Committee hears details, concerns as bill would expand Green Mountain Care Board authority on pricing and hospital budgets

The Senate Health & Welfare Committee took an extended briefing on March 12 from Green Mountain Care Board officials and legal counsel about draft bill language that would require reference‑based pricing, phase in hospital global budgets, and expand hospital reporting and board review duties.

Michael Barber, general counsel for the Green Mountain Care Board, told the committee that the board is “generally supportive” of provisions on reference‑based pricing and global budgets but urged changes to timing language that currently names fiscal year dates the agency cannot meet. Barber recommended replacing specific dates with flexible language such as “as soon as practicable” and said the board might need authority to phase implementation by selecting one or more hospitals to begin the program.

Board staff and counsel flagged several drafting and operational issues. They said statutory language should clearly define which payers are subject to reference‑based pricing (Barber noted the likely focus on commercial, fully insured plans and cautioned about ERISA implications for self‑funded employers). Staff recommended aligning any phased global‑budget rollout with the state’s existing federal agreement targets (referred to in testimony as the AHEAD model agreement) and noted the bill’s FY2028/FY2030 phased targets (testimony: establishing budgets for not fewer than five Vermont hospitals by FY28 and for all hospitals by FY30).

On data and reporting, deputy director Matt Sutter described the board’s challenge analyzing hospital expenses because “other operating expenses” — items such as supplies and pharmaceuticals — account for roughly a third of a hospital’s total expenses but are reported inconsistently across hospitals. Sutter said the board does not require a single chart of accounts but asked for authority to map hospitals’ existing account structures into the board’s reporting system (Adaptive) and requested clarity on the “lowest level of expenses” needed for consistent, system‑wide analysis.

The board’s finance and legal teams said they already collect many of the metrics the bill would put in statute, including executive and clinical leadership compensation metrics, counts of employees whose duties are administrative versus those delivering direct health care, and peer‑group staffing metrics. Staff urged care in duplicating or scattering reporting requirements across multiple statutory sections (the testimony cited overlapping provisions in "18 BSA 09/1954," "9454A" and "9456" as examples) and offered to work with legislative counsel to consolidate reporting language.

Barber also recommended limiting or removing a provision that would require the board to demonstrate that an authorized decrease in hospital services resulted in lower health‑insurance premiums. He called that comparison analytically difficult because many factors affect premiums, although senators and staff discussed potential measurable effects the bill could require hospitals to report when proposing service changes.

Staff asked for more time and written comments to resolve details before the committee moves the bill. Multiple board officials said they would submit targeted written testimony and mapping recommendations for hospital account reporting in Adaptive before the bill’s crossover deadline.

Ending: Committee members said they appreciate the board’s engagement and urged prompt written comments. Board staff agreed to return with formal written testimony and technical recommendations on timing, definitions of payers and required reporting formats to help the committee finalize bill language before crossover.