S 190

     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 1 of 31
 1  S.190
 2   Introduced by Senator Lyons
 3   Referred to Committee on Health and Welfare
 4   Date: January 6, 2026
 5   Subject: Health; health care reform; Green Mountain Care Board; hospitals;
 6  health insurance; reference-based pricing; provider taxes
 7   Statement of purpose of bill as introduced: This bill proposes to set certain
 8   requirements for hospitals and health insurers to meet in order to facilitate the
 9   Green Mountain Care Board’s implementation of reference-based pricing. The
10   bill would establish regulatory oversight of hospitals’ use of outsourcing
11   contracts for clinical services. The bill would repeal authorizing language for
12   health care provider bargaining groups, clarify procedures for appealing Green
13   Mountain Care Board decisions and orders, and allow the Board to conduct
14   examinations and investigations of hospitals, including audits, as part of its
15   hospital budget reviews. The bill would also direct the Green Mountain Care
16   Board to develop an interactive health system performance tool if the State
17   receives the funding necessary to support the project.
18      An act relating to the Green Mountain Care Board, reference-based pricing,
19      and hospital outsourcing of clinical care
        An act relating to the Green Mountain Care Board, reference-based pricing,
        and studying the creation of a Public Employee Health Benefit Authority
        An act relating to reference-based pricing and the Green Mountain Care
        Board
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 2 of 31
 1   It is hereby enacted by the General Assembly of the State of Vermont:
 2  * * * Reference-Based Pricing * * *
 3   Sec. 1. 18 V.S.A. § 9376(e) is amended to read:
 4      (e) Reference-based pricing.
 5  ***
 6  (3)(A) The Board shall begin implementing reference-based pricing as
 7   soon as practicable but not later than hospital fiscal year 2027 by establishing
 8   the maximum amounts that Vermont hospitals shall accept as payment in full
 9   for items provided and services delivered. After initial implementation, the
10   Board shall review the reference-based prices for each hospital annually as part
11   of the hospital budget review process set forth in chapter 221, subchapter 7 of
12   this title.
13  (B) The Board, in collaboration with the Department of Financial
14   Regulation, shall monitor the implementation of reference-based pricing to
15   ensure that any decreases in amounts paid to hospitals also result in decreases
16   in health insurance premiums. The Board shall post its findings regarding the
17   alignment between price decreases and premium decreases annually on its
18   website.
19  (C) For provider contracts entered into on or after October 1, 2026,
20   each hospital and health insurer shall express the rates for all items and
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 3 of 31
 1   services as a percentage of Medicare or of another benchmark, if another
 2   benchmark is deemed appropriate by the Green Mountain Care Board.
 3  (D)(i) Each hospital shall apply for, obtain, and use a unique
 4   National Provider Identifier (NPI) on all claims filed after October 1, 2026, for
 5   reimbursement or payment of items provided and services delivered at an off-
 6   campus department of the hospital that is distinct from the NPI used for
 7   services delivered at the main hospital campus or at any other off-campus
 8   hospital department.
 9  (ii) As used in this subdivision (D):
10  (I) “Campus” has the same meaning as in 42 C.F.R. § 413.65.
11  (II) “Off-campus” means a facility located more than 250 yards
12   from the main hospital campus.
13  (E) When making public the charges for items and services pursuant
14   to 45 C.F.R. Part 180, each hospital shall include in its machine-readable files
15   pricing information shown as a percentage of Medicare rates, as well as in
16   dollars and cents, disaggregated by payer and by plan.
17  (F) The Board shall establish a default percentage of Medicare above
18   which a hospital shall not accept payment for an item or service under any
19   newly established Current Procedural Terminology (CPT) code unless and
20   until the Board establishes a specific reference-based price for the item or
21   service pursuant to this chapter.
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 4 of 31
 1  (G) The Board shall establish a default maximum percentage of
 2   Medicare above which a hospital shall not accept payment for any individual
 3   inpatient or outpatient item or service.
 4  ***
 5  * * * Hospital Outsourcing * * *
 6   Sec. 2. HOSPITAL OUTSOURCING; FINDINGS; PURPOSE
 7      (a) The General Assembly finds that:
 8  (1) Hospitals are increasingly outsourcing their clinical services, such as
 9   emergency medicine, anesthesiology, radiology, laboratory services, and other
10   specialized care, to outside entities.
11  (2) Revenue from outsourced clinical services is not consistently
12   reported in the hospital budget process and has been excluded from the Green
13   Mountain Care Board’s regulatory oversight.
14  (3) Outsourced revenue may circumvent hospital revenue caps and
15   spending limitations, undermining budget transparency and accountability.
16  (4) Without oversight, outsourced services may operate outside price
17   controls, including reference-based pricing, which contributes to cost inflation
18   and market inefficiencies.
19  (5) Patients may face network adequacy issues, surprise medical bills,
20   and inconsistent access to financial assistance when receiving care from
21   outsourced providers.
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 5 of 31
 1      (b) The purposes of 18 V.S.A. § 9415, as enacted in Sec. 3 of this act, are:
 2  (1) to bring all hospital-affiliated revenue within the Green Mountain
 3   Care Board’s regulatory purview, thus closing gaps in spending accountability;
 4  (2) to ensure that reference-based pricing applies to outsourced services,
 5   thus preventing cost inflation and creating transparent rate structures that apply
 6   across all hospital services; and
 7  (3) to apply network adequacy requirements and billing protections to
 8   shield patients from surprise medical bills and ensure consistent access to
 9   legally required financial assistance policies.
10   Sec. 3. 18 V.S.A. § 9415 is added to read:
11   § 9415. HOSPITAL OUTSOURCING OF CLINICAL CARE
12      (a) Definitions. As used in this section, “outsourcing” means an
13   arrangement in which a hospital contracts with an external entity that assumes
14   sole control of direct clinical care offered within the hospital facility.
15   “Outsourced services” may include emergency medicine, anesthesiology,
16   hospitalist services, and other direct patient care services provided on-site at
17   the hospital by a contracted entity. “Outsourced services” do not include
18   services provided by a nurse on a short-term contract with a hospital in which
19   the hospital retains oversight and control over patient care; off-site diagnostic
20   services, including off-site diagnostic interpretation of radiologic images and
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 6 of 31
 1   off-site laboratory testing; or nonclinical services such as laundry services,
 2   nutrition services, information technology, or cybersecurity.
