| 1 | | - | BILLASPASSEDBYTHEHOUSE H.13 |
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| 2 | | - | 2025 Page1of11 |
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| 3 | | - | H.13 |
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| 4 | | - | IntroducedbyRepresentativesWoodofWaterburyandNoyesofWolcott |
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| 5 | | - | ReferredtoCommitteeon |
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| 6 | | - | Date: |
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| 7 | | - | Subject:Humanservices;Medicaid;home-andcommunity-basedservice |
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| 8 | | - | providers;designatedandspecializedserviceagencies |
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| 9 | | - | Statementofpurposeofbillasintroduced:Thisbillproposestorequirethe |
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| 10 | | - | SecretaryofHumanServicestodeterminereasonableandadequateMedicaid |
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| 11 | | - | paymentratesforprovidersofhome-andcommunity-basedservices.Itwould |
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| 12 | | - | directtheSecretarytoadoptrulessettingforththemethodologyforthose |
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| 13 | | - | paymentrates,aswellasfortheMedicaidpaymentratesfordesignatedand |
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| 14 | | - | specializedserviceagencies;therulesforalloftheseprovidertypeswould |
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| 15 | | - | needtoincludeaprocessfordetermininganannualinflationaryadjustment |
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| 16 | | - | andsetforthapredictabletimelineforredeterminingtheproviders’baserates. |
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| 17 | | - | ThebillwouldrequiretheSecretarytoredeterminethepaymentratesfor |
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| 18 | | - | home-andcommunity-basedserviceprovidersandfordesignatedand |
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| 19 | | - | specializedserviceagenciesatleastannuallyandreportthoserates,andthe |
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| 20 | | - | amountsnecessarytofundthem,totheGeneralAssemblyaspartofthe |
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| 21 | | - | AgencyofHumanServices’budgetpresentation.Thebillwouldalsodirect |
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| 22 | | - | theDepartmentofVermontHealthAccesstoconductaratestudyofthe |
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| 23 | | - | currentMedicaidratespaidtoprovidersofhome-andcommunity-based |
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| 44 | | - | 21 BILLASPASSEDBYTHEHOUSE H.13 |
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| 45 | | - | 2025 Page2of11 |
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| 46 | | - | servicesandtoprovidersofsubstanceusedisordertreatmentservicesand |
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| 47 | | - | reporttheDepartment’sfindingsandrecommendationstotheGeneral |
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| 48 | | - | AssemblyandtheSecretaryofHumanServices. |
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| 49 | | - | AnactrelatingtoMedicaidpaymentratesforhome-andcommunity-based |
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| 50 | | - | serviceprovidersanddesignatedandspecializedserviceagencies |
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| 51 | | - | AnactrelatingtoMedicaidpaymentratesforhome-andcommunity-based |
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| 52 | | - | serviceproviders |
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| 53 | | - | ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont: |
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| 54 | | - | Sec.1.33V.S.A.§ 900isamendedtoread: |
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| 55 | | - | §900.DEFINITIONS |
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| 56 | | - | Unlessotherwiserequiredbythecontext,thewordsandphrasesinthis |
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| 57 | | - | chaptershallbedefinedasfollowsAsusedinthischapter: |
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| 58 | | - | *** |
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| 59 | | - | (7)“Home-andcommunity-basedservices”meanslong-termservices |
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| 60 | | - | andsupportsprovidedtoolderadultsandadultswithphysicaldisabilitiesina |
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| 61 | | - | homeorcommunitysettingotherthananursinghome,includingenhanced |
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| 62 | | - | residentialcareservices,pursuanttotheChoicesforCarecomponentof |
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| 63 | | - | Vermont’sGlobalCommitmenttoHealthSection1115Medicaid |
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| 64 | | - | demonstrationorasuccessorprogram.“Home-andcommunity-based |
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| 65 | | - | services”alsoincludesnon-ChoicesforCarehomehealthandhospice |
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| 83 | | - | 18 BILLASPASSEDBYTHEHOUSE H.13 |
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| 84 | | - | 2025 Page3of11 |
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| 85 | | - | services,adultdayrehabilitationservices,assistivecommunitycareservices, |
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| 86 | | - | andservicesforindividualswithtraumaticbraininjury. |
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| 87 | | - | Sec.2.33V.S.A.§ 911isaddedtoread: |
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| 88 | | - | § 911.PAYMENTRATESFORPROVIDERSOFHOME-AND |
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| 89 | | - | COMMUNITY-BASEDSERVICES |
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| 90 | | - | (a)TheSecretaryofHumanServicesshalldeterminepaymentratesfor |
