S 190 — An act relating to reference-based pricing and the Green Mountain Care Board
Last action — Senate Message: Vetoed by Governor June 16, 2026
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✓Introduced
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✓In Committee
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✓Passed Senate
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✓Passed House
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5To Executive
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6Enacted
This bill has been sent to the executive. Introduced January 06, 2026. It awaits signature.
Vetoed by Governor Phil Scott (Republican) on May 29, 2026.
Next likely step: the executive signs it into law or issues a veto.
Odds of enactment
Low chanceBased on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.
Upgrade to see the exact probability and what's driving it.
A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.
Prognosis
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To Executive
Current position in the legislative process.
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1 sponsor
1 primary, 0 co-sponsors signed on.
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Single-party support
Sponsorship is currently within one party (1 D).
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Cleared a recorded vote
Passed 3 recorded votes so far.
Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.
In plain language
The bill addresses reference-based pricing in relation to the Green Mountain Care Board.
This legislation involves reference-based pricing strategies and the oversight role of the Green Mountain Care Board. It aims to influence healthcare pricing frameworks.
What this means for you
- Healthcare: This means changes in pricing structures that could affect how healthcare services are billed.
Bill Text
What changed in the latest version
683 added · 411 removedPlain-language change summary
The recent amendments to Bill S 190 include the addition of a new section regarding hospital outsourcing of clinical care, while removing some earlier references likely deemed unnecessary. The legislation now specifies that all hospitals must apply for a unique National Provider Identifier by October 1, 2026, which helps streamline claims and improves the tracking of healthcare services. These changes are significant because they aim to enhance the efficiency of the healthcare system and the accountability of hospitals, ultimately benefiting patient care.
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 1 of 1824 S.190 AnIntroduced actby relatingSenator toLyons theReferred Greento MountainCommittee Careon Board,Health reference-based pricing, and studyingWelfare theDate: creation of a Public Employee Health Benefit Authority It is hereby enacted by the General Assembly of the State of Vermont:
January 6, 2026 Subject:
Health;
health care reform;
Green Mountain Care Board;
hospitals;
health insurance;
reference-based pricing;
provider taxes Statement of purpose of bill as introduced:
This bill proposes to set certain requirements for hospitals and health insurers to meet in order to facilitate the Green Mountain Care Board’s implementation of reference-based pricing.
The bill would establish regulatory oversight of hospitals’ use of outsourcing contracts for clinical services.
The bill would repeal authorizing language for health care provider bargaining groups, clarify procedures for appealing Green Mountain Care Board decisions and orders, and allow the Board to conduct examinations and investigations of hospitals, including audits, as part of its hospital budget reviews.
The bill would also direct the Green Mountain Care Board to develop an interactive health system performance tool if the State receives the funding necessary to support the project.
An act relating to the Green Mountain Care Board, reference-based pricing, 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 BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 2 of 24 It is hereby enacted by the General Assembly of the State of Vermont:
§§ 9376(e) 9376(e) is amended to read:
VT(C) LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 2 of 18 (C)(i) For provider contracts entered into,into amended, or renewed on or after October 1, 2026, each hospital and health insurer shall beginexpress expressingthe rates for all items and BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 3 of 24 services as a percentage of Medicare or of another benchmark, if another benchmark is deemed appropriate by the Green Mountain Care Board,Board. the rates for items and services identified pursuant to a collaborative process between the Board and representatives of Vermont hospitals.
(D)(i) Each hospital shall apply for, obtain, and use a unique National Provider Identifier (NPI) on all claims filed after October 1, 2026, 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.
(E) 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.
(F) The Board shall establish a default percentage of Medicare above which a hospital shall not accept payment for an item or service under any newly established Current Procedural Terminology (CPT) code unless and until the Board establishes a specific reference-based price for the item or service pursuant to this chapter.
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 4 of 24 (G) The Board shall establish a default maximum percentage of Medicare above which a hospital shall not accept payment for any individual inpatient or outpatient item or service.
* * * * * * Hospital Outsourcing * * * Sec.
2.
