any modifications to the benefit package and includes recommended appropriations, revenue estimates, and necessary modifications to tax rates and other assessments.
[Subsection (d) effective until July 1, 2026; see also subsection (d) effective July 1, 2026 set out below.]
(d) Annually on or before January 15, the Board shall submit a report of its activities for the preceding calendar year to the House Committee on Health Care and the Senate Committee on Health and Welfare.
(1) The report shall include:
(A) any changes to the payment rates for health care professionals pursuant to section 9376 of this title;
(B) any new developments with respect to health information technology;
(C) the evaluation criteria adopted pursuant to subdivision (b)(8) of this section and any related modifications;
(D) the results of the systemwide performance and quality evaluations required by subdivision (b)(8) of this section and any resulting recommendations;
(E) the process and outcome measures used in the evaluation;
(F) the impact of the Medicaid and Medicare cost shifts and uncompensated care on health insurance premium rates and any recommendations on mechanisms to ensure that appropriations intended to address the Medicaid cost shift will have the intended result of reducing the premiums imposed on commercial insurance premium payers below the amount they otherwise would have been charged;
(G) any recommendations for modifications to Vermont statutes; and
(H) any actual or anticipated impacts on the work of the Board as a result of modifications to federal laws, regulations, or programs.
(2) The report shall identify how the work of the Board comports with the principles expressed in section 9371 of this title.
[Subsection (d) effective July 1, 2026; see also subsection (d) effective until July 1, 2026 set out above.]
(d) Annually on or before January 15, the Board shall submit a report of its activities for the preceding calendar year to the House Committee on Health Care and the Senate Committee on Health and Welfare.
(1) The report shall include:
(A) any changes to the payment rates for health care professionals pursuant to section 9376 of this title;
(B) any new developments with respect to health information technology;
(C) the evaluation criteria adopted pursuant to subdivision (b)(8) of this section and any related modifications;
(D) the results of the systemwide performance and quality evaluations required by subdivision (b)(8) of this section and any resulting recommendations;
(E) the process and outcome measures used in the evaluation;
(F) the impact of the Medicaid and Medicare cost shifts and uncompensated care on health insurance premium rates and any recommendations on mechanisms to ensure that appropriations intended to address the Medicaid cost shift will have the intended result of reducing the premiums imposed on commercial insurance premium payers below the amount they otherwise would have been charged;
(G) the status of its efforts to establish methodologies for and begin implementation of reference-based pricing and development of global hospital budgets, and the effects of these efforts and activities on increasing access to care, improving the quality of care, and reducing the cost of care in Vermont;
(H) any recommendations for modifications to Vermont statutes; and
(I) any actual or anticipated impacts on the work of the Board as a result of modifications to federal laws, regulations, or programs.
(2) The report shall identify how the work of the Board comports with the principles expressed in section 9371 of this title.
(e)(1) The Board shall summarize and synthesize the key findings and recommendations from reports prepared by and for the Board, including its expenditure analyses and focused studies. The Board shall develop, in consultation with the Office of the Health Care Advocate, a standard for creating plain language summaries that the public can easily use and understand.
(2) All reports and summaries prepared by the Board shall be available to the public and shall be posted on the Board’s website. (Added 2011, No. 48, § 3, eff. May 26, 2011; amended 2011, No. 171 (Adj. Sess.), § 12, eff. May 16, 2012; 2013, No. 79, § 5 l, eff. Jan. 1, 2014; 2013, No. 79, § 41; 2015, No. 54, § 7, eff. June 5, 2015; 2015, No. 113 (Adj. Sess.), § 4, eff. Jan. 1, 2018; 2017, No. 88 (Adj. Sess.), § 1, eff. Feb. 20, 2018; 2017, No. 113 (Adj. Sess.), § 105; 2017, No. 154 (Adj. Sess.), § 3, eff. May 21, 2018; 2017, No. 167 (Adj. Sess.), §§ 1, 8, eff. May 22, 2018; 2017, No. 187 (Adj. Sess.), § 4, eff. May 28, 2018; 2019, No. 19, § 3, eff. Jan. 1, 2020; 2019, No. 53, § 2; 2019, No. 55, § 4, eff. June 10, 2019; 2019, No. 63, § 10 eff. June 17, 2019; 2019, No. 140 (Adj. Sess.), § 1, eff. July 6, 2020; 2021, No. 167 (Adj. Sess.), § 9, eff. June 1, 2022; 2025, No. 11, § 19, eff. September 1, 2025; 2025, No. 62, § 4, eff. July 1, 2025; 2025, No. 68, § 2, eff. June 12, 2025; 2025, No. 68, § 16, eff. July 1, 2026.)