Bill > S0190

This bill aims to enhance the Green Mountain Care Board's (GMCB) oversight of healthcare costs and quality by implementing new regulations for hospitals and health insurers, particularly concerning reference-based pricing and hospital outsourcing of clinical services. Reference-based pricing is a system where a set maximum amount is paid for a service, often tied to a benchmark like Medicare rates, to control costs. The bill mandates that by October 1, 2026, hospital and insurer contracts must express rates as a percentage of Medicare or another approved benchmark, and hospitals must use unique National Provider Identifiers (NPIs) for off-campus departments to improve billing accuracy. It also requires hospitals to include pricing information as a percentage of Medicare in their public charge files and establishes a default maximum percentage of Medicare that hospitals cannot exceed for payment on services unless a specific reference-based price is set by the GMCB. Furthermore, the bill brings outsourced clinical services, such as emergency medicine or anesthesiology, under the GMCB's regulatory purview, ensuring their revenue is included in hospital budget reviews and that reference-based pricing and consumer protections like network adequacy and financial assistance policies apply to these services, preventing surprise medical bills and ensuring consistent patient access to financial aid. The bill also repeals language authorizing health care provider bargaining groups, clarifies procedures for appealing GMCB decisions, grants the GMCB expanded authority to conduct investigations and audits of hospitals as part of budget reviews, and directs the GMCB to develop an interactive health system performance tool if sufficient funding is secured.

Health and Social Services

https://legislature.vermont.gov/bill/status/2026/S.190