The Vermont Statutes Online

Title 18: Health

Chapter 227: All-Payer Model and Accountable Care Organizations

• Subchapter 001: ALL-PAYER MODEL

• § 9551. All-payer model

  In order to implement a value-based payment model allowing participating health care providers to be paid by Medicaid, Medicare, and commercial insurance using a common methodology that may include population-based payments and increased financial predictability for providers, the Green Mountain Care Board and Agency of Administration shall ensure that the model:

  (1) maintains consistency with the principles established in section 9371 of this title;

  (2) continues to provide payments from Medicare directly to health care providers or accountable care organizations without conversion, appropriation, or aggregation by the State of Vermont;

  (3) maximizes alignment between Medicare, Medicaid, and commercial payers to the extent permitted under federal law and waivers from federal law, including:

  (A) what is included in the calculation of the total cost of care;

  (B) attribution and payment mechanisms;

  (C) patient protections;

  (D) care management mechanisms; and

  (E) provider reimbursement processes;

  (4) strengthens and invests in primary care;

  (5) incorporates social determinants of health;

  (6) adheres to federal and State laws on parity of mental health and substance abuse treatment, integrates mental health and substance abuse treatment systems into the overall health care system, and does not manage mental health or substance abuse care through a separate entity; provided, however, that nothing in this subdivision (6) shall be construed to alter the statutory responsibilities of the Departments of Health and of Mental Health;

  (7) includes a process for integration of community-based providers, including home health agencies, mental health agencies, developmental disability service providers, emergency medical service providers, adult day service providers, and area agencies on aging, and their funding streams to the extent permitted under federal law, into a transformed, fully integrated health care system that may include transportation and housing;

  (8) continues to prioritize the use, where appropriate, of existing local and regional collaboratives of community health providers that develop integrated health care initiatives to address regional needs and evaluate best practices for replication and return on investment;

  (9) pursues an integrated approach to data collection, analysis, exchange, and reporting to simplify communication across providers and drive quality improvement and access to care;

  (10) allows providers to choose whether to participate in accountable care organizations, to the extent permitted under federal law;

  (11) evaluates access to care, quality of care, patient outcomes, and social determinants of health;

  (12) requires processes and protocols for shared decision making between the patient and his or her health care providers that take into account a patient’s unique needs, preferences, values, and priorities, including use of decision support tools and shared decision making methods with which the patient may assess the merits of various treatment options in the context of his or her values and convictions, and by providing patients access to their medical records and to clinical knowledge so that they may make informed choices about their care;

  (13) supports coordination of patients’ care and care transitions through the use of technology, with patient consent, such as sharing electronic summary records across providers and using telemedicine, home telemonitoring, and other enabling technologies; and

  (14) ensures, in consultation with the Office of the Health Care Advocate, that robust patient grievance and appeal protections are available. (Added 2015, No. 113 (Adj. Sess.), § 2, eff. Jan. 1, 2018.)

• Subchapter 002: ACCOUNTABLE CARE ORGANIZATIONS

• § 9571. Definitions

  As used in this subchapter:

  (1) “Accountable care organization” and “ACO” means an organization of health care providers that has a formal legal structure, is identified by a federal taxpayer identification number, and agrees to be accountable for the quality, cost, and overall care of the patients assigned to it.

  (2) “Health care provider” means a person, partnership, or corporation, including a health care facility, that is licensed, certified, or otherwise authorized by law to provide professional health care services in this State to an individual during that individual’s medical care, treatment, or confinement. (Added 2017, No. 59, § 2.)

• § 9572. Meetings of an accountable care organization’s governing body

  (a) Application. This section shall apply to all regular, special, and emergency meetings of an accountable care organization’s governing body, whether in person or by electronic means, as well as to any other assemblage of members of the ACO’s governing body at which binding action is taken on behalf of the ACO. For purposes of this section, the term “ACO’s governing body” shall also include the governing body of any organization acting as a coordinating entity for two or more ACOs.

  (b) Public meetings; exceptions. Meetings of an accountable care organization’s governing body shall be open to the public and shall provide members of the public an opportunity to comment, except that the ACO’s governing body may meet in executive session to consider business related to the following:

  (1) contracts or contract negotiations for which premature general public knowledge would reasonably place the ACO or another person at a substantial disadvantage;

  (2) pending or probable prosecution or civil litigation to which the ACO is or is likely to be a party;

  (3) personnel matters;

  (4) information that reasonably could be considered a trade secret, as defined in 1 V.S.A. § 317(c)(9);

  (5) confidential attorney-client communications;

  (6) information prohibited from public disclosure by the terms of an enforceable data use contract to which the ACO is bound; and

  (7) information prohibited from public disclosure by the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, or by any other State or federal law.

  (c) Notice. An accountable care organization shall make its governing body’s meeting schedule available to the public by posting notice of the time and place of each meeting on the ACO’s website at least one week before the meeting and the agenda for each meeting at least 48 hours before the meeting, except that if an unforeseen occurrence or condition requires the governing body’s immediate attention at an emergency meeting, the ACO shall provide public notice as soon as possible before the meeting occurs.

  (d)(1) Minutes and recordings. All portions of each meeting of an ACO’s governing body that are open to the public shall either be recorded or minutes shall be taken, and the recordings and minutes shall be posted on the ACO’s website within five business days following the meeting.

  (2) Meeting minutes shall include the names of all governing body members present at the meeting in person or by electronic means, the names of any other individuals who participated in the meeting, a summary of any public comments provided at the meeting, and all actions taken or considered by the governing body during the meeting.

  (e) Participation by electronic or other means.

  (1) One or more members of an ACO’s governing body may attend a regular, special, or emergency meeting by electronic or other means without being physically present at a designated meeting location.

  (2) Any member of the governing body attending a meeting by electronic or other means may participate fully in discussing the governing body’s business and voting to take an action, but any vote of the governing body that is not unanimous shall be taken by roll call.

  (3) Each member of the governing body who attends a meeting without being physically present at a designated meeting location shall:

  (A) identify himself or herself when the meeting is convened; and

  (B) be able to hear the conduct of the meeting and be heard throughout the meeting.

  (4) If a quorum or more of the members of the governing body attend a meeting without being physically present at a designated meeting location, the agenda required to be posted pursuant to subsection (c) of this section shall designate at least one physical location where a member of the public can attend and participate in the meeting. At least one member of the governing body or one or more members of the ACO’s staff shall be present at each designated meeting location. (Added 2017, No. 59, § 2.)

• § 9573. Medicaid advisory rate case

  (a) On or before December 31 of each year, the Green Mountain Care Board shall review any all-inclusive population-based payment arrangement between the Department of Vermont Health Access and an accountable care organization for the following calendar year. The Board’s review shall include the number of attributed lives, eligibility groups, covered services, elements of the per member, per month payment, and any other nonclaims payments. The Board’s review may include deliberative sessions to the same extent permitted for insurance rate review under 8 V.S.A. § 4062.

  (b) The review shall be nonbinding on the Agency of Human Services, and nothing in this section shall be construed to abrogate the designation of the Agency of Human Services as the single State agency as required by 42 C.F.R. § 431.10.

  (c) The Board shall review the payment arrangement prior to the finalization of a contract between the Department and the accountable care organization and shall maintain the confidentiality of information as needed to preserve the parties’ contract negotiations. The Board shall release its advisory opinion within 30 days following the finalization of the contract between the parties.

  (d) The Department of Vermont Health Access shall provide the Board and its contractors with all data and information that the Board requests for its review within the time frame set forth by the Board. (Added 2017, No. 167 (Adj. Sess.), § 14, eff. May 22, 2018.)