| 1 | | - | BILLASINTRODUCEDANDPASSEDBYSENATE S.36 |
|---|
| 2 | | - | 2025 Page1of4 |
|---|
| 3 | | - | S.36 |
|---|
| 4 | | - | IntroducedbySenatorsLyonsandGulick |
|---|
| 5 | | - | ReferredtoCommitteeonHealthandWelfare |
|---|
| 6 | | - | Date:January30,2025 |
|---|
| 7 | | - | Subject:Humanservices;Medicaid,substanceusedisorder;mentalhealth; |
|---|
| 8 | | - | long-termresidentialtreatment |
|---|
| 9 | | - | Statementofpurposeofbillasintroduced:Thisbillproposestorequirethe |
|---|
| 10 | | - | AgencyofHumanServicestoprovidecoverageforlong-termresidential |
|---|
| 11 | | - | treatmenttoMedicaidbeneficiarieswithsubstanceusedisorderandaco- |
|---|
| 12 | | - | occurringmentalhealthcondition. |
|---|
| 13 | | - | AnactrelatingtoMedicaidcoverageoflong-termresidentialtreatmentfor |
|---|
| 14 | | - | co-occurringsubstanceusedisorderandmentalhealthconditionAnact |
|---|
| 15 | | - | relatingtotheMedicaidpaymentmodelforresidentialsubstanceuse |
|---|
| 16 | | - | disordertreatmentservices |
|---|
| 17 | | - | ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont: |
|---|
| 18 | | - | Sec.1.33V.S.A.§ 1901misaddedtoread: |
|---|
| 19 | | - | § 1901m.LONG-TERMRESIDENTIALTREATMENTFORSUBSTANCE |
|---|
| 20 | | - | USEDISORDERANDCO-OCCURRINGMENTALHEALTH |
|---|
| 21 | | - | CONDITION |
|---|
| 22 | | - | 1 |
|---|
| 23 | | - | 2 |
|---|
| 24 | | - | 3 |
|---|
| 25 | | - | 4 |
|---|
| 26 | | - | 5 |
|---|
| 27 | | - | 6 |
|---|
| 28 | | - | 7 |
|---|
| 29 | | - | 8 |
|---|
| 30 | | - | 9 |
|---|
| 31 | | - | 10 |
|---|
| 32 | | - | 11 |
|---|
| 33 | | - | 12 |
|---|
| 34 | | - | 13 |
|---|
| 35 | | - | 14 |
|---|
| 36 | | - | 15 BILLASINTRODUCEDANDPASSEDBYSENATE S.36 |
|---|
| 37 | | - | 2025 Page2of4 |
|---|
| 38 | | - | (a)TheAgencyofHumanServicesshallprovidecoverageformedically |
|---|
| 39 | | - | necessarylong-termresidentialtreatmenttoMedicaidbeneficiarieswith |
|---|
| 40 | | - | substanceusedisorderandaco-occurringmentalhealthconditionwhenlong- |
|---|
| 41 | | - | termresidentialtreatmentisprescribedbyahealthcareprofessionalpracticing |
|---|
| 42 | | - | withinthescopeoftheprofessional’slicenseandtheresidentialtreatment |
|---|
| 43 | | - | programisparticipatinginVermont’sMedicaidprogram. |
|---|
| 44 | | - | (b)Coverageprovidedunderthissectionshallnotbeforlessthan: |
|---|
| 45 | | - | (1)30daysifthebeneficiary’ssubstanceusedisordercanbe |
|---|
| 46 | | - | successfullyaddressedbymedicationforopioidusedisorder;and |
|---|
| 47 | | - | (2)60daysifthebeneficiary’ssubstanceusedisordercannotbe |
|---|
| 48 | | - | successfullyaddressedbymedicationforopioidusedisorder. |
|---|
| 49 | | - | Sec.2.33V.S.A.§ 1901misredesignatedtoread: |
|---|
| 50 | | - | § 1901m1901n.REIMBURSEMENT FOREMERGENCYMEDICAL |
|---|
| 51 | | - | SERVICES |
|---|
| 52 | | - | Sec.3.EFFECTIVEDATE |
|---|
| 53 | | - | ThisactshalltakeeffectonJuly1,2025. |
|---|
| 54 | | - | Sec.1.33V.S.A.§ 1901nisaddedtoread: |
|---|
| 55 | | - | § 1901n.HIGH-INTENSITYRESIDENTIALTREATMENTFOR |
|---|
| 56 | | - | SUBSTANCEUSEDISORDERANDCO-OCCURRING |
|---|
| 57 | | - | MENTALCONDITIONS |
|---|
| 58 | | - | (a)TheAgencyofHumanServicesshallprovidecoverageformedically |
|---|
| 59 | | - | necessaryhigh-intensity,medicallymonitoredresidentialtreatmentepisodesto |
|---|
| 60 | | - | Medicaidbeneficiarieswithsubstanceusedisorderandaco-occurringmental |
|---|
| 61 | | - | healthconditionwhenmedicallynecessaryhigh-intensity,medicallymonitored |
|---|
