Vermont

Vermont

Vermont requires CONs within five broad categories—hospital beds, beds outside hospitals, equipment, facilities and services. The definitions of “services” and “equipment” are extremely broad in Vermont, where the program instead relies heavily on expenditures. For example, Vermont does not define individual services that require a CON in its statute or regulations. Instead, any activity or function related to “care, treatment or diagnosis of patients” costing more than $500,000 requires a CON. Vt. Stat. tit. 18, §§ 9432(10), 9434(a)(5). Vermont further maintains a statewide moratorium preventing any new home health agencies from opening through 2025. 2019 Vt. Act. § Resolves No. 5. Sec. 2.

COVID-19 Response

On March 13, 2020, Governor Scott declared a state of emergency in response to COVID-19. Exec. Order 01-20 (Mar. 13, 2020). The Legislature then passed a bill to grant state agencies emergency powers. See H.742 (Act 91) § 5 (signed Mar. 30, 2020). In response, the Green Mountain Care Board (Board), the agency in charge of overseeing and approving the CON program, issued a temporary waiver of CON requirements for certain COVID-19 related projects. Board, Certificate of Need Bulletin 003 (Apr. 9, 2020). The waiver requires facilities to submit a brief notice to the Board before expanding to respond to COVID-19, unless it had already applied for a Medicare or Medicaid waiver or obtained approval to expand services from the State Survey Agency. See Certificate of Need Bulletin 003 at (a), (b). Operating an expanded facility or service after the state of emergency is terminated requires applying for a regular CON.

Application Process

In Vermont, the CON application process takes up to 120 days. Vt. Stat. tit. 18, § 9440(d)(3). Applications can be submitted at any time, and the fee for a CON application is 0.125% of project costs, not to exceed $20,000 with a minimum fee of $250. Vt. Stat. tit. 18, § 9441(a), (b). Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. See Board Rules § 4.406.

CON? Number of CONs Moratoria Temporary COVID-19 response:
Hospital Beds Yes 6 – Suspended at least some CON laws
Beds Outside Hospitals Yes 4 – Suspended at least some CON laws
Equipment Yes 2 – Suspended at least some CON laws
Facilities/ Buildings Yes 16 – Suspended at least some CON laws
Services Yes 1 1 Suspended at least some CON laws
Emergency Medical Transport No – – –

Note: these citations are accurate as of May 2020.

Vermont has a statewide moratorium preventing any new home health agencies from opening through 2025.

Vermont CONs in Detail

Category

Moratoria/Types of CONs

Vt. Stat. tit. 18

Hospital Beds

A CON is required for a “new healthcare project” which includes a “change from one licensing period to the next in the number of licensed beds of a healthcare facility[.]”

Vt. Code R. § 80.280-004;

Vt. Stat. tit. 18 § 9434(a)(2)

1.General hospital beds.

2.Mental hospital beds.

3.Chronic disease facility beds.

4.Birthing center beds.

5.Maternity hospital beds.

6.Psychiatric facility beds.

§ 9432(8)(A)

Beds Outside Hospitals

A CON is needed for a “new healthcare project” which includes a “change from one licensing period to the next in the number of licensed beds of a healthcare facility[.]”

Vt. Code R. § 80-280-004;

Vt. Stat. tit. 18 § 9434(a)(2)

1.Nursing homes.

2.Kidney disease treatment centers.

3.Mental health agencies or centers.

4.Any inpatient or ambulatory surgical, diagnostic or treatment center.

§ 9432(8)(B)

Category

Moratoria/Types of CONs

Vt. Stat. tit. 18

Equipment

1.A single unit of medical equipment or a single system of components with related functions used in a patient care environment to support patient treatment and diagnosis or to provide medical and other health services.

Board Rules § 4.104(7)

2.The purchase, lease, or other comparable arrangement of a single piece of diagnostic or therapeutic equipment that costs more than $1 million.

§ 9434(a)(4)

Facilities/Buildings

The construction, development, purchase, renovation, or other establishment of the following facilities costing more than $1.5 million requires a CON.

Vt. Stat. tit. 18 § 9434(a)(1)

1.Mental hospitals.

2.Chronic disease facilities.

3.Birthing centers.

4.Maternity hospitals.

5.Psychiatric facilities.

§ 9432(8)(A)

6.Nursing homes.

7.Health maintenance organizations.

8.Outpatient diagnostic or therapy programs.

9.Kidney disease treatment centers.

10.Mental health agencies or centers.

11.Diagnostic imaging facilities.

12.Independent diagnostic laboratories.

13.Cardiac catheterization laboratories.

14.Radiation therapy facilities.

15.Any inpatient or ambulatory surgical, diagnostic or treatment center.

§ 9432(8)(B)

16.The construction, development, purchase, renovation, or other establishment of a health care facility by a hospital exceeding $3 million.

§ 9434(b)(1)

Services

1.Moratorium on new home health services through 2025.

2019 Vt. Acts & Resolves No. 5, Sec. 2

1.Home health agencies.

§ 9432(8)(B)

2.Activities and functions of a health care facility that are directly related to care, treatment or diagnosis of patients and that cost more than $500,000.

§§ 9432(10),

9434(a)(5)

Emergency Medical Transport

No CONS in this category.

Vermont CON Exceptions

No CON Required For:

Vt. Stat. tit. 18

1.Offices of physicians, dentists or other practitioners of the healing arts.

§ 9435(a)

2.Community mental health or developmental disability center health care projects.

§ 9435(b)

3.Redesignations, designation revocations and collaborative agreements of home health agencies subject to the supervision of the Commissioner of Disabilities, Aging, and Independent Living.

§ 9435(d)

4.Routine replacements of nonmedical equipment and fixtures, including furnaces, boilers, refrigeration units, kitchen equipment, heating and cooling units, and similar items.

§ 9435(f)

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