The GMCB memorialized their concern for hospital sustainability in the FY 2020 Hospital Budget Orders with the requirement for 6 of 14 hospitals to submit a sustainability plan. On February 26, 2020, GMCB staff presented the draft framework in a public Board Meeting and on July 15, 2020 presented updated draft framework due to COVID-19 concerns. Act 159 of 2020 requires that the GMCB shall consider ways to increase the financial sustainability of Vermont hospitals in order to achieve population based health improvements while maintaining community access to services. In conducting this work, the Board shall consult with the Director of Health Care Reform in the Agency of Human Services, Vermont hospitals, the Vermont Association of Hospitals and Health Systems, certified accountable care organizations, the Office of the Health Care Advocate, and other interested stakeholders. FY 2021 Hospital Budget Orders required all 14 hospitals to participate in the Board's strategic sustainability planning process.