 3      (b) Regulatory oversight and accountability.
 4  (1) Revenue from outsourced services shall be included in a hospital’s
 5   net patient revenue limits, commercial rate limits, operating expense limits,
 6   and other limitations as specified by the Green Mountain Care Board in its
 7   annual hospital budget guidance.
 8  (2) The Green Mountain Care Board’s rate-setting authority, including
 9   reference-based pricing established pursuant to section 9376 of this title and
10   global hospital budgets developed pursuant to section 9456 of this title, shall
11   apply to outsourced services.
12  (3) Revenue generated by outsourced services delivered in a hospital-
13   owned facility shall be deemed to be part of the net patient revenue of the
14   hospital for purposes of the annual assessment on hospitals pursuant to
15   33 V.S.A. § 1953 and other applicable State assessments.
16      (c) Consumer protections.
17  (1) In order to ensure continuity of coverage and prevent surprise
18   medical bills, a hospital shall be responsible for billing the health insurance
19   claims for all outsourced services delivered to a patient at the hospital by a
20   contracted provider who would otherwise be out-of-network under the
21   patient’s health insurance plan.
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 7 of 31
 1  (2) A hospital contracting for outsourced services shall minimize billing
 2   complexity for patients and shall coordinate billing processes with outsourced
 3   service providers to the greatest extent possible.
 4  (3) Hospital financial assistance policies developed in accordance with
 5   subchapter 10 of this chapter and any other policies regarding bad debt or
 6   charity care shall apply to outsourced services to ensure that patients receive
 7   consistent financial protections regardless of service delivery model.
 8   Sec. 4. 18 V.S.A. § 9482 is amended to read:
 9   § 9482. FINANCIAL ASSISTANCE POLICIES FOR LARGE HEALTH
10  CARE FACILITIES
11      (a) Each large health care facility in this State shall develop a written
12   financial assistance policy that, at a minimum, complies with the provisions of
13   this subchapter and any applicable federal requirements.
14      (b) The financial assistance policy shall:
15  (1) apply, at a minimum, to all emergency and other medically
16   necessary health care services that the large health care facility offers,
17   including outsourced services, as defined in section 9415 of this title, that are
18   delivered at the facility;
19  ***
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 8 of 31
 1   Sec. 5. 33 V.S.A. § 1951 is amended to read:
 2   § 1951. DEFINITIONS
 3      As used in this subchapter:
 4  ***
 5  (10) “Net patient revenues” means a provider’s gross charges related to
 6   patient care services less any deductions for bad debts, charity care, contractual
 7   allowances, and other payer discounts, and includes outsourced services, as
 8   defined in 18 V.S.A. § 9415, that are delivered at the hospital.
 9  ***
10  * * * Repeal of Health Care Professional Bargaining Group
11  Authorizing Language * * *
12   Sec. 6. 18 V.S.A. § 9373 is amended to read:
13   § 9373. DEFINITIONS
14      As used in this chapter:
15  ***
16  (12) “Payment reform” means modifying the method of payment from a
17   fee-for-service basis to one or more alternative methods for compensating
18   health care professionals, health care provider bargaining groups created
19   pursuant to section 9409 of this title, integrated delivery systems, and other
20   health care professional arrangements, manufacturers of prescribed products,
21   medical supply companies, and other companies providing health services or
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 9 of 31
 1   health supplies for the provision of high-quality and efficient health services,
 2   products, and supplies while measuring quality and efficiency. The term may
 3   include shared savings agreements, bundled payments, episode-based
 4   payments, and global payments.
 5  ***
 6   Sec. 7. 18 V.S.A. § 9376 is amended to read:
 7   § 9376. PAYMENT AMOUNTS; METHODS
 8  ***
 9      (b) Rate-setting.
10  (1) The Board shall set reasonable rates for health care professionals,
11   health care provider bargaining groups created pursuant to section 9409 of this
12   title, manufacturers of prescribed products, medical supply companies, and
13   other companies providing health services or health supplies based on
14   methodologies pursuant to section 9375 of this title, in order to have a
15   consistent reimbursement amount accepted by these persons. In its discretion,
16   the Board may implement rate-setting for different groups of health care
17   professionals over time and need not set rates for all types of health care
18   professionals. In establishing rates, the Board may consider legitimate
19   differences in costs among health care professionals, such as the cost of
20   providing a specific necessary service or services that may not be available
21   elsewhere in the State, and the need for health care professionals in particular
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 10 of 31
 1   areas of the State, particularly in underserved geographic or practice shortage
 2   areas.
 3  ***
 4      (d) Supervision. To the extent required to avoid federal antitrust violations
 5   and in furtherance of the policy identified in subsection (a) of this section, the
 6   Board shall facilitate and supervise the participation of health care
 7   professionals and health care provider bargaining groups in the process
 8   described in subsection (b) of this section.
 9  ***
10   Sec. 8. REPEAL
11      18 V.S.A. § 9409 (health care provider bargaining groups) is repealed.
12  * * * Appeals of Green Mountain Care Board Orders * * *
13   Sec. 9. 18 V.S.A. § 9381 is amended to read:
14   § 9381. APPEALS
15      (a) The Green Mountain Care Board shall adopt procedures for
16   administrative appeals of its actions, orders, or other determinations. Such
17   procedures shall that provide for the issuance of a final order and for the
18   creation of a record sufficient to serve as the basis for judicial review of the
19   Board’s final actions, orders, and other determinations pursuant to subsection
20   (b) of this section.
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 11 of 31
 1      (b) Any person aggrieved by a final action, order, or other determination of
 2   the Green Mountain Care Board may, upon exhaustion of all administrative
 3   appeals available pursuant to subsection (a) of this section, appeal to the
 4   Supreme Court pursuant to the Vermont Rules of Appellate Procedure.
 5  ***
 6  * * * Hospital Audits * * *
 7   Sec. 10. 18 V.S.A. § 9453 is amended to read:
 8   § 9453. POWERS AND DUTIES
 9      (a) The Board shall:
10  (1) adopt uniform formats that hospitals shall use to report financial,
11   scope-of-services, and utilization data and information;
12  (2) designate a data organization with which hospitals shall file
13   financial, scope-of-services, and utilization data and information; and
14  (3) designate a data organization or organizations to process, analyze,
15   store, or retrieve data or information.
