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Committee reviews wide‑ranging S190 on hospital pricing and reimbursement; vote deferred amid hospital concerns
Summary
S190 would require hospitals and insurers to express prices as percentages of Medicare or another benchmark, impose a 250%‑of‑Medicare cap on qualified‑plan reimbursements, and require reporting on outsourcing and public‑employee plan impacts; members and hospitals asked for clearer methodology and protections for rural providers, and the committee did not vote on S190 at this session.
Diana Harvey of the Office of Legislative Counsel presented S190 as a multipart bill that would change hospital pricing transparency and put limits on commercial reimbursements in certain plans while directing the Green Mountain Care Board to implement reference‑based pricing.
"This is S190, as introduced," Harvey said, and explained several sections: requiring hospitals and insurers to express contracted rates as a percentage of Medicare (or another benchmark) for machine‑readable price transparency files; a temporary limit that would cap reimbursements for hospitals in qualified health plans at 250% of a Medicare‑adjusted base rate until the Care Board adopts its reference‑based pricing rule; prohibitions on balance billing beyond authorized cost‑sharing; and expanded reporting and hospital budget review authority to implement targeted commercial reimbursement reductions.
The bill would also require the Care Board to analyze claims for state employee and teacher plans and report on the projected impact of reference‑based pricing on hospitals; and it would create a study committee to examine establishing a public‑employee health benefit authority, with a $50,000 appropriation to the treasurer's office for consultants in the draft.
Committee members and hospital representatives focused on methodology and implementation: hospitals said they do not have a single, standardized 'Medicare adjusted base rate' to use for the percentage calculations and requested interim language allowing hospitals to use their actual Medicare reimbursement amounts until the Care Board defines a standardized methodology. Members also asked for carve‑outs and an impact process so a hospital could demonstrate that the caps were causing harm to access, quality or rural sustainability.
Senators and counsel debated whether to vote at the Appropriations hearing or to defer to allow more stakeholder work and possible floor or committee amendments. Members expressed caution about moving forward without clearer rules for how the benchmark is calculated and with outstanding questions about the appropriation for the study committee.
Outcome: The committee did not take final action on S190 at this meeting; members asked counsel and staff to prepare clarifying amendments and additional information so the bill can be considered at a later meeting.
