Legislative Update

Devon Green, VP of Government Relations

Last week, I attended a press conference of health care providers and patient advocates supporting prior authorizations and step therapy reform in H.766 (spotlighted in this week’s Update). After Bob Kinzel’s first question, I briefly wondered if anyone would feel hesitant about going to the podium. Instead, every provider jumped at the chance to answer. The passion was palpable. If you have a chance, engage with any health care providers in your life on their experiences around prior authorizations and bureaucratic processes—they have a lot to say, and they’re hoping for action now.

Prior Authorization and Administrative Reform: The Senate Health and Welfare Committee continued to hear from witnesses on H.766, the bill that aligns prior authorizations with Medicaid, expands patient protections for step therapy, and aligns claims edits with Medicare. Mark-ups to the bill are scheduled for this week. 

Data Privacy: At the Senate Committee on Economic Development, Housing and General Affairs, VAHHS joined the health care association coalition in requesting an entity-level exemption from H.121, a state data privacy bill. Separate but different requirements data privacy requirements along with HIPAA diminishes our larger effort to reduce administrative costs and confusion.

Emergency Medical Services Support: The Senate Health and Welfare Committee heard about H.622, which bolster’s Vermont’s EMS, including:

• $74,000 in Global Commitment funds for Medicaid to reimburse treatment without transport

• $150,000 to support the EMS Advisory Committee in developing a five-year statewide plan for coordinated delivery

• $300,000 for training

Reference-Based Pricing: On Friday afternoon, the Senate Government Operations Committee approved allocating $15,000 towards studying reference-based pricing options for the state employee and teacher health insurance plans. Reference-based pricing reimburses hospitals as a percentage of Medicare. The committee heard from the State Auditor’s Office, Vermont-NEA, Vermont State Employees Association, and VAHHS. VAHHS testified that hospitals want to help solve for rising costs, but we also can’t analyze a fee-for-service initiative separate from the current global budget and hospital transformation recommendations under Act 167. Chair Hardy noted that the proposed language would not work for the Joint Fiscal Office and agreed that a study should incorporate other health care reform efforts and will come back with an updated proposal.

GMCB Hospital Budget 2023 Actuals Update: The Green Mountain Care Board updated the House Health Care Committee on their hospital budget process and FY 2023 hospital budget actuals. The Committee discussed contributing factors to rising costs, including workforce, and asked if net patient services revenue was the right measurement moving forward. The Green Mountain Care board acknowledged complications in switching measurements due to patient choice.  

Peer Support Provider and Peer Recovery Support Specialists Certification: The Senate Health and Welfare Committee advanced H. 847, a bill that peer support certification for those with lived experience with trauma, mental health, or substance use challenges to assist individuals with health and wellness supports, accessing community resources and navigating State and local systems, employment supports, and empowerment. This certification will allow peer support providers and peer recovery specialists to bill Medicaid. VAHHS is supportive of the bill, which provides a framework for more peer support resources to help those in mental health crisis or dealing with substance use disorder.

Doula Regulation: The House Health Care Committee advanced S.109, which has the Office of Professional Regulation conduct a sunrise review with recommendations on how to regulate doulas, reimbursement, and health care coverage recommendations.