HOSPITAL OUTSOURCING;
FINDINGS;
PURPOSE (a) The General Assembly finds that:
(1) Hospitals are increasingly outsourcing their clinical services, such as emergency medicine, anesthesiology, radiology, laboratory services, and other specialized care, to outside entities.
(2) Revenue from outsourced clinical services is not consistently reported in the hospital budget process and has been excluded from the Green Mountain Care Board’s regulatory oversight.
(3) Outsourced revenue may circumvent hospital revenue caps and spending limitations, undermining budget transparency and accountability.
(4) Without oversight, outsourced services may operate outside price controls, including reference-based pricing, which contributes to cost inflation and market inefficiencies.
(5) Patients may face network adequacy issues, surprise medical bills, and inconsistent access to financial assistance when receiving care from outsourced providers.
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 5 of 24 (b) The purposes of 18 V.S.A.
§ 9415, as enacted in Sec.
3 of this act, are:
(1) to bring all hospital-affiliated revenue within the Green Mountain Care Board’s regulatory purview, thus closing gaps in spending accountability;
(2) to ensure that reference-based pricing applies to outsourced services, thus preventing cost inflation and creating transparent rate structures that apply across all hospital services;
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and (3) to apply network adequacy requirements and billing protections to shield patients from surprise medical bills and ensure consistent access to legally required financial assistance policies.
Sec.
3.
18 V.S.A.
§ 9415 is added to read:
§ 9415.
HOSPITAL OUTSOURCING OF CLINICAL CARE (a) Definitions.
As used in this section, “outsourcing” means an arrangement in which a hospital contracts with an external entity that assumes sole control of direct clinical care offered within the hospital facility.
“Outsourced services” may include emergency medicine, anesthesiology, hospitalist services, and other direct patient care services provided on-site at the hospital by a contracted entity.
“Outsourced services” do not include services provided by a nurse on a short-term contract with a hospital in which the hospital retains oversight and control over patient care;
off-site diagnostic services, including off-site diagnostic interpretation of radiologic images and BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 6 of 24 off-site laboratory testing;
or nonclinical services such as laundry services, nutrition services, information technology, or cybersecurity.
(b) Regulatory oversight and accountability.
(1) Revenue from outsourced services shall be included in a hospital’s net patient revenue limits, commercial rate limits, operating expense limits, and other limitations as specified by the Green Mountain Care Board in its annual hospital budget guidance.
(2) The Green Mountain Care Board’s rate-setting authority, including reference-based pricing established pursuant to section 9376 of this title and global hospital budgets developed pursuant to section 9456 of this title, shall apply to outsourced services.
(3) Revenue generated by outsourced services delivered in a hospital- owned facility shall be deemed to be part of the net patient revenue of the hospital for purposes of the annual assessment on hospitals pursuant to 33 V.S.A.
§ 1953 and other applicable State assessments.
(c) Consumer protections.
(1) In order to ensure continuity of coverage and prevent surprise medical bills, a hospital shall be responsible for billing the health insurance claims for all outsourced services delivered to a patient at the hospital by a contracted provider who would otherwise be out-of-network under the patient’s health insurance plan.
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 7 of 24 (2) A hospital contracting for outsourced services shall minimize billing complexity for patients and shall coordinate billing processes with outsourced service providers to the greatest extent possible.
(3) Hospital financial assistance policies developed in accordance with subchapter 10 of this chapter and any other policies regarding bad debt or charity care shall apply to outsourced services to ensure that patients receive consistent financial protections regardless of service delivery model.
Sec.
4.
18 V.S.A.
§ 9482 is amended to read:
§ 9482.
FINANCIAL ASSISTANCE POLICIES FOR LARGE HEALTH CARE FACILITIES (a) Each large health care facility in this State shall develop a written financial assistance policy that, at a minimum, complies with the provisions of this subchapter and any applicable federal requirements.
(b) The financial assistance policy shall:
(1) apply, at a minimum, to all emergency and other medically necessary health care services that the large health care facility offers, including outsourced services, as defined in section 9415 of this title, that are delivered at the facility;
* * * BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 8 of 24 Sec.
