Legislative Update
Devon Green, VP of Government Relations
Once again, I am interrupting your regularly scheduled programming to write a love letter to Montpelier. Last week, the Valentine’s Day Phantom plastered the town with hearts. Just like the first snow of the year, it never loses its magic. Montpelier is everything from children getting a five-cent roll after school at Manghis Bread to running into a legislator while grabbing pizza, and I am so thankful to live and work here.
Reimbursement for Telehealth: The House Health Care Committee passed out a bill that makes reimbursement parity for audio/visual telehealth services permanent and proposes increasing audio-only from 75 percent of an in-person visit to full parity. VAHHS appreciates the House Health Care Committee’s recognition of the same reimbursement for the same expertise and providing greater patient choice by supporting telehealth in all its forms.
Health Insurer Administrative Simplification: The House Health Care Committee took up a new draft of H.766, which provides the following changes that VAHHS believes will go a long way to prevent provider burnout and improve care:
Step-therapy: grant exceptions to step-therapy protocols if the prescription drug required will cause an adverse reaction, is expected to be ineffective, or the insured has already tried the drug, the insured is stable on the current drug, or step-therapy will pose a barrier to adherence.
Claims edits: aligns claims edits standards for outpatient, professional services, facility claims, but not pharmaceutical or other claims. Prohibits prepayment reviews.
Prior authorizations: aligns prior authorizations to the greatest extent possible to Medicaid, except for prescription drugs, uncovered Medicaid services, or out-of-network services. For prescription drugs, prior authorizations will last for the course of therapy or one year, whichever is longer. For treatment that last longer than one year, no more frequently than once every five years.
Notice of policy changes: provide notice of a new policy, manual, or change in writing 60 days prior to the change and give opportunity for the health care provider to object.
Medicaid Reimbursement for EMS Services: The House Health Care Committee heard from witnesses on H.622, the EMS bill, which increases reimbursement for treatment without transport and non-emergency medical transportation. The Department of Vermont Health Access testified that Medicaid provides reimbursement for treatment without transport as of July 2023. The bill requires $31,200 in general fund to bring reimbursement up to 100% of the Medicare rate. The Department also claimed that it current covers alternative transport to the extent allowable under federal law. The House Health Care Committee will take up the question of reimbursement for treatment without transport in their budget discussions.
Medicare Advantage: The Senate Finance Committee heard from Dr. Aida Avidic and CEO and President Chris Dougherty from Brattleboro Memorial Hospital about how some Medicare Advantage plans deny end of life care or do not contract with skilled nursing facilities in Vermont, leaving patients unable to discharge. Although states are limited on how they can regulate Medicare Advantage plan, the committee is going to look at what options are available to them within S.230.
Psilocybin: The Senate Health and Welfare Committee took up S.114, a bill that removes criminal penalties for possessing, dispensing, or selling psilocybin and establishes a Psychedelic Advisory Working Group to make recommendations by November 15, 2024 regarding providers administering psychedelics in a therapeutic setting.