Debate over who should review hospital service cuts — Green Mountain Care Board or AHS — dominates S.189 hearing

The Senate Health & Welfare Committee spent substantial time on S.189 debating whether state-level review of proposed hospital service reductions should remain with the Agency of Human Services or be handled through notice and a public-engagement process followed by budget review by the Green Mountain Care Board.

An amendment circulated to the committee would require a hospital intending to reduce or eliminate a service to post notice, conduct at least one public hearing, compile public comments and notify the Green Mountain Care Board within five business days if it proceeds with the change so the board can review budget impacts and direct savings to payers or reinvestment in primary care or community services.

Owen Foster, chair of the Green Mountain Care Board, urged the committee not to remove agency-level review, saying hospital decisions historically have prioritized institutional finances over statewide system needs and have resulted in cuts to services (he cited examples such as cuts to primary care, dialysis, inpatient psychiatry and pediatrics). "When hospitals have made the decisions in the recent past, they haven't done so with a view towards the system," Foster said, arguing that some form of system-level review is essential to avoid unintended access and cost consequences.

Representatives of AHS said the current statutory starting point places oversight with the Green Mountain Care Board and noted AHS is actively engaged in transformation and regionalization work with hospitals. Jill Mazza Olson of AHS testified that the agency cannot credibly be both the state’s transformation partner and its hospital regulator. She suggested retaining the Green Mountain Care Board’s regulatory role while ensuring AHS and the board both participate in public hearings and provide regional strategic context.

Mike Fisher, the state Health Care Advocate, supported a public-engagement component and said the Green Mountain Care Board's public process had previously given community providers and residents an opportunity to be heard in contentious changes. Hospital representatives, including Devin Green of the Vermont Association of Hospitals and Health Systems, welcomed notification and public hearings but asked what support the state would provide if a proposal to maintain a service required subsidy or specialist recruitment.

Committee members said they were not yet ready to finalize the amendment. Several suggested a near-term compromise: preserve public notice and hearings, ensure both AHS and the Green Mountain Care Board present informed recommendations during hearings, and refine whether AHS's role should be advisory, recommendatory or include authority to approve or deny proposals. The committee paused the discussion to continue negotiations and prepare language that can move forward this session.

What's next: The committee intends further briefing and negotiation between the Green Mountain Care Board, AHS and stakeholder groups to define a path that balances community accountability, system-level planning and hospital financial realities.