5.
33 V.S.A.
§ 1951 is amended to read:
§ 1951.
DEFINITIONS As used in this subchapter:
* * * (10) “Net patient revenues” means a provider’s gross charges related to patient care services less any deductions for bad debts, charity care, contractual allowances, and other payer discounts, and includes outsourced services, as defined in 18 V.S.A.
§ 9415, that are delivered at the hospital.
* * * * * * Repeal of Health Care Professional Bargaining Group Authorizing Language * * * Sec.
6.
18 V.S.A.
§ 9373 is amended to read:
§ 9373.
DEFINITIONS As used in this chapter:
* * * (12) “Payment reform” means modifying the method of payment from a fee-for-service basis to one or more alternative methods for compensating health care professionals, health care provider bargaining groups created pursuant to section 9409 of this title, integrated delivery systems, and other health care professional arrangements, manufacturers of prescribed products, medical supply companies, and other companies providing health services or BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 9 of 24 health supplies for the provision of high-quality and efficient health services, products, and supplies while measuring quality and efficiency.
The term may include shared savings agreements, bundled payments, episode-based payments, and global payments.
* * * Sec.
7.
18 V.S.A.
§ 9376 is amended to read:
§ 9376.
PAYMENT AMOUNTS;
METHODS * * * (b) Rate-setting.
(1) The Board shall set reasonable rates for health care professionals, health care provider bargaining groups created pursuant to section 9409 of this title, manufacturers of prescribed products, medical supply companies, and other companies providing health services or health supplies based on methodologies pursuant to section 9375 of this title, in order to have a consistent reimbursement amount accepted by these persons.
In its discretion, the Board may implement rate-setting for different groups of health care professionals over time and need not set rates for all types of health care professionals.
In establishing rates, the Board may consider legitimate differences in costs among health care professionals, such as the cost of providing a specific necessary service or services that may not be available elsewhere in the State, and the need for health care professionals in particular BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 10 of 24 areas of the State, particularly in underserved geographic or practice shortage areas.
* * * (d) Supervision.
To the extent required to avoid federal antitrust violations and in furtherance of the policy identified in subsection (a) of this section, the Board shall facilitate and supervise the participation of health care professionals and health care provider bargaining groups in the process described in subsection (b) of this section.
* * * Sec.
8.
REPEAL 18 V.S.A.
§ 9409 (health care provider bargaining groups) is repealed. * * * Appeals of Green Mountain Care Board Orders * * * Sec.
9.
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.
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 11 of 24 (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.
* * * * * * Hospital Audits * * * Sec.
10.
18 V.S.A.
§ 9453 is amended to read:
§ 9453.
POWERS AND DUTIES (a) The Board shall:
(1) adopt uniform formats that hospitals shall use to report financial, scope-of-services, and utilization data and information;
(2) designate a data organization with which hospitals shall file financial, scope-of-services, and utilization data and information;
and (3) designate a data organization or organizations to process, analyze, store, or retrieve data or information.
(b) The Chair of the Board may:
(1) conduct investigations and examinations, including audits, of hospitals that are reasonably necessary or helpful to the Board’s administration of this subchapter or any rules adopted or orders issued pursuant to this subchapter;
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 12 of 24 (2) retain experts or other persons to assist in any investigation or examination conducted pursuant to subdivision (1) of this subsection;
and (3) require a hospital subject to an investigation or examination conducted pursuant to this subsection to pay the reasonable costs and expenses of the investigation or examination.
(c) To effectuate the purposes of this subchapter, the Board may adopt rules under 3 V.S.A.
chapter 25.
* * * Data Infrastructure * * * Sec.
11.
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 BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 13 of 24 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.
(b)(1) The Board shall develop and maintain a public, interactive tool that displays information on health system performance, including hospital prices relative to Medicare rates, both as a percentage of Medicare and in dollars and cents.
The tool shall enable the user to sort the information by service line and by payer.
(2) The Board shall update the information in the health system performance tool at least quarterly.
Sec.
12.
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.