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| 91 | | - | providersofhome-andcommunity-basedservicesthatarereasonableand |
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| 92 | | - | adequatetoachievetherequiredoutcomesforthepopulationstheyserve. |
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| 93 | | - | Whendeterminingthesepaymentrates,theSecretaryshalladjusttherate |
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| 94 | | - | amountstotakeintoaccountfactorsthatinclude: |
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| 95 | | - | (1)thereasonablecostofanygovernmentalmandatethathasbeen |
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| 96 | | - | enacted,adopted,orimposedbyanyStateorfederalauthority;and |
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| 97 | | - | (2)acostadjustmentfactortoreflectchangesinreasonablecostsof |
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| 98 | | - | goodstoandservicesofprovidersofhome-andcommunity-basedservices, |
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| 99 | | - | includingthoseattributedtoinflationandlabormarketdynamics. |
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| 100 | | - | (b)Whendeterminingreasonableandadequateratesofpaymentfor |
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| 101 | | - | providersofhome-andcommunity-basedservices,theSecretarymayconsider |
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| 102 | | - | geographicdifferencesinwages,benefits,housing,andrealestatecostsin |
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| 103 | | - | eachregionoftheState. |
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| 104 | | - | (c)TheSecretaryshalladoptrulessettingforththemethodologyfor |
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| 105 | | - | determiningpaymentratesforprovidersofhome-andcommunity-based |
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| 126 | | - | 21 BILLASPASSEDBYTHEHOUSE H.13 |
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| 127 | | - | 2025 Page4of11 |
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| 128 | | - | servicesinaccordancewiththissection.Therulesshallincludeaprocessfor |
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| 129 | | - | determininganannualinflationaryrateadjustment,shallsetforthapredictable |
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| 130 | | - | timelineforredeterminationofbaserates,andshalluseVermontlabormarket |
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| 131 | | - | ratesandVermontcostsofoperation. |
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| 132 | | - | (d)TheSecretaryshallredeterminethepaymentratesforprovidersof |
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| 133 | | - | home-andcommunity-basedservicesinaccordancewiththissectionatleast |
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| 134 | | - | annuallyandshallreportthoserates,andtheamountsnecessarytofundthem, |
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| 135 | | - | totheHouseCommitteesonAppropriations,onHumanServices,andon |
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| 136 | | - | HealthCareandtheSenateCommitteesonAppropriationsandonHealthand |
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| 137 | | - | WelfareannuallyaspartoftheAgency’sbudgetpresentation. |
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| 138 | | - | Sec.3.18V.S.A.§ 8914isamendedtoread: |
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| 139 | | - | §8914.RATESOFPAYMENTSTODESIGNATEDANDSPECIALIZED |
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| 140 | | - | SERVICEAGENCIES |
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| 141 | | - | (a)TheSecretaryofHumanServicesshallhavesoleresponsibilityfor |
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| 142 | | - | establishingdeterminetheDepartmentsofHealth’s,ofMentalHealth’s,andof |
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| 143 | | - | Disabilities,Aging,andIndependentLiving’sratesofpaymentsfordesignated |
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| 144 | | - | andspecializedserviceagenciesthatarereasonableandadequatetoachieve |
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| 145 | | - | therequiredoutcomesfordesignatedpopulations.Whenestablishing |
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| 146 | | - | determiningtheseratesofpaymentfordesignatedandspecializedservice |
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| 147 | | - | agencies,theSecretaryshalladjustratestherateamountstotakeintoaccount |
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| 148 | | - | factorsthatinclude: |
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| 169 | | - | 21 BILLASPASSEDBYTHEHOUSE H.13 |
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| 170 | | - | 2025 Page5of11 |
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| 171 | | - | (1)thereasonablecostofanygovernmentalmandatethathasbeen |
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| 172 | | - | enacted,adopted,orimposedbyanyStateorfederalauthority;and |
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| 173 | | - | (2)acostadjustmentfactortoreflectchangesinreasonablecostsof |
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| 174 | | - | goodstoandservicesofdesignatedandspecializedserviceagencies,including |
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| 175 | | - | thoseattributedtoinflationandlabormarketdynamics. |
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| 176 | | - | (b)Whenestablishingdeterminingreasonableandadequateratesof |
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| 177 | | - | paymentfordesignatedandspecializedserviceagencies,theSecretarymay |
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| 178 | | - | considergeographicdifferencesinwages,benefits,housing,andrealestate |
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| 179 | | - | costsineachregionoftheState. |
