S 63

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No. 62. An act relating to modifying the regulatory duties of the Green
Mountain Care Board.
                                     (S.63)
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 18 V.S.A. § 9351 is amended to read:
§ 9351. HEALTH INFORMATION TECHNOLOGY PLAN
   (a)(1) The Department of Vermont Health Access, in consultation with the
Department’s Health Information Exchange Steering Committee, shall be
responsible for the overall coordination of Vermont’s statewide Health
Information Technology Plan. The Plan shall be revised annually and updated
comprehensively every five years to provide a strategic vision for clinical
health information technology.
      (2) The Department shall submit the proposed Plan to the Green
Mountain Care Board annually on or before November 1. The Green Mountain
Care Board shall approve, reject, or request modifications to the Plan within 45
days following its submission; if the Board has taken no action after 45 days,
the Plan shall be deemed to have been approved. [Repealed.]
      (3)(A) The Department, in consultation with the Steering Committee,
shall administer the Plan.
         (B) The Plan shall include the implementation of an integrated
electronic health information infrastructure for the sharing of electronic health
information among health care facilities, health care professionals, public and
private payers, and patients. The Plan shall provide for each patient’s
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electronic health information that is contained in the Vermont Health
Information Exchange to be accessible to health care facilities, health care
professionals, and public and private payers to the extent permitted under
federal law unless the patient has affirmatively elected not to have the patient’s
electronic health information shared in that manner.
         (C) The Plan shall include standards and protocols designed to
promote patient education, patient privacy, physician best practices, electronic
connectivity to health care data, access to advance care planning documents,
and, overall, a more efficient and less costly means of delivering quality health
care in Vermont.
         (D) A representative of the Green Mountain Care Board shall be a
voting member of the Steering Committee.
                                      ***
   (c) The Department of Vermont Health Access, in consultation with the
Steering Committee and subject to Green Mountain Care Board approval, may
propose updates to the Plan in addition to the annual updates as needed to
reflect emerging technologies, the State’s changing needs, and such other areas
as the Department deems appropriate. The Department shall solicit
recommendations from interested stakeholders in order to propose updates to
the Health Information Technology Plan pursuant to subsection (a) of this
section and to this subsection, including applicable standards, protocols, and
pilot programs, and following approval of the proposed updates by the Green
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Mountain Care Board, may enter into a contract or grant agreement with
appropriate entities to update some or all of the Plan. Upon approval of the
updated Plan by the Green Mountain Care Board, the The Department of
Vermont Health Access shall distribute the updated Plan to the Secretary of
Administration; the Secretary of Digital Services; the Commissioner of
Financial Regulation; the Green Mountain Care Board; the Secretary of
Human Services; the Commissioner of Health; the Commissioner of Mental
Health; the Commissioner of Disabilities, Aging, and Independent Living; the
Senate Committee on Health and Welfare; the House Committee on Health
Care; affected parties; and interested stakeholders. Unless major modifications
are required, the Department may present updated information about the Plan
to the legislative committees of jurisdiction in lieu of creating a written report.
   (d) The Health Information Technology Plan shall serve as the framework
within which the Green Mountain Care Board reviews certificate of need
applications for information technology under section 9440b of this title. In
addition, the Commissioner of Information and Innovation Secretary of Digital
Services shall use the Health Information Technology Plan as the basis for
independent review of State information technology procurements.
                                       ***
Sec. 2. 18 V.S.A. § 9352 is amended to read:
§ 9352. VERMONT INFORMATION TECHNOLOGY LEADERS
                                       ***
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   (c) Health information exchange operation.
      (1) VITL shall be designated in the Health Information Technology Plan
approved by the Green Mountain Care Board pursuant to section 9351 of this
title to operate the exclusive statewide health information exchange network
for this State. The Plan shall determine the manner in which Vermont’s health
information exchange network shall be managed. The Green Mountain Care
Board shall have the authority to approve VITL’s budget pursuant to chapter
220 of this title. Nothing in this chapter shall impede local community
providers from the exchange of electronic medical data.