11 of this act, only if the Board receives sufficient funding from the federal government or another source for this purpose.
* * * Effective Date * * * Sec.
13.
EFFECTIVE DATE This act shall take effect on passage.
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 14 of 24 * * * 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 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.
(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-reference-based 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-off-campus campus department of the hospital that is distinct from the NPI used for VTBILL LEGAS #388451INTRODUCED v.1AND AS PASSED BY SENATE S.190 Page 315 of 1824 services delivered at the main hospital campus or at any other off-campus hospital department.
§§ 1815 1815 is added to read:
§§ 1815. 1815.
(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 VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 4 of 18 methodology that would apply if the hospital were not designated as a critical access hospital.
(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.
§§ 9376(e). 9376(e).
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 16 of 24 (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.
§§ 4026, 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.
VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 5 of 18 Sec.
* * * §§ 9459. 9459.
TARGETED COMMERCIAL REIMBURSEMENT RATE REDUCTIONS VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 6 of 18 (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. 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 S.190 Page 17 of 24 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.
§§ 1815, 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.
REPORT (a) The Green Mountain Care Board, in consultation with the Departments of Financial Regulation and of Human Resources and the Vermont Education VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 7 of 18 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.
(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 S.190 Page 18 of 24 * * * Hospital Outsourcing * * * Sec.
REPORT VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 8 of 18 (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.
§§ 9409 9409 is amended to read:
A bargaining group is authorized to VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 9 of 18 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;
Nothing in this section shall be construed to limit the authority of the Secretary of BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 19 of 24 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.
VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 10 of 18 * * * Appeals of Green Mountain Care Board Orders * * * Sec.
§§ 9381 9381 is amended to read:
§§ 9411 9411 is amended to read:
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 VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 11 of 18 services across the State.
The Board shall provide BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 20 of 24 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.
§§ 9411(b), 9411(b), as added by Sec.
8 of this VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 12 of 18 act, only if the Board receives sufficient funding from the federal government or another source for this purpose.
VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 13 of 18 (7) one member representing the Vermont School Boards Association;
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 21 of 24 (9) one member representing the Vermont State College system;
VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 14 of 18 (D) uniform design, coordination, and administration of medical and pharmaceutical health plans, care networks, wellness initiatives, and medical privacy protections;
BILL AS INTRODUCED AND PASSED BY SENATE S.190 Page 22 of 24 (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;
VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 15 of 18 (K) opportunities to expand participant access to primary care, mental health, and community-based health care services;
134 and 2025 Acts and Resolves Nos.
VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 16 of 18 (d) Assistance.
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 S.190 Page 23 of 24 opportunity to share their health care needs and concerns with the Study Committee before the issuance of the Study Committee’s report.
VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 17 of 18 (1) their service contracts or agreements with relevant public-sector entities;
(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.
(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 VT LEG #388451 v.1 AS PASSED BY SENATE S.190 Page 18 of 18 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 S.190 Page 24 of 24 hospital budget review authority under 18 V.S.A.
12.1112.