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| 180 | | - | (c)TheSecretaryshalladoptrulessettingforththemethodologyfor |
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| 181 | | - | determiningthepaymentratesforservicesprovidedbydesignatedand |
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| 182 | | - | specializedserviceagenciestoindividualswithmentalconditions,individuals |
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| 183 | | - | withsubstanceusedisorders,andindividualswithdevelopmentalor |
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| 184 | | - | intellectualdisabilitiesinaccordancewiththissection.Therulesshallinclude |
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| 185 | | - | aprocessfordetermininganannualinflationaryrateadjustment,shallsetforth |
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| 186 | | - | apredictabletimelineforredeterminationofbaserates,andshalluseVermont |
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| 187 | | - | labormarketratesandVermontcostsofoperation. |
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| 188 | | - | (d)TheSecretaryshallredeterminethepaymentratesfordesignatedand |
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| 189 | | - | specializedserviceagenciesinaccordancewiththissectionatleastannually |
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| 190 | | - | andshallreportthoserates,andtheamountsnecessarytofundthem,tothe |
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| 191 | | - | HouseCommitteesonAppropriations,onHumanServices,andonHealth |
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| 212 | | - | 21 BILLASPASSEDBYTHEHOUSE H.13 |
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| 213 | | - | 2025 Page6of11 |
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| 214 | | - | CareandtheSenateCommitteesonAppropriationsandonHealthandWelfare |
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| 215 | | - | annuallyaspartoftheAgency’sbudgetpresentation. |
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| 216 | | - | Sec.4.HOME-ANDCOMMUNITY-BASEDSERVICEPROVIDER |
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| 217 | | - | RATESTUDY;REPORT |
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| 218 | | - | (a)TheDepartmentofVermontHealthAccess,incollaborationwiththe |
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| 219 | | - | DepartmentsofDisabilities,Aging,andIndependentLiving,ofHealth,andof |
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| 220 | | - | MentalHealth,shallconductaratestudyoftheMedicaidreimbursementrates |
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| 221 | | - | paidtoprovidersofhome-andcommunity-basedservices,asdefinedin |
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| 222 | | - | 33 V.S.A.§ 900,andprovidersofsubstanceusedisordertreatmentservices, |
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| 223 | | - | includingtheiradequacyandthemethodologiesunderlyingtherates.Aspart |
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| 224 | | - | oftheratestudy,theDepartmentofVermontHealthAccessshall: |
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| 225 | | - | (1)delineateareasonableandpredictablescheduleforMedicaidrates |
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| 226 | | - | andrateupdates; |
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| 227 | | - | (2)identifywaystoalignMedicaidreimbursementmethodologiesand |
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| 228 | | - | ratesforprovidersofhome-andcommunity-basedserviceswiththoseofother |
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| 229 | | - | payers,totheextentsuchothermethodologiesandratesexist;and |
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| 230 | | - | (3)determinewaystolimitthenumberofmethodologicalexceptions. |
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| 231 | | - | (b)OnorbeforeJanuary15,2026,theDepartmentofVermontHealth |
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| 232 | | - | Access,incollaborationwiththeDepartmentsofDisabilities,Aging,and |
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| 233 | | - | IndependentLiving,ofHealth,andofMentalHealth,shallreporttheresultsof |
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| 234 | | - | theratestudyconductedpursuanttothissectionandtheirfindingsand |
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| 255 | | - | 21 BILLASPASSEDBYTHEHOUSE H.13 |
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| 256 | | - | 2025 Page7of11 |
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| 257 | | - | recommendationstotheHouseCommitteesonHumanServicesandon |
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| 258 | | - | Appropriations,theSenateCommitteesonHealthandWelfareandon |
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| 259 | | - | Appropriations,andtheSecretaryofHumanServices. |
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| 260 | | - | Sec.5.EFFECTIVEDATE |
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| 261 | | - | Thisactshalltakeeffectonpassage,withtherulesadoptedbytheSecretary |
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| 262 | | - | ofHumanServicespursuanttoSecs.2(33V.S.A.§ 911)and3(18V.S.A. |
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| 263 | | - | § 8914)takingeffectonorbeforeJuly1,2026. |
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| 264 | | - | Sec.1.33V.S.A.§ 900isamendedtoread: |
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| 265 | | - | §900.DEFINITIONS |
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| 266 | | - | Unlessotherwiserequiredbythecontext,thewordsandphrasesinthis |
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| 267 | | - | chaptershallbedefinedasfollowsAsusedinthischapter: |
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| 268 | | - | *** |
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| 269 | | - | (7)“Home-andcommunity-basedservices”meansthefollowing |
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| 270 | | - | servicesprovidedpursuanttoVermont’sGlobalCommitmenttoHealthSection |
