Senate Health & Welfare reviews draft bill on reference-based pricing, global hospital budgets, data sharing and oversight

The Senate Health & Welfare committee on March 14 reviewed draft request 250907 (draft 2.1), a committee bill that would overhaul aspects of Vermont's health care payment and delivery system, including implementing reference-based pricing for hospitals, establishing global hospital budgets, expanding hospital reporting and data sharing requirements, and creating an advisory structure and funding to develop a statewide health care delivery plan.

The draft's stated goals, as presented by Jen Carvey of the Office of Legislative Counsel, include improving health outcomes and access, creating an integrated system of care with stronger primary and long-term services, stabilizing providers and reducing commercial insurance premiums through total cost-of-care approaches, and increasing health insurance coverage. Carvey said the draft still carries a draft request number because it has not been formally introduced.

The bill would require the Green Mountain Care Board to establish reference-based prices for Vermont hospitals "as soon as practicable, but not later than 2027," with initial prices tied to a percentage of Medicare rates and the option to update prices later using a separate growth measure such as the Medicare Economic Index. Carvey said the draft requires the board to consider community factors such as demographics, payer mix, acuity and social risk factors when setting reference-based levels.

Carvey described draft language that would bar hospitals from balance billing patients above the reference-based amount: "the board shall implement reference based pricing in a manner that does not allow hospitals to…