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.

S.126 is a comprehensive legislative proposal introduced to transform Vermont's health care system. The bill aims to improve health outcomes, enhance care quality, control costs, and ensure equitable access to health care services. It proposes structural changes through payment reforms, hospital budget oversight, data integration, and strategic planning.

On Tuesday, Nolan Langweil (Principal Fiscal Analyst, Joint Fiscal Office)  reviewed S.98 with the House Appropriations Committee. The bill relates to Green Mountain Care Board (GMCB) authority over prescription drug costs. The House Health Care Committee had made amendments concerning the GMCB Nominating Committee, and then passed the bill on to this Committee.

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.

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 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.

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.

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).