Commercial Sector Pricing Program for All Vermont Hospitals

Agency:	State of Vermont
State:	Vermont
Type of Government:	State & Local
NAICS Category:	236220 - Commercial and Institutional Building Construction 541611 - Administrative Management and General Management Consulting Services 541618 - Other Management Consulting Services
Posted Date:	Jan 7, 2026
Due Date:	Jan 28, 2026
Original Source:	Please Login to View Page
Contact information:	Please Login to View Page
Bid Documents:	Please Login to View Page

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Department of Buildings and General Services

Agency of Administration

Office of Purchasing & Contracting

133 State Street, 5th Floor | Montpelier VT 05633-8000

802-828-2211 phone |802-828-2222 fax

http://bgs.vermont.gov/purchasing

SEALED BID

REQUEST FOR PROPOSAL

DEVELOPMENT AND IMPLEMENTATION OF A

COMMERCIAL SECTOR REFERENCE-BASED

PRICING PROGRAM FOR ALL VERMONT HOSPITALS

ISSUE DATE

QUESTIONS DUE

RESPONSES TO QUESTIONS POSTED

RFP RESPONSES DUE BY

December 10, 2025

December 22, 2025 – 4:30 PM EST

January 7, 2026 – 4:30 PM EST

January 28, 2026 – 4:30 PM EST

PLEASE BE ADVISED THAT ALL NOTIFICATIONS, RELEASES, AND ADDENDUMS ASSOCIATED

WITH THIS RFP WILL BE POSTED AT:

http://www.bgs.state.vt.us/pca/bids/bids.php

THE STATE WILL MAKE NO ATTEMPT TO CONTACT INTERESTED PARTIES WITH UPDATED

INFORMATION. IT IS THE RESPONSIBILITY OF EACH BIDDER TO PERIODICALLY CHECK THE

ABOVE WEBPAGEFOR ANY AND ALL NOTIFICATIONS, RELEASES AND ADDENDUMS

ASSOCIATED WITH THIS RFP.

STATE CONTACT: Kyle Emerson, State Purchasing Agent

E-MAIL:

sov.thepathforward@vermont.gov

USE SUBJECT: HOSPITAL PRICING PROGRAM

1. OVERVIEW:

1.1. SCOPE AND BACKGROUND: Through this Request for Proposal (RFP) the Green Mountain Care

Board (hereinafter the “State”) is seeking to establish contracts with one or more companies to

provide Development and Implementation of a Commercial Sector Reference-Based Pricing

Program for All Vermont Hospitals.

1.2. CONTRACT PERIOD: Any Contract(s) arising from this RFP will be for a period of twelve months

with an option to renew for up to four additional twelve-month periods. The State anticipates the

start date for such contracmayt(s) will be March 16, 2025.

1.3. SINGLE POINT OF CONTACT: All communications concerning this RFP are to be addressed in

writing to the State Contact listed on the front page of this RFP. Actual or attempted contact with

any other individual from the State concerning this RFP is strictly prohibited and may result in

disqualification.

1.4. BIDDERS’ CONFERENCE: A bidders’ conference will not be held remotely at the date and time

indicated on the front page of this RFP.

1.5. QUESTION AND ANSWER PERIOD: Any bidder requiring clarification of any section of this RFP

or wishing to comment on any requirement of the RFP must submit specific questions in writing no

later than the deadline for question indicated on the first page of this RFP. Questions may be e-

mailed to the point of contact on the front page of this RFP. Questions or comments not raised in

writing on or before the last day of the question period are thereafter waived. At the close of the

question period a copy of all questions or comments and the State's responses will be posted on

the State’s web site http://www.bgs.state.vt.us/pca/bids/bids.php . Every effort will be made to post

this information as soon as possible after the question period ends, contingent on the number and

complexity of the questions. All information provided by vendors during this process will be public

and bidders shall not provide confidential information, except as described in 4.1 below.

