by Devon Green, Sr. Vice President of Policy & Strategy, VAHHS
Last week, the breakneck pace of the session picked up even more speed with the realization that Town Meeting and Crossover are on the horizon. Check out all that went on with hospitals, below:
Green Mountain Care Board Bill: The Green Mountain Care Board presented the Senate Health and Welfare Committee with new options for reference-based pricing in S.190. Although VAHHS could not comment on the newly released proposals, VAHHS testified that outsourcing of services should be studied before it is regulated to maintain access to care and that the Green Mountain Care Board should not have audit authority in addition to observer authority because it was duplicative and administratively costly.
As part of testimony on S.190, Blue Cross Blue Shield of Vermont advocated for capping radiology and lab services, noting a $100M reduction to Blue Cross Blue Shield subscribers. VAHHS pointed out that the $100M in savings to Blue Cross Blue Shield subscribers would be several hundred million dollars in loss to hospitals statewide because it would apply across health insurers. It also appears that Blue Cross Blue Shield is utilizing 2024 data for its estimates.
VAHHS and its member hospitals are committed to eliminating $330M in operational expenses by FY 2028. Hospitals eliminated $230M for FY 2026 and have pledged to do $50M for FY2027 and $50M for FY 2028.
Antitrust: The Senate Health and Welfare Committee heard about S.249, which sets out a process for state action immunity of antitrust laws for purposes of hospital transformation. VAHHS believes that there may be more streamlined processes providing similar protections available.
PAs Performing First Certifications: The House Health Care Committee heard testimony on H.573, which would allow physician assistants (PAs) to perform first certifications when determining involuntary status for a person in need of inpatient psychiatric treatment. Currently, only physicians and APRNs can sign off on the first certification, even though shifts at Vermont’s rural emergency departments may consist primarily or completely of PAs. Elizabeth Couto, BSN, RN, CEN, Chair, Director, ENA-Vermont testified in favor of the bill.
Primary Care: Dr. Elliot Fisher, MD, MPH, professor at The Dartmouth Institute, presented on S.197, the primary care bill. He outlined the case for increasing resources to primary care and advocated for increasing investment in primary care under current payment models with the goal of universal primary care for everyone. This work would be financed through a 1% “innovation fund” with a five-year grant set at 1% of local health care spending and payers agreeing to reinvest 50% of their savings back into the innovation fund.
Noncompete and Pay-to-Stay Bill: VAHHS testified in the House Commerce and Economic Development Committee on H.205, which prohibits non-compete clauses, limits non-solicitation agreements and applies guardrails to pay-to-stay initiatives. VAHHS testified that Vermont’s hospitals are already in compliance with the prohibition on noncompete provisions but asked that the pay to stay exemption should include people who are asked to leave during a probationary period. The Committee added the exemption to the bill and advanced the bill by 10-1.
Specialty Medications: The House Health Care Committee heard about a short-form bill, H.736, which would require health care facilities to allow patients to bring in medically necessary medications from home. VAHHS testified that currently all hospitals allow patients to bring in medications from home.
Artificial Intelligence: The House Health Care Committee heard about a suite of bills that would regulate AI, ranging from chatbots to wearables:
- H.814 sets out a comprehensive framework for AI usage in health and human services. Part of the bill addresses neural data, which seems to pertain more to wearables than medical diagnostics.
- H.816 & H.644 address the use of AI in mental health treatment. A comparison of the two bills can be found here.
The committee invites testimony and further discussion.
Insurance Reforms: The House Health Care Committee indicated that the Department of Financial Regulation’s proposal in H.585 to seek a waiver from the federal government to implement a state reinsurance plan is going into the budget.
The House Health Care Committee also heard from the Department of Financial Regulation health sharing plans, which are not health insurance, but are member-based plans to cover the costs of health care. There was a question on whether these plans impact uncompensated care at hospitals.
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