                                     ***
   (e) Report. On or before January 15 of each year, VITL shall file a report
with the Green Mountain Care Board; the Secretary of Administration; the
Secretary of Digital Services; the Commissioner of Financial Regulation; the
Commissioner of Vermont Health Access; the Secretary of Human Services;
the Commissioner of Health; the Commissioner of Mental Health; the
Commissioner of Disabilities, Aging, and Independent Living; the Senate
Committee on Health and Welfare; and the House Committee on Health Care.
The report shall include an assessment of progress in implementing health
information technology in Vermont and recommendations for additional
funding and legislation required. In addition, VITL shall publish minutes of
VITL meetings and any other relevant information on a public website. The
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provisions of 2 V.S.A. § 20(d) (expiration of required reports) shall not apply
to the report to be made under this subsection.
                                         ***
   (i) Certification of meaningful use and connectivity.
      (1) To the extent necessary to support Vermont’s health care reform
goals or as required by federal law, VITL shall be authorized to certify the
meaningful use of health information technology and electronic health records
by health care providers licensed in Vermont.
      (2) VITL, in consultation with health care providers and health care
facilities, shall establish criteria for creating or maintaining connectivity to the
State’s health information exchange network. VITL shall provide the criteria
annually on or before March 1 to the Green Mountain Care Board established
pursuant to chapter 220 of this title.
                                         ***
Sec. 3. 18 V.S.A. § 9374(h) is amended to read:
   (h)(1)(A) Except as otherwise provided in subdivisions (1)(C) and (2) of
this subsection (h), the expenses of the Board shall be borne as follows:
            (i) 40.0 40 percent by the State from State monies;
            (ii) 28.8 36 percent by the hospitals; and
            (iii) 23.2 24 percent by nonprofit hospital and medical service
corporations licensed under 8 V.S.A. chapter 123 or 125, health insurance
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companies licensed under 8 V.S.A. chapter 101, and health maintenance
organizations licensed under 8 V.S.A. chapter 139; and
            (iv) 8.0 percent by accountable care organizations.
         (B) Expenses under subdivision (A)(iii) of this subdivision (1) shall
be allocated to persons licensed under Title 8 based on premiums paid for
health care coverage, which for the purposes of this subdivision (1) shall
include major medical, comprehensive medical, hospital or surgical coverage,
and comprehensive health care services plans, but shall not include long-term
care, limited benefits, disability, credit or stop loss, or excess loss insurance
coverage.
         (C) Expenses Amounts assessed pursuant to the provisions of section
sections 9382 and 9441 of this title shall not be assessed in accordance with the
formula set forth in subdivision (A) of this subdivision (1).
      (2) The Board may determine the scope of the incurred expenses to be
allocated pursuant to the formula set forth in subdivision (1) of this subsection
if, in the Board’s discretion, the expenses to be allocated are in the best
interests of the regulated entities and of the State.
      (3) If the amount of the proportional assessment to any entity calculated
in accordance with the formula set forth in subdivision (1)(A) of this
subsection would be less than $150.00, the Board shall assess the entity a
minimum fee of $150.00. The Board shall apply the amounts collected based
on the difference between each applicable entity’s proportional assessment
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amount and $150.00 to reduce the total amount assessed to the regulated
entities pursuant to subdivisions (1)(A)(ii)–(iv) (1)(A)(ii) and (iii) of this
subsection.
                                       ***
Sec. 4. 18 V.S.A. § 9375 is amended to read:
§ 9375. DUTIES
                                       ***
   (b) The Board shall have the following duties:
                                       ***
      (2)(A) Review and approve Vermont’s statewide Health Information
Technology Plan pursuant to section 9351 of this title to ensure that the
necessary infrastructure is in place to enable the State to achieve the principles
expressed in section 9371 of this title.
         (B) Review and approve the criteria required for health care
providers and health care facilities to create or maintain connectivity to the
State’s health information exchange as set forth in section 9352 of this title.
Within 90 days following this approval, the Board shall issue an order
explaining its decision.
         (C) Annually review and approve the budget, consistent with
available funds, of the Vermont Information Technology Leaders, Inc. (VITL).
This review shall take into account VITL’s responsibilities pursuant to section
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9352 of this title and the availability of funds needed to support those
responsibilities. [Repealed.]
