Mr. Donofrio served as the first general counsel of the Green Mountain Care Board, an innovative regulatory body created by the Vermont Legislature to improve health care quality, access and affordability.
Regulatory Process Design
By statute, the Board assumed control of Vermont’s pre-existing health insurance rate, certificate of need, and hospital budget review processes. In each instance, Mr. Donofrio led the effort to transition each function to the Board and to tailor each to the Board’s novel statutory charge. This entailed drafting rules, engaging with stakeholders, and navigating the rule-making process. The outcome was a set of clear regulations that enabled the Board to successfully take on and implement these regulatory processes.
Delivery and Payment System Reform
The Board’s unique statutory charge empowers it not only regulate, but to innovate. Mr. Donofrio advised the Board on the scope and contours of this authority and supported the payment reform team in adopting a policy governing the Board’s review or proposed reform pilot projects. He also advised the Board during its negotiations with the Centers for Medicare & Medicaid Services that resulted in the Vermont All-Payer Accountable Care Organization Model Agreement. This unique arrangement allows Vermont to move away from fee-for-service reimbursement for health care providers by aligning Medicare, Medicaid, and private insurers through a statewide, Vermont-specific alternative payment model focused on health outcomes.