The bill S.190 seeks to implement reference-based pricing for healthcare services in Vermont, assigning the Green Mountain Care Board the responsibility of establishing maximum payment amounts for hospitals and minimum amounts for non-hospital healthcare professionals. The Board is required to gradually reduce hospital prices to align with national median prices by 2030, using high-quality data to monitor progress. Healthcare professionals are prohibited from charging patients or insurers beyond these reference-based amounts, with the pricing structure set to be implemented by the hospital fiscal year 2027 and subject to annual reviews. Additionally, the bill limits hospital reimbursements for certain health benefit plans and mandates reporting on outsourced clinical services to assess their impact on care quality.

The legislation also aims to improve transparency for Vermont's seniors and Medicare beneficiaries by requiring critical access hospitals to identify outpatient services with charges exceeding five times the Medicare allowed amount by September 1, 2026. Hospitals must post this information on their websites and in outpatient departments, detailing beneficiaries' financial responsibilities and potential for reduced out-of-pocket costs. The proposed disclosures must be approved by the Green Mountain Care Board before publication. Furthermore, the Board is directed to consider proposals from critical access hospitals and stakeholders regarding Medicare outpatient cost-sharing in fiscal year 2027, ensuring alignment with ongoing hospital transformation efforts and existing healthcare reform principles. The act will take effect upon passage.

Statutes affected:
As Introduced: 18-9376(e), 18-9376, 18-9482, 33-1951, 18-9373, 18-9409, 18-9381, 18-9453, 18-9411
As Passed By the Senate -- Official: 18-9376(e), 18-9376, 18-9482, 33-1951, 18-9373, 18-9409, 18-9381, 18-9453, 18-9411, 18-221
As Passed By the Senate -- Unofficial: 18-9376(e), 18-9376, 18-221, 18-9409, 18-9381, 18-9411
As Passed by Both House and Senate -- Official: 18-9376(e), 18-9376, 18-9482, 33-1951, 18-9373, 18-9409, 18-9381, 18-9453, 18-9411, 18-221
As Passed by Both House and Senate -- Unofficial: 18-9376(e), 18-9376, 18-9409, 18-9381, 18-9411