| 62 | | - | residentialtreatmentepisodesareprescribedbyahealthcareprofessional |
|---|
| 63 | | - | 1 |
|---|
| 64 | | - | 2 |
|---|
| 65 | | - | 3 |
|---|
| 66 | | - | 4 |
|---|
| 67 | | - | 5 |
|---|
| 68 | | - | 6 |
|---|
| 69 | | - | 7 |
|---|
| 70 | | - | 8 |
|---|
| 71 | | - | 9 |
|---|
| 72 | | - | 10 |
|---|
| 73 | | - | 11 |
|---|
| 74 | | - | 12 |
|---|
| 75 | | - | 13 |
|---|
| 76 | | - | 14 |
|---|
| 77 | | - | 15 |
|---|
| 78 | | - | 16 BILLASINTRODUCEDANDPASSEDBYSENATE S.36 |
|---|
| 79 | | - | 2025 Page3of4 |
|---|
| 80 | | - | employedbyaresidentialtreatmentprogramwhoispracticingwithinthe |
|---|
| 81 | | - | scopeofthehealthprofessional’slicenseandtheresidentialtreatment |
|---|
| 82 | | - | programisparticipatinginVermont’sMedicaidprogram. |
|---|
| 83 | | - | (b)Coverageprovidedunderthissectionshallbefortheentirelengthof |
|---|
| 84 | | - | stayprescribedbyahealthcareprofessionalemployedbyaresidential |
|---|
| 85 | | - | treatmentprogram,whoshalltakeintoaccountcurrentbestpracticesforeach |
|---|
| 86 | | - | levelofcarewithinthesubstanceusecontinuumofcare. |
|---|
| 87 | | - | Sec.2.33V.S.A.§ 1901oisaddedtoread: |
|---|
| 88 | | - | § 1901o.LOW-INTENSITYRESIDENTIALTREATMENTFOR |
|---|
| 89 | | - | SUBSTANCEUSEDISORDERANDCO-OCCURRING |
|---|
| 90 | | - | MENTALCONDITIONS |
|---|
| 91 | | - | (a)TheAgencyofHumanServicesshallprovidecoverageformedically |
|---|
| 92 | | - | necessarylow-intensity,clinicallymanagedresidentialtreatmentepisodesto |
|---|
| 93 | | - | Medicaidbeneficiarieswithsubstanceusedisorderandaco-occurringmental |
|---|
| 94 | | - | healthconditionwhenmedicallynecessarylow-intensity,clinicallymanaged |
|---|
| 95 | | - | residentialtreatmentepisodesareprescribedbyahealthcareprofessional |
|---|
| 96 | | - | employedbyaresidentialtreatmentprogramwhoispracticingwithinthe |
|---|
| 97 | | - | scopeofthehealthcareprofessional’slicenseandtheresidentialtreatment |
|---|
| 98 | | - | programisparticipatinginVermont’sMedicaidprogram. |
|---|
| 99 | | - | (b)Coverageprovidedunderthissectionshallbefortheentirelengthof |
|---|
| 100 | | - | stayprescribedbyahealthcareprofessionalemployedbyaresidential |
|---|
| 101 | | - | treatmentprogram,whoshalltakeintoaccountcurrentbestpracticesfor |
|---|
| 102 | | - | levelsofcarewithinthesubstanceusecontinuumofcare. |
|---|
| 103 | | - | Sec.3.REPORT;MEDICAIDPAYMENTMODELFORRESIDENTIAL |
|---|
| 104 | | - | SUBSTANCEUSEDISORDERTREATMENTSERVICES |
|---|
| 105 | | - | TheAgencyofHumanServicesshallconductareviewoftheMedicaid |
|---|
| 106 | | - | paymentmodelforresidentialsubstanceusedisordertreatmentserviceswith |
|---|
| 107 | | - | specialconsiderationgiventotheactualcostofprovidingresidentialtreatment |
|---|
| 108 | | - | services,commensuratewithlengthofstay,co-occurringphysicalandmental |
|---|
| 109 | | - | healthneeds,andpostresidentialtreatmentserviceneeds.Theresultsofthe |
|---|
| 110 | | - | reviewshallbesubmittedtotheHouseCommitteeonHumanServicesandthe |
|---|
| 111 | | - | SenateCommitteeonHealthandWelfareonorbeforeDecember1,2025.The |
|---|
| 112 | | - | reviewshallincluderecommendationsandproposedlegislationto: |
|---|
| 113 | | - | (1)aligntheMedicaidpaymentmodelwiththeclinicalneedsof |
|---|
| 114 | | - | individualsreceivingresidentialsubstanceusedisordertreatmentservices;and |
|---|
| 115 | | - | (2)ensurecoordinatedtransitionsbetweenresidentialsubstanceuse |
|---|
| 116 | | - | disordertreatmentprovidersofferingvaryingacuityofcare. BILLASINTRODUCEDANDPASSEDBYSENATE S.36 |