16      (b) The Chair of the Board may:
17  (1) conduct investigations and examinations, including audits, of
18   hospitals that are reasonably necessary or helpful to the Board’s administration
19   of this subchapter or any rules adopted or orders issued pursuant to this
20   subchapter;
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 12 of 31
 1  (2) retain experts or other persons to assist in any investigation or
 2   examination conducted pursuant to subdivision (1) of this subsection; and
 3  (3) require a hospital subject to an investigation or examination
 4   conducted pursuant to this subsection to pay the reasonable costs and expenses
 5   of the investigation or examination.
 6      (c) To effectuate the purposes of this subchapter, the Board may adopt rules
 7   under 3 V.S.A. chapter 25.
 8  * * * Data Infrastructure * * *
 9   Sec. 11. 18 V.S.A. § 9411 is amended to read:
10   § 9411. INTERACTIVE PRICE TRANSPARENCY DASHBOARD AND
11  HEALTH SYSTEM PERFORMANCE TOOL
12      (a)(1) The Green Mountain Care Board shall develop and maintain a
13   public, interactive, Internet-based internet-based price transparency dashboard
14   that allows consumers to compare health care prices for certain health care
15   services across the State. Using data from the Vermont Healthcare Claims
16   Uniform Reporting and Evaluation System (VHCURES) established pursuant
17   to section 9410 of this title, the dashboard shall provide the range of actual
18   allowed amounts for selected health care services, showing both the amount
19   paid by the health insurer or other payer and the amount of the member’s
20   responsibility, and shall allow the consumer to sort the information by
21   geographic location, by health care provider, by payer type, and by the specific
     BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
     2026  Page 13 of 31
 1   health care procedure or health care service. The Board shall provide a link on
 2   the dashboard to the statewide comparative hospital quality report published
 3   by the Commissioner of Health pursuant to section 9405b of this title.
 4      (b)(2) The Board shall update the information in the interactive price
 5   transparency dashboard at least annually.
 6      (b)(1) The Board shall develop and maintain a public, interactive tool that
 7   displays information on health system performance, including hospital prices
 8   relative to Medicare rates, both as a percentage of Medicare and in dollars and
 9   cents. The tool shall enable the user to sort the information by service line and
10   by payer.
11  (2) The Board shall update the information in the health system
12   performance tool at least quarterly.
13   Sec. 12. IMPLEMENTATION OF HEALTH SYSTEM PERFORMANCE
14  TOOL
15      The Green Mountain Care Board shall develop the health system
16   performance tool described in 18 V.S.A. § 9411(b), as added by Sec. 11 of this
17   act, only if the Board receives sufficient funding from the federal government
18   or another source for this purpose.
19  * * * Effective Date * * *
20   Sec. 13. EFFECTIVE DATE
21      This act shall take effect on passage.
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 14 of 31
                     * * * Reference-Based Pricing * * *
Sec. 1. 18 V.S.A. § 9376(e) is amended to read:
   (e) Reference-based pricing.
                                     ***
       (3)(A) The Board shall begin implementing reference-based pricing as
soon as practicable but not later than hospital fiscal year 2027 by establishing
the maximum amounts that Vermont hospitals shall accept as payment in full
for items provided and services delivered. After initial implementation, the
Board shall review the reference-based prices for each hospital annually as
part of the hospital budget review process set forth in chapter 221, subchapter
7 of this title.
         (B) The Board, in collaboration with the Department of Financial
Regulation, shall monitor the implementation of reference-based pricing to
ensure that any decreases in amounts paid to hospitals also result in decreases
in health insurance premiums. The Board shall post its findings regarding the
alignment between price decreases and premium decreases annually on its
website.
         (C)(i) For provider contracts entered into, amended, or renewed on
or after October 1, 2026, each hospital and health insurer shall begin
expressing as a percentage of Medicare or of another benchmark, if another
benchmark is deemed appropriate by the Green Mountain Care Board, the
rates for items and services identified pursuant to a collaborative process
between the Board and representatives of Vermont hospitals.
            (ii) When making public the charges for items and services
pursuant to 45 C.F.R. Part 180, each hospital shall include in its machine-
readable files pricing information shown as a percentage of Medicare rates, as
well as in dollars and cents, disaggregated by payer and by plan.
            (iii) For purposes of subdivisions (i) and (ii) of this subdivision
(3)(C), 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
for determining Medicare rates for use as a benchmark in establishing
reference-based prices pursuant to this subsection (e).
         (D)(i) Each hospital shall apply for, obtain, and use a unique
National Provider Identifier (NPI) on all claims filed after October 1, 2027,
for reimbursement or payment of items provided and services delivered at an
off-campus department of the hospital that is distinct from the NPI used for
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 15 of 31
services delivered at the main hospital campus or at any other off-campus
hospital department.
            (ii) As used in this subdivision (D):
               (I) “Campus” has the same meaning as in 42 C.F.R. § 413.65.
               (II) “Off-campus” means a facility located more than 250
yards from the main hospital campus.
                                     ***
Sec. 2. 33 V.S.A. § 1815 is added to read:
§ 1815. LIMITATIONS ON HOSPITAL REIMBURSEMENTS
   (a)(1) As used in this section, “Medicare adjusted base rate” means the
standardized Medicare payment amount for a hospital inpatient, outpatient, or
professional service as determined under the Medicare program, calculated
prior to the application of any hospital-specific, patient-specific, or policy-
based payment adjustments and reflecting only the core payment methodology
used by the Centers for Medicare and Medicaid Services to establish baseline
payment levels, which include adjustments for geographic factors such as
wages.
      (2) For items provided and services delivered at a critical access
hospital, the Medicare adjusted base rate shall be determined under the
applicable Medicare prospective payment system, using the Medicare payment
methodology that would apply if the hospital were not designated as a critical
access hospital.
   (b)(1) A registered carrier shall not reimburse or agree to reimburse a
hospital more than 250 percent of the Medicare adjusted base rate for any item
provided or service delivered in Vermont to an enrollee in a qualified health
benefit plan.
      (2) In the event that a registered carrier reimburses a hospital for an
item or service on a capitated or other non-fee-for-service basis, the carrier
shall ensure that its reimbursement method is adjusted to account for the
reimbursement limit set forth in subdivision (1) of this subsection.
   (c) The reimbursement limit set forth in subsection (b) of this section shall
apply until the applicability date specified in the Green Mountain Care Board
rule establishing the reference-based pricing methodology for all items
provided and services delivered in Vermont hospitals.
