Vermont § 9384 - Reduction or reallocation of reimbursement rates; risks to health insurer solvency

§ 9384. Reduction or reallocation of reimbursement rates; risks to health insurer solvency

• (a) As used in this section: (1) “Hospital” has the same meaning as in section 9451 of this title. (2) “Hospital network” means a system comprising two or more affiliated hospitals, and
  may include other health care professionals and facilities, that derives 50 percent
  or more of its operating revenue, at the consolidated network level, from Vermont
  hospitals and in which the affiliated hospitals deliver health care services in a
  coordinated manner using an integrated financial and governance structure. (b) If the Green Mountain Care Board determines, after consultation with the Commissioner
  of Financial Regulation, that a domestic health insurer faces an acute and immediate
  threat to its solvency because its risk-based capital level has triggered a regulatory
  action level event pursuant to 8 V.S.A. § 8304, the Board may order a reduction of the insurer’s reimbursement rates to one or more
  Vermont hospitals as set forth in subsection (c) of this section until such time as
  the amount of the insurer’s risk-based capital exceeds the company action level risk-based
  capital threshold defined in 8 V.S.A. § 8301. Notwithstanding any provision of 3 V.S.A. chapter 25 to the contrary, the Board’s activities under this section shall not be construed
  to be a contested case. Any person aggrieved by a final Board action, order, or determination
  under this section may appeal as set forth in section 9381 of this title. (c)(1) The Board shall only order a reduction in the reimbursement rates to a hospital that
  meets one or both of the following criteria: (A) the hospital has more than 135 days’ cash on hand and had a positive operating margin
  in the previous fiscal year; or (B) the hospital is a member of a hospital network that, at the consolidated network level,
  has more than 135 days’ cash on hand or had a positive operating margin in the previous
  fiscal year, or both. (2) The Board shall order a reduction in reimbursement rates to a hospital pursuant to
  this section only to the extent necessary to remediate the threat to the domestic
  health insurer’s solvency. In determining whether and to what extent to reduce a hospital’s
  reimbursement rates pursuant to this section, the Board shall consider the competing
  financial obligations of the hospital and of the domestic health insurer. (3) The Board shall provide a hospital with the opportunity to request relief from a rate
  reduction ordered pursuant to this section. (4) In no event shall a reduction ordered by the Board pursuant to this section result
  in a decrease to a hospital’s or hospital network’s projected days’ cash on hand to
  below 125 days. (Added 2025, No. 49, § 1, eff. June 5, 2025.)