Vermont S 197: An act relating to prohibiting discrimination based on genetic information

Bill Text

No. 173 Page 1 of 12
2026

VT LEG #390266 v.1
No. 173. An act relating to reform for primary care.
(S.197)
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. LEGISLATIVE INTENT; PURPOSES
(a) It is the intent of the General Assembly to invest in primary care and to
establish a program of universal primary care that:
(1) is accessible to and affordable for all Vermonters; and
(2) will promote the public good by:
(A) improving the patient experience of care;
(B) improving population health;
(C) reducing costs; and
(D) improving the well-being of clinicians and staff.
(b) The purposes of this bill are to:
(1) obtain the information necessary to develop a framework for
implementation of universal primary care;
(2) optimize the Blueprint for Health;
(3) determine whether the Blueprint is an appropriate mechanism
through which to provide universal primary care; and
(4) explore other approaches to universal primary care and whether they
may be more suitable than the Blueprint in meeting Vermont’s needs.

No. 173 Page 2 of 12
2026

VT LEG #390266 v.1
Sec. 2. 18 V.S.A. chapter 13, subchapter 1 is amended to read:
Subchapter 1. Blueprint for Health
§ 701. DEFINITIONS
As used in this chapter:
(1) “Blueprint for Health” or “Blueprint” means the State’s program for
integrating a system of health care for patients, improving the health of the
overall population, and improving control over health care costs by promoting
health maintenance, prevention, and care coordination and management.
* * *
(8) “Health insurance plan” has the same meaning as means a major
medical insurance plan as defined in 8 V.S.A. § 4011.
(9) “Health insurer” shall have the same meaning as in section 9402 of
this title means any person that offers, issues, renews, or administers a health
insurance plan or other health benefit plan in this State and includes, to the
extent permitted under federal law, third-party administrators that administer a
health benefit plan offering coverage in this State or that provide
administrative services only for a health benefit plan offering coverage in this
State.
* * *
§ 706. HEALTH INSURER PARTICIPATION; PAYMENTS TO
PRACTICES

No. 173 Page 3 of 12
2026

VT LEG #390266 v.1
(a) As set forth in 8 V.S.A. § 4025, health insurance plans shall be
consistent with the Blueprint for Health as determined by the Commissioner of
Financial Regulation.
(b)(1) Health insurers shall participate in the Blueprint for Health as a
condition of doing business in this State as provided for in this section and in
8 V.S.A. § 4025.
(2) In order to facilitate development of the sustainable payment models
necessary for the Blueprint’s success, health insurers shall submit to the
Agency of Human Services at least quarterly, or more frequently upon the
Agency’s request, all information that the Director of the Blueprint deems
necessary to perform a comprehensive fiscal analysis of the total cost of care
within Vermont and to implement one or more payment models that address
health care capacity, volume, quality, and clinical outcomes.
(c)(1) The Blueprint payment reform methodologies shall include per-
person per-month payments to medical home participating practices, including
medical homes and primary care providers, by each health insurer and
Medicaid for their attributed patients and for contributions to the shared costs
of operating Blueprint initiatives, including the community health teams. Per-
person per-month payments to practices shall be:
(A) based on the official National Committee for Quality
Assurance’s Physician Practice Connections-Patient Centered Medical Home
(NCQA PPC-PCMH) score or another quality standard identified by the

No. 173 Page 4 of 12
2026

VT LEG #390266 v.1
Director of the Blueprint in consultation with the Blueprint Payment
Implementation Workgroup, to the extent practicable and shall be;
(B) provided in addition to their normal a practice’s typical fee-for-
service or other payments; and
(C) from health insurers, in amounts at least equal to Medicaid
payments beginning in 2027.
(2) Consistent with recommendations of the Blueprint Executive
Committee, the Director of the Blueprint may recommend to the
Commissioner of Vermont Health Access Secretary of Human Services
changes to the payment amounts or to the payment reform methodologies
described in subdivision (1) of this subsection, including by providing for
enhanced payment to health care professional practices that operate as a
medical home, including medical homes and primary care naturopathic
physicians’ practices; payment toward the shared costs for community health
teams; or other payment methodologies required by the Centers for Medicare
and Medicaid Services (CMS) for participation by Medicaid or Medicare. In
formulating recommendations, the Director shall strive to achieve or maintain
parity across payers and payment methodologies and to adjust payment
methodologies annually as needed to adequately support practices in
mai