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DVHA urges committee not to extend Medicaid prior-authorization waiver from ACO to hospital global budgets
Summary
Alicia Cooper of the Department of Vermont Health Access told the Senate Health & Welfare Committee that continuing a prior-authorization waiver tied to the Medicaid ACO model would create technical and fiscal risks under the new hospital global budget methodology and therefore DVHA does not recommend the amendment.
Alicia Cooper, director of Managed Care Operations for the Department of Vermont Health Access (DVHA), told the Senate Health & Welfare Committee on April 17 that DVHA does not recommend continuing a prior-authorization (PA) waiver that was used under the Vermont Medicaid Next Generation ACO (VMNG) program.
Cooper said the PA waiver was implemented with the VMNG contract with One Care Vermont in 2017 and remained in effect through the program's conclusion at the end of 2025. "Under this arrangement, providers did not have to seek prior authorizations for any Medicaid members who were attributed to the ACO," she said,…
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