                                        ***
        (12) Review data regarding mental health and substance abuse treatment
reported to the Department of Financial Regulation pursuant to 8 V.S.A. §
4089b(g)(1)(G) and discuss such information, as appropriate, with the Mental
Health Technical Advisory Group established pursuant to subdivision
9374(e)(2) of this title. [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.
                                        ***
Sec. 5. 18 V.S.A. § 9382 is amended to read:
§ 9382. OVERSIGHT OF ACCOUNTABLE CARE ORGANIZATIONS
   (a)(1) In order to be eligible to receive payments from Medicaid or
commercial insurance through any payment reform program or initiative,
including an all-payer model operate in Vermont, each accountable care
organization shall obtain and maintain certification from the Green Mountain
Care Board. The Board shall adopt rules pursuant to 3 V.S.A. chapter 25 to
establish standards and processes for certifying accountable care organizations.
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To the extent permitted under federal law, the Board shall ensure these rules
anticipate and accommodate a range of ACO models and sizes, balancing
oversight with support for innovation. In order to certify an ACO to operate in
this State, the Board shall ensure that the following criteria are met:
         (1)(A) The ACO’s governance, leadership, and management structure is
transparent, reasonably and equitably represents the ACO’s participating
providers and its patients, and includes a consumer advisory board and other
processes for inviting and considering consumer input.
         (2) The ACO has established appropriate mechanisms and care models
to provide, manage, and coordinate high-quality health care services for its
patients, including incorporating the Blueprint for Health, coordinating
services for complex high-need patients, and providing access to health care
providers who are not participants in the ACO. The ACO ensures equal access
to appropriate mental health care that meets standards of quality, access, and
affordability equivalent to other components of health care as part of an
integrated, holistic system of care, taken as a whole, support and do not hinder
the State’s principles for health care reform as set forth in section 9371 of this
title.
         (B) The ACO’s financial incentives for providers and patients are
reasonably calculated to improve, or at a minimum, maintain, the quality of,
access to, and affordability of care.
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      (3)(C) The ACO has established appropriate mechanisms to receive and
distribute payments to its participating health care providers in a fair and
equitable manner. To the extent that the ACO has the authority and ability to
establish provider reimbursement rates, the ACO shall minimize differentials
in payment methodology and amounts among comparable participating
providers across all practice settings, as long as doing so is not inconsistent
with the ACO’s overall payment reform objectives.
      (4)(D) The ACO has established appropriate mechanisms and criteria
for accepting health care providers to participate in the ACO that prevent
unreasonable discrimination and are related to the needs of the ACO and the
patient population served.
      (5) The ACO has established mechanisms and care models to promote
evidence-based health care, patient engagement, coordination of care, use of
electronic health records, and other enabling technologies to promote
integrated, efficient, seamless, and effective health care services across the
continuum of care, where feasible.
      (6) The ACO’s participating providers have the capacity for meaningful
participation in health information exchanges.
      (7)(E) The ACO has performance standards and measures to evaluate
the quality and utilization of care delivered by its participating health care
providers.
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        (8)(F) The ACO does not place any restrictions on the information its
participating health care providers may provide to patients about their health or
decisions regarding their health.
        (9) The ACO’s participating health care providers engage their patients
in shared decision making to inform them of their treatment options and the
related risks and benefits of each.
        (10)(G) The ACO offers assistance to health care consumers, including:
          (A)(i) maintaining a consumer telephone line for questions,
complaints, and grievances from attributed patients;
          (B)(ii) responding and making best efforts to resolve complaints and
grievances from attributed patients, including providing assistance in
identifying appropriate rights under a patient’s health plan;
          (C)(iii) providing an accessible mechanism for explaining how ACOs
work;
          (D)(iv) providing contact information for the Office of the Health
Care Advocate; and
          (E)(v) sharing deidentified complaint and grievance information with
the Office of the Health Care Advocate at least twice annually.
        (11) The ACO collaborates with providers not included in its financial
model, including home- and community-based providers and dental health
providers.
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      (12) The ACO does not interfere with patients’ choice of their own
health care providers under their health plan, regardless of whether a provider
is participating in the ACO; does not reduce covered services; and does not
increase patient cost sharing.
