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Searching 2019-2020 Session

The Vermont Statutes Online

 

Title 18 : Health

Chapter 220 : GREEN MOUNTAIN CARE BOARD

Subchapter 001 : GREEN MOUNTAIN CARE BOARD

(Cite as: 18 V.S.A. § 9374)
  • § 9374. Board membership; authority

    (a)(1) On July 1, 2011, the Green Mountain Care Board is created and shall consist of a chair and four members. The Chair and all of the members shall be State employees and shall be exempt from the State classified system. The Chair shall receive compensation equal to that of a Superior judge, and the compensation for the remaining members shall be two-thirds of the amount received by the Chair.

    (2) The Chair and the members of the Board shall be nominated by the Green Mountain Care Board Nominating Committee established in subchapter 2 of this chapter using the qualifications described in section 9392 of this chapter and shall be otherwise appointed and confirmed in the manner of a Superior judge. The Governor shall not appoint a nominee who was denied confirmation by the Senate within the past six years.

    (b)(1) The initial term of the Chair shall be seven years, and the term of the Chair shall be six years thereafter.

    (2) The term of each member other than the Chair shall be six years, except that of the members first appointed, one each shall serve a term of three years, four years, five years, and six years.

    (3) Subject to the nomination and appointment process, a member may serve more than one term.

    (4) Members of the Board may be removed only for cause. The Board shall adopt rules pursuant to 3 V.S.A. chapter 25 to define the basis and process for removal.

    (c)(1) No Board member shall, during his or her term or terms on the Board, be an officer of, director of, organizer of, employee of, consultant to, or attorney for any person subject to supervision or regulation by the Board; provided that for a health care practitioner, the employment restriction in this subdivision shall apply only to administrative or managerial employment or affiliation with a hospital or other health care facility, as defined in section 9432 of this title, and shall not be construed to limit generally the ability of the health care practitioner to practice his or her profession.

    (2) No Board member shall participate in creating or applying any law, rule, or policy or in making any other determination if the Board member, individually or as a fiduciary, or the Board member's spouse, parent, or child wherever residing or any other member of the Board member's family residing in his or her household has an economic interest in the matter before the Board or has any more than a de minimis interest that could be substantially affected by the proceeding.

    (3) The prohibitions contained in subdivisions (1) and (2) of this subsection shall not be construed to prohibit a Board member from, or require a Board member to recuse himself or herself from Board activities as a result of, any of the following:

    (A) being an insurance policyholder or from receiving health services on the same terms as are available to the public generally;

    (B) owning a stock, bond, or other security in an entity subject to supervision or regulation by the Board that is purchased by or through a mutual fund, blind trust, or other mechanism where a person other than the Board member chooses the stock, bond, or security; or

    (C) receiving retirement benefits through a defined benefit plan from an entity subject to supervision or regulation by the Board.

    (4) No Board member shall, during his or her term or terms on the Board, solicit, engage in negotiations for, or otherwise discuss future employment or a future business relationship of any kind with any person subject to supervision or regulation by the Board.

    (5) No Board member may appear before the Board or any other State agency on behalf of a person subject to supervision or regulation by the Board for a period of one year following his or her last day as a member of the Green Mountain Care Board.

    (d)(1) The Chair shall have general charge of the offices and employees of the Board but may hire a director to oversee the administration and operation.

    (2)(A) Except for final decisions in regulatory matters over which the Board has jurisdiction, a member of the Board, Board officer, or Board employee may perform any service that is within the Board's jurisdiction and that the Board delegates to the member, officer, or employee.

    (B) The Board shall establish procedures to ensure that Board employees have appropriate supervision in their performance of delegated activities and that the Board remains informed regarding these activities.

    (e)(1) The Board shall establish a consumer, patient, business, and health care professional advisory group to provide input and recommendations to the Board. Members of such advisory group who are not State employees or whose participation is not supported through their employment or association shall receive per diem compensation and reimbursement of expenses pursuant to 32 V.S.A. § 1010, provided that the total amount expended for such compensation shall not exceed $5,000.00 per year.

    (2) The Board may establish additional advisory groups and subcommittees as needed to carry out its duties. The Board shall appoint diverse health care professionals to the additional advisory groups and subcommittees as appropriate.

    (3) To the extent funds are available, the Board may examine, on its own or through collaboration or contracts with third parties, the effectiveness of existing requirements for health care professionals, such as quality measures and prior authorization, and evaluate alternatives that improve quality, reduce costs, and reduce administrative burden.

    (f) In carrying out its duties pursuant to this chapter, the Board shall seek advice from the Office of the Health Care Advocate. The Office shall advise the Board regarding the policies, procedures, and rules established pursuant to this chapter. The Office shall represent the interests of Vermont patients and Vermont consumers of health insurance and may suggest policies, procedures, or rules to the Board in order to protect patients' and consumers' interests.

