Lawmakers hear H13 to require annual Medicaid rate-setting and a statewide HCBS rate study

A legislative committee held a hearing on H13, a bill that would require the Secretary of Human Services to determine payment rates for home- and community-based service providers and for designated and specialized service agencies and to adopt rules governing the rate methodology.

The bill would add a definition of “home and community based services” to Title 33 and direct the secretary to determine rates that are “reasonable and adequate to achieve the required outcomes,” adjust rates to reflect the reasonable cost of governmental mandates and an annual cost-adjustment factor for inflation and labor-market dynamics, and adopt rules with a predictable timeline for redetermining base rates. H13 also would direct the Department of Vermont Health Access (DVHA), in collaboration with other departments, to conduct a rate study and report its findings to the legislature.

Why it matters: Medicaid covers a large share of Vermonters’ long-term and specialty services, and committee members and administration witnesses said clearer, regularly updated methodologies would give the legislature and providers data-driven foundations for appropriation decisions and for identifying gaps in access and provider sustainability.

Legislative counsel Jennifer “Jen” Trefavy, Office of Legislative Counsel,…