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H.13 1
Introduced by Representatives Wood of Waterbury and Noyes of Wolcott 2
Referred to Committee on 3
Date: 4
Subject: Human services; Medicaid; home- and community-based service 5
providers; designated and specialized service agencies 6
Statement of purpose of bill as introduced: This bill proposes to require the 7
Secretary of Human Services to determine reasonable and adequate Medicaid 8
payment rates for providers of home- and community-based services. It would 9
direct the Secretary to adopt rules setting forth the methodology for those 10
payment rates, as well as for the Medicaid payment rates for designated and 11
specialized service agencies; the rules for all of these provider types would 12
need to include a process for determining an annual inflationary adjustment 13
and set forth a predictable timeline for redetermining the providers’ base rates. 14
The bill would require the Secretary to redetermine the payment rates for 15
home- and community-based service providers and for designated and 16
specialized service agencies at least annually and report those rates, and the 17
amounts necessary to fund them, to the General Assembly as part of the 18
Agency of Human Services’ budget presentation. The bill would also direct 19
the Department of Vermont Health Access to conduct a rate study of the 20
current Medicaid rates paid to providers of home- and community-based 21 BILL AS INTRODUCED H.13
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services and to providers of substance use disorder treatment services and 1
report the Department’s findings and recommendations to the General 2
Assembly and the Secretary of Human Services. 3
An act relating to Medicaid payment rates for home- and community-based 4
service providers and designated and specialized service agencies 5
It is hereby enacted by the General Assembly of the State of Vermont: 6
Sec. 1. 33 V.S.A. § 900 is amended to read: 7
§ 900. DEFINITIONS 8
Unless otherwise required by the context, the words and phrases in this 9
chapter shall be defined as follows As used in this chapter: 10
* * * 11
(7) “Home- and community-based services” means long-term services 12
and supports provided to older adults and adults with physical disabilities in a 13
home or community setting other than a nursing home, including enhanced 14
residential care services, pursuant to the Choices for Care component of 15
Vermont’s Global Commitment to Health Section 1115 Medicaid 16
demonstration or a successor program. “Home- and community-based 17
services” also includes non-Choices for Care home health and hospice 18
services, adult day rehabilitation services, assistive community care services, 19
and services for individuals with traumatic brain injury. 20 BILL AS INTRODUCED H.13
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Sec. 2. 33 V.S.A. § 911 is added to read: 1
§ 911. PAYMENT RATES FOR PROVIDERS OF HOME - AND 2
COMMUNITY-BASED SERVICES 3
(a) The Secretary of Human Services shall determine payment rates for 4
providers of home- and community-based services that are reasonable and 5
adequate to achieve the required outcomes for the populations they serve. 6
When determining these payment rates, the Secretary shall adjust the rate 7
amounts to take into account factors that include: 8
(1) the reasonable cost of any governmental mandate that has been 9
enacted, adopted, or imposed by any State or federal authority; and 10
(2) a cost adjustment factor to reflect changes in reasonable costs of 11
goods to and services of providers of home- and community-based services, 12
including those attributed to inflation and labor market dynamics. 13
(b) When determining reasonable and adequate rates of payment for 14
providers of home- and community-based services, the Secretary may consider 15
geographic differences in wages, benefits, housing, and real estate costs in 16
each region of the State. 17
(c) The Secretary shall adopt rules setting forth the methodology for 18
determining payment rates for providers of home- and community-based 19
services in accordance with this section. The rules shall include a process for 20
determining an annual inflationary rate adjustment, shall set forth a predictable 21 BILL AS INTRODUCED H.13
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timeline for redetermination of base rates, and shall use Vermont labor market 1
rates and Vermont costs of operation. 2
(d) The Secretary shall redetermine the payment rates for providers of 3
home- and community-based services in accordance with this section at least 4
