Oversight of accountable care organizations
18 V.S.A. § 9382
in effect9382. Oversight of accountable care organizations
(a)(1) In order to be eligible to operate in Vermont, each accountable care organization shall obtain and maintain certification from the Green Mountain Care Board. The Board shall adopt rules pursuant to 3 V.S.A. chapter 25 to establish standards and processes for certifying accountable care organizations. To the extent permitted under federal law, the Board shall ensure these rules anticipate and accommodate a range of ACO models and sizes, balancing oversight with support for innovation. In order to certify an ACO to operate in this State, the Board shall ensure that the following criteria are met:
(A) The ACO’s mechanisms and care models, taken as a whole, support and do not hinder the State’s principles for health care reform as set forth in section 9371 of this title.
(B) The ACO’s financial incentives for providers and patients are reasonably calculated to improve, or at a minimum, maintain, the quality of, access to, and affordability of care.
(C) The ACO has established appropriate mechanisms to receive and distribute payments to its participating health care providers in a fair and equitable manner.
(D) The ACO has established appropriate mechanisms and criteria for accepting health care providers to participate in the ACO that prevent unreasonable discrimination.
(E) The ACO has performance standards and measures to evaluate the quality and utilization of care delivered by its participating health care providers.
(F) The ACO does not place any restrictions on the information its participating health care providers may provide to patients about their health or decisions regarding their health.
(G) The ACO offers assistance to health care consumers, including:
(i) maintaining a consumer telephone line for questions, complaints, and grievances from attributed patients;
(ii) responding and making best efforts to resolve complaints and grievances from attributed patients, including providing assistance in identifying appropriate rights under a patient’s health plan;
(iii) providing an accessible mechanism for explaining how ACOs work;
(iv) providing contact information for the Office of the Health Care Advocate; and
(v) sharing deidentified complaint and grievance information with the Office of the Health Care Advocate at least twice annually.
(H) The ACO has in place a financial guarantee sufficient to cover its potential losses.
(2) Notwithstanding subdivision (1) of this subsection, the Green Mountain Care Board may adopt rules in accordance with 3 V.S.A. chapter 25 to establish a streamlined process for certification as a Medicare-only ACO for an entity authorized by the Centers for Medicare and Medicaid Services to act as an accountable care organization under the Medicare program. The streamlined process may require a Medicare-only ACO to meet one or more of the criteria set forth in subdivision (1) of this subsection. Certification obtained pursuant to the streamlined process shall apply to the Medicare-only ACO’s actions only as they relate to Medicare beneficiaries and only to the extent that the federal authorization allows.
(b) The Green Mountain Care Board shall adopt rules in accordance with 3 V.S.A. chapter 25 to establish standards and processes for reviewing, modifying, and approving the budgets of ACOs that receive payments from Medicaid or commercial insurers, or both, on behalf of attributed lives in Vermont. To the extent permitted under federal law, the Board shall ensure the rules anticipate and accommodate a range of ACO models and sizes, balancing oversight with support for innovation. In its review, the Board shall review and consider:
(1) information gathered from meetings with the ACO to review and discuss its proposed budget for the forthcoming fiscal year;
(2) the efficacy with which the ACO uses funds from Medicaid and commercial insurers, as applicable, to enhance and expedite the State’s health care system transformation efforts;
(3) the ACO’s reasonable use of State and commercial insurance funds for its own administrative costs, as defined by the Board;
(4) the ACO’s collaboration with a range of provider types, such as home- and community-based providers, dental health providers, and mental health and substance use disorder treatment providers;
(5) the ACO’s use of a consumer advisory board and other mechanisms for inviting and considering consumer input; and
(6) public comment on all aspects of the ACO’s costs, operations, and proposed budget.
(c)(1) The Office of the Health Care Advocate shall have the right to receive copies of all materials related to any ACO certification or budget review and may:
(A) ask questions of employees of the Green Mountain Care Board related to the Board’s ACO budget review;
(B) submit written questions to the Board that the Board will ask of the ACO in advance of any hearing held in conjunction with the Board’s ACO review;
(C) submit written comments for the Board’s consideration; and
(D) ask questions and provide testimony in any hearing held in conjunction with the Board’s ACO budget review.
(2) The Office of the Health Care Advocate shall not disclose further any confidential or proprietary information provided to the Office pursuant to this subsection.
(d) The Board’s rules shall include requirements for submission of information and data by ACOs and their participating providers as needed to evaluate an ACO’s success. The rules may also establish standards as appropriate to promote an ACO’s ability to participate in applicable federal programs for ACOs.
(e) All information required to be filed by an ACO pursuant to this section or to rules adopted pursuant to this section shall be made available to the public in accordance with 1 V.S.A. chapter 5, subchapter 3 (Public Records Act), provided that individual patients or health care providers shall not be directly or indirectly identifiable.
(f) To the extent required to avoid federal antitrust violations, the Board shall supervise the participation of health care professionals, health care facilities, and other persons operating or participating in an accountable care organization. The Board shall ensure that its certification and oversight processes constitute sufficient State supervision over these entities to comply with federal antitrust provisions and shall refer to the Attorney General for appropriate action the activities of any individual or entity that the Board determines, after notice and an opportunity to be heard, may be in violation of State or federal antitrust laws without a countervailing benefit of improving patient care, improving access to health care, increasing efficiency, or reducing costs by modifying payment methods.
(g) The Board shall collect the following amounts from an accountable care organization:
(1) $10,000.00 for initial certification in accordance with subsection (a) of this section;
(2) $2,000.00 annually following initial certification to maintain certification; and
(3) $125,000.00 for each review of the accountable care organization’s budget in accordance with subsection (b) of this section.
Added 2015, No. 113 (Adj. Sess.), § 5, eff. Jan. 1, 2018; amended 2017, No. 59, § 1; 2017, No. 167 (Adj. Sess.), §§ 2, 13a, eff. May 22, 2018; 2017, No. 200 (Adj. Sess.), § 15; 2017, No. 204 (Adj. Sess.), § 7; 2019, No. 14, § 54, eff. April 30, 2019; 2019, No. 52, § 2a; 2025, No. 62, § 5.
Source: Vermont General Assembly (legislature.vermont.gov)URL: https://legislature.vermont.gov/statutes/section/18/220/09382Fetched: 10/21/2026