Committee considers strike‑all amendment to expand reference‑based pricing to QHPs, limit extreme rural outpatient charges and add optometry Medicaid SPA

The Health Care Committee reviewed a strike‑all amendment to the bill that would expand early reference‑based pricing to qualified health benefit plans (QHPs) and certain school‑employee health plans, direct the Green Mountain Care Board to set hospital reimbursement limits for hospital fiscal year 2027, and add protections for Medicare beneficiaries at critical access hospitals while adding Medicaid coverage language for advanced optometry procedures.

The Chair introduced the proposal as a staff‑drafted strike‑all amendment and said, "I've asked Jen to draft some legislation, which is, a strike all amendment," framing the change as an attempt to preserve the bill's strengths while replacing a hard 250% cap on payments by QHPs with a process run by the board. A staff member summarized the text for the committee: "[The bill] directs the Green Mountain Care Board to determine the amount of hospital spending that can be reduced for hospital fiscal year 2027" and to implement those reductions through limitations on commercial reimbursement rates for QHPs and the state's Beehive plans.

Why it matters: committee members said the change targets affordability in the individual and small‑group QHP markets — which members described as especially vulnerable — while seeking to avoid sudden damage to hospitals. Members estimated the policy could affect tens of thousands of…