VT LEG #388451 v.1
Show all 200 changed rows (160 more)
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Amendments
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Action History
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Senate Message: Vetoed by Governor June 16, 2026
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Governor vetoed bill on June 16, 2026
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Delivered to Governor on June 10, 2026
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Senate Message: House proposal of amendment concurred in
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As passed by Senate and House
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Roll Call, requested by Senator Collamore, Passed -- Needed 15 of 30 to Pass -- Yeas = 17, Nays = 13
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House proposal of amendment concurred in
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House proposal of amendment; text
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House proposal of amendment
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House proposal of amendment
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Entered on Notice Calendar
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House message: House passed bill in concurrence with proposal(s) of amendment
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Rules suspended and bill messaged forthwith to the Senate as moved by Rep. McCoy of Poultney
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Passed in concurrence with proposal of amendment
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Read third time
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Rules suspended and bill placed in all remaining stages of passage as moved by Rep. McCoy of Poultney
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Third Reading ordered
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Which was agreed to on a Roll Call Passed -- Needed 66 of 131 to Pass -- Yeas = 87, Nays = 44
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Report of Committee on Health Care, as amended, agreed to
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Rep. McCoy of Poultney demanded yeas and nays
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Report of Committee on Health Care amended as recommended by Committee on Appropriations
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Rep. Dickinson of St. Albans Town recommended for the Committee on Appropriations
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Rep. Holcombe of Norwich recommended for the Committee on Ways and Means
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Rep. Black of Essex reported for the Committee on Health Care
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Read second time
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Rules suspended and taken up for immediate consideration as moved by Rep. McCoy of Poultney
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Notice Calendar: Favorable with Amendment
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Pending entry on Notice Calendar, referred to Committee on Appropriations per Rule 35(a)
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Referred to Committee on Ways and Means per Rule 35(a)
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Notice Calendar: Favorable with Amendment
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Read first time and referred to the Committee on Health Care
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Read 3rd time & passed on roll call, requested by Senator Weeks, Passed -- Needed 15 of 29 to Pass -- Yeas = 23, Nays = 6
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Pending third reading, bill amended as moved by Senator(s) Hardy
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New Business/Third Reading
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3rd reading ordered
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Recommendation of amendment by Committee on Health and Welfare, as amended, agreed to
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Recommendation of amendment by Committee on Health and Welfare amended as moved by Senator Lyons, Benson, Cummings, and Morley
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Recommendation of amendment by Committee on Health and Welfare amended as recommended by Committee on Appropriations
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Reported favorably by Senator Lyons for Committee on Appropriations with recommendation of amendment
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Read 2nd time, reported favorably with recommendation of amendment by Senator Lyons for Committee on Health and Welfare
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Recommendation of amendment to be offered by Senator(s) Lyons
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Favorable report with recommendation of amendment by Committee on Appropriations
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Favorable report with recommendation of amendment by Committee on Health and Welfare
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Unfinished Business/Second Reading
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Recommendation of amendment to be offered by Senator(s) Lyons
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Favorable report with recommendation of amendment by Committee on Appropriations
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Favorable report with recommendation of amendment by Committee on Health and Welfare
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Unfinished Business/Second Reading
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Recommendation of amendment to be offered by Senator(s) Lyons
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Favorable report with recommendation of amendment by Committee on Appropriations
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Favorable report with recommendation of amendment by Committee on Health and Welfare
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Second Reading
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Recommendation of amendment to be offered by Senator(s) Lyons
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Favorable report with recommendation of amendment by Committee on Appropriations
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Favorable report with recommendation of amendment by Committee on Health and Welfare
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Second Reading
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Entered on Notice Calendar
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Referred to Committee on Appropriations per Senate Rule 31
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Favorable report with recommendation of amendment by Committee on Health and Welfare
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Second Reading
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Entered on Notice Calendar
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Read 1st time & referred to Committee on Health and Welfare
Sponsors
- Virginia "Ginny" V Lyons · Primary
Sponsorship breakdown
Export CSV (upgrade) →1 sponsors · 0 co-sponsors · 189 not signed on · 56 voted No
Sponsors (1)
- Virginia "Ginny" V Lyons Democrat
Co-sponsors (0)
None.
Not signed on (189)
189 members have not signed on to this bill.
Show all 189 →"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.
