An act relating to increasing the monetary thresholds for certificates of need
Sponsored By: Rep. Mari Cordes
Signed by Governor
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Bill Overview
Analyzed Economic Effects
7 provisions identified: 5 benefits, 0 costs, 2 mixed.
Fewer health facility purchases need review
Beginning May 13, 2025, Vermont raises the certificate-of-need threshold for health facility capital projects from $1.5 million to $10 million. The threshold covers building, buying, renovating, and other capital spending; review applies when costs exceed it. The equipment threshold rises from $1 million to $5 million, covering purchases, leases, similar arrangements, and donated value. Equipment that must work together counts as one purchase. The Green Mountain Care Board can adjust monetary thresholds, but increases cannot exceed total inflation since the thresholds were set. Projects split to avoid review must be reviewed together; Board decisions on splitting and linked equipment can be appealed. The new rules apply to projects started on or after May 13, 2025. Pending applications with formally recognized interested parties keep the filing-date thresholds and exclusions until a final decision. Pending applications without those parties can be withdrawn under Board rules.
Ground ambulance providers skip project review
Beginning May 13, 2025, emergency and nonemergency ground ambulance services are excluded from Vermont's certificate-of-need review system. The exclusion also covers affiliated agencies and equipment and supplies used by emergency medical personnel.
Higher review threshold for new healthcare
Beginning May 13, 2025, fewer new health services and technologies need a certificate of need. Review applies when annual operating costs exceed $3 million in either of the next two budgeted fiscal years. This rule covers services or technology the facility has not offered in the previous three fiscal years, on-site or mobile. Separate review requirements remain for changes in licensed bed counts across licensing periods. They also remain for transfers of more than 50% ownership in facilities other than hospitals or nursing homes.
Routine hospital replacements skip project review
Beginning May 13, 2025, routine replacement of fully depreciated medical equipment is excluded from certificate-of-need review. This means the equipment's cost has been fully written off in accounting records. Routine replacement of nonmedical equipment and fixtures, such as boilers and heating systems, is excluded regardless of remaining useful life. Hospitals must still include these replacements in their budgets, where the Board can review them.
Surgery centers lose automatic review requirement
Beginning May 13, 2025, setting up an outpatient surgery center no longer automatically requires a certificate of need. This change covers building, developing, buying, leasing, or otherwise establishing a center. Other review rules, including the capital spending threshold, still apply.
Large health projects face staged approval
Beginning May 13, 2025, projects already requiring a certificate of need face two approval stages when expected spending exceeds $50 million. Applicants need conceptual approval before project planning and final approval before offering or further developing the project. Preparatory spending before applying for conceptual approval cannot exceed $10 million. During the conceptual phase, applicants can spend up to $10 million on architecture, design, and planning. Final-approval penalties do not apply solely because applicants relied on verified estimates anticipating costs above $50 million.
State health projects exempt with notice
Beginning May 13, 2025, state-owned or state-run health services and facility projects are excluded from certificate-of-need review. Projects funded wholly or substantially by a Vermont state contract or grant also qualify. The sponsoring or awarding state agency must notify the Green Mountain Care Board. Notice is due before the project starts or within 30 days after the contract or grant is signed.
Sponsors & Cosponsors
Sponsor
Rep. Mari Cordes
Affiliation unavailable
Cosponsors
Alyssa Black
Democratic • House
Angela Arsenault
Democratic • House
Brian J Cina
Democrat/Progressive • House
Daisy Berbeco
Democratic • House
Ela Chapin
Democratic • House
Rep. Francis McFaun
Affiliation unavailable
Herb Olson
Democratic • House
Rep. James Harrison
Affiliation unavailable
Kate Logan
Democrat/Progressive • House
Leslie Goldman
Democratic • House
Michael J Marcotte
Republican • House
Monique Priestley
Democratic • House
Woodman H Page
Republican • House
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
House message: Governor approved bill on May 13, 2025
5/14/2025HouseSigned by Governor on May 13, 2025
5/13/2025HouseDelivered to Governor on May 7, 2025
5/7/2025HouseHouse message: House concurred in Senate proposal of amendment
5/6/2025HouseSenate proposal of amendment concurred in
5/2/2025HouseAction Calendar: Senate Proposal of Amendment
5/2/2025HouseNotice Calendar: Senate Proposal of Amendment
5/1/2025HouseSenate Message: Passed in concurrence with proposal of amendment
4/30/2025SenateRead 3rd time & passed in concurrence with proposal of amendment
4/29/2025SenateNew Business/Third Reading
4/29/2025Senate3rd reading ordered
4/25/2025SenateProposal of amendment by Committee on Health and Welfare agreed to
4/25/2025SenateReported favorably by Senator Gulick for Committee on Finance
4/25/2025SenateRead 2nd time, reported favorably with proposal of amendment by Senator Douglass for Committee on Health and Welfare
4/25/2025SenateFavorable report by Committee on Finance
4/25/2025SenateNew Business/Second Reading
4/25/2025SenateFavorable report with proposal of amendment by Committee on Health and Welfare
4/25/2025SenateFavorable report by Committee on Finance
4/24/2025SenateFavorable report with proposal of amendment by Committee on Health and Welfare
4/24/2025SenateSecond Reading
4/24/2025SenateEntered on Notice Calendar
4/24/2025SenateReferred to Committee on Finance per Senate Rule 31
4/9/2025SenateFavorable report with proposal of amendment by Committee on Health and Welfare
4/9/2025SenateSecond Reading
4/9/2025SenateEntered on Notice Calendar
4/9/2025Senate
Bill Text
As Enacted (ACT 15)Opens in a new window
5/20/2025
As Passed by Both Chambers
5/5/2025
As Passed by Both Chambers (Unofficial)
5/5/2025
Senate Proposal of Amendment
5/1/2025
Senate Proposal of Amendment (Unofficial)
5/1/2025
As Passed by the House
3/19/2025
As Passed by the House (Unofficial)
3/19/2025
As Introduced
1/27/2025
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