Hospital payment caps move forward

S.190 is formally titled “An act relating to the Green Mountain Care Board, reference‑based pricing, and hospital outsourcing of clinical care,” and lists Sen. Virginia “Ginny” Lyons as sponsor. (legislature.vermont.gov)) The bill directs the Green Mountain Care Board to establish maximum reference‑based prices that Vermont hospitals shall accept as payment in full no later than hospital fiscal year 2027. (legislature.vermont.gov)) The GMCB’s materials and bill rationale tie S.190 to Act 68 of 2025 and frame the measure as standardizing reference‑based pricing and oversight across Vermont hospitals. (gmcboard.vermont.gov)) Draft language in committee would bar registered carriers from reimbursing hospitals more than 225% of a hospital’s actual, hospital‑specific Medicare reimbursement rate for services delivered to enrollees in qualified health benefit plans. (legislature.vermont.gov)) Proposed amendments would require provider contracts entered on or after Oct. 1, 2026 to express rates as a percentage of Medicare (or another GMCB‑approved benchmark) and would direct hospitals to post those standardized prices for transparency. (legislature.vermont.gov)) Senate Health & Welfare issued favorable reports and the Appropriations Committee took up the bill this month; the Senate recorded a recommendation of amendment to be offered by Sen. Lyons on March 26, 2026. (trackbill.com)) A fiscal note attached to S.190 appropriates $50,000 from the General Fund to the Office of the State Treasurer to hire consultants to facilitate meetings, public hearings, and prepare a report. (legislature.vermont.gov)) Hospital systems and independent physician groups warned in testimony that broad reference‑based pricing or new oversight of outsourcing could disrupt rural staffing and services, while GMCB and reform advocates characterized the bill as a phased effort to increase benchmarking and price transparency. (citizenportal.ai))