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| 271 | | - | 1115Medicaiddemonstrationorasuccessorprogram: |
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| 272 | | - | (A)long-termservicesandsupportsprovidedtoolderadultsand |
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| 273 | | - | adultswithdisabilitiesinahomeorcommunitysettingotherthananursing |
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| 274 | | - | home,includingenhancedresidentialcareservices; |
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| 275 | | - | (B)homehealthandhospiceservices,adultdayrehabilitation |
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| 276 | | - | services,andassistivecommunitycareservices;and |
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| 283 | | - | 7 BILLASPASSEDBYTHEHOUSE H.13 |
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| 284 | | - | 2025 Page8of11 |
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| 285 | | - | (C)short-andlong-termservicesandsupportsprovidedto |
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| 286 | | - | individualswithmentalconditions,individualswithsubstanceusedisorders, |
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| 287 | | - | individualswithdevelopmentalorintellectualdisabilities,andindividualswith |
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| 288 | | - | abraininjury,inahomeorcommunitysettingforwhichtheMedicaidrates |
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| 289 | | - | arenototherwiseestablishedpursuanttostatuteorrule. |
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| 290 | | - | Sec.2.33V.S.A.§ 911isaddedtoread: |
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| 291 | | - | § 911.PAYMENTRATESFORPROVIDERSOFHOME-AND |
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| 292 | | - | COMMUNITY-BASEDSERVICES |
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| 293 | | - | (a)TheSecretaryofHumanServicesshalldeterminepaymentratesfor |
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| 294 | | - | providersofhome-andcommunity-basedservicesthatarereasonableand |
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| 295 | | - | adequatetoachievetherequiredoutcomesforthepopulationstheyserve. |
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| 296 | | - | Whendeterminingthesepaymentrates,theSecretaryshalladjusttherate |
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| 297 | | - | amountstotakeintoaccountfactorsthatinclude: |
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| 298 | | - | (1)thereasonablecostofanygovernmentalmandatethathasbeen |
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| 299 | | - | enacted,adopted,orimposedbyanyStateorfederalauthority;and |
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| 300 | | - | (2)acostadjustmentfactortoreflectchangesinreasonablecostsof |
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| 301 | | - | goodstoandservicesofprovidersofhome-andcommunity-basedservices, |
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| 302 | | - | includingthoseattributedtoinflationandlabormarketdynamics. |
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| 303 | | - | (b)Whendeterminingreasonableandadequateratesofpaymentfor |
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| 304 | | - | providersofhome-andcommunity-basedservices,theSecretarymayconsider BILLASPASSEDBYTHEHOUSE H.13 |
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| 305 | | - | 2025 Page9of11 |
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| 306 | | - | geographicdifferencesinwages,benefits,housing,andrealestatecostsin |
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| 307 | | - | eachregionoftheState. |
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| 308 | | - | (c)TheSecretaryshallestablishamethodologyfordeterminingpayment |
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| 309 | | - | ratesforprovidersofhome-andcommunity-basedservicesinaccordancewith |
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| 310 | | - | thissection.Themethodologyshall: |
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| 311 | | - | (1)provideascheduleforconductingstudiesoftheMedicaid |
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| 312 | | - | reimbursementratespaidtotheprovidersofhome-andcommunity-based |
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| 313 | | - | services,includingtherates’adequacyandtheirunderlyingmethodologies, |
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| 314 | | - | thatincludesstudyingtheratespaidtoprovidersforeachtypeofserviceat |
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| 315 | | - | leastonceeveryfiveyears; |
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| 316 | | - | (2)setforthapredictabletimelineforredeterminationofbaserates; |
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| 317 | | - | (3)includeaprocessfordetermininganannualinflationaryrate |
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| 318 | | - | adjustment; |
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| 319 | | - | (4)totheextentpermittedbytheCentersforMedicareandMedicaid |
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| 320 | | - | Services,takeintoaccountthefinancialneedsofproviderswhose |
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| 321 | | - | reimbursementsmaybenegativelyaffectedbyclientabsences;and |
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| 322 | | - | (5)useVermontlabormarketratesandVermontcostsofoperation. |
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| 323 | | - | (d)TheSecretaryshallestablishaprocessbywhichaproviderwhose |
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| 324 | | - | financialconditionplacesitatimminentriskofclosuremayseekextraordinary |
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| 325 | | - | financialrelieffromtheAgency. BILLASPASSEDBYTHEHOUSE H.13 |
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| 326 | | - | 2025 Page10of11 |
