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House text would let Green Mountain Care Board set hospital payment maxima under reference‑based pricing
Summary
The House amendment to S.126 shifts focus from insurer payment rates to what hospitals may accept as payment in full, expands board authority for non‑hospital settings in some cases, and explicitly excepts Medicare and Medicaid from the board's pricing authority.
Conference committee members reviewed the House amendment to the S.126 reference‑based pricing provisions and discussed how the mechanics would work if enacted.
Under the House text shown by legislative counsel, the Green Mountain Care Board would establish reference‑based prices that represent the maximum amounts hospitals shall accept as payment in full for services delivered in Vermont. The House language moves away from focusing on what insurers pay and instead focuses on what hospitals may accept.
Committee members discussed several implementation details: the bill would allow the board to implement reference‑based pricing outside hospitals for certain services (for example, primary care) and to set minimum payment amounts for non‑hospital providers if doing so would prioritize access. The House also broadened the board’s consultation requirements, adding stakeholders such as the newly referenced Comprehensive Primary Health Care Steering Committee.
The House language retains a role for Medicare benchmarks in some instances but clarifies that the board’s authority to establish reference‑based prices does not include setting prices for Medicare or Medicaid—both remain outside state pricing authority. The board would also review reference‑based prices for each hospital annually as part of its hospital budget review and would have flexibility about site‑neutral pricing where appropriate to local circumstances.
Committee members flagged policy tradeoffs: setting maximum amounts hospitals may accept could make it harder to raise reimbursement rates for certain community providers, so the House text contemplates using minimums or other tools outside hospitals. Witnesses told the committee that different states and stakeholders use varied definitions and indexes when implementing reference‑based pricing, so the GMCB would be authorized to use other payment or pricing systems where appropriate.
No formal vote occurred; members asked staff to produce clarifying language and examples to guide subsequent negotiation.
