Legislative Wrap-Up: The 2025 Session’s Impact on Home Health and Hospice

Legislative Wrap-Up: The 2025 Session’s Impact on Home Health and Hospice

Following the end of the 2025 legislative session, we are releasing our final report on budgetary and policy developments affecting home health and hospice care. In addition to a challenging fiscal environment that shaped the state fiscal year 2026 (SFY26) budget, issues like housing and education reform, in addition to rising health care costs, dominated much of the session.

State Fiscal Year 2026 Budget

The Legislature passed a $9.1 billion budget (Act 27/H.493) that includes several provisions relevant to home health and hospice agencies:

• $6.78 million for rate increases for long-term care rates, specifically for home-based Choices for Care delivered by home health and hospice agencies, and enhanced residential care.

• $12.14 million for a 2% increase to other community-based providers, and designated and specialized services agencies.

• $10 million in provider stabilization grants from the Department of Vermont Health Access (DVHA), with a report due in December on financial impacts and sustainability.

The budget also includes $500,000 in licensed nursing assistant (LNA) recruitment and retention incentives for skilled nursing facilities.

Medicaid Home and Community-Based Services Rates

Act 14 (H.13) directs the Agency of Human Services (AHS) to develop a framework and schedule for calculating “reasonable and adequate” Medicaid rates for home and community-based services.

The service providers impacted include home health and hospice agencies, adult day centers, residential care and assisted living providers participating in the Assistive Community Care Services/Enhanced Residential Care programs, and designated and specialized services agencies.

While the law doesn’t guarantee rate increases, it lays crucial groundwork by requiring AHS to report the funding necessary to meet care delivery costs. VNAs of Vermont, alongside partner organizations, advocated for this important bill, which will improve the quality and consistency of data and information that legislators receive as they are considering rates in the state budget process.

Health Care Infrastructure: CON Thresholds

Act 15 (H.96) increases the spending thresholds that trigger a Certificate of Need (CON) review. Beginning July 1, 2025, only projects exceeding the following thresholds will require a CON.

• $10,000,000 for the construction, development, purchase, renovation or establishment of a health care facility or any capital expenditure by a health care facility. A separate existing statutory provision still requires a CON for all new home health and hospice agencies, regardless of this threshold.
• $5,000,000 for the purchase or lease of diagnostic and therapeutic equipment.
• $3,000,000 for health care service or technology annual operating expenses.
• $50,000,000 the expenditure must first receive a conceptual development phase CON.

Other bills, S.10 and S.20, were introduced on this issue, but H.96 became the vehicle for final legislation.

Health Care Reform

Lawmakers also passed S.126, a broad health care reform bill. S.126 was signed by the Governor on June 12. The bill mandates the development of a statewide health care delivery plan focused on an integrated, coordinated care system with increased investment in primary, home, and long-term care services as well as strategies to recruit and retain health care workforce.

The legislation also requires implementation of reference-based pricing for hospitals not later than 2027, as well as a phased shift to global hospital budgets starting with non-critical access hospitals in fiscal year 2028 and expanding statewide by 2030. Grant funds are allocated for hospital transformation initiatives that reduce costs and improve access, including telehealth services. Additionally, it directs the Agency of Human Services to provide progress reports on preserving some elements of OneCare VT.

Workforce

Lawmakers approved a bill, S.53, signed into law by the Governor, to create a certification process for doulas. It allows doulas to voluntarily become certified through the Secretary of State’s Office of Professional Regulation and requires the Department of Vermont Health Access (DVHA) to seek a state plan amendment to allow Medicaid reimbursement for doula services by July 1, 2026.

Lawmakers passed the annual Office of Professional Regulation (OPR) bill, H.472, which has been approved by the Governor. The legislation updates licensing and renewal fees for several professions, strengthens enforcement against unlicensed practice, and introduces a pre-application process to help applicants assess whether their criminal history may affect licensure, improve transparency, and reduce unnecessary application costs.

A key healthcare workforce provision supports Licensed Nursing Assistants (LNAs) by allowing those with licenses expired for less than 5 years to renew by retaking and passing competency examinations approved by the Department of Disabilities, Aging, and Independent Living (DAIL). If unsuccessful, they must complete a nursing assistant education program again before retesting.

Looking Ahead

Bills that didn’t pass this session could still be taken up during the 2026 session next year. This includes the data privacy bills (S.71, H.208). S.71 was passed by the Senate, after receiving a strike-all amendment, replacing its text with S.93 – a data privacy bill that was found to be more palatable by the coalition of health care associations of which VNAs of Vermont is a member. Notably, the most current version of the bill includes an entity-level exemption for Health Insurance Portability and Accountability Act (HIPAA) covered entities, as well as an exemption for nonprofits.

H.71, a bill targeted at private equity in health care management and ownership, did not move forward this session, but we could see a return of the bill in the 2026 session. Numerous existing health care provider associations raised concerns that the bill could overlap with existing regulatory requirements and could have unintended consequences for existing providers and facilities.

S.33, a bill aimed at establishing a two-year pilot for one or more community nurse programs serving aging Vermonters, was reviewed by Senate Health and Welfare, where the Chair made it clear that that the committee would not have time to work on the bill in the 2025 session. Members of the committee also raised that there could be duplication of work from existing providers, such as nursing-led home health care from home health and hospice agencies (HHAs) and expressed concern about funding new untested programs when there are existing programs from long-time Vermont providers in need of investment. A companion bill, H.140, was introduced in the House, but also was not taken up.

As always, VNAs of Vermont will continue to advocate for funding and regulatory improvements that support the sustainability and growth of home health and hospice services. We’ll keep members updated as the Legislature reconvenes in the fall to respond to federal funding shifts.