An act relating to increasing the monetary thresholds for certificates of need
S.20 would substantially raise the dollar thresholds that trigger Vermont’s certificate of need (CON) review for health care facility projects, equipment purchases, and new services. For non-hospitals, the bill increases the capital-cost threshold for a new health care project from $1.5 million to $10 million, raises the equipment threshold from $1 million to $10 million, and raises the annual operating-expense threshold for a new service or technology from $500,000 to $10 million. For hospitals, it similarly increases the capital-cost threshold from $3 million to $10 million, the equipment threshold from $1.5 million to $10 million, and the annual operating-expense threshold from $1 million to $10 million. It also raises the threshold for conceptual development phase review from $30 million to $50 million and increases the amount that may be spent on preliminary planning before that phase review.
The bill also adds a new exclusion from the CON subchapter for health care services and facility projects that are the result of a contract awarded by the State of Vermont. The act would take effect July 1, 2025. In practical terms, the bill would narrow the number of health care projects subject to Green Mountain Care Board review and would allow more projects to proceed without a CON application, while preserving review for the largest projects and for projects that are split into components to evade the thresholds.
S.20 would amend 18 V.S.A. §§ 9434 and 9435, changing the Green Mountain Care Board’s jurisdiction over health care facility development and service expansion. By increasing the monetary thresholds, it would reduce the number of hospitals, non-hospital facilities, ambulatory surgical centers, and equipment/service acquisitions that require a certificate of need. It would also create an explicit exemption for projects and services arising from state-awarded contracts, which could affect providers working under state procurement arrangements and reduce regulatory review for those projects.
The bill’s stated purpose suggests a deregulatory or streamlining approach to health care facility development, and the text reflects an effort to reduce administrative burden and speed projects that are below the new, much higher thresholds. Because no committee transcripts or votes are provided, there is no recorded debate or roll-call history here to show support or opposition. Based on the bill text alone, the general sentiment appears favorable toward easing CON requirements and encouraging project development, while still retaining oversight for very large undertakings.
The main point of contention is likely to be whether the certificate of need thresholds should be raised so dramatically. Supporters would likely argue that the current thresholds are too low and create unnecessary delays and costs, especially for routine capital improvements, equipment purchases, and service expansions. Opponents would likely worry that reducing CON review could weaken oversight of health care market entry, spending, and facility expansion, potentially affecting cost control, access planning, and the Green Mountain Care Board’s ability to coordinate health system growth. The new exemption for state-awarded contract projects could also be controversial if it is seen as creating a broad carve-out from review.