[S]even years after creating the Green Mountain Care Board, state legislators are taking a closer look at how the regulatory body operates.
The Senate has approved H.912, which modifies the way the care board regulates health care projects and increases the fines the board can impose.
The bill also changes the care board’s makeup by ensuring that, eventually, at least one member will be a medical professional. None of the current board members meet that qualification, but lawmakers say they’re not targeting those members specifically.
“Anyone currently serving on the board will not be displaced, and should they be eligible for and wish to serve a second term, they can do that before this (change) takes place,” said Sen. Claire Ayer, D-Addison and chair of the Senate Health and Welfare Committee.
The Green Mountain Care Board is an independent body that is charged with boosting health care quality while containing costs. The board regulates health insurance rates, accountable care organizations, hospital budgets and any significant investments made by health care providers.
That latter function happens via the certificate of need process. Prior to the 2018 legislative session, care board officials asked lawmakers to “streamline” the permitting process in order to update it and eliminate red tape.
H.912 does that in part by significantly increasing the financial thresholds that hospital projects must meet before triggering a care board review.
For example, the cost of a new piece of diagnostic and therapeutic equipment currently must exceed $1 million before the care board gets involved. That would rise 50 percent to $1.5 million.
Also, a new health care service or technology must have an annual operating expense of more than $500,000 in order to trigger a care board review. H.912 raises that to $1 million.
Ayer said the changes are “a reflection of inflation.”
The bill also says the care board doesn’t have to review any “routine replacements of non-medical equipment and fixtures including furnaces, boilers, refrigeration units, kitchen equipment, heating and cooling units and similar items.”
However, the legislation says those expenses must be included in hospital budgets and will be reviewed by the care board via its budget-approval duties.
H.912 would implement several other measures designed to speed up the certificate of need process. For instance, the bill shortens the amount of time applicants have to respond to board questions, and it gives potential “interested parties” less time to file for that status.
Additionally, the bill says the board should review two types of projects “on an expedited basis” if no one contests them — the “repair, renovation, or replacement of facility infrastructure,” and the “routine replacement of medical equipment” that is similar to current equipment.
H.912 also increases the penalties that health care entities face if they pursue qualifying projects without obtaining a certificate of need from the care board. The fine for one violation rises from $40,000 to $75,000, and the fine for a “continuing violation” would double from $100,000 to $200,000.
Aside from modifying the board’s practices, lawmakers also want to change its complexion.
H.912 says at least one person on the five-member board must be “an individual licensed to practice medicine,” a licensed physician assistant, a registered nurse or an advanced practice registered nurse.
Technically, that requirement would take effect with the first board vacancy after the bill is signed into law. But no one is going to be booted from the board if the bill passes, because H.912 says any non-health care professional who’s a board member at that time could be reappointed.
The Green Mountain Care Board has not taken an official position on the legislative language, a spokesman said.
The Senate debated the matter, but not because anyone disputed whether there ought to be a medical professional on the care board.
Rather, the issue was that the bill as initially presented in the Senate removed a conflict-of-interest provision, potentially setting up a scenario in which a doctor or nurse serving on the board would be regulating his or her employer.
“Do we want to have a practitioner that works for hospitals regulating hospitals?” asked Sen. Chris Pearson, P/D-Chittenden.
Pearson, who serves on the care board’s nominating committee, on Friday presented an amendment saying a care board member could be affiliated with an accountable care organization but could not be employed by a hospital.
Sen. Ginny Lyons, D-Chittenden, said the Senate Health and Welfare Committee opposed Pearson’s amendment because “the pool of clinicians who would be available (for care board service) would be narrowed quite a bit” by excluding those who work for hospitals.
The debate produced a tie vote; Lt. Gov. David Zuckerman, who presides over the Senate, broke the tie by voting in favor of Pearson’s amendment.
H.912 also includes relatively new language not directly related to the care board’s day-to-day business: It directs the state Agency of Human Services to put together a working group to study how the state might regulate “freestanding health care facilities.”
Included on the list for potential regulation are ambulatory surgical centers, freestanding birth centers, urgent care clinics and “retail health clinics.”
A Senate bill that would have taxed and regulated independent surgical centers was scuttled amid controversy earlier this session. But Ayer said it’s fair to examine how such centers fit into the state’s health care industry.
“This is a recognition that the health care landscape is changing from just hospitals and doctors’ offices,” Ayer said.
