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Bill

H 680

An act relating to a primary care access reform program

2025-2026 Regular Session Introduced by Esme Cole and 8 co-sponsors

Vermont would create a voluntary capitation-based Primary Care Access Reform Program to fund routine primary care with no patient cost-sharing, aiming to boost access and workforce

Read first time and referred to the Committee on Health Care
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Bill Summary · H 680

Overview

H.680 (2025-2026, Vermont) would establish a voluntary Primary Care Access Reform Program. The core idea is to compensate participating primary care practices with a monthly capitated payment per attributed patient to cover routine primary care, with no patient cost-sharing. The program aims to reduce administrative burdens, increase access to primary care, expand the primary care workforce, and align payments across payers to support comprehensive, team-based care.

Purpose and Intent

  • Improve Vermonters’ access to timely, comprehensive primary care.
  • Shift from fragmented access (specialists, urgent care, telehealth, etc.) toward robust primary care.
  • Address workforce challenges by incentivizing broader primary care participation and investing in training and loan-repayment programs.
  • Increase overall primary care spending in a way that does not raise total health care costs.

Key Provisions

  • Sec. 2 – Primary Care Access Reform Program

    • The program is voluntary for practices.
    • Funding sources: portions of commercial insurance premiums, premium equivalents from other participating payers, and, where permissible, public funds from Medicare/Medicaid.
    • Payments: A capitation-based, per-member-per-month (PMPM) payment to participating practices to cover routine primary care for attributed patients, with no patient cost-sharing.
    • Administrative requirements: Any participation requirements or quality measures must minimize admin burdens and align with Blueprint for Health requirements.
    • Quality measures: Up to 12 quality measures allowed; practices may be required to adopt up to 6. Measures must be claims-derived, patient-centered, appropriate for primary care, and supported by evidence.
    • Administrative burdens: Identify and reform burdens, data coordination, EHR requirements, and payer alignment.
    • Access standards: Reasonable standards to reduce the share of practices not accepting new patients and to shorten wait times (e.g., walk-ins, same-day appointments, extended hours).

  • (c) Payment Model and Allocation

    • The Agency shall adopt a risk-adjusted allocation model, potentially blending PMPM with fee-for-service as needed.
    • Model must support primary care spending targets, sustainability, and be adaptable to different practice types (independents, FQHCs, hospital-based, rural clinics).
    • If federal law allows, the model should avoid cost-sharing for routine care in participating practices.

  • (d) Payment Pool

    • The Agency operates a pool to collect premiums, premium equivalents, and public funds to distribute PMPM payments to practices.

  • (e) Implementation Rules

    • The Agency of Human Services would adopt rules to define scope, participation eligibility, risk-adjusted allocation, operation of the pool, anti-adverse-selection provisions, and definitions of direct/indirect primary care spending.

  • (f) Federal Engagement

    • The Agency or Board would negotiate with CMS for Medicare participation and reach out to self-funded and other employer plans regarding voluntary participation.

  • (g) Spending Targets and Reporting

    • Initial target: Increase the share of health care spending on primary care to 15% of all health care spending for Vermont residents, to be met by Jan 1, 2029, with a transition schedule.
    • Indirect primary care spending limits: cap the portion of spending considered indirect.
    • Possibility to raise the target if benchmarks (access, quality, health outcomes, cost containment) are met.
    • Definition: Uses NESCSO/State-defined primary care definitions to determine spending.

  • (g)(5) Insurer obligations

    • Insurers with 5,000+ Vermont-covered lives must comply with the program (meet or exceed targets).
    • Ensure insured individuals do not bear disproportionate costs; adjust non-primary care reimbursements to avoid increasing total spending.
    • Rules may be adopted to implement these requirements.

  • Sec. 3 – Implementation Timeline and Reports

    • Program start date: On or before July 1, 2027.
    • By Dec 15, 2026: The Agency, with the Green Mountain Care Board, must report on progress, implementation timeline, and options to expand to all patients of participating practices by Jan 1, 2028.

  • Sec. 4 – Site-Neutral Reimbursements and Clinician Landscape

    • By Jan 1, 2027: GMCB must report on clinician landscape in Vermont and site-neutral reimbursements, highlighting practice settings and ownership and efforts toward site-neutral pay.

  • Sec. 5 – Investments in Primary Care Workforce

    • $6,750,000 appropriated from the General Fund in FY 2027 for workforce investments, including:
    • $1,250,000 for Maple Mountain Family Medicine Residency (Teaching Health Center GME) in rural Vermont.
    • $500,000 for the Medical Student Incentive Scholarship Program (UVM College of Medicine).
    • $5,000,000 for the Vermont Educational Loan Repayment Program for primary care clinicians (physicians, NDs, NPs, PAs) to address demand and support expansion.

  • Sec. 7 – Sunset and Effective Dates

    • Sunset on some related medical student primary care provisions repealed (Sec. 7a reference), with specifics amended in the act.
    • Effective date: Act takes effect on passage; the workforce investment provision becomes effective July 1, 2026.

Who Is Affected

  • Primary care practices that participate voluntarily.
  • Health insurers and payer entities (commercial, and potentially Medicare/Medicaid funds where permissible).
  • Vermont residents attributed to participating practices (no patient cost-sharing for routine care under the program).
  • Health system stakeholders: Green Mountain Care Board, Agency of Human Services, Blueprint for Health, Vermont Steering Committee for Comprehensive Primary Health Care.
  • Clinicians and trainees: physicians, NPs, PAs, and NDs involved in primary care workforce development programs.
  • Employers (including self-funded plans) participating or considering participation.

Procedural and Timeline Notes

  • Implementation targeted for July 1, 2027, with progress reporting by Dec 15, 2026.
  • Annual or ongoing review of primary care spending targets, with potential adjustment based on performance benchmarks.
  • Requires rulemaking by the Agency of Human Services under 3 V.S.A. Chapter 25 to operationalize the program.
  • Requires CMS engagement for Medicare participation and outreach to other employer plans for voluntary participation.

Potential Impact

  • Aims to improve access to primary care, reduce reliance on higher-cost urgent or specialty care, and improve care continuity and outcomes.
  • Seeks to align payments across payers to incentivize comprehensive, team-based primary care, while streamlining administrative burdens.
  • Invests in the primary care workforce to address shortages and geographic disparities, especially in rural areas.

Compiled from official sources — confirm details with the bill’s official record.

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