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House Health Care reviews S.190 to set hospital prices as percentage of Medicare and create public employee study
Summary
The House Health Care Committee walked through S.190, which directs the Green Mountain Care Board to implement reference‑based pricing for hospitals (including public reporting and a 250% of Medicare cap for qualified health plans), requires NPI identifiers for off‑campus sites, and creates a study committee to examine a public employee health benefit authority.
The House Health Care Committee on April 28 reviewed S.190, a bill that would require hospitals and insurers to express certain hospital rates as a percentage of Medicare and add public reporting, while directing the Green Mountain Care Board to implement reference‑based pricing.
Legislative counsel Jen Carvey, speaking during the committee’s walkthrough, said the bill orders the Board to begin implementing reference‑based pricing for hospital services and to publish prices “shown as a percentage of Medicare rates as well as in dollars and cents disaggregated by payer and by point.” The bill also allows hospitals to use the actual Medicare reimbursement amounts they receive until the Board adopts a statewide methodology.
The measure creates a statutory definition of a “Medicare adjusted base rate” and caps reimbursements by registered carriers to hospitals at 250% of that base rate for items and services provided to enrollees in qualified health benefit plans (QHPs). Carvey told the committee the cap remains in effect unless and until the Board establishes a different reference‑based price.
S.190 would also require hospitals to obtain and use distinct national provider identifiers for off‑campus hospital departments on claims filed after Oct. 1, 2027, a provision Carvey said is intended to improve the ability to track where care is delivered.
The bill adds a hospital budget provision directing hospitals to implement any commercial reimbursement reductions ordered by the Board. Those reductions should prioritize rates exceeding 500% of the Medicare adjusted base rate and then move down through the highest rates if deeper cuts are needed.
S.190 creates a Public Employee Health Benefit Authority study committee to examine options for a state authority to administer comprehensive benefits for public sector employees. The bill directs the Board, in consultation with DFR, the Department of Human Resources, and VEHI, to analyze hospital claims for state employees and teachers and report to the Legislature on scope, timing and projected financial impacts.
Committee members pressed advisers on scope and timing. Peter Trombley of the State Treasurer’s Office said the study as drafted is broad and estimated execution costs well above the $50,000 the Senate had appropriated; he asked the committee to consider moving the report deadline and allowing optional study tasks. Carvey and other advisers said the Board will pursue rulemaking and that the statute establishes an initial framework focused on a portion of the population.
The committee did not vote. Members said they will invite the Board, insurers and hospitals for more detailed testimony, and asked for written exhibits and follow‑up analyses before considering statutory changes.
