Committee reports S197 to study universal primary care payments and the Blueprint for Health

The House Ways & Means Committee on May 19 voted to report S197 favorably after a review of provisions directing the Blueprint for Health and state agencies to study payment models and funding for universal primary care.

Jen Carbby of the Office of Legislative Council described S197 as an act to invest in primary care and to establish an operational framework for universal primary care. "Purposes of the bill are to get information necessary to develop a framework for implementation of universal primary care, optimize Blueprint for Health, determine whether the Blueprint is an appropriate mechanism and to explore other approaches," Carbby said.

Key elements: the bill directs the Blueprint director, in consultation with others, to report to the healthcare committees by Jan. 15, 2027 on changes to payment amounts and methodologies needed to transition to per-person-per-month payments that include routine primary care services; to provide an operational plan and timeline; and to recommend risk-adjustment and attribution approaches. Section five requires the Agency of Human Services to establish a target per-person-per-month spending amount for primary care and produce a transitional schedule with a Jan. 2028 report back on targets and adjustments.

S197 also asks the Agency of Human Services, the Green Mountain Care Board, the Department of Financial Regulation and the Office of the Health Care Advocate to evaluate how healthcare regulation and reform functions should be distributed across agencies and to report on gaps, overlaps and proposed legislation. The bill directs an interagency report on accelerating appropriate transitions from hospital care to community care and asks the state treasurer and Agency of Human Services to explore a possible regional universal primary care program with neighboring states.

The bill would also require health insurers to notify patients at least 60 days before removing a prescription drug from a formulary if the patient had filled that drug within the prior year.

Committee discussion focused on process and jurisdiction. Joint Fiscal Office staff (Nolan) cautioned that the steering group named in the bill might not be the best body to analyze the healthcare-claims-tax transition and recommended an amendment to assign fiscal analysis to the Blueprint director in collaboration with the tax department and to route findings to oversight committees. Carbby and members agreed to narrow the committee's focus to its jurisdiction and noted cross-committee consultation would likely be needed.

On a motion to find S197 favorable, the committee recorded the vote announced in the transcript as "911" (reported as 9 yes, 1 no, 1 abstain). The committee closed with scheduling notes and said the amendment process would continue when the amendment text is available.

What happens next: S197 was reported favorable and requires multiple technical reports from the Blueprint and state agencies in 2027 and 2028; committee staff and fiscal offices will continue to refine who performs the claims-tax analysis and how the payment targets will be calculated.