Senate passed H. 766 - House reviews changes this week, then...

Last Friday the Senate passed H. 766, which reduces prior authorization and other insurance paperwork burdens. The bill takes a significant step forward to reduce administrative burdens on patients, clinicians and the health care system and to help deliver the right care in a timely way in a more cost effective location. The changes made by the Senate will be reviewed by the House this week and then the bill will move to the Governor for his consideration. It is not too soon to start contacting the Governor’s office to communicate how the bill will help:

• Support Vermont’s health care workforce – helping retain and recruit clinicians, nurses, and office staff
• Reduce use of inappropriate and expensive care – for example, reducing use of the ED to obtain imaging, preventing hospitalization of kids with asthma, or destabilizing patients on chronic medications

Contact the Governor’s office at: 802-828-3345 or via an email form.

The bill as passed the Senate (see House version here and Senate amendment here) will apply to state regulated commercial insurance plans in Vermont (MVP, BCBSVT and Cigna plans sold on the exchange) and:  

1. Require health plans to allow requests for exceptions to prescription drug step-therapy under specific conditions - if a patient is stable on an existing therapy or if the drug is expected to be ineffective;
2. Mandate adherence to coding standards and guidelines for processing healthcare claims and prohibit prepayment claims edits (ending a burdensome Blue Cross Blue Shield of Vermont policy that requires prepayment review of certain claims, including those used with Modifier -25 and -59);
3. Limit claims edits for services other than pharmacy to those instances when Medicare uses claim edits;
4. Prohibit insurers from applying any prior authorization to primary care clinicians (excepting prescriptions and out of network care) – note this change from the House bill, which would have required health plans to limit prior authorization for procedures and imaging to the instances when Vermont Medicaid uses prior authorization;
5. Require insurers to cover, without requiring prior authorization, at least one readily available asthma controller medication from each class of medication and mode of administration – new Senate language;
6. Reduce the time frames for health plans to respond to prior authorization requests to 24 hours for urgent requests;
7. Limit the occasions for reauthorization of previously approved treatments and medications – and require authorizations for ongoing treatments to last 5 years.