Amendment vs bill House Proposal of Amendment (UnofficialOpens in a new window) vs As Passed by Both House and Senate (UnofficialOpens in a new window)

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AS PASSED BY HOUSE AND SENATE S.190 Page 1 of 14 S.190 An act relating to reference-based pricing and the Green Mountain Care Board It is hereby enacted by the General Assembly of the State of Vermont:
HOUSE PROPOSAL OF AMENDMENT S.190 Page 1 of 14 S.190 An act relating to the Green Mountain Care Board, reference-based pricing, and studying the creation of a Public Employee Health Benefit Authority The House proposes to the Senate to amend the bill by striking out all after the enacting clause and inserting in lieu thereof the following:
(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.
(B) The Board shall utilize reference-based pricing to reduce hospital prices incrementally until they are equal to national median prices by hospital VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 2 of 14 type by calendar year 2030.
The Board shall use the highest quality, nonpartisan data demonstrating hospital prices as a percentage of Medicare to VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 2 of 14 evaluate progress toward reducing hospital prices in Vermont to the national median.
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.
The Board shall post its findings regarding the alignment between price decreases and premium decreases annually on its website.
The Board shall post its findings regarding the VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 3 of 14 alignment between price decreases and premium decreases annually on its website.
VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 3 of 14 (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.
(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.
(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 VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 4 of 14 services delivered at the main hospital campus or at any other off-campus hospital department.
(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 VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 4 of 14 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.
(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.
(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 VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 5 of 14 Medicare and Medicaid Services to establish baseline payment levels, which include adjustments for geographic factors such as wages.
VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 5 of 14 (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.
(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.
(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 VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 6 of 14 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.
(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 VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 6 of 14 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.
(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.
(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 VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 7 of 14 rate, by reducing its commercial reimbursement rates that are the highest in relation to the Medicare adjusted base rate.
VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 7 of 14 (f)(1) In its reviews of premium rates in accordance with 8 V.S.A.
(f)(1) In its reviews of premium rates in accordance with 8 V.S.A.
(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 VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 8 of 14 and Means and the Senate Committees on Health and Welfare and on Finance.
(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 VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 8 of 14 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.
* * * Excluding Reference-Based Pricing from Scope of Health Care Professional Bargaining * * * Sec.
VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 9 of 14 * * * Excluding Reference-Based Pricing from Scope of Health Care Professional Bargaining * * * Sec.
HEALTH CARE PROVIDER BARGAINING GROUPS VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 9 of 14 (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.
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.
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.
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 VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 10 of 14 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 VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 10 of 14 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.
(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.
* * * * * * Data Infrastructure * * * Sec.
* * * VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 11 of 14 * * * Data Infrastructure * * * Sec.
INTERACTIVE PRICE TRANSPARENCY DASHBOARD AND HEALTH SYSTEM PERFORMANCE TOOL VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 11 of 14 (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.
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.
(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.
VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 12 of 14 (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.
VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 12 of 14 Sec.
Sec.
7 of this act, only if the Board receives sufficient funding from the federal government or another source for this purpose.
8 of this act, only if the Board receives sufficient funding from the federal government or another source for this purpose.
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.
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 VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 13 of 14 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 VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 13 of 14 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.
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.
(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 VT LEG #390075 v.1 AS PASSED BY HOUSE AND SENATE S.190 Page 14 of 14 with ongoing hospital transformation efforts and the principles for health care reform expressed in 18 V.S.A.
VT LEG #389838 v.1 HOUSE PROPOSAL OF AMENDMENT S.190 Page 14 of 14 (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.
VT LEG #390075 v.1
and that after passage the title of the bill be amended to read:
“An act relating to reference-based pricing and the Green Mountain Care Board” VT LEG #389838 v.1