VT S0055

Green Mountain Care Board must develop a plan for implementing reference-based pricing for inpatient and outpatient hospital services across all health insurance plans and payer types permitted under federal law

Plan must include initial benchmark rates expressed as a percentage of Medicare rates, methodology for future adjustments, and estimated potential savings

Plan must address protections against balance billing, methods to ensure quality and access to care, and strategies for measuring and mitigating adverse impacts on hospitals

Board must submit the implementation plan to the House Committee on Health Care and Senate Committees on Health and Welfare and Finance by February 1, 2026

Report must include a recommendation on whether reference-based pricing should expand to nonhospital services and a proposed timeline if expansion is recommended