The bill S.190, introduced by Senator Lyons, aims to enhance the regulatory framework surrounding hospitals and health insurers in Vermont, particularly in relation to the implementation of reference-based pricing by the Green Mountain Care Board. Key provisions include the establishment of maximum payment amounts that hospitals must accept for services, the requirement for hospitals and insurers to express rates as a percentage of Medicare, and the introduction of unique National Provider Identifiers for off-campus services. Additionally, the bill mandates that hospitals include outsourced service revenues in their financial reporting and ensures that reference-based pricing applies to these services, thereby promoting transparency and accountability in hospital billing practices.

Furthermore, the bill repeals the authorizing language for health care provider bargaining groups and clarifies the appeals process for decisions made by the Green Mountain Care Board. It also grants the Board the authority to conduct audits and investigations of hospitals as part of its budget review process. The bill emphasizes consumer protections by requiring hospitals to manage billing for outsourced services and ensuring that financial assistance policies apply uniformly. Lastly, it directs the Board to develop an interactive health system performance tool, contingent on receiving adequate funding, to provide consumers with accessible information on health care prices and performance metrics.

Statutes affected:
As Introduced: 18-9376(e), 18-9376, 18-9482, 33-1951, 18-9373, 18-9409, 18-9381, 18-9453, 18-9411