    (c) The reimbursement limit set forth in subsection (b) of this section shall
remain in effect unless and until the Green Mountain Care Board establishes a
different reference-based price pursuant to 18 V.S.A. § 9376(e).
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 16 of 31
   (d) A hospital or hospital provider that is reimbursed in accordance with
subsection (b) of this section shall not charge or collect from the patient any
additional amounts other than the cost-sharing amounts authorized by the
terms of the health benefit plan.
   (e) In its reviews of premium rates in accordance with 8 V.S.A. § 4026, the
Green Mountain Care Board shall ensure that the limitations on
reimbursements established in this section are appropriately reflected in the
premium rates for qualified health benefit plans.
Sec. 3. 18 V.S.A. chapter 221, subchapter 7 is amended to read:
             Subchapter 7. Hospital Budgets and Budget Review
§ 9451. DEFINITIONS
  As used in this subchapter:
                                    ***
   (4)(A) “Medicare adjusted base rate” means the standardized Medicare
payment amount for a hospital inpatient, outpatient, or professional service as
determined under the Medicare program, calculated prior to the application of
any hospital-specific, patient-specific, or policy-based payment adjustments
and reflecting only the core payment methodology used by the Centers for
Medicare and Medicaid Services to establish baseline payment levels, which
include adjustments for geographic factors such as wages.
      (B) For items provided and services delivered at a critical access
hospital, the Medicare adjusted base rate shall be determined under the
applicable Medicare prospective payment system, using the Medicare payment
methodology that would apply if the hospital were not designated as a critical
access hospital.
                                    ***
§ 9459. TARGETED COMMERCIAL REIMBURSEMENT RATE
        REDUCTIONS
   (a) A hospital shall implement any commercial reimbursement rate
reduction ordered by the Board pursuant to section 9456 of this title through
the limitations on its commercial reimbursement rates for qualified health
benefit plans in accordance with 33 V.S.A. § 1815.
   (b) To the extent that a hospital is required by the Board’s budget order to
reduce its commercial reimbursement rates by amounts greater than the
reductions achieved pursuant to subsection (a) of this section, the hospital
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 17 of 31
shall reduce its commercial reimbursement rates that exceed 500 percent of the
Medicare adjusted base rate or, if the hospital does not have any commercial
reimbursement rates that exceed 500 percent of the Medicare adjusted base
rate, by reducing its commercial reimbursement rates that are the highest in
relation to the Medicare adjusted base rate.
   (c) If a hospital demonstrates to the Board that the limitations on the
hospital’s reimbursement rates for qualified health plans set forth in 33 V.S.A.
§ 1815 or pursuant to this section are having a negative impact on access to
care, the quality of care, or the sustainability of rural health care services, or a
combination of these, the hospital may propose to increase the commercial
reimbursement rates for one or more of its service lines, such as primary care,
and the Board shall consider both the demonstrated impact and the proposed
increase to reimbursement rates.
   (c) Except as provided in subsections (a) and (b) of this section and in 33
V.S.A. § 1815, a hospital may increase the commercial reimbursement rates for
one or more of its service lines, such as primary care, provided that in doing so
the hospital remains compliant with the total budget ordered for the hospital
by the Board pursuant to section 9456 of this subchapter.
Sec. 4. IMPLEMENTATION OF REFERENCE-BASED PRICING FOR
        CERTAIN PUBLIC EMPLOYEE HEALTH PLANS; REPORT
   (a) The Green Mountain Care Board, in consultation with the Departments
of Financial Regulation and of Human Resources and the Vermont Education
Health Initiative (VEHI), shall analyze commercial health insurance claims for
inpatient and outpatient hospital items provided and services delivered to
active and retired members and their dependents enrolled in the State
Employees’ Health Benefit Plan and in the health benefit plans offered to
teachers and other school employees through VEHI to determine the
opportunities available through the use of reference-based pricing and the
projected impact on Vermont’s hospitals. VEHI, the Department of Human
Resources, and the administrator of the State Employees’ Health Benefit Plan
shall provide the Board with access to the claims data necessary to perform the
analysis.
   (b) On or before January 15, 2027, the Green Mountain Care Board shall
provide to the House Committee on Health Care and the Senate Committee on
Health and WelfareHouse Committees on Health Care and on Ways and Means
and the Senate Committees on Health and Welfare and on Finance the Board’s
findings and any recommendations with respect to scope, timing, financial
impacts, and other considerations in implementing reference-based pricing for
items provided and services delivered to enrollees in the State Employees’
Health Benefit Plan and in the health benefit plans offered by VEHI.
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 18 of 31
                       * * * Hospital Outsourcing * * *
Sec. 5. HOSPITAL OUTSOURCING; HOSPITAL BUDGETS;
        PROVIDER TAXES; REPORT
   (a) For fiscal year 2027 hospital budgets, the Green Mountain Care Board
shall direct hospitals to provide such information as the Board may require
regarding the clinical services that the hospital outsources to external entities.
   (b) On or before January 15, 2027, the Green Mountain Care Board, after
consulting with hospitals and their contracted independent providers and
assessing the impact of outsourcing on access to and the quality and
availability of care, shall provide findings and recommendations regarding
hospital outsourcing to the House Committee on Health Care and the Senate
Committee on Health and WelfareHouse Committees on Health Care and on
Ways and Means and the Senate Committees on Health and Welfare and on
Finance. In addition, the Board, in collaboration with the Agency of Human
Services, shall report on the extent to which hospital outsourcing affects
provider tax revenue and recommend any necessary modifications to 33 V.S.A.
chapter 19, subchapter 2 to appropriately reflect expenditures for patient care
at Vermont hospitals.
     * * * Excluding Reference-Based Pricing from Scope of Health Care
                       Professional Bargaining * * *
Sec. 6. 18 V.S.A. § 9409 is amended to read:
§ 9409. HEALTH CARE PROVIDER BARGAINING GROUPS
   (a) The Green Mountain Care Board may approve the creation of one or
more health care provider bargaining groups, consisting of health care
providers who choose to participate. A bargaining group is authorized to
negotiate on behalf of all participating providers with the Secretary of
Administration, the Secretary of Human Services, the Green Mountain Care
Board, or the Commissioner of Labor with respect to any matter in this
chapter; chapter 13, 219, 220, or 222 of this title; 21 V.S.A. chapter 9; and 33
V.S.A. chapters 18 and 19 with respect to provider regulation, provider
reimbursement, administrative simplification, information technology,
workforce planning, or quality of health care.
