The Green Mountain Care Board’s mission is to improve the health of Vermonters through a high-quality, accessible, affordable, and sustainable health care system.
GMCB is an independent five-member Board whose members are appointed by the Governor for six-year terms. The Board was created by the Vermont Legislature in 2011 through Act 48, Vermont’s landmark health reform legislation. Per statute (18 V.S.A. § 9372), the Board’s purpose is “to promote the general good of the State by:
- improving the health of the population;
- reducing the per-capita rate of growth in expenditures for health services in Vermont across all payers while ensuring that access to care and quality of care are not compromised;
- enhancing the patient and health care professional experience of care;
- recruiting and retaining high-quality health care professionals; and
- achieving administrative simplification in health care financing and delivery. (Added 2011, No. 48, § 3, eff. May 26, 2011.)
The Board has 6 major regulatory duties:
- Review and establish community hospital budgets.
- Review and approve, modify, or disapprove requests for health insurance premium rates in the large, small, and individual insurance markets plans; in addition, the Board reviews and approves the benefit package or packages for qualified health benefit plans.
- Review and approve, approve with conditions, or deny applications for certificates of need.
- Oversee the Vermont All-Payer Accountable Care Organization Model (APM), including setting financial targets for Vermont Medicare ACOs and limit cost growth for certain health care services; ensuring reasonable alignment across Vermont ACO programs; working with other APM Agreement signatories to achieve targets for the number of aligned Vermonters; and working with other Agreement signatories to achieve targets on twenty quality measures tied to three population health goals.
- Regulate Accountable Care Organizations (ACOs), including certifying ACOs to allow them to receive payments from Medicaid and commercial insurers, and reviewing and approving ACO budgets.
- A variety of duties related to data, analytics, and evaluation, including maintaining Vermont’s all-payer claims database, the Vermont Health Care Uniform Reporting and Evaluation System (VHCURES), and hospital discharge database, the Vermont Uniform Hospital Discharge Data Set (VUHDDS); performing an annual Health Care Expenditure Analysis and annual estimate of future health care spending; and evaluating systemwide performance and quality.
The GMCB also has responsibility for developing a Health Resource Allocation Plan, approving the state’s health care workforce plan and its health information technology plan, and oversight of Vermont Information Technology Leaders, the organization that operates Vermont’s statewide clinical health information exchange. In addition, the Board is tasked to “oversee the development and implementation, and evaluate the effectiveness, of health care payment and delivery system reforms designed to control the rate of growth in health care costs; promote seamless care, administration, and service delivery; and maintain health care quality in Vermont.” (18 V.S.A. § 9375(b)(1))
Throughout all of the Board's work, the Board consistently works closely with Vermont health care providers and health care consumers to enhance health system transparency and consumer involvement.