Title 18: Health
Chapter 221: HEALTH CARE ADMINISTRATION
18 V.S.A. § 9456. Budget review
§ 9456. Budget review
(a) The board shall conduct reviews of each hospital's proposed budget based on the information provided pursuant to this subchapter, and in accordance with a schedule established by the board. The board shall require the submission of documentation certifying that the hospital is participating in the Blueprint for Health if required by section 708 of this title.
(b) In conjunction with budget reviews, the board shall:
(1) review utilization information;
(2) consider the goals and recommendations of the health resource allocation plan;
(3) consider the expenditure analysis for the previous year and the proposed expenditure analysis for the year under review;
(4) consider any reports from professional review organizations;
(5) solicit public comment on all aspects of hospital costs and use and on the budgets proposed by individual hospitals;
(6) meet with hospitals to review and discuss hospital budgets for the forthcoming fiscal year;
(7) give public notice of the meetings with hospitals, and invite the public to attend and to comment on the proposed budgets;
(8) consider the extent to which costs incurred by the hospital in connection with services provided to Medicaid beneficiaries are being charged to non-Medicaid health benefit plans and other non-Medicaid payers;
(9) require each hospital to file an analysis that reflects a reduction in net revenue needs from non-Medicaid payers equal to any anticipated increase in Medicaid, Medicare, or another public health care program reimbursements, and to any reduction in bad debt or charity care due to an increase in the number of insured individuals;
(10) require each hospital to provide information on administrative costs, as defined by the board, including specific information on the amounts spent on marketing and advertising costs.
(c) Individual hospital budgets established under this section shall:
(1) be consistent with the health resource allocation plan;
(2) take into consideration national, regional, or instate peer group norms, according to indicators, ratios, and statistics established by the board;
(3) promote efficient and economic operation of the hospital;
(4) reflect budget performances for prior years; and
(5) include a finding that the analysis provided in subdivision (b)(9) of this section is a reasonable methodology for reflecting a reduction in net revenues for non-Medicaid payers.
(d)(1) Annually, the board shall establish a budget for each hospital by September 15, followed by a written decision by October 1. Each hospital shall operate within the budget established under this section.
(2)(A) It is the general assembly's intent that hospital cost containment conduct is afforded state action immunity under applicable federal and state antitrust laws, if:
(i) the board requires or authorizes the conduct in any hospital budget established by the board under this section;
(ii) the conduct is in accordance with standards and procedures prescribed by the board; and
(iii) the conduct is actively supervised by the board.
(B) A hospital's violation of the board's standards and procedures shall be subject to enforcement pursuant to subsection (h) of this section.
(e) The board may establish a process to define, on an annual basis, criteria for hospitals to meet, such as utilization and inflation benchmarks. The board may waive one or more of the review processes listed in subsection (b) of this section.
(f) The board may, upon application, adjust a budget established under this section upon a showing of need based upon exceptional or unforeseen circumstances in accordance with the criteria and processes established under section 9405 of this title.
(g) The board may request, and a hospital shall provide, information determined by the board to be necessary to determine whether the hospital is operating within a budget established under this section. For purposes of this subsection, subsection (h) of this section, and subdivision 9454(a)(7) of this title, the board's authority shall extend to an affiliated corporation or other person in the control of or controlled by the hospital to the extent that such authority is necessary to carry out the purposes of this subsection, subsection (h) of this section, or subdivision 9454(a)(7) of this title. As used in this subsection, a rebuttable presumption of "control" is created if the entity, hospital, or other person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing 20 percent or more of the voting securities or membership interest or other governing interest of the hospital or other controlled entity.
(h)(1) If a hospital violates a provision of this section, the board may maintain an action in the superior court of the county in which the hospital is located to enjoin, restrain, or prevent such violation.
(2)(A) After notice and an opportunity for hearing, the board may impose on a person who knowingly violates a provision of this subchapter, or a rule adopted pursuant to this subchapter, a civil administrative penalty of no more than $40,000.00, or in the case of a continuing violation, a civil administrative penalty of no more than $100,000.00 or one-tenth of one percent of the gross annual revenues of the hospital, whichever is greater. This subdivision shall not apply to violations of subsection (d) of this section caused by exceptional or unforeseen circumstances.
(B)(i) The board may order a hospital to:
cease material violations of this subchapter or of a regulation or order issued pursuant to this subchapter; or (bb) cease operating contrary to the budget established for the hospital under this section, provided such a deviation from the budget is material; and
(II) take such corrective measures as are necessary to remediate the violation or deviation and to carry out the purposes of this subchapter.
(ii) Orders issued under this subdivision (2)(B) shall be issued after notice and an opportunity to be heard, except where the board finds that a hospital's financial or other emergency circumstances pose an immediate threat of harm to the public or to the financial condition of the hospital. Where there is an immediate threat, the board may issue orders under this subdivision (2)(B) without written or oral notice to the hospital. Where an order is issued without notice, the hospital shall be notified of the right to a hearing at the time the order is issued. The hearing shall be held within 30 days of receipt of the hospital's request for a hearing, and a decision shall be issued within 30 days after conclusion of the hearing. The board may increase the time to hold the hearing or to render the decision for good cause shown. Hospitals may appeal any decision in this subsection to superior court. Appeal shall be on the record as developed by the board in the admini
strative proceeding and the standard of review shall be as provided in 8 V.S.A. § 16.
(3)(A) The board shall require the officers and directors of a hospital to file under oath, on a form and in a manner prescribed by the commissioner, any information designated by the board and required pursuant to this subchapter. The authority granted to the board under this subsection is in addition to any other authority granted to the board under law.
(B) A person who knowingly makes a false statement under oath or who knowingly submits false information under oath to the board or to a hearing officer appointed by the board or who knowingly testifies falsely in any proceeding before the board or a hearing officer appointed by the board shall be guilty of perjury and punished as provided in 13 V.S.A. § 2901. (Added 1983, No. 93, § 1, eff. May 4, 1983; amended 1987, No. 96, § 19; 1991, No. 160 (Adj. Sess.), § 13, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.), § 35; 1999, No. 81 (Adj. Sess.), § 1, eff. Oct. 1, 2000; 2001, No. 63, § 123b; 2003, No. 53, § 24; 2005, No. 71, § 77f; 2005, No. 191 (Adj. Sess.), § 25; 2007, No. 27, § 9; 2009, No. 128 (Adj. Sess.), §§ 16, 22-24, eff. May 27, 2010; 2011, No. 21, § 17, eff. May 11, 2011; No. 48, § 25a; 2011, No. 171 (Adj. Sess.), § 23, eff. May 16, 2012.)