   (b) The Green Mountain Care Board shall adopt by rule criteria for
forming and approving bargaining groups and criteria and procedures for
negotiations authorized by this section.
   (c) The rules relating to negotiations shall include a nonbinding
arbitration process to assist in the resolution of disputes. Nothing in this
section shall be construed to limit the authority of the Secretary of
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 19 of 31
Administration, the Secretary of Human Services, the Green Mountain Care
Board, or the Commissioner of Labor to reject the recommendation or decision
of the arbiter.
   (d) Notwithstanding any provisions of this section to the contrary, the
Green Mountain Care Board shall not be required to negotiate with a provider
bargaining group or engage in a nonbinding arbitration process in connection
with the Board’s establishment of reference-based prices in accordance with
subdivision 9375(b)(1)(A), subdivision 9375(b)(5), or section 9376 of this title.
          * * * Appeals of Green Mountain Care Board Orders * * *
Sec. 7. 18 V.S.A. § 9381 is amended to read:
§ 9381. APPEALS
   (a) The Green Mountain Care Board shall adopt procedures for
administrative appeals of its actions, orders, or other determinations. Such
procedures shall that provide for the issuance of a final order and for the
creation of a record sufficient to serve as the basis for judicial review of the
Board’s final actions, orders, and other determinations pursuant to subsection
(b) of this section.
   (b) Any person aggrieved by a final action, order, or other determination of
the Green Mountain Care Board may, upon exhaustion of all administrative
appeals available pursuant to subsection (a) of this section, appeal to the
Supreme Court pursuant to the Vermont Rules of Appellate Procedure.
                                     ***
                        * * * Data Infrastructure * * *
Sec. 8. 18 V.S.A. § 9411 is amended to read:
§ 9411. INTERACTIVE PRICE TRANSPARENCY DASHBOARD AND
        HEALTH SYSTEM PERFORMANCE TOOL
   (a)(1) The Green Mountain Care Board shall develop and maintain a
public, interactive, Internet-based internet-based price transparency
dashboard that allows consumers to compare health care prices for certain
health care services across the State. Using data from the Vermont Healthcare
Claims Uniform Reporting and Evaluation System (VHCURES) established
pursuant to section 9410 of this title, the dashboard shall provide the range of
actual allowed amounts for selected health care services, showing both the
amount paid by the health insurer or other payer and the amount of the
member’s responsibility, and shall allow the consumer to sort the information
by geographic location, by health care provider, by payer type, and by the
specific health care procedure or health care service. The Board shall provide
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 20 of 31
a link on the dashboard to the statewide comparative hospital quality report
published by the Commissioner of Health pursuant to section 9405b of this
title.
   (b)(2) The Board shall update the information in the interactive price
transparency dashboard at least annually.
   (b)(1) The Board shall develop and maintain a public, interactive tool that
displays information on health system performance, including information
regarding quality, access, and affordability.
      (2) The Board shall update the information in the health system
performance tool on a regular basis, to the extent operationally feasible.
Sec. 9. IMPLEMENTATION OF HEALTH SYSTEM PERFORMANCE
        TOOL
   The Green Mountain Care Board shall develop the health system
performance tool described in 18 V.S.A. § 9411(b), as added by Sec. 8 of this
act, only if the Board receives sufficient funding from the federal government
or another source for this purpose.
   * * * Public Employee Health Benefit Authority Study Committee * * *
Sec. 10. PUBLIC EMPLOYEE HEALTH BENEFIT AUTHORITY
        STUDY COMMITTEE; STATE TREASURER; REPORT
   (a) Creation. There is created the Public Employee Health Benefit
Authority Study Committee to evaluate opportunities to establish a State
authority to develop and administer comprehensive and affordable health
benefits for all public-sector employees in Vermont.
  (b) Membership. The Study Committee shall be composed of the following
members, who shall each be appointed by the entities they represent:
     (1) the State Treasurer or designee;
     (2) one member representing the Vermont State Employees’ Association;
     (3)     one member representing the Vermont-National Education
Association;
     (4) one member representing the American Federation of Teachers;
     (5) one member representing the United Electrical Workers;
     (6) one member representing the American Federation of State, County
and Municipal Employees;
     (7) one member representing the Vermont School Boards Association;
     (8) one member representing the Vermont League of Cities and Towns;
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 21 of 31
     (9) one member representing the Vermont State College system;
     (10) one member representing the University of Vermont; and
     (11) one member representing the Department of Human Resources.
  (c) Powers and duties; report.
      (1) The Study Committee shall consider the topics set forth in this
subsection and produce a report regarding the potential for establishing the
Public Employee Health Benefit Authority to provide and administer health
plans that would meet the health care and wellness needs of Vermont’s
municipal, State, public school, and public college and university employees
and their dependents, including addressing all the following:
        (A) the manner in which health benefits are provided to public
employees in other states, including Oregon and Washington;
        (B) the similarities and differences in the level and scope of coverage
provided by current health plans offered to public employees;
         (C) the similarities and differences in the current service or
contractual agreements negotiated by public-sector parties with commercial
health insurers, third-party administrators, and independent clinical and
analytical vendors;
         (D) uniform design, coordination, and administration of medical and
pharmaceutical health plans, care networks, wellness initiatives, and medical
privacy protections;
         (E) uniform standards and protocols for contract review and
negotiations with hospital facilities, nonhospital health care providers,
commercial health insurers, third-party administrators, independent clinical
and analytical vendors, and pharmacy benefit managers;
         (F) streamlined, auditable processes to confirm the integrity and
accuracy of billing from and reimbursements to hospitals, nonhospital health
care providers, and vendors;
         (G)    opportunities to secure substantial and sustainable cost
reductions for employees, employers, and taxpayers;
        (H) monitoring and management of fiduciary risk;
         (I) Public Employee Health Benefit Authority governance structures,
deliberative processes, and equality of decision making by employer and
organized labor representatives; staff positions; member and patient advocacy;
and problem resolution on behalf of employees and employers;
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 22 of 31
         (J) uniform standards and systems for collecting, analyzing, and
securely transmitting data on clinical, utilization, quality of care, and other
essential metrics to support health benefit plan management and vendor needs;
         (K) opportunities to expand participant access to primary care,
mental health, and community-based health care services; redirect care from
hospitals and their emergency departments to less costly settings; and improve
chronic disease management and medication therapy adherence; and
          (L)   alignment of Public Employee Health Benefit Authority
operations and health benefit plans with the transition to reference-based
pricing, global hospital budgets, and regional care transformations directed by
acts of the General Assembly, including 2024 Acts and Resolves No. 134 and
2025 Acts and Resolves Nos. 55 and 68.
      (2) The Study Committee shall provide recommendations regarding:
         (A) a detailed blueprint, with timelines, to design, build, and launch
the Public Employee Health Benefit Authority;
         (B) the need, if any, for independent consultants or advisory
personnel for establishing the Public Employee Health Benefit Authority and,
going forward, to support its mission, on a regular or intermittent basis; and
       (C) the projected costs of creating and annually funding the Public
Employee Health Benefit Authority.