      (13) The meetings of the ACO’s governing body comply with the
provisions of section 9572 of this title.
      (14) The impact of the ACO’s establishment and operation does not
diminish access to any health care or community-based service or increase
delays in access to care for the population and area it serves.
      (15) The ACO has in place appropriate mechanisms to conduct ongoing
assessments of its legal and financial vulnerabilities.
      (16)(H) The ACO has in place a financial guarantee sufficient to cover
its potential losses.
      (17) The ACO provides connections and incentives to existing
community services for preventing and addressing the impact of childhood
adversity. The ACO collaborates on the development of quality-outcome
measurements for use by primary care providers who work with children and
families and fosters collaboration among care coordinators, community service
providers, and families.
      (2) Notwithstanding subdivision (1) of this subsection, the Green
Mountain Care Board may adopt rules in accordance with 3 V.S.A. chapter 25
to establish a streamlined process for certification as a Medicare-only ACO for
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an entity authorized by the Centers for Medicare and Medicaid Services to act
as an accountable care organization under the Medicare program. The
streamlined process may require a Medicare-only ACO to meet one or more of
the criteria set forth in subdivision (1) of this subsection. Certification
obtained pursuant to the streamlined process shall apply to the Medicare-only
ACO’s actions only as they relate to Medicare beneficiaries and only to the
extent that the federal authorization allows.
   (b)(1) The Green Mountain Care Board shall adopt rules pursuant to in
accordance with 3 V.S.A. chapter 25 to establish standards and processes for
reviewing, modifying, and approving the budgets of ACOs with 10,000 or
more that receive payments from Medicaid or commercial insurers, or both, on
behalf of attributed lives in Vermont. To the extent permitted under federal
law, the Board shall ensure the rules anticipate and accommodate a range of
ACO models and sizes, balancing oversight with support for innovation. In its
review, the Board shall review and consider:
            (A) information regarding utilization of the health care services
delivered by health care providers participating in the ACO and the effects of
care models on appropriate utilization, including the provision of innovative
services;
            (B) the Health Resource Allocation Plan identifying Vermont’s
critical health needs, goods, services, and resources as identified pursuant to
section 9405 of this title;
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         (C) the expenditure analysis for the previous year and the proposed
expenditure analysis for the year under review by payer;
         (D) the character, competence, fiscal responsibility, and soundness of
the ACO and its principals;
         (E) any reports from professional review organizations;
         (F) the ACO’s efforts to prevent duplication of high-quality services
being provided efficiently and effectively by existing community-based
providers in the same geographic area, as well as its integration of efforts with
the Blueprint for Health and its regional care collaboratives;
         (G) the extent to which the ACO provides incentives for systemic
health care investments to strengthen primary care, including strategies for
recruiting additional primary care providers, providing resources to expand
capacity in existing primary care practices, and reducing the administrative
burden of reporting requirements for providers while balancing the need to
have sufficient measures to evaluate adequately the quality of and access to
care;
         (H) the extent to which the ACO provides incentives for systemic
integration of community-based providers in its care model or investments to
expand capacity in existing community-based providers, in order to promote
seamless coordination of care across the care continuum;
         (I) the extent to which the ACO provides incentives for systemic
health care investments in social determinants of health, such as developing
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support capacities that prevent hospital admissions and readmissions, reduce
length of hospital stays, improve population health outcomes, reward healthy
lifestyle choices, and improve the solvency of and address the financial risk to
community-based providers that are participating providers of an accountable
care organization;
         (J) the extent to which the ACO provides incentives for preventing
and addressing the impacts of adverse childhood experiences (ACEs) and other
traumas, such as developing quality outcome measures for use by primary care
providers working with children and families, developing partnerships between
nurses and families, providing opportunities for home visits, and including
parent-child centers and designated agencies as participating providers in the
ACO;
         (K) public comment on all aspects of the ACO’s costs and use and on
the ACO’s proposed budget;
         (L) information gathered from meetings with the ACO to review and
discuss its proposed budget for the forthcoming fiscal year;
         (M) information on the ACO’s administrative costs, as defined by the
Board;
         (N) the effect, if any, of Medicaid reimbursement rates on the rates
for other payers;
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         (O) the extent to which the ACO makes its costs transparent and easy
to understand so that patients are aware of the costs of the health care services
they receive; and
         (P) the extent to which the ACO provides resources to primary care
practices to ensure that care coordination and community services, such as
mental health and substance use disorder counseling that are provided by
community health teams, are available to patients without imposing
unreasonable burdens on primary care providers or on ACO member
organizations.
