BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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H.13
IntroducedbyRepresentativesWoodofWaterburyandNoyesofWolcott
ReferredtoCommitteeon
Date:
Subject:Humanservices;Medicaid;home-andcommunity-basedservice
providers;designatedandspecializedserviceagencies
Statementofpurposeofbillasintroduced:Thisbillproposestorequirethe
SecretaryofHumanServicestodeterminereasonableandadequateMedicaid
paymentratesforprovidersofhome-andcommunity-basedservices.Itwould
directtheSecretarytoadoptrulessettingforththemethodologyforthose
paymentrates,aswellasfortheMedicaidpaymentratesfordesignatedand
specializedserviceagencies;therulesforalloftheseprovidertypeswould
needtoincludeaprocessfordetermininganannualinflationaryadjustment
andsetforthapredictabletimelineforredeterminingtheproviders’baserates.
ThebillwouldrequiretheSecretarytoredeterminethepaymentratesfor
home-andcommunity-basedserviceprovidersandfordesignatedand
specializedserviceagenciesatleastannuallyandreportthoserates,andthe
amountsnecessarytofundthem,totheGeneralAssemblyaspartofthe
AgencyofHumanServices’budgetpresentation.Thebillwouldalsodirect
theDepartmentofVermontHealthAccesstoconductaratestudyofthe
currentMedicaidratespaidtoprovidersofhome-andcommunity-based
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21 BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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servicesandtoprovidersofsubstanceusedisordertreatmentservicesand
reporttheDepartment’sfindingsandrecommendationstotheGeneral
AssemblyandtheSecretaryofHumanServices.
AnactrelatingtoMedicaidpaymentratesforhome-andcommunity-based
serviceprovidersanddesignatedandspecializedserviceagencies
AnactrelatingtoMedicaidpaymentratesforhome-andcommunity-based
serviceproviders
AnactrelatingtoMedicaidpaymentratesforcommunity-basedservice
providers
ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
Sec.1.33V.S.A.§ 900isamendedtoread:
§900.DEFINITIONS
Unlessotherwiserequiredbythecontext,thewordsandphrasesinthis
chaptershallbedefinedasfollowsAsusedinthischapter:
***
(7)“Home-andcommunity-basedservices”meanslong-termservices
andsupportsprovidedtoolderadultsandadultswithphysicaldisabilitiesina
homeorcommunitysettingotherthananursinghome,includingenhanced
residentialcareservices,pursuanttotheChoicesforCarecomponentof
Vermont’sGlobalCommitmenttoHealthSection1115Medicaid
demonstrationorasuccessorprogram.“Home-andcommunity-based
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services”alsoincludesnon-ChoicesforCarehomehealthandhospice
services,adultdayrehabilitationservices,assistivecommunitycareservices,
andservicesforindividualswithtraumaticbraininjury.
Sec.2.33V.S.A.§ 911isaddedtoread:
§ 911.PAYMENTRATESFORPROVIDERSOFHOME-AND
COMMUNITY-BASEDSERVICES
(a)TheSecretaryofHumanServicesshalldeterminepaymentratesfor
providersofhome-andcommunity-basedservicesthatarereasonableand
adequatetoachievetherequiredoutcomesforthepopulationstheyserve.
Whendeterminingthesepaymentrates,theSecretaryshalladjusttherate
amountstotakeintoaccountfactorsthatinclude:
(1)thereasonablecostofanygovernmentalmandatethathasbeen
enacted,adopted,orimposedbyanyStateorfederalauthority;and
(2)acostadjustmentfactortoreflectchangesinreasonablecostsof
goodstoandservicesofprovidersofhome-andcommunity-basedservices,
includingthoseattributedtoinflationandlabormarketdynamics.
(b)Whendeterminingreasonableandadequateratesofpaymentfor
providersofhome-andcommunity-basedservices,theSecretarymayconsider
geographicdifferencesinwages,benefits,housing,andrealestatecostsin
eachregionoftheState.
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(c)TheSecretaryshalladoptrulessettingforththemethodologyfor
determiningpaymentratesforprovidersofhome-andcommunity-based
servicesinaccordancewiththissection.Therulesshallincludeaprocessfor
determininganannualinflationaryrateadjustment,shallsetforthapredictable
timelineforredeterminationofbaserates,andshalluseVermontlabormarket
ratesandVermontcostsofoperation.
