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Committee advances reference-based pricing bill after edits, asks for data analyses and clarifications
Summary
The committee voted to report S190 (reference-based pricing) after restructuring language on price disclosures, requesting analyses of Medicare benchmarking methodology and a report on impacts to state employee plans; members removed duplicative language they said was covered by existing budget guidance.
The Senate Health & Welfare Committee voted to advance S190, a reference-based pricing and price-transparency measure, after the sponsor reorganized disclosure language and the committee agreed to several edits and reporting requirements.
The sponsor explained she moved provisions so hospitals would present charges as a percentage of Medicare rates in both provider contracts and public charge lists, but left the substantive public-disclosure requirement unchanged. "A hospital may express rates as a percentage of Medicare based on the actual reimbursement amounts the hospital receives from Medicare for items provided and services delivered to Medicare beneficiaries until such time as the Green Mountain Care Board adopts a rule establishing the methodology," the sponsor explained.
Committee members asked for operational clarity. Devon Green of Buzz explained that "it's basically like it can just be an Excel spreadsheet" when describing machine-readable files for public disclosure. Several senators raised concerns that using hospitals' Medicare reimbursement as the benchmark may be difficult for critical-access hospitals that do not bill under PPS, and that insurers will have some responsibility for plan-based calculations.
The committee also added a new reporting provision directing the Green Mountain Care Board, in consultation with Financial Regulation, Human Resources and VHI, to analyze commercial claims for state employee plans and report by Jan. 15, 2027, on opportunities and projected impacts of reference-based pricing for state employee and teacher plans. The sponsor said she reduced a study appropriation from $200,000 to $50,000 to reflect the short-term nature of the study.
Members agreed to remove subsection E, which would have explicitly constrained hospitals from raising other commercial charges to offset reduced revenue; the parties said existing budget guidance effectively addresses that concern and returning the duplication would be unnecessary.
A motion to move S190 (draft 3.2) favorably to the full Senate passed on a recorded roll call. Committee members noted the bill will likely have further conversations in appropriations and with insurers about premium impacts.