Votes
Roll Call, requested by Senator Collamore, Passed -- Needed 15 of 30 to Pass -- Yeas = 17, Nays = 13
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Democrat/Progressive | 3 | 0 | 0 | 0 |
| Democrat | 10 | 0 | 0 | 0 |
| Republican | 1 | 13 | 0 | 0 |
| Unaffiliated | 2 | 0 | 0 | 0 |
| Progressive/Democrat | 1 | 0 | 0 | 0 |
| Total | 17 | 13 | 0 | 0 |
| % of votes cast | 57% | 43% | 0% | 0% |
How each member voted (30)
| Member | Party | Vote |
|---|---|---|
| White | — | Yea |
| Ram Hinsdale | — | Yea |
| Alison Clarkson | Democrat | Yea |
| Ann E Cummings | Democrat | Yea |
| Joseph "Joe" D Major | Democrat | Yea |
| Martine Larocque L Gulick | Democrat | Yea |
| Nader A Hashim | Democrat | Yea |
| Robert Plunkett | Democrat | Yea |
| Ruth E Hardy | Democrat | Yea |
| Seth Bongartz | Democrat | Yea |
| Thomas I Chittenden | Democrat | Yea |
| Virginia "Ginny" V Lyons | Democrat | Yea |
| Andrew J Perchlik | Democrat/Progressive | Yea |
| Anne E Watson | Democrat/Progressive | Yea |
| Philip E Baruth | Democrat/Progressive | Yea |
| Tanya C Vyhovsky | Progressive/Democrat | Yea |
| Brian P Collamore | Republican | Nay |
| Christopher P Mattos | Republican | Nay |
| David H Weeks | Republican | Nay |
| Jim F Harrison | Republican | Yea |
| John Benson | Republican | Nay |
| John S Morley III | Republican | Nay |
| Patrick "Pat" M Brennan | Republican | Nay |
| Randy D Brock | Republican | Nay |
| Richard A Westman | Republican | Nay |
| Robert W Norris | Republican | Nay |
| Russ H Ingalls | Republican | Nay |
| Scott L Beck | Republican | Nay |
| Steven Heffernan | Republican | Nay |
| Terry K Williams | Republican | Nay |
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Democrat | 73 | 1 | 0 | 9 |
| Republican | 4 | 40 | 0 | 7 |
| Unaffiliated | 3 | 1 | 0 | 1 |
| Progressive/Democrat | 3 | 0 | 0 | 0 |
| Independent | 4 | 0 | 0 | 1 |
| Republican/Democrat | 0 | 2 | 0 | 1 |
| Total | 87 | 44 | 0 | 19 |
| % of votes cast | 58% | 29% | 0% | 13% |
How each member voted (150)
| Member | Party | Vote |
|---|---|---|
| Casey | — | Yea |
| White | — | Yea |
| White | — | Yea |
| Hooper | — | Nay |
| Casey | — | Not Voting |
| Abbey Duke | Democrat | Yea |
| Alice M. M Emmons | Democrat | Yea |
| Alyssa Black | Democrat | Yea |
| Amy D Sheldon | Democrat | Yea |
| Angela Arsenault | Democrat | Yea |
| Barbara Rachelson | Democrat | Not Voting |
| Bram Kleppner | Democrat | Yea |
| Brian Minier | Democrat | Yea |
| Bridget M Burkhardt | Democrat | Yea |
| Carol Ode | Democrat | Yea |
| Charles A Kimbell | Democrat | Yea |
| Chea Waters Evans | Democrat | Yea |
| Christopher Morrow | Democrat | Yea |
| Daisy Berbeco | Democrat | Yea |
| Daniel A Noyes | Democrat | Yea |
| Dara Torre | Democrat | Yea |
| David K Durfee | Democrat | Yea |
| David W Yacovone | Democrat | Yea |
| Doug Bishop | Democrat | Yea |
| Edward "Teddy" Waszazak | Democrat | Yea |
| Edye Graning | Democrat | Yea |
| Ela Chapin | Democrat | Yea |
| Elizabeth L Burrows | Democrat | Yea |
| Emilie K Kornheiser | Democrat | Yea |
| Emilie Krasnow | Democrat | Yea |
| Emily Carris Duncan | Democrat | Yea |
| Emily J Long | Democrat | Yea |
| Emily J Long | Democrat | Nay |
| Erin Brady | Democrat | Yea |
| Esme Cole | Democrat | Not Voting |
| Gayle S Pezzo | Democrat | Yea |