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| 327 | | - | (e)TheSecretaryshallredeterminethepaymentratesforprovidersof |
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| 328 | | - | home-andcommunity-basedservicesinaccordancewiththissectionatleast |
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| 329 | | - | annuallyandshallreportthoserates,andtheamountsnecessarytofundthem, |
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| 330 | | - | totheHouseCommitteesonAppropriations,onHumanServices,andon |
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| 331 | | - | HealthCareandtheSenateCommitteesonAppropriationsandonHealthand |
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| 332 | | - | WelfareannuallyaspartoftheAgency’sbudgetpresentation. |
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| 333 | | - | Sec.3.18V.S.A.§ 8914isamendedtoread: |
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| 334 | | - | §8914.RATESOFPAYMENTSTODESIGNATEDANDSPECIALIZED |
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| 335 | | - | SERVICEAGENCIES |
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| 336 | | - | (a)TheSecretaryofHumanServicesshallhavesoleresponsibilityfor |
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| 337 | | - | establishingdeterminetheDepartmentsofHealth’s,ofMentalHealth’s,and |
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| 338 | | - | ofDisabilities,Aging,andIndependentLiving’sratesofpaymentsfor |
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| 339 | | - | designatedandspecializedserviceagenciesthatarereasonableandadequate |
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| 340 | | - | toachievetherequiredoutcomesfordesignatedpopulationsinaccordance |
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| 341 | | - | with33V.S.A.§ 911.Whenestablishingratesofpaymentfordesignatedand |
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| 342 | | - | specializedserviceagencies,theSecretaryshalladjustratestotakeinto |
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| 343 | | - | accountfactorsthatinclude: |
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| 344 | | - | (1)thereasonablecostofanygovernmentalmandatethathasbeen |
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| 345 | | - | enacted,adopted,orimposedbyanyStateorfederalauthority;and BILLASPASSEDBYTHEHOUSE H.13 |
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| 346 | | - | 2025 Page11of11 |
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| 347 | | - | (2)acostadjustmentfactortoreflectchangesinreasonablecostsof |
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| 348 | | - | goodsandservicesofdesignatedandspecializedserviceagencies,including |
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| 349 | | - | thoseattributedtoinflationandlabormarketdynamics. |
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| 350 | | - | (b)Whenestablishingratesofpaymentfordesignatedandspecialized |
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| 351 | | - | serviceagencies,theSecretarymayconsidergeographicdifferencesinwages, |
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| 352 | | - | benefits,housing,andrealestatecostsineachregionoftheState. |
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| 353 | | - | Sec.4.PAYMENTRATESFORPROVIDERSOFHOME-AND |
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| 354 | | - | COMMUNITY-BASEDSERVICES;UPDATEON |
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| 355 | | - | IMPLEMENTATION;REPORT |
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| 356 | | - | OnorbeforeJanuary15,2026,theAgencyofHumanServicesshallreport |
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| 357 | | - | totheHouseCommitteesonHumanServicesandonHealthCareandthe |
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| 358 | | - | SenateCommitteeonHealthandWelfarewithanupdateontheAgency’s |
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| 359 | | - | implementationof33V.S.A.§ 911,asaddedbySec.2ofthisact,includingthe |
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| 360 | | - | Agency’sproposedscheduleforMedicaidratestudiesandthemethodologythe |
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| 361 | | - | Agencydevelopedfordeterminingpaymentratesforprovidersofhome-and |
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| 362 | | - | community-basedservices. |
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| 363 | | - | Sec.5.EFFECTIVEDATE |
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| 364 | | - | Thisactshalltakeeffectonpassage. |
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| 1 | + | BILL AS INTRODUCED H.13 |
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| 2 | + | 2025 Page 1 of 7 |
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| 3 | + | |
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| 4 | + | |
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| 5 | + | VT LEG #378430 v.1 |
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| 6 | + | H.13 1 |
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| 7 | + | Introduced by Representatives Wood of Waterbury and Noyes of Wolcott 2 |
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| 8 | + | Referred to Committee on 3 |
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| 9 | + | Date: 4 |
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| 10 | + | Subject: Human services; Medicaid; home- and community-based service 5 |
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| 11 | + | providers; designated and specialized service agencies 6 |
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| 12 | + | Statement of purpose of bill as introduced: This bill proposes to require the 7 |
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| 13 | + | Secretary of Human Services to determine reasonable and adequate Medicaid 8 |
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| 14 | + | payment rates for providers of home- and community-based services. It would 9 |