|---|
| 117 | | - | 2025 Page4of4 |
|---|
| 118 | | - | Sec.4.REPEAL |
|---|
| 119 | | - | 2019ActsandResolvesNo.6,Secs.99and100(amendmentsto18V.S.A. |
|---|
| 120 | | - | §§ 4810(d)–(j)and4811thatprohibitedpublicinebriatesfrombeing |
|---|
| 121 | | - | incarceratedinaDepartmentofCorrections’facility)arerepealed. |
|---|
| 122 | | - | Sec.5. 2019ActsandResolvesNo.6,Sec.105isamendedtoread: |
|---|
| 123 | | - | Sec.105. EFFECTIVEDATES |
|---|
| 124 | | - | *** |
|---|
| 125 | | - | (c) Secs.99and100(amending18V.S.A.§§4910and4811)shalltake |
|---|
| 126 | | - | effectonJuly1,2025. [Deleted.] |
|---|
| 127 | | - | *** |
|---|
| 128 | | - | Sec.6.EFFECTIVEDATE |
|---|
| 129 | | - | ThisactshalltakeeffectonJuly1,2025. |
|---|
| 1 | + | BILL AS INTRODUCED S.36 |
|---|
| 2 | + | 2025 Page 1 of 2 |
|---|
| 3 | + | |
|---|
| 4 | + | |
|---|
| 5 | + | VT LEG #378522 v.1 |
|---|
| 6 | + | S.36 1 |
|---|
| 7 | + | Introduced by Senators Lyons and Gulick 2 |
|---|
| 8 | + | Referred to Committee on 3 |
|---|
| 9 | + | Date: 4 |
|---|
| 10 | + | Subject: Human services; Medicaid, substance use disorder; mental health; 5 |
|---|
| 11 | + | long-term residential treatment 6 |
|---|
| 12 | + | Statement of purpose of bill as introduced: This bill proposes to require the 7 |
|---|
| 13 | + | Agency of Human Services to provide coverage for long-term residential 8 |
|---|
| 14 | + | treatment to Medicaid beneficiaries with substance use disorder and a co-9 |
|---|
| 15 | + | occurring mental health condition. 10 |
|---|
| 16 | + | An act relating to Medicaid coverage of long-term residential treatment for 11 |
|---|
| 17 | + | co-occurring substance use disorder and mental health condition 12 |
|---|
| 18 | + | It is hereby enacted by the General Assembly of the State of Vermont: 13 |
|---|
| 19 | + | Sec. 1. 33 V.S.A. § 1901m is added to read: 14 |
|---|
| 20 | + | § 1901m. LONG-TERM RESIDENTIAL TREATMENT FOR SUBSTANCE 15 |
|---|
| 21 | + | USE DISORDER AND CO-OCCURRING MENTAL HEALTH 16 |
|---|
| 22 | + | CONDITION 17 |
|---|
| 23 | + | (a) The Agency of Human Services shall provide coverage for medically 18 |
|---|
| 24 | + | necessary long-term residential treatment to Medicaid beneficiaries with 19 |
|---|
| 25 | + | substance use disorder and a co-occurring mental health condition when long-20 BILL AS INTRODUCED S.36 |
|---|
| 26 | + | 2025 Page 2 of 2 |
|---|
| 27 | + | |
|---|
| 28 | + | |
|---|
| 29 | + | VT LEG #378522 v.1 |
|---|
| 30 | + | term residential treatment is prescribed by a health care professional practicing 1 |
|---|
| 31 | + | within the scope of the professional’s license and the residential treatment 2 |
|---|
| 32 | + | program is participating in Vermont’s Medicaid program. 3 |
|---|
| 33 | + | (b) Coverage provided under this section shall not be for less than: 4 |
|---|
| 34 | + | (1) 30 days if the beneficiary’s substance use disorder can be 5 |
|---|
| 35 | + | successfully addressed by medication for opioid use disorder; and 6 |
|---|
| 36 | + | (2) 60 days if the beneficiary’s substance use disorder cannot be 7 |
|---|
| 37 | + | successfully addressed by medication for opioid use disorder. 8 |
|---|
| 38 | + | Sec. 2. 33 V.S.A. § 1901m is redesignated to read: 9 |
|---|
| 39 | + | § 1901m 1901n. REIMBURSEMENT FOR EMERGENCY MEDICAL 10 |
|---|
| 40 | + | SERVICES 11 |
|---|
| 41 | + | Sec. 3. EFFECTIVE DATE 12 |
|---|
| 42 | + | This act shall take effect on July 1, 2025. 13 |
|---|