Legislative Update
Devon Green, VP of Government Relations
After years of studies and small pilots on prior authorization, the Senate passed H.766, a bill that provides incremental but very real reform. A last-minute amendment changed H.766 from aligning prior authorizations with Medicaid to eliminating prior authorizations for primary care providers. To misquote Joe Biden’s reaction when the Affordable Care Act passed: this is a big deal. Needless delays caused by prior authorizations drive patients away from primary care and toward emergency departments. Reducing administrative burden will not only result in better care but will also help recruit and retain the primary care providers we so desperately need. A huge thank you to Sen. Ginny Lyons and the Senate Health and Welfare Committee along with Sen. Jane Kitchel for coming up with a compromise to keep the bill alive. And many thanks to all of the providers and patients who have reached out to legislators with their stories. Please take a moment to thank your delegation for supporting this bill—click here to look up the emails of your local legislators.
Prior Authorization Reform and Administrative Simplification: H.766 also includes:
Allowing patients to request an exemption from step therapy if their current medication is already working for them
No prior authorization for asthma controller medication
Aligning insurance claims edits to Medicare (with the exception of pharmacy)
Time limits for prior authorization, including 24 hours for urgent prior authorizations, 2 business days for nonurgent prior authorizations, no prior auth renewals over course of treatment or one year, whichever longer, with limit of 5 years
Provide notice of policy or manual changes 60 days prior to effective date and right to object
Budget: The Senate also passed the budget, H.883 with a vote of 26-2. The next step is a committee of conference to align the differences between the House and Senate versions. Several health care initiatives were included in the Senate bill:
$4.9 million to support skilled nursing facilities
$4.9 million in rates and rate incentives for the iCare facility in Bennington County
$9 million for a 3 percent increase for home and community-based providers
$1 million for start-up costs related to the youth psychiatric inpatient facility at Southwestern Vermont Medical Center
$3.5 million gross for a youth psychiatric residential treatment facility currently proposed at the Brattleboro Retreat
$560,000 for emergency non-medical transportation providers
$9.2 million for Medicaid hospital global budget pilot project at select hospitals
Medicaid Expansion: The Medicaid expansion bill has been moved over to the budget and stripped down to increasing the eligibility level for the Medicare Savings Program.
Telehealth Parity: The House concurred on S.189, the bill that makes reimbursement parity for all telehealth services, permanent. It now goes to the governor for his signature.
EMS: The Senate Government Operations Committee advanced H.622, the EMS bill. The committee made an amendment to require further coordination from the EMS advisory committee with other government entities to ensure system alignment. Next stop for the bill is Senate Finance and Senate Appropriations.