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| 15 | + | direct the Secretary to adopt rules setting forth the methodology for those 10 |
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| 16 | + | payment rates, as well as for the Medicaid payment rates for designated and 11 |
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| 17 | + | specialized service agencies; the rules for all of these provider types would 12 |
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| 18 | + | need to include a process for determining an annual inflationary adjustment 13 |
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| 19 | + | and set forth a predictable timeline for redetermining the providers’ base rates. 14 |
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| 20 | + | The bill would require the Secretary to redetermine the payment rates for 15 |
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| 21 | + | home- and community-based service providers and for designated and 16 |
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| 22 | + | specialized service agencies at least annually and report those rates, and the 17 |
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| 23 | + | amounts necessary to fund them, to the General Assembly as part of the 18 |
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| 24 | + | Agency of Human Services’ budget presentation. The bill would also direct 19 |
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| 25 | + | the Department of Vermont Health Access to conduct a rate study of the 20 |
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| 26 | + | current Medicaid rates paid to providers of home- and community-based 21 BILL AS INTRODUCED H.13 |
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| 27 | + | 2025 Page 2 of 7 |
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| 28 | + | |
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| 29 | + | |
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| 30 | + | VT LEG #378430 v.1 |
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| 31 | + | services and to providers of substance use disorder treatment services and 1 |
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| 32 | + | report the Department’s findings and recommendations to the General 2 |
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| 33 | + | Assembly and the Secretary of Human Services. 3 |
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| 34 | + | An act relating to Medicaid payment rates for home- and community-based 4 |
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| 35 | + | service providers and designated and specialized service agencies 5 |
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| 36 | + | It is hereby enacted by the General Assembly of the State of Vermont: 6 |
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| 37 | + | Sec. 1. 33 V.S.A. § 900 is amended to read: 7 |
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| 38 | + | § 900. DEFINITIONS 8 |
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| 39 | + | Unless otherwise required by the context, the words and phrases in this 9 |
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| 40 | + | chapter shall be defined as follows As used in this chapter: 10 |
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| 41 | + | * * * 11 |
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| 42 | + | (7) “Home- and community-based services” means long-term services 12 |
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| 43 | + | and supports provided to older adults and adults with physical disabilities in a 13 |
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| 44 | + | home or community setting other than a nursing home, including enhanced 14 |
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| 45 | + | residential care services, pursuant to the Choices for Care component of 15 |
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| 46 | + | Vermont’s Global Commitment to Health Section 1115 Medicaid 16 |
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| 47 | + | demonstration or a successor program. “Home- and community-based 17 |
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| 48 | + | services” also includes non-Choices for Care home health and hospice 18 |
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| 49 | + | services, adult day rehabilitation services, assistive community care services, 19 |
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| 50 | + | and services for individuals with traumatic brain injury. 20 BILL AS INTRODUCED H.13 |
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| 51 | + | 2025 Page 3 of 7 |
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| 52 | + | |
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| 53 | + | |
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| 54 | + | VT LEG #378430 v.1 |
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| 55 | + | Sec. 2. 33 V.S.A. § 911 is added to read: 1 |
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| 56 | + | § 911. PAYMENT RATES FOR PROVIDERS OF HOME - AND 2 |
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| 57 | + | COMMUNITY-BASED SERVICES 3 |
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| 58 | + | (a) The Secretary of Human Services shall determine payment rates for 4 |
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| 59 | + | providers of home- and community-based services that are reasonable and 5 |
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| 60 | + | adequate to achieve the required outcomes for the populations they serve. 6 |
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| 61 | + | When determining these payment rates, the Secretary shall adjust the rate 7 |
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| 62 | + | amounts to take into account factors that include: 8 |
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| 63 | + | (1) the reasonable cost of any governmental mandate that has been 9 |
