Healthcare

This bill requires Vermont hospitals and health insurers to adopt reference-based pricing for services, setting payment limits based on Medicare rates starting in 2027. It mandates hospitals to report all outsourced clinical services (like emergency medicine or radiology) in budget reviews, closing loopholes where outsourced revenue bypassed oversight. Hospitals must display pricing both as a percentage of Medicare rates and in dollars, and use unique identifiers for off-campus services. The goal is to ensure price transparency, apply cost controls across all hospital services, and prevent surprise bills for patients receiving outsourced care.

This Vermont bill (S 126) reforms how healthcare is paid for and delivered by establishing reference-based pricing as the primary payment method by 2027. It directly affects hospitals, doctors, insurers, and patients by setting maximum payment rates based on Medicare benchmarks, aiming to control costs while ensuring providers remain financially stable. Key mechanisms include requiring the Board to implement payment models like bundled payments, global budgets, and reference-based pricing to reduce cost-shifting and improve care coordination. The law also mandates standardized metrics to track progress on goals like reducing healthcare disparities, expanding primary care access, and supporting healthcare workforce retention. These changes apply statewide to all commercial health insurance and provider reimbursement systems.

This bill, S.28, aims to protect access to and the provision of certain legally protected health care services, specifically reproductive and gender-affirming care. It expands legal protections for individuals who aid or encourage these services, even if their actions occur in other U.S. jurisdictions. The bill also prevents professional disciplinary action against Vermont-licensed health care providers solely for offering these services, regardless of other states' laws. Additionally, it enhances the privacy of licensed professionals by exempting their personal contact information from public records and seeks to ensure transparent and accurate information from pregnancy service centers.