An act relating to miscellaneous changes affecting the duties of the Department of Vermont Health Access

VPMS access (Sec. 3, 18 V.S.A. 4284(b)(1)(C)): The Pharmacy Director of DVHA and the Pharmacy Director's designee were removed from those authorized to query the Vermont Prescription Monitoring System. Only the Medical Director and the Medical Director's designee retain access for Medicaid quality assurance, utilization, and federal monitoring purposes.

FQHC alternative payment methodology report (Sec. 4): The deadline was moved up from December 15, 2023 to October 1, 2023, and the deliverable changed from a 'progress report' to a 'final report.' The Joint Fiscal Committee was added as a recipient of the report alongside the House Health Care Committee and Senate Health and Welfare Committee.

Medicaid dental coverage (Sec. 1, 33 V.S.A. 1992(a)(2)(A)): The phrase 'as defined by the Department by rule' was added after 'emergency dental services,' giving DVHA explicit rulemaking authority to define what qualifies as an emergency dental service for purposes of exceeding the $1,000 annual cap.

Medicaid dental coverage exemption (Sec. 1, 33 V.S.A. 1992(a)(2)(B)(i)): The reference to the Section 1115 waiver was updated from 'waivers authorized under Vermont's Section 1115 Demonstration waiver' to 'programs pursuant to Vermont's Global Commitment to Health Section 1115 demonstration,' reflecting the actual name of the state's Medicaid waiver.

VPMS access was narrowed: the Pharmacy Director of DVHA and their designee lost access to query the Vermont Prescription Monitoring System. Only the Medical Director and the Director's designee retain access for Medicaid quality assurance, utilization, and federal monitoring purposes.

Emergency dental services under the Medicaid dental coverage section are now defined 'by the Department by rule' rather than simply being listed as an example of exceptional medical circumstances, giving DVHA regulatory authority to define the scope.

The reference to the 1115 waiver was changed from 'Community Rehabilitation and Treatment and Developmental Disability Services waivers authorized under Vermont's Section 1115 Demonstration waiver' to 'programs pursuant to Vermont's Global Commitment to Health Section 1115 demonstration,' using more precise program naming.

New Section 6 repeals the prospective repeal of 18 V.S.A. section 9473(g), which related to pharmacy benefit managers and 340B entities (originally from 2021 Acts and Resolves No. 74, as amended by 2022 Acts and Resolves No. 131). This effectively preserves the 340B-related provision that was set to be repealed.

New Section 8 requires the Agency of Human Services to engage in transformation planning with up to four hospitals (or more if possible with alternate funds) to reduce inefficiencies, lower costs, improve population health outcomes, reduce health inequities, and increase access to essential services while maintaining emergency capacity. A progress report is due to legislative committees by February 15, 2024.

The FQHC alternative payment methodology section was strengthened: the report deadline moved from December 15, 2023 to October 1, 2023, it changed from a 'progress report' to a 'final report,' the Joint Fiscal Committee was added as a recipient, and a new requirement was added that the alternative methodology must be at least equal to what would be paid under the prospective payment system established by the Benefits Improvement and Protection Act of 2000.

New Section 5 requires the Director of Health Care Reform to recommend by January 15, 2024, specific dollar amounts by which health insurers and Vermont Medicaid should increase per-person, per-month payments to Blueprint for Health patient-centered medical homes. The Agency must also estimate State funding needed for the Medicaid portion and evaluate mechanisms for equitable payer contributions, including consideration of the health care claims tax.

New Section 7 establishes a comprehensive hospital lien framework in 18 V.S.A. section 2251. Hospitals may file liens on patient recoveries for accident injuries not covered by Workers' Compensation, capped at one-third of the recovery or $500 (whichever is lesser), subordinate to attorney's liens. No lien applies if the patient has health insurance and provides proof within 90 days of discharge or death, though hospitals may still file for deductible/coinsurance amounts with 120-day notice. Insurance plans cannot deny payment based on potential property and casualty coverage unless required by law.

The effective date section was changed from a single July 1, 2023 date to a split schedule: the act generally takes effect July 1, 2023, but Section 7 (hospital liens) takes effect January 1, 2024.

In Section 1 (33 V.S.A. 1992), the unofficial version defined 'exceptional medical circumstances' as including emergency dental services 'as defined by the Department by rule.' The official version removes the phrase 'as defined by the Department by rule,' meaning the definition of emergency dental services is no longer explicitly delegated to a future rulemaking.

The list of individuals exempt from the $1,000 annual dental cap was reworded. The unofficial version referenced 'individuals served through the Community Rehabilitation and Treatment and Developmental Disability Services programs pursuant to Vermont's Global Commitment to Health Section 1115 demonstration.' The official version changes this to 'individuals served on the Community Rehabilitation and Treatment and Developmental Disability Services waivers authorized under Vermont's Section 1115 Demonstration waiver,' shifting from a program-based description to a waiver-based one.

Section 3 (18 V.S.A. 4284) expands VPMS query access. The unofficial version granted access to 'the Medical Director of the Department of Vermont Health Access and the Director's designee.' The official version adds 'the Pharmacy Director' and changes 'the Director's designee' to 'a designee of each Director,' giving both the Medical Director and the Pharmacy Director (and their respective designees) access for Medicaid quality assurance, utilization, and federal monitoring purposes.

The structure of Section 1 was reorganized. The unofficial version used a (2)(A)/(B) sub-structure where (A) set the $1,000 cap and (B) listed exceptions. The official version places the $1,000 cap directly in subdivision (2) and lists the two exception categories as (A) and (B), simplifying the hierarchy.

The Pharmacy Director of DVHA and their designee were removed from the list of persons authorized to query the Vermont Prescription Monitoring System (VPMS). Only the Medical Director and their designee retain access for Medicaid quality assurance, utilization, and federal monitoring purposes.

A new Section 4 was added requiring DVHA to collaborate with representatives of Vermont's federally qualified health centers (FQHCs) to develop a mutually agreeable alternative payment methodology for Medicaid payments to FQHCs, with a progress report due to the House and Senate health committees by December 15, 2023.

In the dental coverage section, 'exceptional medical circumstances' are now explicitly defined as including 'emergency dental services, as defined by the Department by rule,' giving DVHA rulemaking authority to define what qualifies as an emergency dental service for purposes of exceeding the $1,000 annual cap.

The exemption from the annual dental benefit cap was reworded from 'individuals served on the Community Rehabilitation and Treatment and Developmental Disability Services waivers authorized under Vermont's Section 1115 Demonstration waiver' to 'individuals served through the Community Rehabilitation and Treatment and Developmental Disability Services programs pursuant to Vermont's Global Commitment to Health Section 1115 demonstration,' reflecting updated program naming.