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Panel adjusts hospital reimbursement cap language, asks board and hospitals to reconcile estimates
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Summary
Legislative counsel outlined a replacement section for S.190 that would change the benchmark used to cap insurer hospital reimbursements and lower the cap from 250% to 225% of that benchmark; the Green Mountain Care Board and hospital officials were asked to reconcile differing cost estimates before the language is finalized.
The committee reviewed proposed replacement language for S.190 that would change the definition used to cap insurer reimbursements to hospitals and adjust the cap percentage. The draft replaces a uniform "Medicare adjusted base rate" benchmark with an "actual hospital‑specific Medicare reimbursement rate" and lowers the cap from 250% to 225% of that rate.
Emily Brown, executive director of the Green Mountain Care Board, warned that using hospital‑specific Medicare reimbursement rates would yield a higher benchmark than the board’s adjusted base rate and could alter the bill’s expected savings. The board had estimated roughly $50 million in savings under the earlier definition; Brown said the board had not completed full new estimates under the revised definition and recommended publishing a uniform adjusted base rate to reduce variability across hospitals.
Devon Green of the Vermont Association of Hospitals and Health Systems said the hospitals’ calculation on the board’s tool produced a $72.7 million impact under the revised approach, larger than the board’s $50 million figure using the previous definition. He asked for more time and collaboration to resolve the difference.
Committee members and the chair urged the board and hospital association to work with legislative counsel, and the chair said the bill includes language that could guard against catastrophic financial impacts on hospitals. The committee deferred final wording and instructed the board and hospitals to seek a reconciled approach before the bill proceeds to appropriations and the floor.
No vote was taken; legislative counsel and the Green Mountain Care Board agreed to continue technical work and publish clearer guidance on the benchmark so insurers and hospitals can consistently calculate the cap.