1.6. CHANGES TO THIS RFP: Any modifications to this RFP will be made in writing by the State

through the issuance of an Addendum to this RFP and posted online at

http://www.bgs.state.vt.us/pca/bids/bids.php . Modifications from any other source are not to be

considered.

1.7. SOURCE OF FUNDS:

This project may be funded in whole or in part using federal monies. If a bidder requires assistance in

preparing their proposal or needs guidance on socioeconomic certifications, the bidder may contact

the VT APEX Accelerator. The APEX Accelerator specializes in helping small businesses navigate

the documentation associated with State and Federal procurement. Their website is:

http://apex.vermont.gov.

2. DETAILED REQUIREMENTS/DESIRED OUTCOMES: The State of Vermont is interested in obtaining bids

to meet the following business need(s):

2.1 PROJECT OVERVIEW

The Green Mountain Care Board (GMCB) seeks proposals from qualified vendors to support the design,

development, and implementation of Vermont’s Reference-Based Pricing (RBP) program. This program

will establish fair, transparent, and sustainable hospital payment levels through benchmarking services to

a defined reference point (e.g., Medicare rates, regional benchmarks, or other methodologies).

The selected vendor will be responsible for developing, testing, and refining a statewide, commercial-payer

methodology implemented through the GMCB’s rate-setting authority that will serve as an input to the

annual hospital budget review process beginning in hospital fiscal year 2028. This work will include

comprehensive financial impact modeling, safeguards to ensure savings flow to Vermonters, mechanisms

to monitor and prevent unintended distortions (such as service shunting or site-of-care shifting), and options

for enforcement.

Alongside producing a defensible and data-driven methodology, the vendor must deliver transparent and

reusable analytic processes and products, provide training and technical assistance to GMCB staff, and

ensure the capacity for ongoing refinement and repricing of services in response to Board direction,

stakeholder feedback, policy developments, or new data. The ultimate goals are to build a documented,

efficient, reusable, and adjustable process to examine overall healthcare costs vis-a-vis access to essential

services and quality care.

2.2 SCOPE OF SERVICES

The selected vendor(s) will be responsible for proposing and executing a comprehensive project plan to

achieve the following to the greatest extent practicable. Additionally, proposals must include:

• Narrative and Rationale. A written narrative that demonstrates understanding of Vermont’s statutory

and policy context, including Act 68 and the GMCB’s hospital budget authority, and explains how the

proposed plan advances fairness, predictability, and sustainability in hospital payment reform.

• Content Area Expertise. Clear documentation of prior experience in developing and implementing

payment reform models, with particular emphasis on Medicare reference-based pricing, hospital

budgeting, or all-payer regulatory environments. Staff expertise in policy, data analytics, financial

modeling, and stakeholder engagement must be highlighted.

• Experience with Vermont or Comparable States. Evidence of collaboration with Vermont officials

or other state entities on payment reform, delivery system transformation, or affordability initiatives.

Familiarity with Vermont’s healthcare market, including rural hospital dynamics and payer mix, should

be emphasized.

• Excluded or Deferred Work Items. Identification of any scope elements not included in the

proposed project plan, with justification for their exclusion and an explanation of how exclusions will

not compromise achievement of the program’s goals and objectives.

Proposal Domains and Project Elements

A. Reference-Based Pricing (RBP) Rate-Setting Methodological Development

This section of the proposal should detail the Vendor(s) approach to develop a statewide, commercial-

market reference-based pricing (RBP) data model and benchmarking methodology, capable of examining

the data by hospital and by service, using relevant data sources (one example: VHCURES, Vermont’s All-

Payer Claims Database). The benchmarking methodology will be codified through rulemaking and must be

enforceable, defensible, and consistent across years.

Beginning on April 1, 2027, the GMCB intends to annually determine and publish guidance detailing

payment thresholds and the underlying reimbursement benchmarking methodology used to establish

maximum allowable rates for Vermont inpatient and outpatient hospital services.

