Legislative Update

by Devon Green, Sr. Vice President of Policy & Strategy, VAHHS Last week, I was slowed down by someone taking a photo of the State House. The building looked glorious in the morning sun with a fresh coat of snow, and I mentally thanked this tourist for giving me a moment to look around and appreciate where I was. Imagine my surprise when I discovered the “tourist” was one of our long-serving legislators! It speaks volumes that this place engenders a sense of awe even to those of us who have been here day in and day out for years.  

And now, on to health care. Buckle up because Week 3 felt like Week 30: 

Private Equity: The House Health Care Committee started their work on H.583, which restricts health care transactions and addresses the corporate practice of medicine. The committee received a national perspective from witnesses, including Dr. Zirui Song from Harvard Medical School and Massachusetts General Hospital, who spoke to the fact that private equity is interested in rural hospitals because they tend to have higher prices. He noted that there are no private equity-owned hospitals in Vermont. 

The Office of the Health Care Advocate, the driving force behind the bill, said they changed their approach from a regulatory approval process in H.71 from last year to a total prohibition on certain transactions in H.583. 

The Green Mountain Care Board and the Attorney General’s Office testified that while they support prohibiting bad practices, they need a better understanding of the bill and its enforcement. 

VAHHS testified that H.583 prohibits or substantially curtails:

• hospital affiliation with other hospitals or certain other health care providers
• allowing hospitals to use debt to finance the acquisition of a health care entity
• group purchasing and shared services

VAHHS also asked about the impact to nursing homes and emphasized that hospitals and patients can’t afford to have the same capacity crisis as a few years ago with patients being unable to discharge. 

Primary Care Payment Reform Program: The Senate Health and Welfare Committee heard about S. 197, which would do the following:

• Establish a primary care payment reform program that is voluntary by 2027 and mandatory by 2028
• Payments to primary care providers will be aggregated by payers and paid on a per-member per-month basis
• No out of pocket costs for primary care
• Reduction in administrative work/costs for primary care providers
• Increase the percentage spent on the total cost of care from about 10% to 15%

The Vermont Medical Society offered additional experts that could testify on this sort of program, including savings achieved after four years. They also recommended that the Agency of Human Services implement the program, as opposed to the Department of Vermont Health Access, so their could be coordination with the Blueprint for Health. 

Green Mountain Care Board Technical Bill: The Senate Health and Welfare heard testimony on S.190. The bill does several things:

• Reference-based pricing
• Hospitals will report their prices as a percentage of Medicare or other benchmark for FY 2027 budget
• Requires hospitals to obtain a unique National Provider Identifier (NPI) for all services that are “off-campus”
• The GMCB will establish a maximum percentage of Medicare for any newly established CPT code
• The GMCB will establish a maximum percentage of Medicare for any inpatient or outpatient service
• Outsourcing of clinical services
• Hospitals report on outsourcing of clinical sources
• Revenue from outsourced clinical services will be subject to the Provider Tax
• Hospitals are responsible for billing for outsourced services and financial assistance policies shall apply
• No mid-level appeal for hospital budgets
• The Chair of the GMCB may conduct investigations and audits of hospitals
• The GMCB will develop a public, interactive tool on health system performance if they receive funding

Elimination or Reduction of Hospital Services: The Green Mountain Care Board set out its proposals in S.189, which would shift oversight of the elimination or reduction of hospital services from the Green Mountain Care Board to the Agency of Human Services. The Green Mountain Care Board believes the Agency of Human Services is best positioned to do this work because they are working on hospital transformation. The Agency of Human Services noted that assigning them regulatory authority would conflict with their policy work for health care transformation. 

Workforce Development: The Vermont Department of Health presented their budget to the House Human Services Committee. Notably, the proposed budget eliminates $4.1M in health professional education assistance with the idea that workforce development will be reenvisioned through the rural health transformation funding. 

Forensic Facility: The Senate Judiciary Committee heard about S.193, a bill that would enact restoration of competency and set up a secure forensic treatment facility for certain individuals involved with the criminal justice system. 

Transportation: VAHHS updated the Senate Health and Welfare Committee and the Senate Transportation Committee on coordination of non-emergency medical transport. A working group was formed to coordinate the scheduling of health care appointments and shared rides and found opportunities with tapping into hospital volunteers as ride volunteers, coordination of rides for dialysis appointments, and potential coordination with new transportation scheduling software. 

Doula Certification: The Department of Vermont Health Access proposed a delay in doula certification to the House Health Care Committee. The Doula Association of Vermont is opposed, and the Chair expressed concerns around further delay.

Visit https://www.vahhs.org/ to stay up to date with the latest from the Vermont Association of Hospitals and Health Systems.

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