Senate Health & Welfare reviews H.31 to clarify claim-edit standards and expand primary-care prior-authorization exemption

On Feb. 14 the Vermont Senate Health & Welfare committee received an introduction to H.31, a bill from the House that amends Act 111 of 2024 to clarify how insurers must apply claim-edit standards and to change which primary care providers are exempt from prior-authorization requirements.

The bill, presented by Representative Alyssa Black, chair of the House Health Care Committee, revises two parts of Act 111: it specifies that the claim-edit standards apply to claims submitted by Vermont providers (not to out-of-state providers unless the payer and that out-of-state provider agree), and it replaces a Blueprint-for-Health–based definition of “primary care provider” with a definition tied to a provider’s enrollment and contracting status with a health plan and the provider’s designation as a primary care provider by that plan. Representative Black described H.31 as “the product of a very collaborative process” and summarized the claim-edit change by saying, in the committee hearing, that “the claim edit…