Meetings
Transcript: Select text below to play or share a clip
[Jennifer Carbee (Office of Legislative Counsel)]: You're welcome. All right, we're back.
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: This is Center Health and Welfare. We're looking at an amendment that we asked Green Mountain Care Board and the hospitals to work on, and they've come back with a recommendation that's a combination of what I had put up yesterday, the hospitals have put up, and what the board had put up, and Jenna, you're gonna tell us what we have.
[Jennifer Carbee (Office of Legislative Counsel)]: I am. Good morning, Jen Carpe from the Office of Legislative Counsel. This is an amendment to S-one 190, and it's the language we looked at yesterday, so I've incorporated that without any highlights anymore. This is using that actual, one of the editors took the comment out, so now it's just actual hospital specific Medicare reimbursement rate as the definition, then a 225% cap for enrollees and qualified health plans. And then a new instance of amendment that would amend provision of section three, which was the hospital budget and budget review chapter in the bill, and there's that new section the new section nine thousand four and fifty nine that says hospitals should first implement commercial rate reductions from their budget orders by targeting the qualified health plans. And then if they still need to reduce rates more, they go for the rates that are more than 500% of the Medicare rate, or if they don't have any of those, the highest ones relative to the Medicare rate. And then there was language in C that said, if a hospital shows the board that the limitations on its rates for the qualified health plans or those other very high rates are having a negative impact on access, quality, or sustainability of care, then the hospital can propose to increase the rates for service lines, and the board would consider both the demonstrated impact and the proposed increase. This would strike that language and put in instead, except as provided in subsections A and B and in 33 BSA section eighteen fifteen. So except as we've already specifically said around the February cap and target the highest rates as a percentage of manic care if you still need to do more rate reductions, a hospital may increase the commercial reimbursement rates for one or more of its service lines, such as primary care, provided that in doing so the hospital remains compliant with the total budget order for the hospital by the board under section 94.56. So allowing the hospital then not to go through the board to increase those rates. They can't affect what you've already put in place for the qualified health plans and the highest rates if that's something they're directed to do
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: in the budget order, but otherwise they can adjust their other commercial reimbursement rates. Got it. So in the timeline on this, this goes on until such time as
[Jennifer Carbee (Office of Legislative Counsel)]: So the QHP cap goes on until such time as the Green Mountain Care Board sets a different rate than 225%. There isn't a specific provision sunsetting
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: this piece. Well, wouldn't this piece go along with that memo?
[Jennifer Carbee (Office of Legislative Counsel)]: It could, I mean, there may be adjustments, there may be rates set as part of overall rate setting. But there was no expiration date to your, I believe. Don't think it was in But the early yeah, there was no, the language that is in 9459 directs hospitals to implement commercial rate reductions through the QHP cap first, and then if they have to make further reductions, then by reducing rates in excess of 500% of Medicare rate. We changed the term, let me change the term up here. Just
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: wondering if this should be consistent, I'm looking at, if this should be as long as what the board thinks it establishes it's
[Jennifer Carbee (Office of Legislative Counsel)]: I don't know if that's necessary to I mean, think the board's gonna be making the changes. We're gonna have to update the statutes to reflect the board as As things roll out.
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Okay. All right, so this is a compromise that was reached with the board and the hospitals. Right. Emily Brown is on.
[Jennifer Carbee (Office of Legislative Counsel)]: Emily Brown is on the Zoom as well if you are wanting to hear anything from Board. I didn't hear you, sorry. Emily Brown is on the Zoom as well if there's anything you're wanting to hear from Board. Oh, yes. Board, stop my Who's there?
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Emily is here.
[Jennifer Carbee (Office of Legislative Counsel)]: Thank you, Webb. Good morning.
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: It's a tough day for any parent in the
[Jennifer Carbee (Office of Legislative Counsel)]: room. So
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: very quickly, a comment from the board and from us would be helpful.