1) Proposed workplans and outputs should incorporate the following:

a) Vendor(s) will be expected to develop hospital benchmarking methodology and requirements,

which will determine the maximum rate a Vermont hospital can charge for inpatient (DRG-based)

and outpatient (APC-based) services, including carrier contracted payment rates and any

applicable member cost-sharing, expressed as a percentage of what Medicare would have

reimbursed for the same or similar service, or other appropriate reimbursement benchmarking

methodology.

b) Vendor(s) will be expected to provide a strategic theory of change, process map, timeline, and

steps required to implement a successful RBP strategy that integrates GMCB’s regulatory levers.

c) Vendor(s) will be expected to produce explicit logic for service definitions, code mappings, and

outlier handling (e.g., CPT, HCPCS, APC, DRG, revenue codes). Vendors may propose

alternative approaches but must provide reproducible code sets, mapping tables, handling of

missing data from VHCURES, and validation results against sample claims.

d) Vendor(s) will be expected to pre-specify and document key analytics choices (e.g., weights,

case-mix adjustment, trimming rules) and justify them in relation to policy objectives. Variations

may be proposed but must be transparent and reproducible.

e) Vendor(s) will be expected to allow stakeholders to offer written comments on draft RBP

methodology and rate models. This will include providing responses to comments/explanations to

stakeholders of whether and how feedback was incorporated or not, with stated rationale.

f) Vendor(s) will be expected to identify and recommend evidence-based strategies to measure and

improve quality outcomes as part of the RBP methodology, including alignment with existing

GMCB quality metrics.

g) Vendor(s) will be expected to propose a range of policy options and economic incentives as part

of the rate-setting methodology (e.g., quality payment withholds, requiring investments in a

population health fund, innovative technology add-ons). This should contemplate a sustainable

pathway towards hospital global budgets.

h) Vendor(s) will be expected to articulate and document assumptions for draft benchmarking

methodology rates that are subject to policy decisions and would have a substantial impact on

final rate amounts, and what the range of fiscal impact is associated with those changes (e.g.,

what are ranges of reasonable assumptions for wages, staff ratios, etc.).

B. Enforcement, Compliance, and Monitoring Approach

This section should detail the Vendor(s) conceptual framework, deliverables, and timeline to develop an

integrated framework for enforcement and compliance monitoring of the RBP benchmarking methodology

across GMCB’s annual insurer rate review and hospital budget review processes.

1) Propose detailed technical specifications, policy manuals, statistical process controls and or options for

annual monitoring and enforcement measurement, including whether and how reliance on payer-

submitted data is feasible, what supplemental sources are required, and how the State will independently

verify compliance with annual RBP benchmarking methodology.

2) Develop methods to detect and remediate hospital behavior that undermines affordability (and quality and

access) and propose specific enforcement triggers and a range of corrective actions. Analytic methods

should include but are not limited to the following anticipated strategic responses:

a) Service shunting (e.g., reducing low-priced services while expanding high-priced services)

b) Site-of-care shifting (e.g., moving services to higher-priced hospital outpatient departments); and,

c) Coding or case-mix distortions (e.g., upcoding, DRG creep).

(1) Develop and propose concrete detection methods for coding and case-mix distortions,

including baseline profiling of historical coding intensity, peer and statewide comparisons,

and statistical tools to flag abnormal DRG/CPT shifts. Proposals must define thresholds for

triggering audits or enforcement actions.

C. Financial Impact Analysis

This section should detail the Vendor(s) modeling capabilities to estimate and refine the financial impact on

hospital operating margins under a portfolio of design choices for the RBP benchmarking methodology

(e.g., applying Medicare thresholds only to a subset of high-priced hospitals, phasing in differential RBP

thresholds, cross-subsidizing services).

1) Analyze and estimate hospital, payer, and systemwide financial impacts using robust modeling. This must

include counterfactual baselines, hospital behavioral scenarios (e.g., volume responses, service mix shifts),

and explicit uncertainty intervals. Analyses must link hospital-level savings to expected impacts on

premiums and out-of-pocket spending under multiple scenarios. The assessment should incorporate a

portfolio of simulations that capture:

a) Mechanical impacts (baseline repricing).

b) Behavioral impacts (hospital and payer strategic responses).

c) System stress tests (access, equity, and consolidation).