      (2) The Green Mountain Care Board shall adopt rules pursuant to 3
V.S.A. chapter 25 to establish standards and processes for reviewing,
modifying, and approving the budgets of ACOs with fewer than 10,000
attributed lives in Vermont. In its review, the Board may consider as many of
the factors described in subdivision (1) of this subsection as the Board deems
appropriate to a specific ACO’s size and scope
      (1) information gathered from meetings with the ACO to review and
discuss its proposed budget for the forthcoming fiscal year;
      (2) the efficacy with which the ACO uses funds from Medicaid and
commercial insurers, as applicable, to enhance and expedite the State’s health
care system transformation efforts;
      (3) the ACO’s reasonable use of State and commercial insurance funds
for its own administrative costs, as defined by the Board;
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      (4) the ACO’s collaboration with a range of provider types, such as
home- and community-based providers, dental health providers, and mental
health and substance use disorder treatment providers;
      (5) the ACO’s use of a consumer advisory board and other mechanisms
for inviting and considering consumer input; and
      (6) public comment on all aspects of the ACO’s costs, operations, and
proposed budget.
      (3)(A)(c)(1) The Office of the Health Care Advocate shall have the right
to receive copies of all materials related to any ACO certification or budget
review and may:
            (i)(A) ask questions of employees of the Green Mountain Care
Board related to the Board’s ACO budget review;
            (ii)(B) submit written questions to the Board that the Board will
ask of the ACO in advance of any hearing held in conjunction with the Board’s
ACO review;
            (iii)(C) submit written comments for the Board’s consideration;
and
            (iv)(D) ask questions and provide testimony in any hearing held in
conjunction with the Board’s ACO budget review.
         (B)(2) The Office of the Health Care Advocate shall not disclose
further any confidential or proprietary information provided to the Office
pursuant to this subdivision (3) subsection.
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   (c)(d) The Board’s rules shall include requirements for submission of
information and data by ACOs and their participating providers as needed to
evaluate an ACO’s success. They The rules may also establish standards as
appropriate to promote an ACO’s ability to participate in applicable federal
programs for ACOs.
   (d)(e) All information required to be filed by an ACO pursuant to this
section or to rules adopted pursuant to this section shall be made available to
the public upon request in accordance with 1 V.S.A. chapter 5, subchapter 3
(Public Records Act), provided that individual patients or health care providers
shall not be directly or indirectly identifiable.
   (e)(f) To the extent required to avoid federal antitrust violations, the Board
shall supervise the participation of health care professionals, health care
facilities, and other persons operating or participating in an accountable care
organization. The Board shall ensure that its certification and oversight
processes constitute sufficient State supervision over these entities to comply
with federal antitrust provisions and shall refer to the Attorney General for
appropriate action the activities of any individual or entity that the Board
determines, after notice and an opportunity to be heard, may be in violation of
State or federal antitrust laws without a countervailing benefit of improving
patient care, improving access to health care, increasing efficiency, or reducing
costs by modifying payment methods.
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   (g) The Board shall collect the following amounts from an accountable care
organization:
      (1) $10,000.00 for initial certification in accordance with subsection (a)
of this section;
      (2) $2,000.00 annually following initial certification to maintain
certification; and
      (3) $125,000.00 for each review of the accountable care organization’s
budget in accordance with subsection (b) of this section.
Sec. 6. 18 V.S.A. § 9454 is amended to read:
§ 9454. HOSPITALS; DUTIES
                                      ***
   (b)(1) Hospitals General hospitals, as defined in section 1902 of this title,
shall adopt a fiscal year that shall begin on October 1.
