Vermont S 126: An act relating to expanding community health teams to provide additional mental health and substance use disorder services

Bill Text

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No. 68. An act relating to health care payment and delivery system
reform.
(S.126)
It is hereby enacted by the General Assembly of the State of Vermont:
* * * Purpose of the Act; Goals * * *
Sec. 1. PURPOSE; GOALS
The purpose of this act is to achieve transformation of and structural
changes to Vermont’s health care system. In enacting this legislation, the
General Assembly intends to advance the following goals:
(1) improvements in health outcomes, population health, quality of care,
regional access to services, and reducing disparities in access resulting from
demographic factors or health status;
(2) an integrated system of care, with robust care coordination and
increased investments in primary care, home health care, and long-term care;
(3) stabilizing health care providers, controlling the costs of commercial
health insurance, and managing hospital costs based on the total cost of care,
beginning with reference-based pricing and continuing on to global hospital
budgets;
(4) evaluating progress in achieving system transformation and
structural changes by creating and applying standardized accountability
metrics; and

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(5) establishing a health care system that will attract and retain high-
quality health care professionals to practice in Vermont and that supports,
develops, and preserves the dignity of Vermont’s health care workforce.
* * * Hospital Budgets and Payment Reform * * *
Sec. 2. 18 V.S.A. § 9375 is amended to read:
§ 9375. DUTIES
(a) The Board shall execute its duties consistent with the principles
expressed in section 9371 of this title.
(b) The Board shall have the following duties:
(1) Oversee the development and implementation, and evaluate the
effectiveness, of health care payment and delivery system reforms designed to
control the rate of growth in health care costs; promote seamless care,
administration, and service delivery; and maintain health care quality in
Vermont, including ensuring that the payment reform pilot projects set forth in
this chapter are consistent with such reforms.
(A) Implement by rule, pursuant to 3 V.S.A. chapter 25,
methodologies for achieving payment reform and containing costs that may
include the participation of Medicare and Medicaid, which may include the
creation of health care professional cost-containment targets, reference-based
pricing, global payments, bundled payments, global budgets, risk-adjusted
capitated payments, or other uniform payment methods and amounts for

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integrated delivery systems, health care professionals, or other provider
arrangements.
* * *
(5) Set rates for health care professionals pursuant to section 9376 of
this title, to be implemented over time beginning with reference-based pricing
as soon as practicable, but not later than hospital fiscal year 2027, and make
adjustments to the rules on reimbursement methodologies as needed.
(6) Approve, modify, or disapprove requests for health insurance rates
pursuant to 8 V.S.A. § 4062, taking into consideration the requirements in the
underlying statutes,; changes in health care delivery,; changes in payment
methods and amounts, including implementation of reference-based pricing;
protecting insurer solvency,; and other issues at the discretion of the Board.
(7) Review and establish hospital budgets pursuant to chapter 221,
subchapter 7 of this title, including establishing standards for global hospital
budgets that reflect the implementation of reference-based pricing and the total
cost of care targets determined in collaboration with federal partners and other
stakeholders or as set by the Statewide Health Care Delivery Plan developed
pursuant to section 9403 of this title, once established. Beginning not later
than hospital fiscal year 2028, to the extent that resources are available, the
Board shall establish global hospital budgets for one or more Vermont
hospitals that are not critical access hospitals. By hospital fiscal year 2030, to

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the extent that resources are available, the Board shall establish global hospital
budgets for all Vermont hospitals.
* * *
Sec. 3. 18 V.S.A. § 9376 is amended to read:
§ 9376. PAYMENT AMOUNTS; METHODS
(a) Intent. It is the intent of the General Assembly to ensure payments to
health care professionals that are consistent with efficiency, economy, and
quality of care and will permit them to provide, on a solvent basis, effective
and efficient health services that are in the public interest. It is also the intent
of the General Assembly to eliminate the shift of costs between the payers of
health services to ensure that the amount paid to health care professionals is
sufficient to enlist enough providers to ensure that health services are available
to all Vermonters and are distributed equitably.
(b) Rate-setting.
(1) The Board shall set reasonable rates for health care pro