[Emily Brown (Executive Director, Green Mountain Care Board)]: Sure, of course. Thank you. Emily Brown, the Executive Director of the Green Mountain Care Board. Yesterday, we got together with Vaz and discussed the amended language of the definition of the Medicare adjusted base rate, and agree that at this point in time, based on feedback from the hospitals and the insurers, it makes sense to use VOS suggested definition with an acknowledgement that in rulemaking, once we move towards reference based pricing, that might change. To make sure this is able to be implemented in the time that the bill proposes, we agree that having the definition be adjusted to what the actual Medicare rate the hospitals are paid makes sense. We also came to an agreement that the percentage should be lower or used as kind of a placeholder until we are able to do more analysis to make sure that the 02/25, which was replacing the two fifty in the original language is the right place. We are planning on continuing that work, and making sure that's the right landing place for the QHP plans as well as the hospitals. And then there was also some adjusted language in there around basically if the hospitals implement the QHP adjustment, we wanted it to be clear that as long as they're meeting their budget guidance, that there wouldn't be a further expectation of reduced rates. So I think it's a good place. I want to thank Devin for working with us on this and for the committee for giving us the chance to take this back.
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Thank you. That's really helpful. Thank you for doing that work at a difficult time. I know it's never easy, but I know how busy everyone has. Devin Green,
[Devin Green (Vermont Association of Hospitals and Health Systems)]: Vermont Association of Hospitals and Health Systems. And I would also like to thank both Emily Brown and Elena Verbe from the Green Medicare Board for their work on this. We really appreciate the thoughtful conversation that we had with them. And it is laid out as Emily Brown mentioned, and we would just say that the two twenty five is a placeholder until we can figure out something that is manageable both for the QHP and the hospitals. So thanks.
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Okay. Good. That's good. I know it's hard to put categorical things in, so I'm hoping that we can resolve this ASAP. I know that's not possible. I know there's a lot of work that goes on in analyzing what's possible. Thank you for your work. And so we have gotten to a good place, committee. This is a proposed amendment that I will be bringing to the Senate, and I'm happy to add signatures to this, and I'm looking at my committee if you'd like to sign on. Is there
[Devin Green (Vermont Association of Hospitals and Health Systems)]: anybody who wants to sign on, I'll sign on. But one well, I have a question, though. Sure. So we don't have the bill. Right?
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: It's in appropriations, and appropriations doesn't wanna touch this with a 10 foot ball. Unfortunately, no. They it's not their jurisdiction. They're not their they're problem we're a policy.
[Unidentified Committee Member (Senator)]: Okay.
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: So they asked they suggested that I that we work on this, and we've worked on it. And now I am reassuring appropriations that they're taking the money out that's in our bill. We'll have this language that will support both the board and the hospitals, especially So
[Unidentified Committee Member (Senator)]: there will be amendment on the floor?
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: Yes, will. I'll put it in the calendar.
[Jennifer Carbee (Office of Legislative Counsel)]: Sounds like everybody wants, because you don't have the bill, possession of the bill, it can't come from this committee. It's from the individual members. As many members as want to be on it. It sounds like everybody, is everybody okay? Is there
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: anybody who does not want to be on it?
[Devin Green (Vermont Association of Hospitals and Health Systems)]: Alright, I'm
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: gonna put the chair
[Jennifer Carbee (Office of Legislative Counsel)]: first and then alphabetical.
[Senator Virginia "Ginny" Lyons (Chair, Senate Health and Welfare)]: This is good. This is rich. Thank you all. Is there anything else? I'm working on 193 with judiciary right now and they found one thing they want to cross out on it and I'll keep you apprised of that proposal amendment. They've crossed out one phrase that suggested to them because they were concerned about one of the parts of the description of the facility for the So we're going to sort out and Senator Harrison is in there now and I hope she's not messing up our proposal, but no she's not too good. So I'm gonna go back there and I'll keep you informed about that amendment. But thank you all. We we call it a wrap today and you've all done
[Jennifer Carbee (Office of Legislative Counsel)]: great work and I appreciate