| Golrang "Rey" Garofano | Democrat | Not Voting |
| Herb Olson | Democrat | Yea |
| Ian Goodnow | Democrat | Yea |
| James W Masland | Democrat | Yea |
| Jill L Krowinski | Democrat | Not Voting |
| John K O'Brien | Democrat | Not Voting |
| John L Bartholomew | Democrat | Yea |
| Jonathan Cooper | Democrat | Yea |
| Jubilee McGill | Democrat | Yea |
| Karen Lueders | Democrat | Yea |
| Karen N Dolan | Democrat | Yea |
| Kate Lalley | Democrat | Not Voting |
| Kate McCann | Democrat | Yea |
| Kate Nugent | Democrat | Yea |
| Kathleen C James | Democrat | Yea |
| Kevin "Coach" B Christie | Democrat | Not Voting |
| Kevin P Scully | Democrat | Yea |
| Kristi C Morris | Democrat | Yea |
| Larry Satcowitz | Democrat | Yea |
| Leanne Harple | Democrat | Yea |
| Leonora Dodge | Democrat | Not Voting |
| Leslie Goldman | Democrat | Yea |
| Lori Houghton | Democrat | Yea |
| Lucy Boyden | Democrat | Yea |
| Marc B Mihaly | Democrat | Yea |
| Martin J LaLonde | Democrat | Yea |
| Mary E. E Howard | Democrat | Yea |
| Mary-Katherine A Stone | Democrat | Yea |
| Matthew J Birong | Democrat | Yea |
| Michael Mrowicki | Democrat | Yea |
| Michael N Hoyt | Democrat | Yea |
| Michael Nigro | Democrat | Not Voting |
| Michelle Bos-Lun | Democrat | Yea |
| Mollie S. S Burke | Democrat | Yea |
| Monique Priestley | Democrat | Yea |
| Peter C Conlon | Democrat | Yea |
| Phil Pouech | Democrat | Yea |
| R. Scott Campbell | Democrat | Yea |
| Rebecca Holcombe | Democrat | Yea |
| Robert Hunter | Democrat | Yea |
| Robin P Scheu | Democrat | Yea |
| Sarah "Sarita" C Austin | Democrat | Yea |
| Saudia LaMont | Democrat | Yea |
| Shawn Sweeney | Democrat | Yea |
| Theresa A Wood | Democrat | Yea |
| Thomas S Stevens | Democrat | Yea |
| Tiffany Bluemle | Democrat | Yea |
| Timothy R. R Corcoran II | Democrat | Yea |
| Trevor J Squirrell | Democrat | Yea |
| Wendy A Critchlow | Democrat | Yea |
| William "Will" Greer | Democrat | Yea |
| Zon Eastes | Democrat | Yea |
| Anne B. B Donahue | Independent | Yea |
| Jed Lipsky | Independent | Yea |
| Joseph Parsons | Independent | Not Voting |
| Laura H Sibilia | Independent | Yea |
| Troy Headrick | Independent | Yea |
| Brian J Cina | Progressive/Democrat | Yea |
| Chloe Tomlinson | Progressive/Democrat | Yea |
| Kate Logan | Progressive/Democrat | Yea |
| Allen "Penny" R Demar | Republican | Nay |
| Anthony "Tony" Micklus | Republican | Yea |
| Beth M Quimby | Republican | Nay |
| Brenda Steady | Republican | Nay |
| Carolyn W Branagan | Republican | Nay |
| Chris A Taylor | Republican | Nay |
| Chris Brown | Republican | Yea |
| Chris Keyser | Republican | Nay |
| Christopher "Chris" A Pritchard | Republican | Nay |
| Christopher Howland | Republican | Nay |
| David "Dave" Bosch | Republican | Nay |
| David J Soucy | Republican | Nay |
| Deborah "Debbie" C Dolgin | Republican | Nay |
| Debra L Powers | Republican | Nay |
| Eileen G Dickinson | Republican | Nay |
| Eric Maguire | Republican | Not Voting |
| Gina M Galfetti | Republican | Nay |
| Gregory "Greg" Burtt | Republican | Not Voting |
| Jack H Brigham | Republican | Nay |
| James A Gregoire | Republican | Nay |
| John Kascenska | Republican | Nay |
| Joseph "Joe" Luneau | Republican | Nay |
| Joshua Dobrovich | Republican | Nay |
