The Vermont House Healthcare Committee convened on April 17, 2025, to discuss critical aspects of healthcare pricing regulation, particularly focusing on reference-based pricing for hospitals and other healthcare services. The meeting highlighted the complexities surrounding the authority of the Green Mountain Care Board in setting rates for hospitals and the implications of proposed legislative changes.

A significant point of discussion was the language in the bill regarding how health insurers are required to pay hospitals for services. Committee members debated whether the current framework should be adjusted to allow for more direct regulation of the amounts insurers pay, rather than solely capping hospital charges. The conversation revealed concerns about the potential legal challenges that could arise from regulating health insurers directly, particularly under the Employee Retirement Income Security Act (ERISA).

Members expressed that while the board currently has the authority to set hospital rates, the proposed bill could shift this authority in a way that complicates the relationship between insurers and hospitals. The committee discussed the possibility of maintaining the existing rate-setting authority while implementing a reference-based pricing model, which would allow hospitals to negotiate rates with insurers within a capped framework.

Additionally, the meeting addressed the scope of reference-based pricing beyond hospitals, noting that the Agency of Human Services would also be involved in regulating services delivered outside of hospital settings. This dual authority raised questions about the potential for confusion and overlap in regulatory responsibilities.

The committee concluded that further clarification and refinement of the bill's language would be necessary to ensure a clear understanding of the intended regulatory framework. Members agreed to collaborate with legislative councils to develop precise language that aligns with the goals of the proposed changes while minimizing legal risks and maintaining effective oversight of healthcare pricing in Vermont.