Responsibilities of the Department of Health Access (H.206) - April 20, 2023

The Senate Health and Welfare Committee heard testimonies on Thursday from various entities concerning H.206. The bill relates to the duties of the Department Vermont Health Access (DVHA), which was initially created in the House Health Care Committee back in February. Subsequently, reviewed by the House Appropriations Committee and then passed House sent to the Senate.

Ginger Irish (Director of Communications and Legislative Affairs, DVHA) testified along with Andrea DeLaBruere (Commissioner, DVHA). They provided additional information about the bill, referring to a section that addressed dental procedures for individuals served on the Community Rehabilitation and Treatment and Developmental Disability Services that allows for payment of emergency dental services beyond the dental cap. They supported the language, with an effort to expand access for vulnerable Vermonters.

Irish then spoke to a section that addressed changes to the Federal Medicaid Act requirements surround insurance authorization. The changes would assist Vermont Medicaid by streamlining "recovery" from primary health insurers, increasing third-party liability collections, and ensuring compliance with new requirements. Another section addresses adding addition access to the Vermont Prescription Monitoring System that DHVA uses to review statewide prescription trends to support patient safety. Their Department supports that provision of the bill.

Finally, Irish discussed a section that would allow DVHA to continue its collaboration with Bi-State Primary Care Association to develop a "mutually agreeable" alternative payment methodologies, which they also supported.

Mike Fisher (Chief Health Care Advocate) testified next. His office supported H.206, particularly the provisions relating to Medicaid coverage for adult dental services. He stressed that access to dental services continues to be one of the "more pressing challenges for Vermonters on Medicaid in need of care." He also stated that, coupled with the provider rate increase,  this year’s budget represents a "real attempt" to improve access.

He also supported the elimination of the Medicaid dental cap for individuals in the Community Rehabilitation and Treatment program and those in the Developmental Disability Services programs. Further, Fisher supported codifying the elimination of the cap for those beneficiaries who are pregnant or in the postpartum eligibility period. However, he described the proposed increase in the cap from $1,000 to $1,500 as the "bare minimum increase necessary" to assure people on Medicaid are not "harmed by the increase in provider rates." Ultimately, their position is that the dental cap "should be eliminated."

Mary Kate Mohlman (Director of Public Policy, Bi-State Primary Care Association) testified next. Her organization represents Vermont’s federally qualified health centers (FQHCs), and they are requesting an amendment to the bill. First, they wished to clarify the relationship between an alternative payment methodology (APM) and the Prospective Payment System (PPS) for FQHCs as established in federal statute. Second, she stated that their conversation with DVHA began in Feb. 2022, with the goal of including the updated payment methodology in the FY2024 budget, and that has not yet occurred. She stated that their members need assurance that the updated payment methodology will be in place by the next calendar year, as the updated reporting would ensure both parties, Bi-State and DVHA would be held accountable for that timeline.

She concluded that a mutually agreeable alternative payment methodology for Medicaid payments to the FQHCs should available in December of this year (so that providers know what to expect in 2024). They would provide a progress report on the development of the methodology to the appropriate legislative committees. Mohlman further clarified that the alternative payment methodology would ensure that FQHC's would be compensate "at least equal" to the amount that would be paid under the prospective payment system established under the Benefits Improvement and Protections Act of 2000 (BIPA).

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