      (3) On or before February 15, 2027, the Study Committee shall submit a
report detailing the information set forth in subdivisions (1) and (2) of this
subsection to the General Assembly and the Governor.
   (d) Assistance. The Study Committee shall have the administrative,
technical, and legal assistance of the Office of the State Treasurer and may
engage the services of one or more consultants or firms to assist with
facilitating meetings and public hearings and preparing its report, to the extent
funds are made available for this purpose.
   (e) Meetings.
      (1) The State Treasurer or designee shall call the first meeting of the
Study Committee to occur on or before August 15, 2026.
      (2) The State Treasurer or designee shall be the chair.
      (3) A majority of the membership shall constitute a quorum.
      (4) The Study Committee shall cease to exist on March 1, 2027.
   (f) Public hearings. The Study Committee shall schedule public hearings,
both remote and in person, to allow public-sector employers and employees the
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 23 of 31
opportunity to share their health care needs and concerns with the Study
Committee before the issuance of the Study Committee’s report.
   (g) Access to information. Commercial health insurers, third-party
administrators, the Vermont Education Health Initiative (VEHI), and clinical
and analytical vendors that serve the public sector shall provide full and timely
access to the Study Committee, with appropriate nondisclosure agreements in
place as needed, to:
       (1) their service contracts or agreements with relevant public-sector
entities; and
      (2) any data, including claims, actuarial, financial, and other data, that
the Study Committee requests.
   (h) Compensation and reimbursement. Members of the Study Committee
shall not receive per diem compensation and reimbursement of expenses for
their participation on the Study Committee.
   (i) Appropriation. The sum of $50,000.00 is appropriated to the Office of
the State Treasurer from the General Fund in fiscal year 2027 to pay for the
services of one or more consultants or firms.
   * * * Critical Access Hospitals; Medicare Outpatient Cost Sharing * * *
Sec. 11. CRITICAL ACCESS HOSPITALS; MEDICARE OUTPATIENT
         COST SHARING; WORKING GROUP; REPORT
   (a)(1) The Green Mountain Care Board shall convene a working group
comprising representatives of the Board, of the Departments of Vermont Health
Access and of Financial Regulation, of critical access hospitals, of health
insurers offering Medicare supplement insurance policies, and of the Office of
the Health Care Advocate to develop recommendations for ways to mitigate the
effects of a federal requirement that Medicare beneficiaries bear financial
responsibility for 20 percent of the amount charged for outpatient services
delivered by critical access hospitals.
      (2) On or before January 15, 2027, the Green Mountain Care Board
shall provide the working group’s recommendations, including the projected
impact of each recommendation on patients, critical access hospitals, and
premiums for Medicare supplement insurance policies, and the State budget, to
the House Committees on Health Care and on Appropriations and the Senate
Committees on Health and Welfare, on Finance, and on Appropriations.
   (b) The Green Mountain Care Board shall not address or attempt to
address the effects of the federal Medicare cost-sharing requirements for
outpatient services delivered by critical access hospitals through the Board’s
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 24 of 31
hospital budget review authority under 18 V.S.A. chapter 221, subchapter 7 in
the fiscal year 2027 hospital budgets.
                           * * * Effective Date * * *
Sec. 1112. EFFECTIVE DATE
   This act shall take effect on passage.
                      * * * Reference-Based Pricing * * *
Sec. 1. 18 V.S.A. § 9376(e) is amended to read:
   (e) Reference-based pricing.
      (1)(A) The Board shall establish reference-based prices that represent
the maximum amounts that hospitals shall accept as payment in full for items
provided and services delivered in Vermont. The Board may also implement
reference-based pricing for services delivered outside a hospital by setting the
minimum amounts that shall be paid for items provided and services delivered
by nonhospital-based health care professionals. The Board shall consult with
health insurers, hospitals, other health care professionals as applicable, the
Office of the Health Care Advocate, and the Agency of Human Services in
developing reference-based prices pursuant to this subsection (e), including on
ways to achieve all-payer alignment on the design and implementation of
reference-based pricing.
         (B) The Board shall utilize reference-based pricing to reduce hospital
prices incrementally until they are equal to national median prices by hospital
type by calendar year 2030. The Board shall use the highest quality,
nonpartisan data demonstrating hospital prices as a percentage of Medicare to
evaluate progress toward reducing hospital prices in Vermont to the national
median.
         (C) The Board shall implement reference-based pricing in a manner
that does not allow health care professionals to charge or collect from patients
or health insurers any amount in excess of the reference-based amount
established by the Board.
                                      ***
       (3)(A) The Board shall begin implementing reference-based pricing as
soon as practicable but not later than hospital fiscal year 2027 by establishing
the maximum amounts that Vermont hospitals shall accept as payment in full
for items provided and services delivered. After initial implementation, the
Board shall review the reference-based prices for each hospital annually as
part of the hospital budget review process set forth in chapter 221, subchapter
7 of this title.
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 25 of 31
         (B) The Board, in collaboration with the Department of Financial
Regulation, shall monitor the implementation of reference-based pricing to
ensure that any decreases in amounts paid to hospitals also result in decreases
in health insurance premiums. The Board shall post its findings regarding the
alignment between price decreases and premium decreases annually on its
website.
         (C)(i) For provider contracts entered into, amended, or renewed on
or after January 1, 2028, each hospital and health insurer shall begin
expressing as a percentage of Medicare or of another benchmark, if another
benchmark is deemed appropriate by the Green Mountain Care Board, the
rates for items and services identified pursuant to a collaborative process
between the Board and representatives of Vermont hospitals.