(d)TheSecretaryshallredeterminethepaymentratesforprovidersof
home-andcommunity-basedservicesinaccordancewiththissectionatleast
annuallyandshallreportthoserates,andtheamountsnecessarytofundthem,
totheHouseCommitteesonAppropriations,onHumanServices,andon
HealthCareandtheSenateCommitteesonAppropriationsandonHealthand
WelfareannuallyaspartoftheAgency’sbudgetpresentation.
Sec.3.18V.S.A.§ 8914isamendedtoread:
§8914.RATESOFPAYMENTSTODESIGNATEDANDSPECIALIZED
SERVICEAGENCIES
(a)TheSecretaryofHumanServicesshallhavesoleresponsibilityfor
establishingdeterminetheDepartmentsofHealth’s,ofMentalHealth’s,andof
Disabilities,Aging,andIndependentLiving’sratesofpaymentsfordesignated
andspecializedserviceagenciesthatarereasonableandadequatetoachieve
therequiredoutcomesfordesignatedpopulations.Whenestablishing
determiningtheseratesofpaymentfordesignatedandspecializedservice
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agencies,theSecretaryshalladjustratestherateamountstotakeintoaccount
factorsthatinclude:
(1)thereasonablecostofanygovernmentalmandatethathasbeen
enacted,adopted,orimposedbyanyStateorfederalauthority;and
(2)acostadjustmentfactortoreflectchangesinreasonablecostsof
goodstoandservicesofdesignatedandspecializedserviceagencies,including
thoseattributedtoinflationandlabormarketdynamics.
(b)Whenestablishingdeterminingreasonableandadequateratesof
paymentfordesignatedandspecializedserviceagencies,theSecretarymay
considergeographicdifferencesinwages,benefits,housing,andrealestate
costsineachregionoftheState.
(c)TheSecretaryshalladoptrulessettingforththemethodologyfor
determiningthepaymentratesforservicesprovidedbydesignatedand
specializedserviceagenciestoindividualswithmentalconditions,individuals
withsubstanceusedisorders,andindividualswithdevelopmentalor
intellectualdisabilitiesinaccordancewiththissection.Therulesshallinclude
aprocessfordetermininganannualinflationaryrateadjustment,shallsetforth
apredictabletimelineforredeterminationofbaserates,andshalluseVermont
labormarketratesandVermontcostsofoperation.
(d)TheSecretaryshallredeterminethepaymentratesfordesignatedand
specializedserviceagenciesinaccordancewiththissectionatleastannually
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andshallreportthoserates,andtheamountsnecessarytofundthem,tothe
HouseCommitteesonAppropriations,onHumanServices,andonHealth
CareandtheSenateCommitteesonAppropriationsandonHealthandWelfare
annuallyaspartoftheAgency’sbudgetpresentation.
Sec.4.HOME-ANDCOMMUNITY-BASEDSERVICEPROVIDER
RATESTUDY;REPORT
(a)TheDepartmentofVermontHealthAccess,incollaborationwiththe
DepartmentsofDisabilities,Aging,andIndependentLiving,ofHealth,andof
MentalHealth,shallconductaratestudyoftheMedicaidreimbursementrates
paidtoprovidersofhome-andcommunity-basedservices,asdefinedin
33 V.S.A.§ 900,andprovidersofsubstanceusedisordertreatmentservices,
includingtheiradequacyandthemethodologiesunderlyingtherates.Aspart
oftheratestudy,theDepartmentofVermontHealthAccessshall:
(1)delineateareasonableandpredictablescheduleforMedicaidrates
andrateupdates;
(2)identifywaystoalignMedicaidreimbursementmethodologiesand
ratesforprovidersofhome-andcommunity-basedserviceswiththoseofother
payers,totheextentsuchothermethodologiesandratesexist;and
(3)determinewaystolimitthenumberofmethodologicalexceptions.
