[{"_1":2,"_87":-5,"_88":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},"mediaId",6240095,"mediaKeyId","3331391-57308d24182d48aeecd97cf06bd25716","parentId",3331391,"title","Committee debates H.266 language to cap hospital outpatient drug charges at 120% of ASP and preserve white-bagging ban","audioSeconds",1597,"startMs",2676000,"endMs",4273000,"viewUrl","/Search/View?dp=1&key=3331391-57308d24182d48aeecd97cf06bd25716&start=2676&end=4273","thumbnailUrl","https://assets.pipeline.soar.com/3331391-57308d24182d48aeecd97cf06bd25716/thumbnail_2676000.jpg","articleUrl","/articles/6240095/Vermont/Committee-debates-H266-language-to-cap-hospital-outpatient-drug-charges-at-120-of-ASP-and-preserve-white-bagging-ban","mediaUrl","https://secure.pipeline.soar.com/6240095-46bdd5b2c1f0d6cd32cfd50c5c71b463/orig.mp4?Expires=1771147033&Signature=RF45IUPjEflAv68PthUwiGoTsJ3sFZ8dN~XC3u-rbxg4TvA~HvPBeVEU566p-S~Ukip4Djq~zAi5yL5Z20J3nMh2J64RgeBDHQJtRLe18CScd1G6m7eMk420GpHJDB9UBqlh~YQCboRT3xVfTmNetoeNAxGlSprexDp-hPrZeaqmuoIyUU39EFCEMLQu7Tlb1rmKNvg0meITv0fJh6Tlsrz4iqME~K2OyWH23xLRC~NepMcvdZZjdjyQwd24wyKqA1Ldkp-ewr54he0VhUlUdp2mIYIOK~awEYw6KvXGMorROn-5JGLx9NHu2TFmW2RT7gzSB4Hb5z6kNcJ2lXur3g__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-05-16T03:50:30Z","article","The House Committee on Health Care on Thursday, May 15, discussed an amendment to H.266 that would limit what hospitals may bill insurers for outpatient prescription drugs administered in outpatient or office settings by capping reimbursement at 120% of the Centers for Medicare & Medicaid Services’ (CMS) average sales price (ASP) for each drug, with critical access hospitals exempted.

The amendment language under consideration would (1) cap charges for drugs that hospitals charged at more than 120% of ASP as of April 1, 2025, to a maximum of 120% of the most recent quarterly CMS ASP going forward; (2) prevent hospitals from increasing the percentage of ASP charged for drugs that were at or below 120% as of April 1; and (3) bar hospitals from balance-billing patients or increasing other hospital charges to offset reductions in drug revenue. The bill would not apply to hospitals designated as critical access hospitals.

The proposal was introduced alongside data from Blue Cross Blue Shield of Vermont. Sarah (Analyst, Blue Cross Blue Shield of Vermont) presented claims-based estimates showing wide variation in hospital markups for several expensive outpatient drugs and an estimated $46 million in annual savings to Blue Cross members if hospitals were capped at 120% of ASP. She cautioned that the data cover Blue Cross claims only, are based on a limited set of rare, high-cost drugs and that small sample sizes in some hospitals can skew averages: \"these are rare drugs that are not administered at every hospital in our system regularly,\" she said.

Sarah presented hospital-level examples for a single drug (Inflectra) from the claims window she analyzed: Southwestern charged roughly 1,600% of ASP for Inflectra in the sample period; University of Vermont Medical Center charged about 2,312% of ASP for that drug in the same window; Central Vermont Medical Center charged about 1,358% of ASP; Mount Ascutney was about 2,481%; Northwestern about 561%; and North Country about 697%. She also said approximately 70% of the $46 million estimated savings would come from the University of Vermont Medical Center, with smaller shares attributed to Rutland Regional and Central Vermont. \"So that's if I take that $46,000,000 and divide it by the hospitals ... almost 70% of that $46,000,000 would be from the University of Vermont Medical Center,\" she said.

Committee members and witnesses discussed the bill alongside a related Senate amendment on \"white bagging\" and the 340B program (referred to in the hearing as \"3 40 b\"). White bagging is a practice where a pharmacy or pharmacy benefit manager supplies a dispensed drug directly to a provider for administration rather than the provider obtaining it through the hospital’s usual supply chain; the Senate amendment included temporary changes the House committee had previously restricted. Committee members described three procedural paths: let the bill die, concur with the Senate amendment (including white-bagging language), or amend the bill and send it back to the Senate.