            (ii) When making public the charges for items and services
pursuant to 45 C.F.R. Part 180, each hospital shall include in its machine-
readable files pricing information shown as a percentage of Medicare rates, as
well as in dollars and cents, disaggregated by payer and by plan.
            (iii) For purposes of subdivisions (i) and (ii) of this subdivision
(3)(C), 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
for determining Medicare rates for use as a benchmark in establishing
reference-based prices pursuant to this subsection (e).
         (D)(i) Each hospital shall apply for, obtain, and use a unique
National Provider Identifier (NPI) on all claims filed after October 1, 2027,
for reimbursement or payment of items provided and services delivered at an
off-campus department of the hospital that is distinct from the NPI used for
services delivered at the main hospital campus or at any other off-campus
hospital department.
           (ii) As used in this subdivision (D):
              (I) “Campus” has the same meaning as in 42 C.F.R. § 413.65.
               (II) “Off-campus” means a facility located more than 250
yards from the main hospital campus.
                                    ***
Sec. 2. LIMITATIONS ON HOSPITAL REIMBURSEMENTS FOR
        QUALIFIED HEALTH BENEFIT PLANS AND PLANS
        COVERING SCHOOL EMPLOYEES FOR HOSPITAL FISCAL
        YEAR 2027
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 26 of 31
   (a) As used in this section:
     (1) “Health benefit association” has the same meaning as in 24 V.S.A.
§ 4947.
      (2)(A) “Medicare adjusted base rate” means the standardized Medicare
payment amount for a hospital inpatient, outpatient, or professional service as
determined under the Medicare program, calculated prior to the application of
any hospital-specific, patient-specific, or policy-based payment adjustments
and reflecting only the core payment methodology used by the Centers for
Medicare and Medicaid Services to establish baseline payment levels, which
include adjustments for geographic factors such as wages.
         (B) For items provided and services delivered at a critical access
hospital, the Medicare adjusted base rate shall be determined under the
applicable Medicare prospective payment system, using the Medicare payment
methodology that would apply if the hospital were not designated as a critical
access hospital.
      (3) “Qualified health benefit plan” has the same meaning as in
33 V.S.A. § 1802.
      (4) “Registered carrier” has the same meaning as in 33 V.S.A. § 1811.
      (5) “School employee” has the same meaning as in 16 V.S.A. § 2101.
   (b) Notwithstanding any provision of 18 V.S.A. § 9375(b)(1)(A) to the
contrary, for hospital fiscal year 2027, the Green Mountain Care Board may
order hospitals to reduce their commercial reimbursement rates for qualified
health benefit plans and for health benefit plans offered to school employees by
a health benefit association pursuant to 24 V.S.A. § 4947 based on a
percentage of the Medicare adjusted base rate determined by the Board for
each item provided and service delivered in Vermont to enrollees in these
plans.
   (c)(1) A registered carrier or health benefit association shall not reimburse
or agree to reimburse a hospital more than the percentage of the Medicare
adjusted base rate specified by the Green Mountain Care Board pursuant to
subsection (b) of this section, if any, for the applicable hospital fiscal year for
any item provided or service delivered in Vermont to an enrollee in a qualified
health benefit plan or a health benefit plan offered to school employees by a
health benefit association.
      (2) In the event that a registered carrier or health benefit association
reimburses a hospital for an item or service on a capitated or other non-fee-
for-service basis, the carrier or association shall ensure that its reimbursement
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 27 of 31
method is adjusted to account for the reimbursement limit set forth in
subdivision (1) of this subsection.
   (d) A hospital or hospital provider that is reimbursed in accordance with
subsections (b) and (c) of this section shall not charge or collect from the
patient any additional amounts other than the cost-sharing amounts authorized
by the terms of the health benefit plan.
   (e) To the extent that a hospital is required by the Board’s budget order to
reduce its commercial reimbursement rates by amounts greater than the
reductions achieved pursuant to subsection (b) of this section, the hospital
shall reduce its commercial reimbursement rates that exceed 500 percent of the
Medicare adjusted base rate or, if the hospital does not have any commercial
reimbursement rates that exceed 500 percent of the Medicare adjusted base
rate, by reducing its commercial reimbursement rates that are the highest in
relation to the Medicare adjusted base rate.
   (f)(1) In its reviews of premium rates in accordance with 8 V.S.A. § 4026,
the Green Mountain Care Board shall ensure that the limitations on
reimbursements established in this section are appropriately reflected in the
premium rates for qualified health benefit plans.
       (2) In its review of premium rates in accordance with 8 V.S.A. § 4026
and 24 V.S.A. chapter 121, subchapter 6, the Department of Financial
Regulation shall ensure that the limitations on reimbursements established in
this section are appropriately reflected in the premium rates for health benefit
plans offered to school employees by a health benefit association.
Sec. 3. [Deleted.]
                       * * * Hospital Outsourcing * * *
Sec. 4. HOSPITAL OUTSOURCING; HOSPITAL BUDGETS;
        PROVIDER TAXES; REPORT
   (a) For fiscal year 2027 hospital budgets, the Green Mountain Care Board
shall direct hospitals to provide such information as the Board may require
regarding the clinical services that the hospital outsources to external entities.
   (b) On or before January 15, 2027, the Green Mountain Care Board, after
consulting with hospitals and their contracted independent providers and
assessing the impact of outsourcing on access to and the quality and
availability of care, shall provide findings and recommendations regarding
hospital outsourcing to the House Committees on Health Care and on Ways
and Means and the Senate Committees on Health and Welfare and on Finance.
In addition, the Board, in collaboration with the Agency of Human Services,
shall report on the extent to which hospital outsourcing affects provider tax
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 28 of 31
revenue and recommend any necessary modifications to 33 V.S.A. chapter 19,
subchapter 2 to appropriately reflect expenditures for patient care at Vermont
hospitals.
          * * * Section 1332 Waiver for Reinsurance Program * * *
Sec. 4a. REINSURANCE; AUTHORIZATION TO PURSUE SECTION
         1332 WAIVER
   The Department of Vermont Health Access, in consultation with the
Department of Financial Regulation, is authorized to submit a State
Innovation Waiver pursuant to Section 1332 of the Patient Protection and
Affordable Care Act of 2010, Pub. L. No. 111-148, as amended by the Health
Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, to
establish a program for reinsurance and seek federal pass-through funding of
amounts attributable to premium tax credits under 26 U.S.C. § 36B.
