Green Mountain Care Board

What Green Mountain Care Board does

The Green Mountain Care Board (GMCB) is an independent, five-member regulatory board established by the Vermont Legislature under Act 48 of 2011, headquartered in Montpelier, Vermont. The Board operates under the statutory authority of Title 18 V.S.A. Chapter 220 and serves as the primary state regulator of Vermont's healthcare system. Its core regulatory functions include reviewing and approving hospital budgets, regulating health insurance premium rates submitted by carriers, overseeing major capital investments through the Certificate of Need (CON) process, and certifying and monitoring Accountable Care Organizations (ACOs), most notably OneCare Vermont, under the All-Payer ACO Model.

The Board's core technology assets are two state-mandated healthcare data systems. VHCURES (Vermont Health Care Uniform Reporting and Evaluation System) is an all-payer claims database capturing medical, dental, and pharmacy claims for services paid by Vermont-based insurers, while VUHDDS (Vermont Uniform Hospital Discharge Data Set) aggregates hospital discharge data for care delivered in Vermont and to Vermont residents out of state. Data flow is governed by Rule 8.000 (submission) and Rule 9.000 (release), with the Board acting as steward and gatekeeper of this comprehensive utilization and cost dataset.

GMCB does not operate on a commercial revenue model. As a state government entity, it is funded through Vermont state appropriations and does not charge for regulatory services. The Board serves Vermont's hospitals and health systems, health insurance carriers (BCBS-VT, MVP Health), ACOs (OneCare Vermont), and ultimately Vermont residents, with its work supported by strategic coordination with the Vermont Association of Hospitals and Health Systems (VAHHS), the Vermont Department of Health, and the Agency of Administration.

Name

Green Mountain Care Board

Legal name

Green Mountain Care Board

Website

https://gmcboard.vermont.gov

Company type

Private

Founded year

2011

Operating status

Operating

Headcount range

101–250 employees

Short description

The Green Mountain Care Board is an independent Vermont state regulatory board established by Act 48 of 2011. It oversees hospital budgets, health insurance premium rates, certificates of need, and ACO performance, and stewards the VHCURES and VUHDDS all-payer healthcare databases.

Ownership category

akta.pro rank

Product category

Healthcare Regulation and Oversight

NAICS

Executive, Legislative, and Other General Government Support (921), Regulation, Licensing, and Inspection of Miscellaneous Commercial Sectors (92615)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Healthcare Licensing, Accreditation & Credentialing Boards (HLAJACAC)

Keywords

• Healthcare regulation
• Hospital budget review
• Insurance rate review
• Certificate of need
• Health data analytics

Headquarters

HQ city

Montpelier

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Others

Distribution channels1 record

Marketing channels4 records

Core offering

The Green Mountain Care Board is an independent Vermont state government regulatory board that oversees healthcare costs, access, and quality. Its core functions include reviewing and approving hospital budgets, regulating health insurance premium rates, issuing Certificates of Need for major capital investments, and certifying and monitoring Accountable Care Organizations. It also stewards two major all-payer data systems, VHCURES and VUHDDS, and evaluates statewide payment and delivery system reforms including the Vermont All-Payer ACO Model.

Product overview

Green Mountain Care Board operates as a regulatory agency providing oversight of Vermont's health care system through multiple interconnected regulatory functions. The core offerings include Hospital Budget Review (Rule 3.000), Health Insurance Rate Review (Rule 2.000), Certificate of Need oversight (Rule 4.000), and ACO Oversight (Rule 5.000). Supporting these are two major data systems: VHCURES (Vermont Health Care Uniform Reporting and Evaluation System), an all-payer claims database, and VUHDDS (Vermont Uniform Hospital Discharge Data Set), governed by Rules 8.000 and 9.000 for data submission and data release respectively. Additional regulatory functions include prescription drug transparency, hospital reference-based pricing, and All-Payer Model evaluation.

Differentiator

Problem solved

Functional benefit

Products and services

• Hospital Budget Review Annual review and approval of hospital budgets for Vermont hospitals, pursuant to Vermont statute, taking into consideration changes in health care delivery, payment methods, and amounts. Promotes population health improvement, reduction of per-capita expenditure growth, enhanced patient and professional experience, and recruitment of healthcare professionals. Regulates all 14 Vermont acute care hospitals and 8 Critical Access Hospitals.
• Health Insurance Rate Review Annual review of proposed health insurance premium rates submitted by health insurers operating in Vermont, including BCBS-VT and MVP Health, pursuant to 18 V.S.A. § 9375 and 8 V.S.A. § 4062. Also includes qualified health plan (QHP) oversight.
• Certificate of Need (CON) Regulatory review process for major capital investments by health care facilities, designed to prevent unnecessary duplication of health care facilities and services, promote cost containment, and ensure provision of high quality services.
• Accountable Care Organization (ACO) Oversight Certification and oversight of Vermont Accountable Care Organizations including budget review, monitoring of activities and performance, and enforcement mechanisms including the authority to limit, suspend, or revoke certification. OneCare Vermont is the primary ACO subject to this oversight.
• Vermont Health Care Uniform Reporting and Evaluation System (VHCURES) All-payer claims database containing information related to health care utilization, costs, and resources provided to Vermont residents, including medical, dental, and pharmacy claims for services paid by Vermont-based insurers.
• Vermont Uniform Hospital Discharge Data Set (VUHDDS) Database containing information related to health care provided to patients at health care facilities in Vermont and to Vermont residents at facilities in other states.
• Data Submission (Rule 8.000) Regulatory requirements for health insurers, providers, hospitals, and governmental agencies to submit claims and eligibility data, inpatient discharge data, outpatient procedure and service data, emergency department data, and other health care information to GMCB.
• Data Release (Rule 9.000) Processes for making data from the VHCURES and VUHDDS health care databases available to support legitimate and beneficial research and analysis, subject to certain restrictions and limitations.
• Prescription Drug Transparency Drug pricing transparency initiatives under Vermont's prescription drug affordability provisions, providing oversight of prescription drug pricing in the state.
• All-Payer ACO Model Statewide payment and delivery system reform framework, including the Vermont All-Payer Accountable Care Organization Model, which GMCB evaluates and monitors.
• Hospital Reference-Based Pricing Hospital pricing regulation under reference-based pricing frameworks, providing oversight of hospital pricing methodology in Vermont.

