Vermont's Green Mountain Care Board is developing hospital-price limits required by Act 68 of 2025. Consultants are analyzing commercial insurance claims, but the cap and phase-in schedule remain decisions for the board.
Materials presented Oct. 21 by RAND and Bailit Health say the team has mapped services to Medicare payment categories and calculated Medicare reference rates for all 14 Vermont hospitals. Analysis of commercial claims is underway, while planning for the financial-impact analysis continues.
The approach is called reference-based pricing. It would cap prices commercial insurers pay for hospital services at a percentage of Medicare's payment rates. Hospitals and insurers could still negotiate prices below that ceiling.
The approach includes a gradual transition. Options under discussion include different limits by hospital type or service, later performance incentives and possible relief for financially distressed hospitals.
Consultants expect to model effects on hospital finances, premiums and patients' out-of-pocket costs and gather stakeholder input over the coming months. Their contract runs through June 2027; the presentation says the timing of policy decisions rests with the board.
A draft strategy in the presentation says the goal is to lower premiums and patients' out-of-pocket costs while monitoring access, quality and hospital finances. The modeling is intended to help the board assess those effects before choosing the rates.
Sources: Board Meeting Information & Materials; Oct. 21 hospital-pricing and efficiency presentation.