H 583

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2026
No. 133. An act relating to clinical decision making.
                                          (H.583)
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 18 V.S.A. chapter 233 is added to read:
                  CHAPTER 233. CLINICAL DECISION MAKING
§ 9771. DEFINITIONS
   As used in this chapter:
       (1) “Health care facility” has the same meaning as in section 9432 of
this title.
       (2) “Health care provider” has the same meaning as in section 9402 of
this title.
       (3) “Health care services” has the same meaning as in section 9481 of
this title and includes all of the following:
              (A) inpatient; outpatient; habilitative; rehabilitative; dental;
palliative, including hospice; therapeutic; supportive; nursing home; home
health; mental health; and substance use disorder services, provided by a health
care facility;
              (B) pharmacy services, including drugs, devices, and medical
supplies;
              (C) performance of functions to refer, arrange, and coordinate care;
              (D) durable medical equipment, diagnostic equipment, surgical
devices, and infusion equipment; and
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          (E) technology associated with providing the services and equipment
set forth in subdivisions (A)–(D) of this subdivision (3), such as telehealth,
electronic health records, software, claims processing, and utilization systems.
      (4) “Health care staffing company” means a person engaged in the
business of providing or procuring health care personnel for temporary
employment or contracting by a health care facility, but does not include an
individual who independently provides the individual’s own services on a
temporary basis to health care facilities as an employee or contractor.
      (5)(A) “Hedge fund” means a pool of funds managed by investors for
the purpose of earning a return on those funds, regardless of the strategies used
to manage the funds. Hedge funds include a pool of funds managed or
controlled by private limited partnerships.
          (B) “Hedge fund” does not include:
            (i) individuals or entities that contribute, or promise to contribute,
funds to a hedge fund but do not participate in the management of the hedge
fund or the fund’s assets or in any change of control of the hedge fund or the
fund’s assets; or
            (ii) entities that solely provide or manage debt financing secured
in whole or in part by the assets of a health care facility, including banks, credit
unions, commercial real estate lenders, bond underwriters, and trustees.
      (6) “Management services organization” means any organization or
entity that contracts with a health care provider or provider organization to
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perform management or administrative services relating to, supporting, or
facilitating the provision of health care services.
      (7) “Ownership or investment interest” means any of the following:
          (A) direct or indirect possession of equity in the capital, stock, or
profits totaling more than five percent of an entity;
          (B) interest held by an investor or group of investors who engage in
the raising or returning of capital and who invest, develop, or dispose of
specified assets; or
          (C) interest held by a pool of funds by investors, including a pool of
funds managed or controlled by private limited partnerships, if those investors
or the management of that pool or private limited partnership employs
investment strategies of any kind to earn a return on that pool of funds.
      (8)(A) “Private equity group” means an investor or group of investors
who primarily engage in the raising or returning of capital and who invest,
develop, dispose of, or purchase any equity interest in assets, either as a parent
company or through another entity the investor or investors completely or
partially own or control.
          (B) “Private equity group” does not include individuals or entities
that contribute, or promise to contribute, funds to the private equity group but
otherwise do not participate in the management of the private equity group or
the group’s assets, or in any change in control of the private equity group or
the group’s assets.
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      (9) “Provider organization” means any corporation, partnership,
business trust, association, or organized group of persons that is in the business
of health care delivery or management, whether incorporated or not, that
represents one or more health care providers in contracting with health insurers
for payment for health care services. The term includes physician
organizations, physician-hospital organizations, independent practice
associations, provider networks, accountable care organizations, management
services organizations, and any other organization that contracts with health
insurers for payment for health care services.
      (10) “Significant equity investor” means:
          (A) any private equity group with a direct or indirect ownership or
investment interest in a health care facility or management services
organization;
          (B) an investor, group of investors, or other entity with a direct or
indirect possession of equity in the capital, stock, or profits totaling more than
10 percent of a health care provider or provider organization; or
          (C) any private equity group, investor, group of investors, or other
entity with a direct or indirect controlling interest in a health care facility or
management services organization or that operates the business or substantially
all the real or personal property, or both, of a health care facility or
management services organization under a lease, management, or operating
agreement.
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§ 9772. LIMITATIONS ON CONTROL OVER CLINICAL DECISION
            MAKING BY PRIVATE EQUITY GROUP OR HEDGE FUND
   (a) The purpose of this section is to ensure that clinical decision making
and treatment decisions are exclusively in the hands of health care providers
and to safeguard against nonlicensed individuals or entities, such as private
equity groups and hedge funds, exerting influence or control over health care
delivery.