Quantifiable outcome

• Review and approve hospital budgets annually for Vermont hospitals
• +2 more outcomes

Segments4 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Partnerships

Seven partnerships are on record, tiered core and major.

• Vermont Association of Hospitals and Health Systems (VAHHS)coreStrategic or Co-development PartnerVAHHS represents Vermont hospitals and health systems and works with GMCB on hospital budget review processes, policy development, and healthcare reform initiatives. The organizations engage in regular dialogue on regulatory matters affecting Vermont hospitals including Critical Access Hospitals.
• BlueCross BlueShield of Vermont (BCBS-VT)coreStrategic or Co-development PartnerBCBS-VT is a major health insurer operating in Vermont whose premium rate proposals are subject to GMCB review and approval. The relationship involves regulatory rate review processes.
• MVP HealthcoreStrategic or Co-development PartnerMVP Health is a health insurer operating in Vermont whose premium rate proposals and qualified health plan designs are subject to GMCB review and approval.
• OneCare VermontcoreStrategic or Co-development PartnerOneCare Vermont is the primary ACO operating in Vermont, certified and overseen by GMCB. GMCB reviews and approves OneCare's budget and monitors its performance under the All-Payer ACO Model.
• UVM Health NetworkcoreStrategic or Co-development PartnerUVM Health Network is Vermont's largest health system. GMCB maintains a liaison team to monitor UVM Health Network's work related to healthcare affordability, access to care, and system performance.
• Vermont Department of HealthmajorImplementation/ SI/ Consulting PartnerCollaboration on healthcare data and public health initiatives. Vermont Health Information Technology (HIT) resources shared between agencies.
• Agency of Administration (AOA)majorImplementation/ SI/ Consulting PartnerAOA provides administrative support and oversight. GMCB refers to AOA resources including Vermont Spotlight for financial transparency and state budget information.

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Maryland Health Services Cost Review Commission (HSCRC): An independent Maryland state agency that sets hospital service rates and regulates hospital budgets statewide. It is the closest functional analog to GMCB, with a comparable hospital budget review mandate and similar statutory authority over rates.
• Massachusetts Health Policy Commission (HPC): An independent Massachusetts state agency that monitors healthcare spending, sets cost-growth benchmarks, and analyzes healthcare market performance. It overlaps with GMCB in statewide cost containment, transparency, and performance oversight functions.
• Oregon Health Authority: An Oregon state agency that oversees health policy, the all-payer model, ACO certification, and hospital oversight. Like GMCB, it operates an all-payer-style payment reform agenda and regulates ACOs and hospitals in its state.
• Washington State Health Care Authority: Washington's statewide health policy and purchasing agency, overseeing public option health plans, ACO-like delivery models, and healthcare cost transparency. Comparable to GMCB in combining payer-side policy with regulatory authority.
• Connecticut Office of Health Strategy (OHS): Connecticut's state health policy office with authority over cost growth benchmarks, APCD, CON, and healthcare market performance. Closely mirrors GMCB's mix of data, rate, and certificate-of-need oversight.
• Maine Health Data Organization (MHDO): Maine's state all-payer claims data steward that collects, manages, and releases healthcare utilization and cost data, similar to GMCB's VHCURES and VUHDDS stewardship function.

Broad incumbents

• New York State Department of Health: A much larger state agency that encompasses functions GMCB focuses on—rate review, hospital oversight, CON, and analytics—as part of a broader public health portfolio. Useful as an incumbent comparable for a vertically integrated state health regulator.
• California Department of Managed Health Care (DMHC): California's managed care regulator with health plan oversight and rate review authority. Overlaps with GMCB's health insurance rate review function, though DMHC's scope is broader and plan-focused rather than budget-focused.
• Centers for Medicare & Medicaid Services (CMS): Federal regulator with which GMCB partners on the All-Payer ACO Model and the broader regulatory framework governing ACOs, hospital payment, and Medicare cost-sharing issues affecting Vermont Critical Access Hospitals.

Others

• National Association of Insurance Commissioners (NAIC): Umbrella organization that supports state insurance regulators with model rules and data infrastructure. Comparable to GMCB's regulatory function in health insurance rate review only at an enabling/standards level, not direct service delivery.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat3 records

Key risks5 records

Key highlights5 records

Customer concentration

Revenue estimate

Valuation estimate

Number of profiles

Profiles3 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Green Mountain Care Board