Adjusting the Green Mountain Care Board Regulatory Oversight (S.63 / Act 62) - Overview & Analysis

Ben Kinsley

Written by
July 15, 2025

Adjusting the Green Mountain Care Board Regulatory Oversight (S.63 / Act 62) - Overview & Analysis

S.63 modifies the regulatory duties of the Green Mountain Care Board (GMCB) with a focus on health information technology, accountable care organizations (ACOs), and hospital budget oversight. The legislation amends several sections of law to enhance coordination, transparency, and efficiency in Vermont’s health care system.

The Details:

  1. Health Information Technology Plan:

    • The Department of Vermont Health Access, in consultation with its Health Information Exchange Steering Committee, oversees the statewide Health Information Technology Plan, revised annually and comprehensively updated every five years.

    • Removes GMCB approval for the statewide HIT Plan (now managed by DVHA with stakeholder input) and VITL's budget. VITL remains the exclusive HIT exchange operator, must report annually by January 15, and establishes connectivity criteria (submitted to GMCB by March 1). GMCB's duties to review the HIT Plan and connectivity criteria are repealed, emphasizing patient privacy, data sharing (opt-out model), and integration with advance care planning.

    • The Plan promotes an integrated electronic health information infrastructure, ensuring patient privacy, accessibility, and connectivity to health care data, with provisions for patient opt-out from data sharing.

    • The GMCB has a voting member on the Steering Committee, and the Plan guides certificate of need reviews for information technology and state IT procurements.

  2. Vermont Information Technology Leaders:

    • VITL is designated in the Plan to operate the health information exchange and certify meaningful use of health IT and connectivity criteria for providers, with annual criteria submission to the GMCB by March 1.

  3. GMCB Funding & Duties:

    • Adjusts expense allocation: 40% from state funds (unchanged), 36% from hospitals (up from 28.8%), 24% from insurers/HMOs (up from 23.2%), and 0% from ACOs (down from 8%). Repeals GMCB's review of mental health/substance abuse data and adopts rules for ACO standards (e.g., reporting, patient protections, solvency).

    • Repeals the requirement to review mental health and substance abuse data reported to the Department of Financial Regulation and the associated budget review.

  4. ACO Oversight:

    • Establishes certification requirements for ACOs to participate in payment reform programs, ensuring transparency, equitable governance, and consumer protections.

    • The GMCB adopts rules for certifying ACOs, accommodating various models and sizes, and reviews budgets for ACOs with 10,000 or more attributed lives, considering factors like utilization, quality, and community integration.

    • Introduces fees for ACO certification ($10,000 initial, $20,000 annually) and budget reviews ($12,500 per review).

    • Ensures public access to ACO data under the Public Records Act, with protections for patient and provider privacy.

    • Applies public meeting requirements to ACO governing bodies contracting with Vermont Medicaid, including coordinating entities for multiple ACOs.

  5. Hospital Budgets:

    • The GMCB establishes budgets for general hospitals by September 15th and for psychiatric hospitals by December 15th. Hospitals must operate within these budgets, with penalties for violations (up to $40,000 or $100,000 for continuing violations, or 0.1% of gross annual revenue, whichever is greater).

 

The Good:

  • Enhanced Health IT Coordination:

    • The structured oversight of the Health Information Technology Plan ensures a robust, integrated electronic health infrastructure, improving data sharing and care coordination while respecting patient privacy.

    • Annual updates and stakeholder input allow the Plan to adapt to emerging technologies and state needs.

  • Streamlined Regulatory Burden:

    • Reduces GMCB's administrative burden by eliminating duplicative reviews (e.g., HIT Plan, VITL budget, mental health data), allowing focus on core duties like cost control and hospital oversight. Streamlines ACO processes, potentially fostering innovation in smaller or Medicare-only models.

    • Tailored processes for smaller ACOs support innovation while maintaining accountability.

  • Improved Hospital Budget Oversight:

    • Standardized fiscal year start dates and budget establishment timelines enhance predictability and accountability for hospitals.

    • Penalties for non-compliance incentivize adherence to budgets, potentially controlling health care costs.

  • Consumer Protections:

    • ACOs must maintain consumer advisory boards, transparent cost structures, and grievance mechanisms, empowering patients and ensuring equitable access to care.

    • Public access to ACO data under the Public Records Act promotes transparency.

The Bad:

  • Increased Administrative Burden:

    • New fees for ACO certification and budget reviews ($10,000–$20,000) may strain smaller organizations, potentially limiting their ability to participate in payment reform programs.

    • Annual reporting and compliance requirements for ACOs and hospitals could divert resources from direct patient care.

  • Potential for Overregulation:

    • The GMCB’s extensive oversight of ACO budgets and operations may stifle innovation, particularly for smaller or non-traditional ACO models, despite provisions for flexibility.

    • The 45-day approval window for the Health Information Technology Plan may rush complex decisions, risking inadequate review.

  • Limited Scope for Psychiatric Hospitals:

    • Excluding state-operated psychiatric hospitals from fiscal year standardization may create inconsistencies in oversight compared to general and non-state psychiatric hospitals.

  • Repeal of Mental Health Data Review:

    • Eliminating the GMCB’s review of mental health and substance abuse data may reduce focus on these critical areas, potentially weakening integration with broader health care reforms.

    • The reliance on federal law compliance for data sharing and ACO operations may limit flexibility in addressing Vermont-specific needs.

Analysis:

As Act 62 is implemented in Vermont, several key areas warrant close monitoring to assess its impact and effectiveness. First, tracking whether the new fees create barriers for smaller ACOs or limit their participation in payment reform programs. Monitor if these costs lead to reduced innovation or consolidation among ACOs. More importantly, is evaluating the effectiveness of GMCB's impact on the overall cost of care in Vermont using the global hospital budget model.

While ACO's may be going away, at least for now, in our health care landscape, the additional oversight provisions contained in this bill could be both useful to reign in larger ACO's but at the same time hamstring smaller ones. Understanding the long-term impact of this might be important if ACO's again become a prominent feature of our health care delivery system.

By tracking these areas, stakeholders can gauge whether Act 62 achieves its goals of improving health care coordination, transparency, and cost control while identifying any unintended consequences or areas needing adjustment.

 

Current Status:

The bill was signed into law by the Governor on June 12, 2025.

 

News coverage on Act 62

Read the Bill

More bill summaries

Last updated: 8/24/2025

DISCLAIMER: Generative AI used to assist in the production of this report.

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