Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Medicaid Prior Authorization topic
No spam. Unsubscribe anytime.
LCAR approves Agency of Human Services rule shortening Medicaid prior-authorization timelines
Summary
The Legislative Committee on Administrative Rules approved Agency of Human Services Rule 4.10324 P30 to align Vermont prior-authorization timelines with a new federal requirement that shortens standard and expedited decision deadlines for Medicaid services.
The Legislative Committee on Administrative Rules approved a change to prior-authorization rules for Vermont Medicaid on May 29, 2025, moving the decision deadline for standard prior-auth requests from 14 days to seven and aligning the expedited prior-authorization deadline with a federal 72-hour requirement.
The change, filed as HCAR Rule 4.10324 P30 by the Agency of Human Services, implements a new federal regulation effective Jan. 1, 2026. Ashley Berliner, director of Medicaid policy for the Agency of Human Services, told the committee the rule “provides that standard authorizations must be decided within 7 days of request instead of the current 14 days” and that expedited requests must be decided within 72 hours.
The rule clarifies that the seven-day timeline for standard prior-authorizations does not apply to pharmacy prior-authorizations and adds prior-authorization requirements for routine patient costs related to beneficiary participation in clinical trials. Berliner said the agency moved Medicaid rules into the Healthcare Administrative Rules (HCAR) style and that the change reflects a federal timeline that will begin in 2026.
Berliner told the committee the agency shared the proposed rule with internal and external stakeholders including Vermont Legal Aid, the Vermont Medical Society, the Vermont Hospital Association and the Medicaid and Exchange Advisory Committee. The agency filed the rule with the Legislative Committee on Administrative Rules in July 2024, held a public hearing on Sept. 11, 2024 (no attendees), and received written public comments from the Vermont Medical Society and Laboratory Corporation of America Holdings. Berliner said the agency made some revisions based on stakeholder feedback and that no changes were made in response to the written public comments submitted during the public hearing process.
Committee discussion was brief. A committee member moved to approve the rule; the committee approved it by voice vote with no opposed voices recorded.
Background: Berliner said LCAR granted an extension that moved the legislative deadline from April 1, 2025, to June 15, 2025, to allow time for final consideration. The effective date in the rule is Jan. 1, 2026, matching the federal requirement.
Implementation details and next steps: The rule text clarifies scope and timelines for prior-authorization decisions, distinguishes pharmacy prior-authorization procedures, and adds prior-authorization language for routine costs related to clinical trials. The agency confirmed the seven-day standard timeline applies to non-pharmacy prior-authorizations only. The committee did not request additional materials before the vote.
For readers: The change implements a federal requirement and will affect how quickly non-pharmacy prior-authorizations are decided for Medicaid beneficiaries starting Jan. 1, 2026. The committee recorded no roll-call vote; approval was by voice vote.
