Legislative Update
Devon Green, VP of Government Relations
After making a big deal about S.151 being THE health care reform bill last week, S.211 and S.183 came out with major changes to government structures around health care. Such is the session—turns on a dime and keeps you on your toes.
Medicaid expansion: The House Health Care Committee heard a walkthrough of H.721, which would expand access to Medicaid by raising Dr. Dynasaur eligibility to age 26 and increasing income eligibility for adults to 312% by 2030. Primary care, mental health, substance use disorder, and long-term care providers would be reimbursed at a rate no lower than 125%. The bill also expands financial eligibility for Medicare Savings Programs which subsidize Medicare costs for older Vermonters.
Health care leadership and regulation: The Senate Health and Welfare Committee heard about S.211, a bill that partners the Agency of Human Services on policy initiatives and removes areas like workforce development and prior authorization from Green Mountain Care Board jurisdiction. It gives the Green Mountain Care Board the ability to pursue reference-based pricing or site-neutral payments. The bill also aligns enrollment and credentialing, quality measurements, and data collection to Medicare and works towards a single entity for health care data.
The Senate Government Operations Committee heard about a different bill, S.183, that creates a work group to develop a plan to move health care policy, planning, payment, and public health out of the Agency of Human Services and into a new entity— The Agency of Health Care Administration.
Workforce: Within the depths of S.211 is also an initiative for the Board of Nursing to establish a student nurse apprenticeship program.
Claims edits: “Claims edits” or “modifier to CPT codes” doesn’t usually elicit a lot of emotion, but hospital, independent, and FQHC representatives expressed frustration when testifying on commercial insurer claims edit and policy changes. Providers recounted the administrative burden of having to contest and resubmit claims, two-hour wait times on the phone when seeking assistance, and needing to hire extra staff to deal with the added administrative requirements. Shortly after, H.766 was released and includes:
patient protections for step therapy medication
standardizing claims edits to NCCI or other nationally recognized standards
limiting edit changes to once a year with 90 days advance notice
prohibiting pre-payment review
requiring clear communication of changes
clarifying that a new policy that impacts provider reimbursement is a change in contract
insurers collecting out of pocket costs
Act 167 hospital transformation and AHEAD model updates: Both health care committees heard updates from the Green Mountain Care Board and the Agency of Human Services on progress with Act 167 hospital transformation and hospital global budgets under the AHEAD model.