House advances H.766 with committee strike-all to third reading, citing reduced prior authorization burden

The Vermont House on the floor adopted a committee strike-all amendment to H.766, a bill intended to reduce administrative burdens on health care providers by aligning prior authorization and step-therapy rules with Medicaid practices and standardizing claims-editing processes. Representative Black (member from Essex), who presented the amendment, said the changes are designed to let clinicians make clinical determinations without undue payer interference.

Representative Black described the bill as touching multiple administrative pain points: clarifying that “it is the provider that should make the clinical decision that is in the best interest of their patient, not the payer,” aligning coding and claim-edit standards across payers to reduce duplicate work, limiting the release of new claim edits to quarterly filings with the Department of Financial Regulation, and reviving a stakeholder working group to review trends in coding and billing (sunset Jan. 1, 2028). The bill also seeks to align prior-authorization requirements with Medicaid where possible and shortens the urgent prior-authorization response window from 48 to 24 hours while maintaining two business days for nonurgent requests.

H.766 would require plans to acknowledge prior-authorization requests within 24 hours, ask for needed information at that time, and maintain an approval for the duration of treatment or one year, whichever is longer; for therapies that continue beyond one year plans could not require renewal more than once every five years. The measure also would require insurers to notify providers of new or amended policies and give providers an opportunity to object.

The bill requires health insurers to report by Jan. 15, 2027 on the effects of the prior-authorization provisions for plan years 2025–2026, including impacts on utilization, premium rates, and estimated avoided costs; provider organizations must gather member information and summarize impacts by the same date. Representative Black said testimony included provider reports of spending up to two hours per day on paperwork and listed a wide range of organizations and payers who testified before the committee.

During floor questioning, the Member from Georgia asked whether the bill provides protections or a safety net for physicians affected by recent payment outages or clearinghouse hacks. Representative Black replied the bill does not address clearinghouse security or payment-system outages.

After brief remarks in support from other members, the House adopted the committee amendment by voice vote and ordered the bill read a third time.

The bill’s sponsors and proponents argue the changes will reduce clinician burnout tied to administrative tasks and could decrease denials and appeals by standardizing coding and prior-authorization practices; supporters said they expect more timely care and fewer interruptions in treatment. The bill includes staggered effective dates, with several provisions effective on passage and other operational sections effective Jan. 1, 2025, allowing plans time to modify systems.

Next steps: H.766 was ordered to third reading and will return to the floor for final consideration.