Several committee members favored preserving the House’s white-bagging ban and instead incorporating the ASP cap amendment as a more precise, immediate tool to reduce insurer costs without reintroducing patient-safety risks tied to white bagging. \"It's a much more precise way of dealing with the issue,\" said Mari (committee member) in support of the ASP approach and of keeping the white-bagging ban intact.

Supporters of the ASP cap framed it as a targeted emergency tool to reduce drug-driven outpatient costs and preserve insurer and system solvency. \"I feel like it's really irresponsible not to do it, not to really rein in those drug [price] drivers because the system has to find many millions of dollars in order to stay solvent,\" said Wesley (committee member).

Some members asked for technical clarifications: how the cap would be implemented across payers, effective dates to ensure a reduction in premiums in 2026, and whether hospitals might offset drug-revenue losses by raising other charges (the draft language expressly prohibits such offsets).

The amendment language that staff drafted and posted to the committee record placed the cap in Title 18 (general health care administration), referenced CMS quarterly ASP updates as the price basis, and specified that the provision would remain in effect unless the Green Mountain Care Board established a different reference-based price under the board authority cited as section 93 76 in committee discussion.

The bill as discussed would exempt critical access hospitals from the cap; committee staff said that exemption was intentional to avoid imposing further burdens on small, rural hospitals known to be financially vulnerable.

Committee members said the bill would move quickly if the Senate returns its version to the House calendar. They signaled support for pursuing an amendment that replaces the Senate white-bagging language with the ASP cap language, while noting staff would invite additional witnesses and data to refine implementation details before any final floor action.

No formal committee vote on final language was recorded at this hearing; members agreed the committee should continue outreach to stakeholders and refine effective dates, enforcement mechanisms and premium-translation provisions to ensure the intended insurer and premium savings flow to consumers.","mediaType","Video","parentTitle","House Healthcare - 2025-05-15 - 10:35 AM","oneSentenceSummary","The House Committee on Health Care on Thursday, May 15, discussed an amendment to H.266 that would cap hospitals’ outpatient prescription drug charges at 120% of CMS average sales price (ASP) for each drug, with critical access hospitals exempted and a prohibition on offsetting other hospital charges.","taxTitle","Health Care, HOUSE OF REPRESENTATIVES, Committees, Legislative , Vermont","taxId",30956,"location","Vermont","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6240100,"Committee reviews H.482 giving Green Mountain Care Board limited power to cut hospital rates and appoint observers",2664,50000,2714000,"/Search/View?dp=1&key=3331391-57308d24182d48aeecd97cf06bd25716&start=50&end=2714","https://assets.pipeline.soar.com/3331391-57308d24182d48aeecd97cf06bd25716/thumbnail_50000.jpg","/articles/6240100/Vermont/Committee-reviews-H482-giving-Green-Mountain-Care-Board-limited-power-to-cut-hospital-rates-and-appoint-observers","https://secure.pipeline.soar.com/6240100-46febbb7ef42a7482ffb311844df053d/orig.mp4?Expires=1771147033&Signature=ApBga4gy8Tvr-587EH18uTqwncEkB1Rni3pCEL9YVeeC--VrY9h6RtWGyd5LWDDY1U14cGbDUeuoLm9CgrGzXUofUhMDOAanUJs5kNXFXFinzAMl7fNE~bT4glITrkw3rw40Fh8~eOgHj36DgjQ00vxTC8yqZ7lBpORa~SrMX1I6VIvPPDKt0tSh-0tdXYzdoKTW3a4V4iic1aRHhhsDmvRe0brZlDnvSRXsISEm3mxpcqV9hNggdnW6sfBTnHZGFz8c3jMVw8W90-lkQTRisIMuaGHDe14MzVAmaydpwIBg4Dw6GQNSnaTI~xGWnTx5-XEd0poxK9VQxoDdH9oDQg__&Key-Pair-Id=KUT5TJCACFTXG","The House Committee on Health Care on Thursday, May 15, reviewed H.482, a bill that would let the Green Mountain Care Board order temporary reductions in a Vermont hospital’s reimbursement rates when a domestic health insurer faces an acute, immediate threat to solvency and that would allow the board to appoint an independent hospital observer in certain budget-related cases.

Committee members and outside witnesses said the measure is meant to protect insurer solvency and the wider health system while hospitals and insurers both warned of possible unintended harms. \"This is 4 82. As I said, showing markup from the Senate Health and Welfare Amendment,\" said Jen Carvey, Office of Legislative Council, as she walked members through the bill’s language and the Senate amendment.

The bill matters because it creates two distinct tools for the Green Mountain Care Board: temporary rate reductions tied to insurer solvency and a narrow observer authority tied to hospital budget compliance. Supporters said the tools are designed to avert insurer failures that could disrupt care; critics said the powers risk destabilizing hospitals already under financial strain.