   (b) A private equity group or hedge fund involved in any manner with a
health care facility doing business in this State, including as an investor in a
health care facility or as an investor or owner of the assets of a health care
facility, shall not do any of the following with respect to the health care
facility:
      (1) interfere with the judgment of health care providers in making health
care decisions, including any of the following:
            (A) determining which diagnostic tests are appropriate for a
particular condition;
            (B) determining the need for referrals to or consultation with another
health care provider;
            (C) determining the patient’s care plan, including the treatment
options available to the patient; and
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          (D) determining how many patients a health care provider shall see in
any given period of time or how many hours a health care provider shall work;
or
      (2) exercise control over, or be delegated the power to do, any of the
following:
          (A) setting clinical standards or policies, including clinical staffing
levels;
          (B) controlling or otherwise determining the content of patient
medical records;
          (C) hiring or firing health care providers, clinical staff, or medical
assistants, or any combination of these, based in whole or in part on clinical
competency or proficiency;
          (D) setting the parameters under which a health care provider or
health care facility shall enter into contractual relationships with third-party
payers;
          (E) setting the prices, rates, or amounts the health care facility
charges for a health care provider’s services;
          (F) setting the clinical competency or proficiency parameters under
which a health care provider shall enter into contractual relationships with
other health care providers for the delivery of health care services;
          (G) making decisions regarding the coding and billing of diagnoses
and procedures for patient care services; and
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          (H) selecting or approving the selection of medical equipment and
medical supplies for the health care facility.
   (c) A private equity group or hedge fund, or an entity controlled directly in
whole or in part by a private equity group or hedge fund, shall not enter into an
agreement or arrangement with a health care facility doing business in this
State if the agreement or arrangement would enable the person to interfere with
the ability of health care providers to make health care decisions, as set forth in
subdivision (b)(1) of this section, or to exercise control over or be delegated
the powers set forth in subdivision (b)(2) of this section.
   (d)(1) The organizational form of a health care facility as a sole
proprietorship, partnership, foundation, or corporate entity of any kind shall
not affect the applicability of this section.
      (2) Nothing in this section shall be construed to prohibit an unlicensed
individual or entity from providing nonclinical management, administrative, or
business services to; assisting; or consulting with a health care facility doing
business in this State with respect to the decisions and activities described in
subdivision (b)(2) of this section, provided that a licensed health care provider
retains the ultimate responsibility for or approval of those decisions and
activities and the services provided do not constitute an exercise of de facto
control over the administrative, business, or clinical operations of a health care
facility in a manner that affects a health care provider’s clinical decision
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making or the nature or quality of the health care services that the health care
facility delivers.
   (e) A health care provider who is aggrieved by the actions of a private
equity group or hedge fund, or an entity controlled directly in whole or in part
by a private equity group or hedge fund, in violation of this section may bring
an action in Superior Court for appropriate equitable relief, actual damages,
reasonable costs, and attorney’s fees.
§ 9773. REPORTING OF OWNERSHIP AND CONTROL OF CERTAIN
          HEALTH CARE ENTITIES
   (a) On or before March 1, 2027, each health care facility and each
management services organization shall provide to the Green Mountain Care
Board either:
      (1) for a health care facility or management services organization in
which one or more private equity groups or hedge funds held an ownership or
investment interest as of June 1, 2026, the information required by subsection
(b) of this section; or
      (2) for a health care facility or management services organization in
which no private equity group or hedge fund held an ownership or investment
interest as of June 1, 2026, an attestation that the health care facility or
management services organization currently has no private equity or hedge
fund ownership or investment.
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   (b) Each health care facility or management services organization in which
one or more private equity groups or hedge funds holds an ownership or
investment interest as of June 1, 2026, shall report the following information to
the Green Mountain Care Board, in a form and manner required by the Board:
      (1) the name, business address, and business identification numbers for
each person that, with respect to the relevant health care facility or
management services organization:
          (A) has an ownership or investment interest;
          (B) has a controlling interest;
          (C) for health care facilities only, is a management services
organization; or
          (D) is a significant equity investor;
      (2) a current organizational chart showing the business structure of the
health care facility or management services organization, including:
          (A) any entity listed in subdivision (1) of this subsection (b);
          (B) affiliates, including entities that control or are under common
control as the health care facility or management services organization; and
          (C) subsidiaries; and
      (3) the health care facility’s or management services organization’s most
recent fiscal year’s profit and loss statement and balance sheet.
