Green Mountain Care Board attorney urges narrowing S.126 powers, flags timeline and transparency concerns

Mark Hengstler, an attorney for the Green Mountain Care Board, told the Health Care Committee on May 1 that the board supports reference‑based pricing but urged lawmakers to remove or narrow several provisions in S.126 to avoid duplication, reduce procedural ambiguity and preserve the board's existing budget authority.

Hengstler said one change he recommended was removing language in Section 3 that directs the Agency of Human Services to implement reference‑based pricing for nonhospital providers, because the Green Mountain Care Board already has rate‑setting authority for commercial market hospital and nonhospital providers. “We would recommend just removing it,” he said, arguing the deletion would reduce confusion about who has authority for commercial rate setting.

Hengstler also recommended against a provision that would require the board to exclude revenue hospitals receive for primary care, mental‑health and substance‑use services when setting hospital budgets. He said the board’s finance staff can model such exclusions, but that excluding revenue could complicate budget work and might incentivize hospitals to acquire those services. He described the recommendation as designed to avoid unintended consequences rather than to block efforts to expand community‑based services.

A third major recommendation concerns language in Section 6 that would let the board investigate a hospital network and “take appropriate action” to correct network structure or…