     * * * Excluding Reference-Based Pricing from Scope of Health Care
                       Professional Bargaining * * *
Sec. 5. 18 V.S.A. § 9409 is amended to read:
§ 9409. HEALTH CARE PROVIDER BARGAINING GROUPS
   (a) The Green Mountain Care Board may approve the creation of one or
more health care provider bargaining groups, consisting of health care
providers who choose to participate. A bargaining group is authorized to
negotiate on behalf of all participating providers with the Secretary of
Administration, the Secretary of Human Services, the Green Mountain Care
Board, or the Commissioner of Labor with respect to any matter in this
chapter; chapter 13, 219, 220, or 222 of this title; 21 V.S.A. chapter 9; and 33
V.S.A. chapters 18 and 19 with respect to provider regulation, provider
reimbursement, administrative simplification, information technology,
workforce planning, or quality of health care.
   (b) The Green Mountain Care Board shall adopt by rule criteria for
forming and approving bargaining groups and criteria and procedures for
negotiations authorized by this section.
    (c) The rules relating to negotiations shall include a nonbinding
arbitration process to assist in the resolution of disputes. Nothing in this
section shall be construed to limit the authority of the Secretary of
Administration, the Secretary of Human Services, the Green Mountain Care
Board, or the Commissioner of Labor to reject the recommendation or decision
of the arbiter.
  (d) Notwithstanding any provisions of this section to the contrary, the
Green Mountain Care Board shall not be required to negotiate with a provider
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 29 of 31
bargaining group or engage in a nonbinding arbitration process in connection
with the Board’s establishment of reference-based prices in accordance with
subdivision 9375(b)(1)(A), subdivision 9375(b)(5), or section 9376 of this title.
          * * * Appeals of Green Mountain Care Board Orders * * *
Sec. 6. 18 V.S.A. § 9381 is amended to read:
§ 9381. APPEALS
   (a) The Green Mountain Care Board shall adopt procedures for
administrative appeals of its actions, orders, or other determinations. Such
procedures shall that provide for the issuance of a final order and for the
creation of a record sufficient to serve as the basis for judicial review of the
Board’s final actions, orders, and other determinations pursuant to subsection
(b) of this section.
   (b) Any person aggrieved by a final action, order, or other determination of
the Green Mountain Care Board may, upon exhaustion of all administrative
appeals available pursuant to subsection (a) of this section, appeal to the
Supreme Court pursuant to the Vermont Rules of Appellate Procedure.
                                     ***
                        * * * Data Infrastructure * * *
Sec. 7. 18 V.S.A. § 9411 is amended to read:
§ 9411. INTERACTIVE PRICE TRANSPARENCY DASHBOARD AND
        HEALTH SYSTEM PERFORMANCE TOOL
    (a)(1) The Green Mountain Care Board shall develop and maintain a
public, interactive, Internet-based internet-based price transparency
dashboard that allows consumers to compare health care prices for certain
health care services across the State. Using data from the Vermont Healthcare
Claims Uniform Reporting and Evaluation System (VHCURES) established
pursuant to section 9410 of this title, the dashboard shall provide the range of
actual allowed amounts for selected health care services, showing both the
amount paid by the health insurer or other payer and the amount of the
member’s responsibility, and shall allow the consumer to sort the information
by geographic location, by health care provider, by payer type, and by the
specific health care procedure or health care service. The Board shall provide
a link on the dashboard to the statewide comparative hospital quality report
published by the Commissioner of Health pursuant to section 9405b of this
title.
   (b)(2) The Board shall update the information in the interactive price
transparency dashboard at least annually.
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 30 of 31
   (b)(1) The Board shall develop and maintain a public, interactive tool that
displays information on health system performance, including information
regarding quality, access, and affordability.
      (2) The Board shall update the information in the health system
performance tool on a regular basis, to the extent operationally feasible.
Sec. 8. IMPLEMENTATION OF HEALTH SYSTEM PERFORMANCE
        TOOL
   The Green Mountain Care Board shall develop the health system
performance tool described in 18 V.S.A. § 9411(b), as added by Sec. 7 of this
act, only if the Board receives sufficient funding from the federal government
or another source for this purpose.
   * * * Critical Access Hospitals; Medicare Outpatient Cost Sharing * * *
Sec. 9. CRITICAL ACCESS HOSPITALS; MEDICARE OUTPATIENT
        COST SHARING
   (a) The General Assembly and the Green Mountain Care Board have
recently become aware of a federal requirement that Medicare beneficiaries
must bear financial responsibility for 20 percent of the amount charged for
outpatient services delivered by critical access hospitals, not 20 percent of the
amount that Medicare pays for the service. While the General Assembly
understands that it cannot invalidate this federal requirement, it also
recognizes both that this requirement has a significant, unfair, and negative
financial impact on Medicare beneficiaries in the State’s most rural
communities and that Vermont’s critical access hospitals are some of the
State’s most financially vulnerable health care facilities. It is the intent of this
section to provide information to Vermont’s seniors and other Medicare
beneficiaries about the federal requirement while a working group of interested
stakeholders endeavors to develop appropriate and enduring solutions that do
not undermine the financial sustainability of our critical access hospitals and
that comply with federal law.
    (b) On or before September 1, 2026, each critical access hospital shall do
all of the following:
      (1) Identify all the outpatient services for which the amount that the
hospital charges equals five or more times the Medicare allowed amount for
that service.
      (2) Post prominently on its website and in outpatient departments of the
hospital a disclosure about the federal requirement that Medicare beneficiaries
must pay 20 percent of the charge for outpatient services at critical access
hospitals, that Medicare beneficiaries may be able to receive care with reduced
BILL AS INTRODUCED AND PASSED BY SENATE AND HOUSE S.190
2026  Page 31 of 31
out-of-pocket costs from other providers, and how to contact the hospital’s
patient financial assistance department for more information. The hospital
shall file its proposed disclosure materials with the Green Mountain Care
Board for the Board’s approval prior to posting.
   (c) To the extent that the Green Mountain Care Board engages in efforts to
address the Medicare outpatient cost-sharing issue in hospital fiscal year
2027, the Board shall consider any proposals from the critical access hospitals
and other interested stakeholders and shall ensure that its actions are
consistent with ongoing hospital transformation efforts and the principles for
health care reform expressed in 18 V.S.A. § 9371.
                          * * * Effective Date * * *
Sec. 10. EFFECTIVE DATE
  This act shall take effect on passage.