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Vermont law requires reference‑based hospital prices and broader transformation as board, AHS take lead
Summary
Legislation (Act 68) directs the Green Mountain Care Board and Agency of Human Services to set reference‑based prices and consider global hospital budgets, with implementation milestones (start by hospital FY2027) and new reporting and contracting transparency aimed at lowering premiums and improving access.
Jennifer Carvey of the Office of Legislative Council told the Senate Health & Welfare Committee that Act 68 — the state's recent health‑care payment and delivery reform law — requires the Green Mountain Care Board (GMCB) to establish reference‑based prices that represent the maximum amounts Vermont hospitals may accept as payment in full.
"A reference based price is a price, that is literally linked to a particular reference," Carvey said, explaining the reference is usually a Medicare rate or another benchmark and can be expressed as a percentage of Medicare (for example, 125% or 300% of the Medicare rate). The law directs GMCB to start work "as soon as practicable, but not later than hospital fiscal year 2027," she said.
Carvey said the purpose of reference‑based pricing is to increase transparency and create a consistent benchmark that GMCB can use when reviewing hospital budgets and insurer…
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