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 bill (H 585) reforms health insurance company governance and pricing in Vermont. It requires health insurers to have boards where at least 75% of members are subscribers or public representatives (not providers), with the Governor appointing two public members. The bill also mandates a compensation committee with public representatives to review executive pay and limits primary care provider exemptions from prior authorization. Additionally, it allows limited age-based pricing in individual/small group insurance markets and begins implementing site-neutral billing for certain services. These changes directly affect health insurance companies operating in Vermont’s individual and small group markets.

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.