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| 64 | + | enacted, adopted, or imposed by any State or federal authority; and 10 |
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| 65 | + | (2) a cost adjustment factor to reflect changes in reasonable costs of 11 |
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| 66 | + | goods to and services of providers of home- and community-based services, 12 |
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| 67 | + | including those attributed to inflation and labor market dynamics. 13 |
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| 68 | + | (b) When determining reasonable and adequate rates of payment for 14 |
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| 69 | + | providers of home- and community-based services, the Secretary may consider 15 |
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| 70 | + | geographic differences in wages, benefits, housing, and real estate costs in 16 |
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| 71 | + | each region of the State. 17 |
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| 72 | + | (c) The Secretary shall adopt rules setting forth the methodology for 18 |
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| 73 | + | determining payment rates for providers of home- and community-based 19 |
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| 74 | + | services in accordance with this section. The rules shall include a process for 20 |
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| 75 | + | determining an annual inflationary rate adjustment, shall set forth a predictable 21 BILL AS INTRODUCED H.13 |
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| 76 | + | 2025 Page 4 of 7 |
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| 77 | + | |
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| 78 | + | |
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| 79 | + | VT LEG #378430 v.1 |
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| 80 | + | timeline for redetermination of base rates, and shall use Vermont labor market 1 |
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| 81 | + | rates and Vermont costs of operation. 2 |
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| 82 | + | (d) The Secretary shall redetermine the payment rates for providers of 3 |
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| 83 | + | home- and community-based services in accordance with this section at least 4 |
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| 84 | + | annually and shall report those rates, and the amounts necessary to fund them, 5 |
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| 85 | + | to the House Committees on Appropriations, on Human Services, and on 6 |
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| 86 | + | Health Care and the Senate Committees on Appropriations and on Health and 7 |
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| 87 | + | Welfare annually as part of the Agency’s budget presentation. 8 |
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| 88 | + | Sec. 3. 18 V.S.A. § 8914 is amended to read: 9 |
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| 89 | + | § 8914. RATES OF PAYMENTS TO DESIGNATED AND SPECIALIZED 10 |
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| 90 | + | SERVICE AGENCIES 11 |
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| 91 | + | (a) The Secretary of Human Services shall have sole responsibility for 12 |
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| 92 | + | establishing determine the Departments of Health’s, of Mental Health’s, and of 13 |
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| 93 | + | Disabilities, Aging, and Independent Living’s rates of payments for designated 14 |
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| 94 | + | and specialized service agencies that are reasonable and adequate to achieve 15 |
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| 95 | + | the required outcomes for designated populations. When establishing 16 |
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| 96 | + | determining these rates of payment for designated and specialized service 17 |
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| 97 | + | agencies, the Secretary shall adjust rates the rate amounts to take into account 18 |
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| 98 | + | factors that include: 19 |
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| 99 | + | (1) the reasonable cost of any governmental mandate that has been 20 |
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| 100 | + | enacted, adopted, or imposed by any State or federal authority; and 21 BILL AS INTRODUCED H.13 |
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| 101 | + | 2025 Page 5 of 7 |
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| 102 | + | |
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| 103 | + | |
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| 104 | + | VT LEG #378430 v.1 |
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| 105 | + | (2) a cost adjustment factor to reflect changes in reasonable costs of 1 |
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| 106 | + | goods to and services of designated and specialized service agencies, including 2 |
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| 107 | + | those attributed to inflation and labor market dynamics. 3 |
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| 108 | + | (b) When establishing determining reasonable and adequate rates of 4 |
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| 109 | + | payment for designated and specialized service agencies, the Secretary may 5 |
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| 110 | + | consider geographic differences in wages, benefits, housing, and real estate 6 |
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| 111 | + | costs in each region of the State. 7 |
