Reduce Prior Authorizations, Strengthen Telehealth Access - Vermont Legislature

VMS is following and supporting work in the Vermont legislature to reduce prior authorizations and strengthen telehealth access. They have reached out to the members of the Primary Care Advisory Group (of the GMCB) to do outreach among our colleagues. This legislation could decrease provider and office staff workload and improve access to care for our patients. Further information and links from VMS:

• H. 766 had its first hearing in the Senate Health and Welfare Committee this week. Please reach urge the Committee to support this bill, allowing clinicians and office staff to spend more time with patients rather than on paperwork. You can email them at:  VLyons@leg.state.vt.us; rhardy@leg.state.vt.us; mgulick@leg.state.vt.us; dweeks@leg.state.vt.us; tkwilliams@leg.state.vt.us; KCarasi-Schwartz@leg.state.vt.us.  Payers are stating this bill will increase insurance premiums.  Please share stories about how reducing PAs can actually reduce health care costs by getting patients the right care earlier, reducing extra costs like referring patients to the ED and reducing staffing costs. 

Earlier in the session the House unanimously passed H.766, which will reduce prior authorization, step therapy & insurer billing requirements. The bill would also end a burdensome Blue Cross Blue Shield of Vermont policy that requires prepayment review of certain claims, including those used with Modifier -25 and -59.  The bill has now been referred to the Senate Health and Welfare Committee. 

In more detail, H. 766 as passed the House  would:

• Require health plans to allow requests for exceptions to prescription drug step-therapy under specific conditions, like if a patient is stable on an existing therapy or if the drug is expected to be ineffective;
• Mandate adherence to coding standards and guidelines for processing healthcare claims and prohibit prepayment claims edits;
• Limit claims edits for services other than pharmacy to those instances when Medicare uses claim edits;
• Require health plans to limit prior authorization for procedures and imaging to the instances when Vermont Medicaid uses prior authorization;
• Reduce the time frames for health plans to respond to prior authorization requests to 24 hours for urgent requests;
• Limit the occasions for reauthorization of previously approved treatments and medications.

Take Action TODAY to Strengthen Telehealth Access!  The Senate Finance Committee is considering voting on H. 861 this week. The Department of Financial Regulation has said the bill will have no noticeable impact on insurance premiums while it will: (1) Require commercial payers to reimburse at parity with in-person visits for audio-only visits (vs the current requirement of 75%); and (2) Eliminate a 2026 sunset on payment parity for audio-visual telehealth visits.  Please contact the Senate Finance Committee THIS WEEK to express support for this important patient access protection. See testimony submitted to the Committee on behalf of VMS, VTAFP and AAPVT here.  Please consider addressing:

• When and under what circumstances you use telehealth (especially audio-only services) to provide patients with access to care;
• Why reimbursing the same as in-person services is fair helps preserve access to care; and/or
• Any stories about how telehealth helps patients. 

Please email the Committee at:  acummings@leg.state.vt.us; mmacdonald@leg.state.vt.us; cbray@leg.state.vt.us; rmccormack@leg.state.vt.us; rbrock@leg.state.vt.us; kramhinsdale@leg.state.vt.us; tchittenden@leg.state.vt.us; ZBuckminster@leg.state.vt.us.