(b)OnorbeforeJanuary15,2026,theDepartmentofVermontHealth
Access,incollaborationwiththeDepartmentsofDisabilities,Aging,and
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IndependentLiving,ofHealth,andofMentalHealth,shallreporttheresultsof
theratestudyconductedpursuanttothissectionandtheirfindingsand
recommendationstotheHouseCommitteesonHumanServicesandon
Appropriations,theSenateCommitteesonHealthandWelfareandon
Appropriations,andtheSecretaryofHumanServices.
Sec.5.EFFECTIVEDATE
Thisactshalltakeeffectonpassage,withtherulesadoptedbytheSecretary
ofHumanServicespursuanttoSecs.2(33V.S.A.§ 911)and3(18V.S.A.
§ 8914)takingeffectonorbeforeJuly1,2026.
Sec.1.33V.S.A.§ 900isamendedtoread:
§900.DEFINITIONS
Unlessotherwiserequiredbythecontext,thewordsandphrasesinthis
chaptershallbedefinedasfollowsAsusedinthischapter:
***
(7)“Home-andcommunity-basedservices”meansthefollowing
servicesprovidedpursuanttoVermont’sGlobalCommitmenttoHealthSection
1115Medicaiddemonstrationorasuccessorprogram:
(A)long-termservicesandsupportsprovidedtoolderadultsand
adultswithdisabilitiesinahomeorcommunitysettingotherthananursing
home,includingenhancedresidentialcareservices;
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(B)homehealthandhospiceservices,adultdayrehabilitation
services,andassistivecommunitycareservices;and
(C)short-andlong-termservicesandsupportsprovidedto
individualswithmentalconditions,individualswithsubstanceusedisorders,
individualswithdevelopmentalorintellectualdisabilities,andindividualswith
abraininjury,inahomeorcommunitysettingforwhichtheMedicaidrates
arenototherwiseestablishedpursuanttostatuteorrule.
Sec.2.33V.S.A.§ 911isaddedtoread:
§ 911.PAYMENTRATESFORPROVIDERSOFHOME-AND
COMMUNITY-BASEDSERVICES
(a)TheSecretaryofHumanServicesshalldeterminepaymentratesfor
providersofhome-andcommunity-basedservicesthatarereasonableand
adequatetoachievetherequiredoutcomesforthepopulationstheyserve.
Whendeterminingthesepaymentrates,theSecretaryshalladjusttherate
amountstotakeintoaccountfactorsthatinclude:
(1)thereasonablecostofanygovernmentalmandatethathasbeen
enacted,adopted,orimposedbyanyStateorfederalauthority;and
(2)acostadjustmentfactortoreflectchangesinreasonablecostsof
goodstoandservicesofprovidersofhome-andcommunity-basedservices,
includingthoseattributedtoinflationandlabormarketdynamics. BILLASPASSEDBYTHEHOUSEANDSENATE H.13
2025 Page9of16
(b)Whendeterminingreasonableandadequateratesofpaymentfor
providersofhome-andcommunity-basedservices,theSecretarymayconsider
geographicdifferencesinwages,benefits,housing,andrealestatecostsin
eachregionoftheState.
(c)TheSecretaryshallestablishamethodologyfordeterminingpayment
ratesforprovidersofhome-andcommunity-basedservicesinaccordancewith
thissection.Themethodologyshall:
(1)provideascheduleforconductingstudiesoftheMedicaid
reimbursementratespaidtotheprovidersofhome-andcommunity-based
services,includingtherates’adequacyandtheirunderlyingmethodologies,
thatincludesstudyingtheratespaidtoprovidersforeachtypeofserviceat
leastonceeveryfiveyears;
(2)setforthapredictabletimelineforredeterminationofbaserates;
(3)includeaprocessfordetermininganannualinflationaryrate
adjustment;
(4)totheextentpermittedbytheCentersforMedicareandMedicaid
Services,takeintoaccountthefinancialneedsofproviderswhose
reimbursementsmaybenegativelyaffectedbyclientabsences;and
(5)useVermontlabormarketratesandVermontcostsofoperation. BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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(d)TheSecretaryshallestablishaprocessbywhichaproviderwhose
financialconditionplacesitatimminentriskofclosuremayseekextraordinary
financialrelieffromtheAgency.
