Jennifer Carbee (Director, Office of Legislative Counsel) reviewed amendments on S.98 on Friday. It is an act relating to Green Mountain Care Board (GMCB) authority over prescription drug costs. It specifies that the GMCB, in consultation with its own technical advisory groups and other state agencies, shall explore and create a framework and methodology for implementing a program to oversee the cost of prescription drugs for Vermont consumers and Vermont’s health care system. The Board shall consider options for and likely impacts of regulating the cost of prescription drugs that includes prescription drug affordability.

Charles Becker (Staff Attorney, Office of Health Care Advocate (HCA)) testified before the Senate Health & Welfare Committee on Thursday morning about S.98, an act relating to GMCB authority over prescription drug costs. He specifically addressed Copay Accumulator Adjustment Programs, considering them to be a problem in need of a solution. He believes at least part of the problem is that we have a system based on hidden discounts and rebates that incentivizes high drug list prices.

Susan Barrett (Executive Director, Green Mountain Care Board (GMCB)) and Julia Boles (Health Policy Advisor, GMCB) opened the Friday session with Senate Health & Welfare Committee discussing the GMCB. Their mission is to drive system-wide improvements in access, affordability and quality of health care to improve the health of Vermonters. They regulate major areas of Vermont’s health care system in service of the public interest. They also serve as an unbiased source of information and analysis on health system performance. Thirdly, they monitor and evaluate health care payment and delivery system reform to provide public care payment delivery system reform to provide public transparency. 

Chairwoman Lyons opened Wednesday's meeting of the Senate Health & Welfare Committee by introducing Dr. Elliott Fisher (Professor of Medicine and Health Policy, Dartmouth Institute). He introduced some Framing Questions. The first being that Vermont had established an aspirational set of goals for health system reform (Act 48) and created an independent agency (the Green Mountain Care Board) with the responsibility to evaluate and improve health system performance. He claimed that the Green Mountain Care Board (GMCB) is effective, transparent and accountable, “the envy of many states.” He questioned whether the Legislature wants to build on this foundation. 

The Senate Health and Welfare Committee reviewed S.211 on Friday. Senators Lyons, Clarkson, and Kitchel had sponsored the bill.

The Senate Health and Welfare Committee met on Friday to hear testimonies regarding S.211, which intends to look at the health care reform and regulatory duties of the Green Mountain Care Board (GMCB). The initial testimony was presented by Devon Green (VP of Government Relations, Vermont Association Hospitals and Health Systems). She initially addressed the Vermont Landscape of the Rural and Aging Population. There has been a population increase in the 65 to 79 age group during the last decade, with an increase of about 40,000 from 2010 to 2021. That increase is the largest of any age group and more than double the rate of the overall population. This has impacted hospital stays. In 2021 70 people were waiting for post-hospital placement and now 142 are awaiting placement.

Senator Lyons, Chair of the Senate Health and Welfare Committee discussed some of the primary issues they would be addressing during the 2024 session. Her overall emphasis was on Health Care access. Act 81 would address health care related to housing and homelessness.

H.206 was reviewed in the Senate Health and Welfare Committee on April 27 by Chairwoman Lyons and Legal Counsel (see previous reports on this bill here). It was determined favorable after making changes in the Blueprint for Health regarding how much insurers and Vermont Medicaid should increase the amount paid per-person to medical homes for providing the additional resources necessary for delivery of comprehensive primary care services to Vermonters. 

On Tuesday, Julia Boles, Health Policy Advisor at Green Mountain Care Board (GMCB), presented a report regarding Prior Authorization (PA) to the Senate Health and Welfare Committee. She explained that “Prior Authorization” means the process used by a health plan to determine the medical necessity, medical appropriateness (or both) of otherwise covered drugs. It is also applied to medical procedures, medical tests, and other health care services. Prior authorization is a process by which a medical provider (or the patient, in some scenarios) must obtain approval from a patient's health plan before moving ahead with a particular treatment, procedure, or medication.

The Senate Health and Welfare Committee heard testimonies on Thursday from various entities concerning H.206. The bill relates to the duties of the Department Vermont Health Access (DVHA), which was initially created in the House Health Care Committee back in February. Subsequently, reviewed by the House Appropriations Committee and then passed House sent to the Senate.

The Health Equity Advisory Commission (HEAC) presented to a joint Committee meeting of the House Health Care and Senate Health and Welfare on Wednesday. The agenda included an overview of the HEAC responsibilities, a summary of the HEAC’s 2023 Annual Report, budget and fiscal proposals, and final notes and reflections. The Commission members include thirty representatives from various entities in Vermont. Rev. Mark Hughes is the Chair and represents Vermont Racial Justice Alliance. He and Kristen Murphy (Executive Director, Vermont Developmental Disabilities Council) presented the annual report to the committee, which included government equity, programmatic approach/framework, community engagement, legal and administrative support, policies and programs, funding, grants and training, and continuing education.

Robin Lunge and Jessica Holmes, members of the Green Mountain Care Board (GMCB) presented the history and overview of the GMCB to the House Appropriations Committee on Wednesday. Holmes introduced herself stating that she is an economist and has been a member of the Board for eight years. She explained how the uniqueness of health care justifies the extensive government oversight through laws and regulations. In most markets, transactions involve only a buyer and seller, but in health care there is the presence of third parties, including insurers as well as the role of government.

The Senate Health and Welfare Committee held confirmation hearing on Wednesday for Dr. David Murman to be appointed to the Green Mountain Care Board (GMCB).

The House Health Care Committee took up H.206, which is entitled “An act relating to miscellaneous changes affecting the duties of the Department of Vermont Health Access,” on Thursday. Stephanie Winters of the Vermont Medical Society (VMS) shared the perspective of the VMS on Section 3 of the bill pertaining to the Vermont Prescription System (VPMS) and the use of the data in this important registry. She reiterated that “VMS was involved in the design of VPMS at its inception and has always been our position that the focus should be clinical improvement and coordination and not enforcement purposes.”

This week the Senate Health and Welfare Committee confirmed the appointments of a number of the Green Mountain Care Board (GMCB) members.

S.54 was introduced by Senators Cummings, Perchlik, Watson, and Wrenner with the intent of extending the separation between the individual and small group markets in Vermont Health Connect through plan year 2025.

The Green Mountain Care Board (GMCB) met with the House Appropriations Committee on Tuesday to present their budget for 2024. The new Chairman, Owen Foster, introduced the current Board, which includes Jessica Holmes, Robin Lunge, David Murman, Thom Walsh, and Susan Barrett.