Vermont witnesses describe Medicaid’s decade of reference-based pricing as Legislature weighs S.126

Lawmakers continued review of S.126 on Oct. 12 with testimony from Agency of Human Services officials and independent clinicians about reference-based pricing and how it is already used in Vermont Medicaid.

Alicia Cooper, director of managed care operations at the Department of Vermont Health Access, told the committee that Vermont Medicaid has benchmarked many fees to Medicare for more than a decade and uses Medicare-based schedules as an “underlying architecture” on which to build payment reforms. “We think of it as the underlying architecture, and then we can build on top of that with innovative payment models,” Cooper said.

The issue matters because S.126 would task the Green Mountain Care Board with designing reference-based pricing for commercial payers, while Vermont Medicaid already uses similar methods. Sarah Rosenblum, deputy director of health care reform at the Agency of Human Services, said she expected the bill’s commercial provisions to affect commercial insurers rather than change Medicaid’s rates. “I don't think anything would change specifically for Medicaid because we would expect that we would continue to use these reference-based pricing approaches and that we would still be…