Bill > H0585

This bill proposes several health insurance reforms, including allowing limited age rating for premiums in the individual and small group markets, expanding access to association health plans (which are group plans offered by organizations like trade associations) and short-term, limited-duration health insurance (which offers temporary coverage with fewer benefits), and defining "high-dollar claims" as those exceeding $25,000 per episode of care for claims editing purposes. It also restricts the exemption from prior authorization requirements for primary care providers to only those practicing independently and not affiliated with hospitals, and begins implementing "site-neutral billing" policies, meaning certain healthcare services will be paid at a standardized rate regardless of whether they are performed in a hospital or a non-hospital setting. Additionally, the bill authorizes the state to seek a federal waiver (a Section 1332 waiver under the Affordable Care Act) to establish a reinsurance program, which helps stabilize insurance markets by covering a portion of high-cost claims. The bill also modifies governance and executive compensation reporting requirements for nonprofit hospital service corporations.

Health and Social Services

https://legislature.vermont.gov/bill/status/2026/H.585