Committee reviews H.13 to redefine home- and community-based services and require Medicaid rate studies

In a Thursday markup session, a legislative committee considered amendments to H.13 that would redefine "home and community-based services," require the Agency of Human Services to conduct periodic rate studies and set payment rates for Medicaid-funded services, and create a predictable schedule for rate redetermination, members said.

The changes under discussion aim to consolidate several existing statutory references into a single definition focused on services rather than on named provider categories. Jen, legislative counsel, presented a strike‑all amendment that would remove repeated statutory text for designated and specialized service agencies and replace it with a consolidated definition of services delivered in home or community settings. Jen said the draft would point existing DA/SSA statutory provisions to the consolidated process rather than duplicating language.

Monica Ogilby, Medicaid director at the Agency of Human Services, told the committee she was not prepared to answer detailed questions about the state's plan to comply with the federal Medicaid access rule released earlier in 2024. "I'll be honest. I am not prepared to answer those questions in detail today. I didn't realize that that was gonna be a topic of conversation," Ogilby said, and offered to return with more information. Ogilby also described a recent visit to Granite State Recovery and said the agency has "engaged to them about becoming a Vermont Medicaid enrolled provider."

Committee members pressed for specific scheduling and methodology for rate work. Representative Rebecca suggested setting a frequency for deeper rate studies rather than leaving reviews purely annual: "set a fee ... no less than every, I don't know, 3 years," she said, later proposing that a full rate study occur on a multi‑year cadence. Several members and counsel coalesced around language that would require a rate study for categories of home‑ and community‑based services at least once every five years and require the secretary to publish a predictable timeline and an annual redetermination that includes an inflationary adjustment.

The draft rulemaking language discussed would require the Secretary of Human Services to adopt a rate‑setting methodology that includes an annual inflation adjustment and a predictable timeline for redeterminations. Committee members and counsel discussed staggering full rate studies across provider groups (for example, studying different service categories on a rotation) so no provider type would go more than five years without a full study. Members also noted that a staggered schedule could create perceived tensions between settings if one group's base rates are updated earlier than another's.

Members debated how broadly to define the covered services. Some speakers urged phrasing that captures the full continuum of home and community supports (including long‑term services and supports for older adults and adults with disabilities) without inadvertently excluding services that fall outside traditional labels such as "Choices for Care" or the DS waiver. The committee discussed whether some residential substance‑use treatment facilities (for example, Valley Vista) would be excluded if the bill's definition strictly distinguished community settings from institutional settings; members agreed to clarify the text so that services, not only named provider types, are the focus.

Several members raised budgetary and policy concerns. A committee member noted that Vermont currently covers services beyond what CMS requires and warned that future federal or administrative changes could pressure the state to narrow optional services. A member summarized the risk: higher payment rates based on updated cost information could force the state to prioritize which optional services to continue funding. The secretary and staff acknowledged those tradeoffs and the difficulty of writing durable legislation during ongoing federal uncertainty.

Next steps: counsel will circulate a revised draft reflecting the committee discussion. The chair said the committee will likely place the revised bill on the agenda for a possible vote next Tuesday to report it out of committee; if language remains unsettled, the vote could be delayed. The chair also said the bill may be shared with the House Health Care Committee for technical review once the committee has a near‑final draft.

Ending: The committee paused markup pending a revised draft from legislative counsel; members expect to reconvene with updated language and potentially vote to report H.13 out of committee next week.