    (g) The Chair of the Board or designee may apply for grant funding, if available, to advance or support any responsibility within the Board's jurisdiction.

    (h)(1) The Board may assess and collect from each regulated entity the actual costs incurred by the Board, including staff time and contracts for professional services, in carrying out its regulatory duties for health insurance rate review under 8 V.S.A. § 4062; hospital budget review under chapter 221, subchapter 7 of this title; and accountable care organization certification and budget review under section 9382 of this title.

    (2)(A) In addition to the assessment and collection of actual costs pursuant to subdivision (1) of this subsection and except as otherwise provided in subdivisions (2)(C) and (3) of this subsection, all other expenses of the Board shall be borne as follows:

    (i) 40 percent by the State from State monies;

    (ii) 30 percent by the hospitals;

    (iii) 24 percent by nonprofit hospital and medical service corporations licensed under 8 V.S.A. chapter 123 or 125, health insurance companies licensed under 8 V.S.A. chapter 101, and health maintenance organizations licensed under 8 V.S.A. chapter 139; and

    (iv) six percent by accountable care organizations certified under section 9382 of this title.

    (B) Expenses under subdivision (A)(iii) of this subdivision (2) shall be allocated to persons licensed under Title 8 based on premiums paid for health care coverage, which for the purposes of this subdivision (2) shall include major medical, comprehensive medical, hospital or surgical coverage, and comprehensive health care services plans, but shall not include long-term care, limited benefits, disability, credit or stop loss, or excess loss insurance coverage.

    (C) Expenses incurred by the Board for regulatory duties associated with certificates of need shall be assessed pursuant to the provisions of section 9441 of this title and not in accordance with the formula set forth in subdivision (A) of this subdivision (2).

    (3) The Board may determine the scope of the incurred expenses to be allocated pursuant to the formula set forth in subdivision (2) of this subsection if, in the Board's discretion, the expenses to be allocated are in the best interests of the regulated entities and of the State.

    (4) If the amount of the proportional assessment to any entity calculated in accordance with the formula set forth in subdivision (2)(A) of this subsection would be less than $150.00, the Board shall assess the entity a minimum fee of $150.00. The Board shall apply the amounts collected based on the difference between each applicable entity's proportional assessment amount and $150.00 to reduce the total amount assessed to the regulated entities pursuant to subdivisions (2)(A)(ii)-(iv) of this subsection.

    (5)(A) Annually on or before September 15, the Board and the Department of Financial Regulation shall report to the House and Senate Committees on Appropriations the total amount of all expenses eligible for allocation pursuant to this subsection (h) during the preceding State fiscal year and the total amount actually billed back to the regulated entities during the same period. The provisions of 2 V.S.A. § 20(d) (expiration of required reports) shall not apply to the report to be made under this subdivision.

    (B) The Board and the Department shall also present the information required by this subsection (h) to the Joint Fiscal Committee annually at its September meeting.

    (i) In addition to any other penalties and in order to enforce the provisions of this chapter and empower the Board to perform its duties, the Chair of the Board may issue subpoenas, examine persons, administer oaths, and require production of papers and records. Any subpoena or notice to produce may be served by registered or certified mail or in person by an agent of the Chair. Service by registered or certified mail shall be effective three business days after mailing. Any subpoena or notice to produce shall provide at least six business days' time from service within which to comply, except that the Chair may shorten the time for compliance for good cause shown. Any subpoena or notice to produce sent by registered or certified mail, postage prepaid, shall constitute service on the person to whom it is addressed. Each witness who appears before the Chair under subpoena shall receive a fee and mileage as provided for witnesses in civil cases in Superior Courts; provided, however, any person subject to the Board's authority shall not be eligible to receive fees or mileage under this section.

    (j) A person who fails or refuses to appear, to testify, or to produce papers or records for examination before the Chair upon properly being ordered to do so may be assessed an administrative penalty by the Chair of not more than $2,000.00 for each day of noncompliance and proceeded against as provided in the Administrative Procedure Act, and the Chair may recommend to the appropriate licensing entity that the person's authority to do business be suspended for up to six months. (Added 2011, No. 48, § 3, eff. May 26, 2011; amended 2011, No. 171 (Adj. Sess.), § 5, eff. May 16, 2012; 2013, No. 79, § 35b, eff. Jan. 1, 2014; 2013, No. 79, § 37a; 2015, No. 113 (Adj. Sess.), § 9, eff. May 17, 2016; 2017, No. 154 (Adj. Sess.), § 23, eff. May 21, 2018; 2017, No. 167 (Adj. Sess.), § 13, eff. May 22, 2018; 2017, No. 167 (Adj. Sess.), § 17.)