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| 112 | + | (c) The Secretary shall adopt rules setting forth the methodology for 8 |
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| 113 | + | determining the payment rates for services provided by designated and 9 |
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| 114 | + | specialized service agencies to individuals with mental conditions, individuals 10 |
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| 115 | + | with substance use disorders, and individuals with developmental or 11 |
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| 116 | + | intellectual disabilities in accordance with this section. The rules shall include 12 |
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| 117 | + | a process for determining an annual inflationary rate adjustment, shall set forth 13 |
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| 118 | + | a predictable timeline for redetermination of base rates, and shall use Vermont 14 |
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| 119 | + | labor market rates and Vermont costs of operation. 15 |
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| 120 | + | (d) The Secretary shall redetermine the payment rates for designated and 16 |
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| 121 | + | specialized service agencies in accordance with this section at least annually 17 |
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| 122 | + | and shall report those rates, and the amounts necessary to fund them, to the 18 |
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| 123 | + | House Committees on Appropriations, on Human Services, and on Health Care 19 |
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| 124 | + | and the Senate Committees on Appropriations and on Health and Welfare 20 |
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| 125 | + | annually as part of the Agency’s budget presentation. 21 BILL AS INTRODUCED H.13 |
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| 126 | + | 2025 Page 6 of 7 |
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| 127 | + | |
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| 128 | + | |
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| 129 | + | VT LEG #378430 v.1 |
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| 130 | + | Sec. 4. HOME- AND COMMUNITY -BASED SERVICE PROVIDER 1 |
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| 131 | + | RATE STUDY; REPORT 2 |
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| 132 | + | (a) The Department of Vermont Health Access, in collaboration with the 3 |
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| 133 | + | Departments of Disabilities, Aging, and Independent Living, of Health, and of 4 |
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| 134 | + | Mental Health, shall conduct a rate study of the Medicaid reimbursement rates 5 |
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| 135 | + | paid to providers of home- and community-based services, as defined in 6 |
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| 136 | + | 33 V.S.A. § 900, and providers of substance use disorder treatment services, 7 |
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| 137 | + | including their adequacy and the methodologies underlying the rates. As part 8 |
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| 138 | + | of the rate study, the Department of Vermont Health Access shall: 9 |
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| 139 | + | (1) delineate a reasonable and predictable schedule for Medicaid rates 10 |
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| 140 | + | and rate updates; 11 |
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| 141 | + | (2) identify ways to align Medicaid reimbursement methodologies and 12 |
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| 142 | + | rates for providers of home- and community-based services with those of other 13 |
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| 143 | + | payers, to the extent such other methodologies and rates exist; and 14 |
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| 144 | + | (3) determine ways to limit the number of methodological exceptions. 15 |
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| 145 | + | (b) On or before January 15, 2026, the Department of Vermont Health 16 |
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| 146 | + | Access, in collaboration with the Departments of Disabilities, Aging, and 17 |
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| 147 | + | Independent Living, of Health, and of Mental Health, shall report the results of 18 |
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| 148 | + | the rate study conducted pursuant to this section and their findings and 19 |
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| 149 | + | recommendations to the House Committees on Human Services and on 20 BILL AS INTRODUCED H.13 |
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| 150 | + | 2025 Page 7 of 7 |
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| 151 | + | |
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| 152 | + | |
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| 153 | + | VT LEG #378430 v.1 |
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| 154 | + | Appropriations, the Senate Committees on Health and Welfare and on 1 |
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| 155 | + | Appropriations, and the Secretary of Human Services. 2 |
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| 156 | + | Sec. 5. EFFECTIVE DATE 3 |
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| 157 | + | This act shall take effect on passage, with the rules adopted by the Secretary 4 |
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| 158 | + | of Human Services pursuant to Secs. 2 (33 V.S.A. § 911) and 3 (18 V.S.A. 5 |
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| 159 | + | § 8914) taking effect on or before July 1, 2026. 6 |
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