      (2) Psychiatric hospitals, as defined in section 1902 of this title but
excluding those conducted, maintained, or operated by the State of Vermont,
shall adopt a fiscal year that shall begin on January 1.
Sec. 7. 18 V.S.A. § 9456 is amended to read:
§ 9456. BUDGET REVIEW
   (a) The Board shall conduct reviews of each hospital’s proposed budget
based on the information provided pursuant to this subchapter and in
accordance with a schedule established by the Board. Notwithstanding any
provision of 3 V.S.A. chapter 25 to the contrary, the Board’s review,
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establishment, and enforcement of hospital budgets under this section shall not
be construed to be a contested case. Any person aggrieved by a final Board
action, order, or determination under this section may appeal as set forth in
section 9381 of this title.
                                       ***
   (d)(1)(A) Annually, the Board shall establish a budget for each general
hospital, as defined in section 1902 of this title, on or before September 15,
followed by a written decision by on or before October 1.
         (B) Annually, the Board shall establish a budget for each psychiatric
hospital, as defined in section 1902 of this title but excluding those conducted,
maintained, or operated by the State of Vermont, on or before December 15,
followed by a written decision on or before December 31.
         (C) Each hospital shall operate within the budget established under
this section.
                                       ***
   (h)(1) If a hospital violates a provision of this section, the Board may
maintain an action in the Superior Court of the county in which the hospital is
located to enjoin, restrain, or prevent such violation.
      (2)(A) After notice and an opportunity for hearing, the Board may
impose on a person who knowingly violates a provision of this subchapter, or a
rule adopted pursuant to this subchapter, a civil administrative penalty of no
not more than $40,000.00, or in the case of a continuing violation, a civil
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administrative penalty of no not more than $100,000.00 or one-tenth of one
percent of the gross annual revenues of the hospital, whichever is greater. This
subdivision shall not apply to violations of subsection (d) of this section caused
by exceptional or unforeseen circumstances.
         (B)(i) The Board may order a hospital to:
                                       ***
            (ii) Orders issued under this subdivision (2)(B) shall be issued
after notice and an opportunity to be heard, except where the Board finds that a
hospital’s financial or other emergency circumstances pose an immediate
threat of harm to the public or to the financial condition of the hospital. Where
there is an immediate threat, the Board may issue orders under this subdivision
(2)(B) without written or oral notice to the hospital. Where an order is issued
without notice, the hospital shall be notified of the right to a hearing at the time
the order is issued. The hearing shall be held within 30 days after receipt of
the hospital’s request for a hearing, and a decision shall be issued within 30
days after conclusion of the hearing. The Board may increase the time to hold
the hearing or to render the decision for good cause shown. Hospitals may
appeal any decision in this subsection to Superior Court. Appeal shall be on
the record as developed by the Board in the administrative proceeding and the
standard of review shall be as provided in 8 V.S.A. § 16.
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Sec. 8. 18 V.S.A. § 9572 is amended to read:
§ 9572. MEETINGS OF AN ACCOUNTABLE CARE ORGANIZATION’S
         GOVERNING BODY
   (a) Application. This section shall apply to all regular, special, and
emergency meetings of the governing board of an accountable care
organization’s governing body organization that contracts with the Vermont
Medicaid program, whether the meeting is held in person or by electronic
means, as well as to any other assemblage of members of the ACO’s governing
body at which binding action is taken on behalf of the ACO. For purposes of
this section, the term “ACO’s governing body” shall also include the
governing body of any organization acting as a coordinating entity for two or
more ACOs that contract with Vermont Medicaid.
                                      ***
Sec. 9. REPEAL
   18 V.S.A. § 9573 (Medicaid advisory rate case) is repealed.
Sec. 10. EFFECTIVE DATES
   (a) In Sec. 5, (18 V.S.A. § 9382), subsection (a) shall take effect on January
1, 2027 and subsections (b)–(g) shall take effect on January 1, 2026.
   (b) Secs. 6 (18 V.S.A. § 9454) and 7 (18 V.S.A. § 9456) and this section
shall take effect on passage.
   (c) The remaining sections shall take effect on July 1, 2025.
Date Governor signed bill: June 12, 2025
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