by Devon Green, VP of Government Relations, VAHHS
Crossover week is usually intense, but the heat was ratcheted up to volcanic levels last week with the announcement of Blue Cross Blue Shield’s financial struggles from the Green Mountain Care Board and the Department of Financial Regulation. While we are seeing these trends nationally both with health insurers and hospitals, it appears that the combination of Vermont’s aging demographics, rurality, and housing costs have put us at the tip of the spear. What I love about this state is the ability to get everyone in a room to hash things out. VAHHS welcomes the opportunity to do that here.
Below is everything that happened last week. This week will be all about the “money committees” passing out any bill with appropriations or taxes or fees with their deadline happening on Friday.
GMCB Enhanced Powers: The House Health Care Committee introduced a committee bill on the Friday before Town Meeting week. That bill popped up again at the crossover deadline. Citing Blue Cross Blue Shield’s financial struggles, the Green Mountain Care Board testified that they needed the ability to make mid-year adjustments to hospital rates for one insurer if that insurer is in financial distress. As of the final bill, this would apply to independent hospitals that have 135 days’ cash on hand and a positive operating margin or a member of a hospital network that has 135 days’ cash on hand or a positive operating margin.
The GMCB also requested the power to appoint an independent observer to monitor hospital operations and financials if the hospital made a material misrepresentation or is materially noncompliant with their budget. VAHHS testified that they understand the gravity of our fragile health care system and we should explore options to spread the risk to avoid irreversibly damaging one part of the sector to help another. The bill as passed by the committee is here.
Senate Health Care Reform: As House Health Care was fast-tracking their bill, the Senate Health and Welfare Committee passed out their extensive health care reform bill with the following:
- Reference-based pricing: GMCB, with stakeholder input, to develop and implement reference-based pricing for hospitals as soon as practicable but no later than FY 2027
- Global budgets: Hospitals to participate in global budgets if they include Medicare, such as AHEAD, with one hospital participating by 2028 and all hospitals participating by 2030
- GMCB to collect reporting on hospital employee compensation and administrative versus direct-care staffing
- The GMCB has oversight of hospital networks
- Integration of clinical and claims data
- Statewide health care delivery plan due in 2029 that will be overseen by an advisory group with representation from providers, consumers, and payers
- 7 new GMCB positions
- Not included in the bill are:
- requirement for a single auditor
- requirement for a uniform system of accounts
- 200% reference-based pricing for 60,000 teacher and state employees
340B Protection Bill: H.266, which ensures that the 340B program is not eroded by pharmaceutical manufacturers, passed out of the House Health Committee with hospital reporting requirements and is on the floor of the House.
Green Mountain Care Board Miscellaneous Bill: The Senate Health and Welfare Committee passed out a GMCB housekeeping bill, S.63, that changes the GMCB’s role with VITL and updated oversight of ACOs now that OneCare is winding down. The bill does not contain a controversial proposal that would exclude hospital budget decisions as contested cases under the Vermont Administrative Procedures Act.
Data Privacy: There were two data privacy bills in Senate Institutions: S.71 and S.93. The Vermont Medical Society, representing a broad coalition of health care providers including VAHHS, testified in support of S.93 which contains an entity-level HIPAA exemption and non-profit exemption. The committee struck S.71 and inserted the language from S.93 in its place to pass the bill out of committee. Latest bill language can be found here. Thank you to the coalition and the Vermont Medical Society for this effort.
Residential Treatment of Co-Occurring Conditions and Public Inebriate Program: The Senate Health and Welfare Committee passed S.36, a bill that provides Medicaid coverage for residential treatment of co-occurring substance use disorder and mental health conditions. The bill, along with S.109, also repeals a provision set to go into effect in July that would increase the number of intoxicated people in emergency departments.
Workplace Violence Prevention: The House Health Care Committee advanced H.259, a bill that standardizes workplace violence prevention efforts at hospitals by requiring an oversight committee with representation from direct-care staff, de-escalation and trauma-informed training, and a security plan. The bill also exempts projects to reduce workplace violence from the Certificate of Need process and has workplace violence prevention taken into consideration during the hospital budget process.
Health Care Advocate: The Health Care Advocate’s bill, H.80, passed out of the House Health Care Committee. The Health Care Advocate will have more involvement in health insurance rate filings, state agency meetings, and the CON process.
To support vital journalism, access our archives and get unique features like our award-winning profiles, Book of Lists & Business-to-Business Directory, subscribe HERE!