Under the version described to the committee, the board could order a reduction in reimbursement rates to one or more Vermont hospitals if, after consulting the Commissioner of Financial Regulation, it determines a domestic health insurer is at an acute, immediate risk of insolvency because of low risk-based capital. The board’s reductions must be only \"to the extent necessary to remediate the threat to the domestic health insurer solvency,\" and the bill adds a requirement that the board consider the competing financial obligations of both the hospital and the insurer when setting any reduction.

The statute sets financial-eligibility criteria for hospitals: a hospital must have at least 135 days cash on hand and have had a positive operating margin in the previous fiscal year, or be part of a hospital network meeting those metrics. The bill also requires that projected days cash on hand not be reduced below 125 days as a result of any ordered rate reduction.

Jen Carvey noted procedural protections in the language: \"notwithstanding any provision of 3 VSA chapter 25 to the contrary, the board's activities under this section shall not be construed to be a contested case. Any person aggrieved by a final board action order or determination under this section may appeal as set forth in the board's appeal statute.\" Committee members discussed how appeals would work under the board’s appeal statute, cited in the hearing as 93 81.

Members pressed on the bill’s separate observer authority, which would let the board appoint an independent observer if it finds a hospital has made a material misrepresentation or is materially noncompliant with a budget established by the board. The language describes the observer as someone \"with experience and expertise relevant to the specific circumstances\" whose duties would be limited to monitoring operations, obtaining requested information and reporting findings and recommendations to the board and the Office of the Health Care Advocate, subject to confidentiality limits.

Committee member Leslie (committee member) asked for plain-language definitions of \"material misrepresentation\" and \"material noncompliance.\" Jen Carvey and other committee speakers said the bill does not define a numeric threshold but that materiality generally means an error or omission of substance rather than a de minimis error. \"Material misrepresentation...has to be of some level of substance,\" Carvey said.

Hospital-sector witnesses voiced practical concerns about where the line would be drawn and who would pay for observers. \"This is why you have the budget adjustment act every year,\" said Devin Green (commenter), arguing that budgets routinely vary and that a narrow definition of \"material\" should prevent trivial budget deviations from triggering costly observers. Green said hospitals were concerned that a small miss—\"something like 1.91%\" in one example discussed—could be treated as materially noncompliant and trigger monitoring the hospital would be required to pay for.

Committee members and other witnesses pointed to real examples and enforcement history in the state. \"There has been enforcement over the years. Northwestern Medical Center was enforced in 2018,\" said Evan Green (commenter), noting that enforcement has been used before and that reductions or adjustments can have long-term financial effects for hospitals.

Witnesses also raised the possible cost of an independent observer in extreme cases: committee discussion referenced a figure tied to a UVM Health Network proposal, described in committee testimony as up to roughly $15,000,000 for a highly involved engagement, although speakers said they did not expect that scale for routine monitoring. The bill includes permissive language that the board may order the hospital to pay portions of the cost of an independent observer where the board found material misrepresentation or material noncompliance.

Several members said the authority is intended to be narrowly applied. Jen Carvey and others emphasized the statutory triggers are distinct: the insurer-solvency rate reductions and the observer appointment are separate provisions with different triggers and limits. The observer authority as drafted does not give the observer power to take over operations; the observer may monitor, request information and report.

Committee members asked about the duration of the observer authority. Committee discussion noted a sunset in the language: the observer authority would be repealed on Jan. 1, 2030, unless the legislature extends it.

No final committee vote on H.482 was recorded in the hearing. Committee members said the bill remained on the Senate calendar for second reading and could be taken up by the Senate; the committee indicated it would seek additional testimony and clarification if the bill returned for further consideration.

For now, H.482 remains under active consideration: it would expand the board’s toolkit to address insurer solvency but leaves open how the board would apply materiality standards, how costs for observers would be allocated, and how the board would balance harms to insurers against harms to hospitals and patients.

The committee said it would continue to gather information about enforcement history, costs of observers, and how appeals under the board’s appeals statute (cited in testimony as 93 81) would be handled if a hospital sought review of a board determination.","The House Committee on Health Care on Thursday, May 15, reviewed H.482, a bill that would let the Green Mountain Care Board order temporary reductions in a Vermont hospital’s reimbursement rates when a domestic health insurer faces an acute, immediate threat to solvency and that would allow the board to appoint an independent hospital observer in certain budget-related cases.","actionData","errors"]

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Committee debates H.266 language to cap hospital outpatient drug charges at 120% of ASP and preserve white-bagging ban

Committee reviews H.482 giving Green Mountain Care Board limited power to cut hospital rates and appoint observers