D. Deliverables and Timeline

This section should detail a clear project timeline with milestones and deliverables reflecting the proposed

scope of services under Domains A - C, culminating in a finalized RBP methodology suitable for inclusion

in Fiscal Year 2028 Hospital Budget Guidance issued in March 2027.

1) All final price schedules, hospital-level standardized price tables, and code must be released in machine-

readable formats alongside a public methodological appendix that documents all key decisions,

justification, diagnostics, and sensitivity results. The proposal must detail how the vendor requires access

to information and data retained by the State of Vermont.

2) Key dates to include in the proposed project timeline:

a) Proposed RBP rule: Wednesday, April 29, 2026

b) Final RBP rule (adopted, filed, and enacted): Monday, November 2, 2026

c) Final Hospital Budget Guidance with incorporated benchmarking methodology: Wednesday,

March 17, 2027

3) General Requirements

a) Perform the scope of services described in each domain as included in the Vendor’s proposal

submission.

b) Provide interim reports, presentations, and draft materials to GMCB staff at key points in the

project for review and feedback.

c) Collaborate with and take direction from GMCB personnel assigned to any project awarded to the

Vendor(s).

d) The Contractor agrees all digital products, services, and content provided under this Contract

shall comply with Section 504 Rehabilitation Act of 1973 and Title II of the Americans with

Disabilities Act of 1990 (28 CFR Part 35), which requires adherence to the World Wide Web

Consortium (WC3) Web Content Accessibility Guidelines Version 2.1 Conformance Levels A and

AA or higher, and all applicable standards, orders and regulations issued or adopted thereunder.

The Contractor shall certify compliance annually throughout the term of this Contract. Upon

request, the Contractor shall provide documentation of compliance and promptly remediate any

accessibility barriers at no additional cost to the State.

4) Vendor(s) will be held to modern reproducibility standards for all deliverables and analytics, which

include:

a) Transparent Data Practices

b) Open and Documented Code

c) Methodological Rigor

d) Independent Verification

e) Adherence to FAIR (Findable, Accessible, Interoperable, and Reusable) Principles

3. GENERAL REQUIREMENTS:

3.1. PRICING: Bidders must price the terms of this solicitation at their best pricing. Any and all costs that

Bidder wishes the State to consider must be submitted for consideration. If applicable, all equipment

pricing is to include F.O.B. delivery to the ordering facility. No request for extra delivery cost will be

honored. All equipment shall be delivered assembled, serviced, and ready for immediate use,

unless otherwise requested by the State.

3.1.1.Prices and/or rates shall remain firm for the initial term of the contract. The pricing policy

submitted by Bidder must (i) be clearly structured, accountable, and auditable and (ii) cover the full

spectrum of materials and/or services required.

3.1.2.Cooperative Agreements. Bidders that have been awarded similar contracts through a

competitive bidding process with another state and/or cooperative are welcome to submit the

pricing in response to this solicitation.

3.2. STATEMENT OF RIGHTS: The State shall have the authority to evaluate Responses and select the

Bidder(s) as may be determined to be in the best interest of the State and consistent with the goals

and performance requirements outlined in this RFP. The State of Vermont reserves the right to

obtain clarification or additional information necessary to properly evaluate a proposal. Failure of

bidder to respond to a request for additional information or clarification could result in rejection of that

bidder's proposal. To secure a project that is deemed to be in the best interest of the State, the State

reserves the right to accept or reject any and all bids, in whole or in part, with or without cause, and

This page summarizes the opportunity, including an overview and a preview of the attached documents.

TITLE	QUESTIONS DUE	ANSWERS POSTED	DUE DATE	NO POSTING AFTER
Commercial Sector Pricing Program for All Vermont Hospitals	12/22/2025 04:30PM	Q&A - GMCB Pricing Program. (01/07/2026)	01/28/2026 04:30PM

Commercial Sector Pricing Program for All Vermont Hospitals

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