Vermont committee hears Green Mountain Care Board on reference-based pricing and unclear global budget plans

Representatives of the Green Mountain Care Board told the Vermont House Committee on Health Care on April 17 that the board supports moving to reference-based pricing for hospitals but urged changes in the bill’s wording, more flexibility on methodology and clearer funding and timeline provisions.

The board’s testimony matters because the bill would require the board to set ‘‘reference‑based prices’’ and to begin implementing those prices by a fixed date tied to hospital fiscal year 2027, while also directing the Agency of Human Services to implement reference‑based pricing for services delivered outside hospitals and to pursue hospital global budgets.

Michael Barber, general counsel for the Green Mountain Care Board, said at the hearing that the board “just at the outset supports moving to reference based pricing,” but he warned the bill’s current language frames reference‑based pricing as a requirement on what insurers must pay rather than a cap on what hospitals may charge. He said that distinction has legal and operational implications and recommended regulating the insurer’s allowed amount rather than the amount actually paid by an insurer because patients often bear much of the allowed amount through deductibles or cost…