Overview
Vermont has been active in cost containment and transparency through a number of state planning initiatives, rate and premium control, and the VHCURES all-payer claims database. Most notably, Vermont attempted to be the first state to operate a single-payer healthcare system, Green Mountain Care, in 2011; however, the state gave up on the plan in 2014 due to lack of viable financing system to fund the system. Following that effort, the state began implementing an all-payer ACO model in 2016, designed to encourage the state’s largest payers — Medicare, Medicaid, and Blue Cross and Blue Shield of Vermont — to move quickly from fee-for-service to risk-based contracting by using a common payment methodology. Regulated by the Green Mountain Care Board, which was created along with the single payer system to improve the quality of health care and reduce the growth in health care costs for Vermont residents, the alternative payment model has resulted in a total savings of $97 million across the first three implementation years. The state also proposed a publicly funded public option for health care coverage that would be available to all Vermont residents and employers.
Besides an all-payer claims database mandated since 1991, now administered by the Green Mountain care Board, Vermont law also provides surprise and balance billing protections by requiring a hold harmless provision and no liability notice requirement for both emergency and non-emergency healthcare services. Additional price transparency initiatives prohibit gag clauses in managed care organization contracts with health care providers, requiring that the terms cannot prohibit the health care provider from disclosing to members information about the contract or the members’ enrollment plan. Vermont’s ACPD statute is also the subject of the far-reaching Supreme Court decision regarding ERISA preemption of state laws. Decided in 2016, Gobeille v. Liberty Mut. Ins. determined that Vermont’s law requiring health insurers to report payments and other information relating to health care claims and services for compilation in its APCD is preempted as applied to ERISA plans.
In the healthcare provider market, the state mandates notice of all nonprofit healthcare transactions to the attorney general and allows for review and approval by the Green Mountain Care Board, and either the AG or the court. Additionally, the state requires a certificate of need for the construction, development, purchase, renovation, or other establishment of certain health care facilities and ambulatory surgical centers, which is granted based on criteria of cost, affordability, and access. The state also prohibits most-favored nation clauses in provider contracts to curb anticompetitive practices.
To encourage use of telemedicine, Vermont requires health insurance plans to provide parity for coverage, reimbursement, and cost-sharing of telehealth services to the same extent that the plan would cover the services if they were provided through in-person consultation.
In recent terms, Vermont tackled prescription drug costs with legislation to allow the wholesale purchase of prescription drugs from Canada. Also, to promote drug price transparency, Vermont law requires state officials to identify 15 drugs whose wholesale acquisition costs rose by 50 percent or more over the last five years, and 15 medicines that rose 15 percent or more over a 12-month period. The drugs’ makers must justify the price increases to the state’s attorney general and the information is made public.
See below for an overview of existing Vermont state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/4/2023 - 5/9/2023 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
H 0077 (see companion bill S 0113) – Vermont
Introduced: 2015 Status: Inactive / Dead
HEALTH CARE QUALITY AND PRICE COMPARISON DATABASE: would require the Green Mountain Care Board to create an online database through which consumers could compare the cost and quality of health care services in the state. …
H 0197 – Vermont
Introduced: 2015 Status: Inactive / Dead
PATIENT SERVICE PRICE DISCLOSURE: would require health care providers, except in an emergency, to disclose to a patient or other health care consumer the cost of a health care services prior to the patient or …
H 1 – Vermont
Introduced: 2019 Status: Inactive / Dead
This bill proposes to prohibit agreements that prohibit individuals from competing with their former employers following the conclusion of their employment.
H 102 – Vermont
Introduced: 2021 Status: Inactive / Dead
An act relating to reducing prior authorization requirements in health insurance plans. This bill proposes to specify that the prior authorization requirements that health insurance plans must eliminate annually after review include those for which …
H 103 – Vermont
Introduced: 2021 Status: Inactive / Dead
An act relating to an independent review of Vermont’s current health care reform efforts
H 524 – Vermont
Introduced: 2019 Status: Enacted
The act requires each individual filing a Vermont income tax return to indicate whether the individual maintained minimum essential coverage in accordance with Vermont’s individual mandate for the entire taxable year or was exempt from …
S 175 – Vermont
Introduced: 2018 Status: Enacted
Establishes a program to allow wholesale importation of prescription drugs from Canada into Vermont. Creates a bulk purchasing program for prescription drugs through the Department of Health and require prescription drug manufacturers to provide notice …
S 19 – Vermont
Introduced: 2017 Status: Enacted
This bill allows health insurers to offer silver-level nonqualified health benefit plans outside the Vermont Health Benefit Exchange in the event that federal costsharing reduction payments to insurers are suspended or discontinued. These “reflective” silver …
S 92 – Vermont
Introduced: 2018 Status: Enacted
Requires pharmacists to dispense the lowest priced generic or interchangeable product. Would require an insurer to annually file a summary of proposed rates, including an analysis of the impact of drug cost on premium increases. …
Vt. Stat. Ann. tit. 11, § 1030. Conspiracies or combinations in restraint of trade: Cooperatives – Vermont
Introduced: Status: Enacted
An association organized under this subchapter and complying with the terms hereof shall not be deemed to be a conspiracy or a combination in restraint of trade or an illegal monopoly or an attempt to …
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In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Vermont’s fiscal year begins on July 1 and end on June 30 the following year. Vermont enacted its 2020 budget during the 2019 legislative session. To view Vermont’s FY 2020 Budget, click here.
REGULATION & ENFORCEMENT
- On January 17, 2017, the commissioner of the Department of Financial Regulation announced that MVP Health Insurance Company has paid the state of Vermont $70, 500 in administrative penalties and $158, 915 as reimbursement to Vermont residents for consistent overcharging for colorectal screenings.
- Administrative orders issued by the Department of Financial Regulation respecting insurance market conduct can be found here.
KEY RESOURCES
- Vermont General Assembly
- Vermont Office of the Attorney General
- Vermont Department of Financial Regulation
- Green Mountain Care
- Blueprint for Health