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Senate amends S-190 to require reference-based hospital pricing, limit QHP payments to 250% of Medicare
Summary
The Vermont Senate amended S-190 to require hospitals to express prices as percentages of Medicare, cap qualified health plan reimbursements at up to 250% of Medicare, and create a working group to study critical access hospital Medicare cost-sharing; the Legislature ordered third reading after committee amendments.
The Vermont Senate amended S-190 on reference-based pricing, directing hospitals to express publicly their prices as percentages of Medicare rates and limiting reimbursements from qualified health plans (QHPs) to up to 250% of Medicare. The amendment package, carried after committee debate, also creates a Green Mountain Care Board working group to study how Medicare beneficiary cost-sharing affects small "critical access" hospitals and to recommend mitigations.
The Health and Welfare committee's reporter told the chamber the bill "adds the 250% of Medicare for hospital payments, but only for qualified health plans," and said the change is intended to push downward on hospital charges and return savings to consumers. The reporter also said hospitals must publish disaggregated prices by plan and payer by October 2027 to increase transparency.
Committee members described additional guardrails: hospitals must first apply any commercial reimbursement rate reductions to QHP caps, and the bill directs the board to require hospitals to bring extremely high commercial charges (those above 500% of Medicare) down first. Hospitals may petition the board for targeted adjustments if reductions would harm access, quality or sustainability for particular service lines.
Lawmakers debated implementation, the size of projected savings and analytic support. The reporter cited committee testimony and prior budget orders and gave a projection of about $1,550,000,000 in potential savings tied to the policy while noting that no Joint Fiscal Office (JFO) analysis had been prepared for this bill. Another senator flagged that the changes would affect roughly 88,000 Vermonters enrolled in qualified health plans.
Supporters said the bill builds on earlier legislation (Act 167 and Act 68) and budget orders that have already produced hospital budget reductions, and that the new statutory direction will help translate savings into premium relief. Critics cautioned against unintended impacts on small rural hospitals and urged the working group and the Green Mountain Care Board to consider accessibility and financial sustainability before broad reductions are required.
The Senate voted to adopt the committee amendments, including an appropriations-related change and the Lyons amendment creating a one-year study group focused on Medicare beneficiary coinsurance impacts for critical access hospitals. The body then ordered third reading of S-190; further rulemaking and Board action will follow before most provisions take effect.