| Kenneth "Ken" L Wells | Republican | Not Voting |
| Kenneth W Goslant | Republican | Nay |
| Kevin C Winter | Republican | Not Voting |
| Larry Labor | Republican | Nay |
| Leland J Morgan | Republican | Not Voting |
| Lisa A Hango | Republican | Nay |
| Mark A Higley | Republican | Nay |
| Martha A Feltus | Republican | Yea |
| Mary A. A Morrissey | Republican | Nay |
| Matt E Walker | Republican | Not Voting |
| Michael "Mike" Southworth | Republican | Nay |
| Michael "Mike" Tagliavia | Republican | Nay |
| Michael Boutin | Republican | Nay |
| Michael J Marcotte | Republican | Nay |
| Michael R Morgan | Republican | Nay |
| Patricia A McCoy | Republican | Nay |
| Richard J Bailey | Republican | Nay |
| Richard M Nelson | Republican | Nay |
| Rob North | Republican | Yea |
| Sandra "Sandy" H Pinsonault | Republican | Not Voting |
| Thomas "Tom" F Charlton | Republican | Nay |
| Thomas B Burditt | Republican | Nay |
| Todd Nielsen | Republican | Nay |
| VL L Coffin IV | Republican | Nay |
| Wayne A Laroche | Republican | Nay |
| William P Canfield | Republican | Nay |
| Woodman H Page | Republican | Nay |
| Zachary J Harvey | Republican | Nay |
| Alicia Malay | Republican/Democrat | Not Voting |
| Ashley R Bartley | Republican/Democrat | Nay |
| Thomas Oliver | Republican/Democrat | Nay |
| Party | Yea | Nay | Present | Not Voting |
|---|---|---|---|---|
| Democrat/Progressive | 3 | 0 | 0 | 0 |
| Republican | 8 | 6 | 0 | 0 |
| Democrat | 10 | 0 | 0 | 0 |
| Unaffiliated | 2 | 0 | 0 | 0 |
| Progressive/Democrat | 0 | 0 | 0 | 1 |
| Total | 23 | 6 | 0 | 1 |
| % of votes cast | 77% | 20% | 0% | 3% |
How each member voted (30)
| Member | Party | Vote |
|---|---|---|
| White | — | Yea |
| Ram Hinsdale | — | Yea |
| Alison Clarkson | Democrat | Yea |
| Ann E Cummings | Democrat | Yea |
| Joseph "Joe" D Major | Democrat | Yea |
| Martine Larocque L Gulick | Democrat | Yea |
| Nader A Hashim | Democrat | Yea |
| Robert Plunkett | Democrat | Yea |
| Ruth E Hardy | Democrat | Yea |
| Seth Bongartz | Democrat | Yea |
| Thomas I Chittenden | Democrat | Yea |
| Virginia "Ginny" V Lyons | Democrat | Yea |
| Andrew J Perchlik | Democrat/Progressive | Yea |
| Anne E Watson | Democrat/Progressive | Yea |
| Philip E Baruth | Democrat/Progressive | Yea |
| Tanya C Vyhovsky | Progressive/Democrat | Not Voting |
| Brian P Collamore | Republican | Nay |
| Christopher P Mattos | Republican | Yea |
| David H Weeks | Republican | Nay |
| Jim F Harrison | Republican | Yea |
| John Benson | Republican | Yea |
| John S Morley III | Republican | Yea |
| Patrick "Pat" M Brennan | Republican | Yea |
| Randy D Brock | Republican | Nay |
| Richard A Westman | Republican | Yea |
| Robert W Norris | Republican | Nay |
| Russ H Ingalls | Republican | Nay |
| Scott L Beck | Republican | Yea |
| Steven Heffernan | Republican | Yea |
| Terry K Williams | Republican | Nay |
Subjects
Frequently asked questions
- Who sponsors S 190?
- S 190 is sponsored by Virginia "Ginny" V Lyons (Democrat).
- What is the current status of S 190?
- This bill has been sent to the executive. Introduced January 06, 2026. It awaits signature.
- Where can I track S 190?
- Track S 190 free on One Click Politics — get push/email alerts when it moves.
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