(e)TheSecretaryshallredeterminethepaymentratesforprovidersof
home-andcommunity-basedservicesinaccordancewiththissectionatleast
annuallyandshallreportthoserates,andtheamountsnecessarytofundthem,
totheHouseCommitteesonAppropriations,onHumanServices,andon
HealthCareandtheSenateCommitteesonAppropriationsandonHealthand
WelfareannuallyaspartoftheAgency’sbudgetpresentation.
Sec.3.18V.S.A.§ 8914isamendedtoread:
§8914.RATESOFPAYMENTSTODESIGNATEDANDSPECIALIZED
SERVICEAGENCIES
(a)TheSecretaryofHumanServicesshallhavesoleresponsibilityfor
establishingdeterminetheDepartmentsofHealth’s,ofMentalHealth’s,and
ofDisabilities,Aging,andIndependentLiving’sratesofpaymentsfor
designatedandspecializedserviceagenciesthatarereasonableandadequate
toachievetherequiredoutcomesfordesignatedpopulationsinaccordance
with33V.S.A.§ 911.Whenestablishingratesofpaymentfordesignatedand
specializedserviceagencies,theSecretaryshalladjustratestotakeinto
accountfactorsthatinclude: BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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(1)thereasonablecostofanygovernmentalmandatethathasbeen
enacted,adopted,orimposedbyanyStateorfederalauthority;and
(2)acostadjustmentfactortoreflectchangesinreasonablecostsof
goodsandservicesofdesignatedandspecializedserviceagencies,including
thoseattributedtoinflationandlabormarketdynamics.
(b)Whenestablishingratesofpaymentfordesignatedandspecialized
serviceagencies,theSecretarymayconsidergeographicdifferencesinwages,
benefits,housing,andrealestatecostsineachregionoftheState.
Sec.4.PAYMENTRATESFORPROVIDERSOFHOME-AND
COMMUNITY-BASEDSERVICES;UPDATEON
IMPLEMENTATION;REPORT
OnorbeforeJanuary15,2026,theAgencyofHumanServicesshallreport
totheHouseCommitteesonHumanServicesandonHealthCareandthe
SenateCommitteeonHealthandWelfarewithanupdateontheAgency’s
implementationof33V.S.A.§ 911,asaddedbySec.2ofthisact,includingthe
Agency’sproposedscheduleforMedicaidratestudiesandthemethodologythe
Agencydevelopedfordeterminingpaymentratesforprovidersofhome-and
community-basedservices.
Sec.5.EFFECTIVEDATE
Thisactshalltakeeffectonpassage. BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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Sec.1.33V.S.A.§ 900isamendedtoread:
§900.DEFINITIONS
Unlessotherwiserequiredbythecontext,thewordsandphrasesinthis
chaptershallbedefinedasfollowsAsusedinthischapter:
***
(7)“Community-basedservices”meansthefollowingservicesprovided
pursuanttoVermont’sGlobalCommitmenttoHealthSection1115Medicaid
demonstrationorasuccessorprogram:
(A)long-termservicesandsupportsprovidedtoolderadultsand
adultswithdisabilitiesinahomeorcommunitysettingotherthananursing
home,includingenhancedresidentialcareservices;
(B)homehealthandhospiceservices,adultdayrehabilitation
services,andassistivecommunitycareservices;and
(C)short-andlong-termservicesandsupportsprovidedto
individualswithmentalconditions,individualswithsubstanceusedisorders,
individualswithdevelopmentalorintellectualdisabilities,andindividualswith
abraininjury,inahomeorcommunitysettingthatisnotaclinicalresidential
settingoraprivatenonmedicalresidentialsetting.
Sec.2.33V.S.A.§ 911isaddedtoread:
§ 911.PAYMENTRATESFORPROVIDERSOFCOMMUNITY-BASED
SERVICES BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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(a)TheSecretaryofHumanServicesshallcalculatepaymentratesfor
providersofcommunity-basedservicesthatarereasonableandadequateto
achievetherequiredoutcomesforthepopulationstheyserve.When
calculatingthesepaymentrates,theSecretary:
(1)forinformationalpurposes,shallensurethatthecalculationstake
intoaccountfactorsthatinclude:
(A)thereasonablecostofanygovernmentalmandatethathasbeen
enacted,adopted,orimposedbyanyStateorfederalauthority;and
(B)acostadjustmentfactortoreflectchangesinreasonablecostsof
goodstoandservicesofprovidersofcommunity-basedservices,including
thoseattributedtoinflationandlabormarketdynamics;and
(2)mayconsidergeographicdifferencesinwages,benefits,housing,
andrealestatecostsineachregionoftheState.