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   (c) After March 1, 2027, a health care facility or management services
organization shall report the information described in subsection (b) of this
section any time that:
      (1) a private equity group or hedge fund takes on an ownership or
investment interest in the health care facility or management services
organization that had not previously been reported to the Green Mountain Care
Board in accordance with subsection (b) of this section; or
      (2) there is a modification to a private equity group’s or hedge fund’s
existing ownership or investment interest in the health care facility or
management services organization.
   (d) The Green Mountain Care Board shall collaborate with relevant
stakeholders to develop the processes for reporting data pursuant to this section
and the Agency of Human Services shall provide relevant, necessary data to
the Board.
   (e) The following entities are exempt from the reporting requirements set
forth in this section:
      (1) nursing homes, as defined in 33 V.S.A. § 7102;
      (2) health care staffing companies;
      (3) federally qualified health centers; and
      (4) entities whose health care services delivered in Vermont are
provided exclusively through telehealth, including services delivered using
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telemedicine and store-and-forward means, as those terms are defined in
8 V.S.A. § 4098a, and all forms of remote patient monitoring.
   (f) Information provided pursuant to this section shall be public
information and shall not be considered confidential, proprietary, or a trade
secret, except that:
      (1) any individual health care provider’s taxpayer ID that is also the
individual’s Social Security number, and any nonbusiness telephone number,
email address, physical address, or mailing address of any individual health
care provider, shall be exempt from public inspection and copying under the
Public Records Act and shall be kept confidential; and
      (2) all profit and loss statements and balance sheets submitted pursuant
to subdivision (b)(3) of this section shall be exempt from public inspection and
copying under the Public Records Act and shall be kept confidential, except
that the Board shall provide copies of these materials, or the information
contained in them, to the Office of the Health Care Advocate, which shall not
further disclose this confidential information.
   (g)(1) A health care facility or management services organization that
knowingly fails to report the information required by this section is liable to
the State for a civil penalty of not more than $50.00 for each day, not to exceed
a total of $10,000.00 for each year, that it fails to report the required
information.
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      (2) A health care facility or management services organization that
makes a material misrepresentation in a report required under this section is
liable to the State for a civil penalty of not more than $25,000.00 for each
material misrepresentation included in the report.
      (3) The Attorney General may maintain an action in Superior Court to
collect the penalties imposed in this subsection and to seek appropriate
injunctive relief.
§ 9774. SHARING OF OWNERSHIP INFORMATION TO IMPROVE
          TRANSPARENCY
   (a) On or before July 1, 2027, and every two years thereafter, the Green
Mountain Care Board shall post on its website a report regarding the
information provided to the Board pursuant to section 9773 of this chapter
during the previous two-year period, including:
      (1) the number of health care facilities and management services
organizations reporting for such year, disaggregated by the business structure
of each specified entity;
      (2) the names, addresses, and business structure of any entities with an
ownership or controlling interest in each health care facility or management
services organization;
      (3) any change in ownership or control for each health care facility or
management services organization;
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      (4) any change in the tax identification number of a health care facility
or management services organization; and
      (5) as applicable, the name, address, tax identification number, and
business structure of other affiliates under common control, subsidiaries, and
management services entities as the health care facility or management
services organization, including the business type and the tax identification
number of each.
   (b) Information provided pursuant to this section shall be public
information and shall not be considered confidential, proprietary, or a trade
secret; provided, however, that any individual health care provider’s taxpayer
ID that is also the individual’s Social Security number shall be exempt from
public inspection and copying under the Public Records Act and shall be kept
confidential.
   (c) The Green Mountain Care Board may share information reported under
this chapter with the Attorney General, the Secretary of State, other State
agencies, and other State officials to reduce or avoid duplication in reporting
requirements or to facilitate oversight or enforcement pursuant to Vermont
law, or both, and any tax identification numbers that are individual Social
Security numbers and other confidential information may be shared with the
Attorney General, other State agencies, and other State officials who agree to
maintain the confidentiality of such information. The Board may, in
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consultation with the relevant State agencies, merge similar reporting
requirements where appropriate.
Sec. 2. EFFECTIVE DATE
   This act shall take effect on July 1, 2026.
Date Governor signed bill: June 15, 2026
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