Montpelier
Vermont’s certificate of need statute requires hospitals to seek regulatory approval for expenditures on buildings, equipment and technology projects. The rules for the process have not been updated in 14 years.
Kevin Mullin, a former state senator who was appointed by Gov. Phil Scott in May to be chairman of the Green Mountain Care Board, said critics have suggested that the board drop regulation of health care capital projects.
“I can tell you that I believe strongly that there should be (regulation),” Mullin said in recent testimony before the House Health Committee. “If we’re going to try to bend the (health care) cost curve, we need to be able to have a discussion on the different projects that come before us.”
At the same time, the board wants to update the process. “I think it’s a little bit of a feeling that there might be some unnecessary red tape,” Mullin said.
The Green Mountain Care Board is an independent body with a mandate to boost health care quality while containing costs. The board’s regulatory authority extends to health insurance rates, accountable care organizations, hospital budgets and major investments made by health care providers.
Certificates issued in 2017 included a surgical center in Colchester, Vt.; an opiate addiction treatment clinic in St. Albans, Vt.; a merger of home health services in Rutland and Bennington counties; and a $22.7 million expansion at Brattleboro Memorial Hospital.
Certificates of need that are currently pending include a nearly $24 million project featuring a new medical office building at Rutland Regional Medical Center and a University of Vermont Medical Center electronic records project with capital costs topping $112 million.
A top priority, officials said, is to increase the financial thresholds for Green Mountain Care Board review. This change would apply only to hospital projects.
For example, the current statute says hospitals that are purchasing or leasing a piece of diagnostic or therapeutic equipment valued at $1 million or more must seek a certificate of need. The care board says that should be raised to $1.5 million.
In a similar vein, a new health care service or technology with annual operating costs exceeding $500,000 currently is subject to a certificate of need. That threshold should be doubled to $1 million, the care board recommends.
The board also is recommending that some projects be excluded from or expedited within the certificate of need process. For instance, routine replacement of non-medical equipment shouldn’t require a certificate of need, officials said.
The Vermont Association of Hospitals and Health Systems is backing the changes in statute.
Jeff Tieman, president and CEO of the trade group, said “routine hospital maintenance … shouldn’t be subject to this kind of review process.”