VAHHS Update: Legislative session winds down

Submitted by tim on Mon, 06/02/2025 - 08:59

by Devon Green, VP of Government Relations, VAHHS

Although no one has gaveled out, this will be my last column of the session… for now. The health care bills are done, but if this session has made one thing clear, it’s that health care permeates Vermont’s economy, government, and communities. There is much work to be done in the off-session to make care more affordable while maintaining access to essential services.

Below are the happenings from last week, as well as a summary of the health care bills that passed out of the legislature.

340B Protection/Prescription Drug Cap: In a 20-10 vote, the Senate approved of a floor amendment to change the start date in H.266 from July 1, 2025 to January 1, 2026. This will give hospitals time to implement the 120% price cap on prescription drugs administered in a hospital outpatient setting while ensuring premium savings for the Vermonters during the calendar year. The bill also maintains 340B protections for hospitals, FQHCs, and retail pharmacies along with 340B reporting requirements for hospitals.

Health Care Reform: The Conference Committee met on S.126 and came to agreement that included requiring global hospital budgets for at least one non-critical access hospital in 2028 and all hospitals in 2030. The legislature passed out the bill and it is on its way to the governor. Below is a summary:

AHS must make recommendations on reducing hospital spend by 2.5% ($100M) statewide over the course of FY 2026, with first report by July 1, 2025
Green Mountain Care Board to implement reference-based pricing for hospitals by 2027 with hospital input
If it has the resources, the Green Mountain Care Board will implement global hospital budgets to at least one non-CAH hospital in 2028 and all hospitals by 2030
Hospitals must report the number of administrative versus direct-care employees to the Green Mountain Care Board
Hospitals must report variable compensation to the Green Mountain Care Board
Hospitals must notify the Green Mountain Care Board, the Agency of Human Services, the Health Care Advocate, and their legislative delegation about the reduction or elimination of hospital services in order to comply with a budget 45 days prior to implementation
Actions recommended by Act 167 are exempt
Green Mountain Care Board oversees hospital networks and makes recommendations
Requires AHS to develop a statewide health care plan overseen by a health care delivery advisory committee, including hospital representation
Establishes a Vermont Steering Committee for Comprehensive Primary Health Care to create a plan every three years, starting with December 1, 2030
AHS shall work with the HIE steering committee to create a “Unified Health Data Space” and examine whether to integrate clinical and claims data—report due on January 15, 2026

2025 Health Care Bills Passed by the Legislature

Topic	Bill	Description
340B Protection/Prescription Drug Price Cap	H.266	Protects the 340B program for hospitals, FQHCs, and retail pharmacies. Requires hospital reporting on 340B. Establishes a 120% price cap on prescription drugs administered in a hospital outpatient setting starting on 1/1/26
Admin Burden	H.31/Act 3	Act 111 changes- clarifies definition of primary care provider and that claims edits changes do not apply to care provided outside of Vermont
Birthing Services/CON	S.18/Act 19	Licensure and no CON for freestanding birth centers
CON	H.96/Act 15	Increases CON jurisdictional thresholds for construction to $10M, equipment to $5M, health care services to $3M, conceptual development to $50M. Also exempts fully depreciated equipment and government-funded projects
GMCB	S.63	GMCB miscellaneous bill and hospital budgets are not a contested case under VAPA
GMCB	H.482	Expansion of GMCB powers: rate change for certain hospitals if BCBSVT near insolvency, rate change for all hospitals if missing budget, independent monitor if hospital materially misrepresents info or is materially noncompliant with budget
Government/Regulation	H.80/Act 6	Health Care Advocate-- redefines the role to include access to health services and allows HCA access to an individual's records with consent and allows health care advocate to join confidential state proceedings
Health Care Coverage	H.35/Act 2	Unmerges the Individual and Small Group Market
Health Care Coverage	S.30/Act 11	Update and reorganize health insurance laws to use consistent language

Health Care Reform	S.126	Reference-based pricing for 2027, global budgets for all hospitals by 2030, new reporting requirements for hospital budgets, hospitals to find operational savings of 2.5% for FY 2026
Long Term Care	H.13/Act 14	AHS to determine reasonable and adequate Medicaid payment rates for providers of home- and community-based services
Medical Debt	S.27/Act 21	State Treasurer medical debt relief program
Workplace Violence Prevention	H.259/Act 9	Requires hospitals to make security plans and include direct-care providers in the planning process. Carves out investments in workplace violence prevention from regulatory process
Workplace Violence Prevention	S.36/Act 22	Repeals prohibition against the DOC holding intoxicated individuals that was supposed to go into effect on 7/1/25. Medicaid coverage for long-term residential treatment of those with SUD and a co-occuring mental health condition

I welcome all ideas and discussion at [email protected].