The bill S.190 aims to implement reference-based pricing for hospital services in Vermont, establishing a framework for hospitals and health insurers to set and disclose prices for medical services. By hospital fiscal year 2027, the Green Mountain Care Board will determine maximum payment amounts that hospitals can accept, with annual reviews of these prices. New provisions require hospitals to express their rates as a percentage of Medicare or another benchmark and to provide detailed pricing information in machine-readable formats. The bill also introduces a reimbursement limit for registered carriers, capping payments to hospitals at 250% of the Medicare adjusted base rate, and prohibits hospitals from charging patients more than authorized cost-sharing amounts.

Additionally, the bill establishes a Public Employee Health Benefit Authority Study Committee to explore the creation of a state authority for managing health benefits for public-sector employees. This committee will evaluate various aspects of health benefits, including comparisons with other states and opportunities for cost reductions, and is required to produce a detailed report by February 15, 2027. Furthermore, the Green Mountain Care Board is mandated to form a working group to address the financial burden on Medicare beneficiaries regarding outpatient service costs at critical access hospitals, with recommendations due by January 15, 2027. 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