| Rule Number: |
25P042 |
| Title: |
Green Mountain Care Board: Rule 5.000: Oversight of Accountable Care Organizations. |
|
Type:
|
Standard |
|
Status:
|
Adopted |
| Agency: |
Green Mountain Care Board
|
| Legal Authority: |
18 V.S.A. §§ 9375(b)(13), 9380, and 9382. |
| Summary:
| This rule establishes revised standards and processes, consistent with Act 62 of 2025, that the Green Mountain Care Board (GMCB) will use to certify Accountable Care Organizations (ACOs) and review, modify, and approve the budgets of ACOs. First, as of January 1, 2026, the GMCB will no longer review the budgets of all ACOs operating in Vermont, as required by the current GMCB Rule 5.000. Instead, the GMCB will only review the budgets of ACOs that contract with Vermont Medicaid and/or Vermont commercial payers. The GMCB will not review the budgets of ACOs that contract only with Medicare. Second, as of January 1, 2027, all ACOs operating in Vermont must be certified by the GMCB. This is a revision from the current GMCB Rule 5.000, which requires certification only for ACOs that contract with Vermont Medicaid
and/or Vermont commercial payers. Third, this revised rule includes revisions to ACO certification and budget review criteria, consistent with Act 62 of 2025. |
| Persons Affected:
| Accountable Care Organizations (ACOs), Vermont health care providers, Vermont Medicaid and commercial payers, The Office of the Health Care Advocate, and Vermont patients attributed to ACOs. |
| Economic Impact:
| This revised rule does not meaningfully alter the economic impact of the GMCB's oversight of ACOs. However, Act 62 of 2025 amended the manner by which ACOs make payments to the GMCB. Under prior law, ACOs paid a portion of the expenses of the GMCB under 18 V.S.A. § 9374(h)(1). Under Act 62, ACOs are instead subject to an initial certification fee of$10,000, an annual verification fee of $2,000, and, where applicable, an annual budget review fee $125,000. This revised rule does not meaningfully alter the economic impact of GMCB oversight of ACOs to the other entities and people listed above. |
| Posting date: |
Dec 03,2025 |
