Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Health Care Prior Authorization topic
No spam. Unsubscribe anytime.
Senate orders third reading of H.31 to clarify claims-edit and prior-authorization rules
Summary
The Senate ordered a third reading of H.31, a House bill that clarifies prior-authorization and claims-edit language from a prior law, including exemptions for out-of-state services, a revised definition of primary care provider, and a delayed effective date for one provision.
The Senate on a voice vote ordered a third reading of H.31, an act clarifying claims-edit standards and prior-authorization requirements that were first enacted last spring as part of Act 111. Senator Lyons, reporting the bill, said the changes align statutory language with payer and provider practices.
Senator Lyons told the Senate the bill makes three primary clarifications intended to reduce confusion between payers and providers and to implement the prior-authorization reforms adopted in Act 111. Lyons said stakeholders including the Vermont Medical Society, Blue Cross and Blue Shield, the Hospital Association, MVP and the Department of Financial Regulation worked with lawmakers on the language in committee.
Lyons said one clarification exempts claims edits when services were delivered out of state, noting “the claims edits would not be, adhered to under those conditions when it's out of state.” A second change revises the definition of “primary care provider.” Lyons said the original bill tied that term to the Vermont Blueprint for Health; H.31 changes the definition to “mean a health care provider who is contracted and enrolled with a health plan in a as a primary care provider,” so the prior-authorization reduction intended for primary care will apply to all primary care providers enrolled with health plans rather than only to Blueprint providers. The bill also delays the effective date for that section to Jan. 26, 2026, after which the revised definition will apply. Lyons said some payers have already begun applying the Blueprint provision and the later date permits a smoother transition.
The bill passed through the Senate committee with a 5-0-0 report in favor, Lyons said, and the House had passed the bill on Jan. 31, 2025. The Senate completed a voice vote ordering third reading; no roll-call tally was recorded on the floor.
The changes in H.31 focus on statutory wording to align expectations around claims processing and prior authorization between payers and providers. The amendment exempting out-of-state services preserves limitations on state regulation of care provided outside Vermont, Lyons explained. The next formal step on the floor will be the third reading already ordered by the Senate.
Details reported in committee and on the floor indicate interest from major insurers and provider associations; the transcript records no additional debate on the floor beyond Lyons's report and the voice vote.
