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Updates from the Executive Director

Summer Regulatory Updates

The summer is always a busy time for the GMCB, with two key regulatory processes in full swing – Health Insurance Premium Rate Review and Hospital Budget Review. Below is an outline of the statutory authority of the Board, the timeline for this work, and opportunities for public engagement for both regulatory processes. 

On July 11, outgoing Chair Kevin Mullin published an op-ed highlighting some of the challenges the Board is facing this summer:

“As I prepare for retirement and the Green Mountain Care Board enters its busy summer regulatory season, the implications for Vermonters weigh on me heavily. The last two years have been incredibly challenging. The pandemic has put unprecedented strain on Vermonters and families as well as our health care facilities and their workforce...Our fragile health care system needs stability today and sustainability for the future...

In this challenging environment, we have to do the best we can with what we have and balance our priorities as required by Vermont law. The challenges this year underscore the need for Vermont to envision a sustainable health care system for years to come.”

2023 Rate Review: Individual & Small Group Rate Filings 

On August 4, 2022, the Green Mountain Care Board issued decisions requiring Blue Cross Blue Shield of Vermont (BCBSVT) and MVP Health Plan, Inc. (MVP) to lower the premiums they wanted to charge individuals and small businesses for health insurance plans in 2023. The final decision and orders are posted under each filing on the rate review website.  

  • Drivers of the Requested Rates: The rates were mainly driven by 1) the rising costs for specialty pharmaceuticals, and 2) higher costs paid to health care providers for delivering services, driven by inflationary and workforce pressures. 
  • Board Approved Rates: Acting within its statutory authority, and balancing a number of statutory factors, the Board reduced BCBSVT’s and MVP’s proposed rates by the amounts reflected in the following tables:
Small Group - Average Annual Increase Over 2022 Rates
Insurer Rate Request (PMPM)** Board Approved (PMPM)**
BCBSVT 15.4% ($94 PMPM) 11.7%* ($71 PMPM)
MVP 23.4% ($135 PMPM) 18.3%* ($106 PMPM)
Individual & Family - Average Annual Increase Over 2022 Rates
Insurer Rate Request (PMPM)** Board Approved (PMPM)**
BCBSVT 14.9% ($104 PMPM) 11.4%* ($79 PMPM)
MVP 24.4% ($164 PMPM) 19.3%* ($130 PMPM)
  • Information for Vermonters
    • How to Access Health Care Subsidies: Approximately 5,500 Vermonters could still save money in 2022 on their monthly premium by signing up through Vermont Health Connect (VHC). To find out if you qualify for a subsidy, use the VHC Plan Comparison Tool.  As of August 4, 2022, it remains uncertain whether Congress will renew for 2023 the expanded premium tax credits initially made available through the American Rescue Plan Act (ARPA). Information is available here about ARPA and how it impacts eligibility for premium assistance.
    • Open Enrollment: Vermonters can use the Plan Comparison Tool starting October 14, 2022, to compare plans for 2023. Open enrollment for 2023 plans begins November 1, 2022. 
    • Questions About Your Health Insurance?: For questions about your health insurance or health care access, please contact Vermont Legal Aid’s Office of the Health Care Advocate at 1-800-917-7787.

*These rate increases represent averages across different benefit plans with varying levels of cost sharing. For small group, the plan-level increases approved range from 9.1% to 15.3% for BCBSVT and 10.5% to 21.5% for MVP. For individual and family plans, the plan-level increases approved range from 8.8% to 15.3% for BCBSVT and 11.3% to 26.3% for MVP.  

**Per member per month (PMPM) is the dollar amount a member pays each month for a health care plan.   

2023 Hospital Budget Review

Background: Annually by October 1, the Green Mountain Care Board has the responsibility to review and establish budgets for Vermont’s 14 community hospitals. In its review, the Board considers local health care needs and resources, utilization and quality data, hospital administrative costs, and other data, as well as presentations from hospitals and comments from members of the public.

  Timeline and Opportunities for Public Engagement

  • Guidance: On March 31, the Board issued Hospital Budget Guidance for the upcoming hospital budget review.
  • Hospital Budgets Due: On July 1, Hospital Budgets were due to the GMCB. Budget Submissions for each hospital can be found on the Individual Hospital Documents page. 
    • July 27: GMCB Staff Preliminary Review of FY2023 Hospital Budget Submissions
    • Summary: the weighted average for change in Net Patient Care Revenue/Fixed Prospective Payments requests is a 10.1% increase and a 10.7% increase in change in charge. “Change in charge” reflects average changes to hospitals’ chargemasters (list prices), which impacts the prices private insurance plans and self-pay patients pay for services.
  • Hospital Budget Hearings: Weeks of August 15 and 22 on MWF beginning at 8:30 AM. Further details will be available in August on the GMCB Board Meeting Information page. 
  • Public Comment: The Board is accepting public comment on an ongoing basis from July 13 until Aug 30, 2022.
  • Public Deliberation: In September, the Board will publicly deliberate to approve, modify, or deny budgets by September 15.
  • Budget Orders: By October 1, the budget orders will be delivered to hospitals. October 1 also marks the start of the hospitals’ fiscal year. 

Hospital Budget Public Comment

Sustainability Planning

Act 167: An act relating to health care reform initiatives, data collection, and access to home- and community-based services.

  • This session, the legislature passed Act 167 (S. 285). One component of the Act requires the Board and the Agency of Human Services to consider options for a more sustainable health care system through community and provider engagement. 
  • The Board is actively undertaking its work as defined by Act 167 in partnership with Vermont’s Agency of Human Services. Check back for further updates. 

Press Releases and Upcoming GMCB Meeting Information

For the 2022 Board Meeting information and materials click here.

Recent Decisions and Bulletins

  • On May 18, 2022, the Board issued its decision and order approving modifications to the BCBSVT and TVHP large group filings for Q3 2022. Click here for the decision. 
  • On May 4, 2022, the Board issued its decision and order approving modifications to the MVP Health Plan, Inc. 2023 Non-Standard Bronze QHP. Click here for the decision. 
  • On March 7, 2022, the Board issued its decision approving modifications to the EHB Benchmark Plan for 2024. Click here for the decision.