annually and shall report those rates, and the amounts necessary to fund them, 5
to the House Committees on Appropriations, on Human Services, and on 6
Health Care and the Senate Committees on Appropriations and on Health and 7
Welfare annually as part of the Agency’s budget presentation. 8
Sec. 3. 18 V.S.A. § 8914 is amended to read: 9
§ 8914. RATES OF PAYMENTS TO DESIGNATED AND SPECIALIZED 10
SERVICE AGENCIES 11
(a) The Secretary of Human Services shall have sole responsibility for 12
establishing determine the Departments of Health’s, of Mental Health’s, and of 13
Disabilities, Aging, and Independent Living’s rates of payments for designated 14
and specialized service agencies that are reasonable and adequate to achieve 15
the required outcomes for designated populations. When establishing 16
determining these rates of payment for designated and specialized service 17
agencies, the Secretary shall adjust rates the rate amounts to take into account 18
factors that include: 19
(1) the reasonable cost of any governmental mandate that has been 20
enacted, adopted, or imposed by any State or federal authority; and 21 BILL AS INTRODUCED H.13
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(2) a cost adjustment factor to reflect changes in reasonable costs of 1
goods to and services of designated and specialized service agencies, including 2
those attributed to inflation and labor market dynamics. 3
(b) When establishing determining reasonable and adequate rates of 4
payment for designated and specialized service agencies, the Secretary may 5
consider geographic differences in wages, benefits, housing, and real estate 6
costs in each region of the State. 7
(c) The Secretary shall adopt rules setting forth the methodology for 8
determining the payment rates for services provided by designated and 9
specialized service agencies to individuals with mental conditions, individuals 10
with substance use disorders, and individuals with developmental or 11
intellectual disabilities in accordance with this section. The rules shall include 12
a process for determining an annual inflationary rate adjustment, shall set forth 13
a predictable timeline for redetermination of base rates, and shall use Vermont 14
labor market rates and Vermont costs of operation. 15
(d) The Secretary shall redetermine the payment rates for designated and 16
specialized service agencies in accordance with this section at least annually 17
and shall report those rates, and the amounts necessary to fund them, to the 18
House Committees on Appropriations, on Human Services, and on Health Care 19
and the Senate Committees on Appropriations and on Health and Welfare 20
annually as part of the Agency’s budget presentation. 21 BILL AS INTRODUCED H.13
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Sec. 4. HOME- AND COMMUNITY -BASED SERVICE PROVIDER 1
RATE STUDY; REPORT 2
(a) The Department of Vermont Health Access, in collaboration with the 3
Departments of Disabilities, Aging, and Independent Living, of Health, and of 4
Mental Health, shall conduct a rate study of the Medicaid reimbursement rates 5
paid to providers of home- and community-based services, as defined in 6
33 V.S.A. § 900, and providers of substance use disorder treatment services, 7
including their adequacy and the methodologies underlying the rates. As part 8
of the rate study, the Department of Vermont Health Access shall: 9
(1) delineate a reasonable and predictable schedule for Medicaid rates 10
and rate updates; 11
(2) identify ways to align Medicaid reimbursement methodologies and 12
rates for providers of home- and community-based services with those of other 13
payers, to the extent such other methodologies and rates exist; and 14
(3) determine ways to limit the number of methodological exceptions. 15
(b) On or before January 15, 2026, the Department of Vermont Health 16
Access, in collaboration with the Departments of Disabilities, Aging, and 17
Independent Living, of Health, and of Mental Health, shall report the results of 18
the rate study conducted pursuant to this section and their findings and 19
recommendations to the House Committees on Human Services and on 20 BILL AS INTRODUCED H.13
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Appropriations, the Senate Committees on Health and Welfare and on 1
Appropriations, and the Secretary of Human Services. 2
Sec. 5. EFFECTIVE DATE 3
This act shall take effect on passage, with the rules adopted by the Secretary 4
of Human Services pursuant to Secs. 2 (33 V.S.A. § 911) and 3 (18 V.S.A. 5
§ 8914) taking effect on or before July 1, 2026. 6