Bill S198 would let board cap hospital prices and bring outsourced clinical revenue under oversight

Jennifer Carvey, legislative counsel, introduced S198 and described a package of changes designed to enable implementation of reference‑based pricing for Vermont hospitals and to close loopholes from outsourced clinical services.

Carvey said the bill would require insurers and hospitals to provide standardized information and permit the Green Mountain Care Board to set ceiling rates, commonly as a percentage of Medicare reimbursement. "The Green Mountain Care Board would set as the set a percentage of Medicare," she said, explaining that the percentage can in practice be above 100% for certain items depending on hospital budgets and circumstances.

A central concern in the bill is hospital outsourcing. Counsel said revenue from outsourced clinical services (emergency medicine, anesthesiology, radiology and other contracted clinician services) is not consistently reported in the hospital budget process and can escape price controls. S198 would require revenue from outsourced services delivered in a hospital facility to be included in hospital net patient revenue and subject to the Board's rate setting and hospital budget limits. The bill also proposes consumer protections by making hospitals responsible for billing patients for outsourced services in order to reduce surprise out‑of‑network charges and to ensure hospital financial assistance policies apply.

S198 would expand the Green Mountain Care Board's regulatory and audit authority, permitting investigations, examinations, and audits and allowing the Board to recover reasonable costs from a hospital subject to such reviews. The bill also directs the Board to develop a public interactive tool showing hospital prices relative to Medicare and other health system performance metrics, updated at least quarterly; the counsel noted the tool is not a funded mandate and would depend on the Board securing federal or other funds.

Committee members asked for examples of outsourced services and raised questions about continuity of care; counsel and members noted the Board and Green Mountain Care Board hospital budget process would be central to implementation. Carvey said further testimony is expected from the Board and other stakeholders.