Green Mountain Care Board outlines phased plan for reference‑based pricing as hospitals report strained finances

The Green Mountain Care Board on Jan. 8 told a legislative committee it will move to implement reference‑based pricing for hospital services in a phased way beginning in fiscal year 2027, even as many Vermont hospitals report tight cash reserves and negative operating margins.

"Our goals are to improve access, affordability and quality of health care," Emily Brown, executive director of the Green Mountain Care Board, said in opening remarks. Brown outlined the board's limited regulatory jurisdiction—hospital budgets, rate review for qualified health plans, certificate of need and ACO oversight—and described rule development and stakeholder engagement now under way to put reference‑based pricing into hospital budget guidance.

Owen Foster, chair of the board, said the board plans rulemaking this year and hopes to have guidance in place for FY27, with phased implementation to allow hospitals and insurers to adapt. Foster noted the board has used budget enforcement to reduce commercial prices in prior years, citing a roughly 8.9% reduction in one hospital system's commercial prices after enforcement.

Board leaders emphasized the financial pressures that motivate the change. Foster…