Last year, the Green Mountain Care Board flexed a newfound muscle.
Bolstered by three recently appointed members, the health care regulator clashed with the UVM Health Network and trimmed the charge increases requested by multiple hospitals. The board ordered OneCare Vermont, a UVM Health Network subsidiary at the center of health care payment reform, to cap executives’ 2023 salaries, and issued a rare subpoena for information about how OneCare compensates its highest paid staff.
Now, a bill in Vermont’s Senate would substantially overhaul the Green Mountain Care Board, limiting its oversight powers and shifting some of its mandate to the state Agency of Human Services.
It’s not clear whether the bill, S.211, will advance, or in what form. The 31-page draft, currently being considered by the Senate Health and Welfare Committee, includes a hodgepodge of health care-related provisions, including the creation of a nursing apprenticeship and changes to regulations on the storage of state health care data.
But many observers see parts of the proposed legislation as a response to recent tensions between the board, which oversees large swaths of Vermont’s health care sector, and the entities that it regulates.
And advocates fear that, by giving some responsibilities to the administration, the oversight process could be subject to greater political pressure — and to lobbying from the entities it regulates.
Sen. Ginny Lyons, D-Chittenden Southeast, the chair of the Senate Health and Welfare Committee and the bill’s primary sponsor, said that the proposed legislation merely seeks to clarify the roles of the entities overseeing health care in Vermont.
The bill contains proposals requested by multiple stakeholders, Lyons said: hospitals, the Agency of Human Services and the Green Mountain Care Board.
“Obviously, there are pieces of the bill that are very attractive to the hospitals,” Lyons said in an interview. “There are pieces of the bill attractive to the Agency of Human Services. And then there are parts of the bill that are attractive to the Green Mountain Care Board.”
But the bill has drawn criticism from some lawmakers and advocates, who believe it would primarily benefit hospitals and curtail the Green Mountain Care Board’s independence.
“On the whole, I think the words on the page of this bill do more harm than good,” Mike Fisher, the chief health care advocate at Vermont Legal Aid, told lawmakers last week.
‘In collaboration’
The Green Mountain Care Board exercises significant power, albeit in an arcane area of state policy.
The board is tasked with authorizing changes in hospital budgets and in health insurance rates, signing off on the construction or development of new health care projects, and overseeing accountable care organizations, including OneCare Vermont. Accountable care organizations negotiate contracts between health insurers and providers, with the ultimate goal of changing how health care is paid for in order to improve outcomes and reduce costs.
S. 211, however, would split off some of the care board’s roles. The bill would remove the board’s mandate to create “a method for evaluating systemwide performance and quality” and give that responsibility to the state director of health care reform, a position at the Agency of Human Services. That function would be exercised “in collaboration” with the board.
If passed, the proposed legislation would also allow the care board to conduct some business in deliberative sessions, a type of meeting that is exempt from some state open meeting requirements.
And one section of the bill would require board members to be trained in how to properly conduct meetings, “including appropriate decorum during hearings.”
Lyons, the chair of the Senate Health and Welfare Committee, said that she had inserted that last language personally.
“I read in the press, including the Vermont Digger, about the discomfort that applicants feel when they go to the board, and I hear it from the applicants and I hear it from the public,” Lyons said in an interview. “I think you can have differences and carry out your work in a more collegial manner, that’s all.”
‘Grave concerns’
The legislation comes just months after a series of high-profile clashes between the Green Mountain Board and other players in the state’s health care ecosystem.
In September, as the board prepared for a final vote on hospital budgets, the UVM Health Network Board penned a letter expressing concern that the Green Mountain Care Board “may overreach its authority” on hospital budgeting.
“We have grave concerns with the current regulatory system governing health care in our state, and want to specifically alert you to the very real harm we fear will come to Vermonters as a result of a regulator making critical budget and capacity decisions, which we believe are in conflict with what is set out in our State’s laws,” the UVM Health Network board wrote in the letter, which was addressed to legislative leaders, including Lyons.
Days later, the care board voted to substantially trim UVM Medical Center’s proposed increases to service charges.
Jason Williams, a University of Vermont Health Network senior communications executive, said that he felt the board had been inconsistent in its dealings with the network.
“I would say that we feel, particularly in this past year, that the rules did change somewhat over the course of the process,” he said.
Ahead of the legislative session, UVM Health Network had asked lawmakers for “proposals that are grounded in predictability,” Williams said. The network has not sought similar language from the Legislature in past years, he said.
The care board has also been embroiled in a separate legal tussle with OneCare Vermont, a subsidiary of the University of Vermont Health Network, over compensation for its top executives.
The board ordered OneCare to cap the salaries of its executives in its 2023 budget, and after the organization declined to disclose exactly how it determined executive pay, the care board issued an unusual subpoena for that information.
“You know, for me, unfortunately, my experience as a regulated entity so far is that the regulation has not been consistent or stable,” Abe Berman, the interim CEO of OneCare, told lawmakers last week. “Having a five-person board, with five different personalities and five different sets of priorities, is a real challenge for the health care system.”
In an interview, Berman echoed complaints about the board’s predictability, saying that he felt the board’s expectations for OneCare’s budget had changed midway through the year.
“I think that’s just a function of a very broad mandate, and some turnover, and membership that has individuals having different goals,” he said.
‘A rigid, bright line’
But critics say the legislation would erode the independence of the care board, and could open the process to influence from powerful health care players.
“Who has access to the decision makers is important,” Fisher, the chief health care advocate, told lawmakers last week. “We know that (BlueCross BlueShield of Vermont CEO) Don George gets access to the governor’s office. We know that (UVM Health Network CEO) Sunny Eappen, now, has access to the governor’s office. I don’t have access to the governor’s office as the health care advocate. The regular person doesn’t.”
Owen Foster, who was tapped to chair the Green Mountain Care Board in 2022, told committee members earlier this month that the bill as written “injects a political element” into the board’s work.
“Historically, the care board has been treated independently, without influence from the administration,” Foster said. “And in my experience of the care board, that’s been really a rigid, bright line, very carefully-followed rule. And, I think, a good one.”
A spokesperson for the Green Mountain Care Board declined a request for an interview.
On Monday, a group of 29 people, including the leaders of multiple unions and advocacy nonprofits, urged lawmakers to reject the bill, saying it would help UVM Health Network while “(imposing) greater medical and financial hardships on Vermonters.”
The Health and Welfare Committee is also not in lockstep on the bill. Sen. Ruth Hardy, D-Addison, who serves on the committee, said in an interview that the Green Mountain Care Board was “newly effective” following the addition of its new members.
“They asked really tough questions, and they held the hospitals and (OneCare Vermont) and the insurance companies accountable. And that’s their job,” Hardy said. “And so to immediately come back with legislation that would essentially gut their ability to do that job is extremely concerning to me.”
