Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Payment Reform topic
No spam. Unsubscribe anytime.
DVHA, Green Mountain Care Board outline payment-reform options; committee requests written detail
Summary
A Department of Vermont Health Access official and Green Mountain Care Board chair told senators the state is exploring reference-based pricing, fixed prospective payments and hospital global budgets; DVHA requested clearer statutory authority language and offered to provide more detailed written recommendations.
Department of Vermont Health Access and Agency of Human Services officials told the Senate Health & Welfare Committee on Feb. 20 they support exploring payment reforms that could align public and commercial payers, but they asked for clearer statutory authority for Medicaid rate-setting and implementation.
Alicia Cooper, director of payment reform at the Department of Vermont Health Access, told the committee the Medicaid program has used Medicare benchmarking and reference-based approaches for more than a decade and has piloted fixed prospective payments within Vermont Medicaid’s Next Generation ACO program. She said the agency is developing Medicaid hospital global budget methodologies as a successor to those fixed payments and urged statutory clarity on AHS’s and DVHA’s authority to set Medicaid rates and implement payment methodologies “such as global hospital budgets.”
Cooper described a 2024 pilot called the Global Payment Program that provides fixed monthly payments to participating hospitals for the majority of their Medicaid revenue, and said DIVA (DVHA) has been working toward methodologies consistent with federal waivers (she referenced the Global Commitment to Health waiver).
Green Mountain Care Board Chair Oliver Foster emphasized the scale of the affordability problem and urged the committee to “work backwards” from what the state can afford, then prioritize services and consider whether certain services (for example, obstetrics at every hospital) are sustainable in all locations. Foster said the care board has been working to reduce commercial rate increases and has enforced budget overages where necessary.
Committee members requested more detail and written testimony. Lawmakers said they will take up reference-based pricing and payment reform topics in subsequent hearings and asked DVHA and AHS to return with legal and operational detail on timelines, cost implications and pilot lessons.
Ending: The committee scheduled follow-up conversations on payment reform, reference-based pricing and hospital budget methods and invited DVHA and GMCB staff to return with written materials and witnesses.
