Devon Green, VP of Government Relations, VAHHS
The start of the session always feels like going back to school, and even more so during a new biennium. With new committees come introductory and refresher courses on Medicaid, health insurance, and Vermont’s health care system. In our Vermont Hospitals 101 presentation last week, we introduced some of the VAHHS and hospital initiatives we’re undertaking to address affordability and access.
We also made the point that while we know hospitals need to do more, we cannot do affordability work alone—all areas of health care and health care coverage must be examined. For instance, in New York, the only other state besides Vermont that has pure community rating, counties with comparative populations have a choice of 27 bronze health care plans ranging from $500 to $850 in premiums while Vermont has 7 bronze plans ranging from $800-$900.
Are there ways to address affordability in our health insurance plan designs? Legislators must ensure that all facets of affordability and access are examined during the upcoming session.
With that, let’s turn to everything else that happened last week in the legislature:
Budget Adjustment Proposal: The Scott Administration rolled out its budget adjustment proposal for FY2025. This bill makes adjustments to the current year’s budget. Noted health care-related proposals include:
- $2M increase for health care transformation contracts as a continuation of Act 167
- One-time funding of $4M for additional hospital to participate in hospital global Medicaid payments and for “tail claims” of hospitals that are already participating
- $78.8M to the Medicaid consensus caseload and utilization
- $21M to anticipated nursing home emergency financial relief
- $24.4M increase for nursing home bed days utilization
Prior Authorization and Claims Edits: Health insurers noted that some technical corrections were needed to last year’s Act 111 regarding prior authorizations and claims edits. The bill, H. 31, proposes that the new claims edits standards do not apply to care provided outside of Vermont and clarifies the definition of primary care provider as a health care provider who is contracted and enrolled with the health plan as a primary care provider.
Reference-Based Pricing: The Vermont National Education Association and Vermont State Employees’ Association advocated for reference-based pricing in the House Education Committee based on the findings of the Green Mountain Care Board’s report. The report finds substantial savings in cutting reimbursements but does not detail the impact to patient access or health care provider sustainability. The House Education Committee chair noted that any further discussion on reference-based pricing would take place in the House Health Care Committee.
1.21.2025. Vermont Association of Hospitals & Health Systems
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