(b)TheSecretaryshallestablishamethodologyforcalculatingpayment
ratesforprovidersofcommunity-basedservicesinaccordancewiththis
section.Themethodologyshall:
(1)provideascheduleforconductingstudiesoftheMedicaid
reimbursementratespaidtotheprovidersofcommunity-basedservices,
includingtherates’adequacyandtheirunderlyingmethodologies,that
includesstudyingtheratespaidtoprovidersforeachtypeofserviceatleast
onceeveryfiveyears; BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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(2)setforthapredictabletimelineforredeterminationofbaserates;
(3)includeaprocessforcalculatinganannualinflationaryrate
adjustment;
(4)totheextentpermittedbytheCentersforMedicareandMedicaid
Services,takeintoaccountthefinancialneedsofproviderswhose
reimbursementsmaybenegativelyaffectedbyclientabsences;and
(5)useVermontlabormarketratesandVermontcostsofoperation.
(c)TheSecretaryshallestablishaprocessbywhichaproviderof
community-basedserviceswhosefinancialconditionplacesitatimminentrisk
ofclosuremayrequestproviderstabilizationfromtheAgency.
(d)TheSecretaryshallrecalculatethepaymentratesforprovidersof
community-basedservicesinaccordancewiththissectionatleastannually
andshallreportthoserates,andtheamountsnecessarytofundthem,tothe
HouseCommitteesonAppropriations,onHumanServices,andonHealth
CareandtheSenateCommitteesonAppropriationsandonHealthandWelfare
annuallyaspartoftheAgency’sbudgetpresentation.
Sec.3.18V.S.A.§ 8914isamendedtoread:
§8914.RATESOFPAYMENTSTODESIGNATEDANDSPECIALIZED
SERVICEAGENCIES
(a)TheSecretaryofHumanServicesshallhavesoleresponsibilityfor
establishingcalculatetheDepartmentsofHealth’s,ofMentalHealth’s,andof BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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Disabilities,Aging,andIndependentLiving’sratesofpaymentsfordesignated
andspecializedserviceagenciesthatarereasonableandadequatetoachieve
therequiredoutcomesfordesignatedpopulationsinaccordancewith33V.S.A.
§ 911.Whenestablishingratesofpaymentfordesignatedandspecialized
serviceagencies,theSecretaryshalladjustratestotakeintoaccountfactors
thatinclude:
(1)thereasonablecostofanygovernmentalmandatethathasbeen
enacted,adopted,orimposedbyanyStateorfederalauthority;and
(2)acostadjustmentfactortoreflectchangesinreasonablecostsof
goodsandservicesofdesignatedandspecializedserviceagencies,including
thoseattributedtoinflationandlabormarketdynamics.
(b)Whenestablishingratesofpaymentfordesignatedandspecialized
serviceagencies,theSecretarymayconsidergeographicdifferencesinwages,
benefits,housing,andrealestatecostsineachregionoftheState.
Sec.4.PAYMENTRATESFORPROVIDERSOFCOMMUNITY-BASED
SERVICES;UPDATEONIMPLEMENTATION;REPORT
OnorbeforeJanuary15,2026,theAgencyofHumanServicesshallreport
totheHouseCommitteesonHumanServicesandonHealthCareandthe
SenateCommitteeonHealthandWelfarewithanupdateontheAgency’s
implementationof33V.S.A.§ 911,asaddedbySec.2ofthisact,includingthe
Agency’sproposedscheduleforMedicaidratestudiesandthemethodologythe BILLASPASSEDBYTHEHOUSEANDSENATE H.13
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Agencydevelopedforcalculatingpaymentratesforprovidersofcommunity-
basedservices.
Sec.5.EFFECTIVEDATE
Thisactshalltakeeffectonpassage.