Health & Welfare hears hospital plea to extend prior-authorization waiver for Medicaid global budgets

A Health & Welfare committee session on April 14 examined H.611 and a proposal from hospitals to extend a prior-authorization waiver used under the One Care ACO model to Medicaid hospital global-budget pilots.

A representative of Living Green Vermont Association of Hospitals and Health Systems told the committee that "prior authorization is a huge amount of administrative burden for hospitals" and urged language in H.611 to waive most prior-authorizations for hospitals that accept a Medicaid global budget. The speaker said clinical safeguards — for items such as durable medical equipment — could remain in place while routine authorizations would be streamlined.

Alex McCracken, director of communications and legislative affairs for the Department of Vermont Health Access, said the department had only learned of this proposal earlier that morning and cautioned the committee that implementing such a waiver in a global-budget model "would require a pretty large systems change." McCracken recommended the committee invite Alicia Cooper, the department's subject-matter expert on hospital global budgets, to explain operational implications.

Legislative staff said the committee could mark up H.611 line-by-line and work with stakeholders to draft technical language. Witnesses asked staff to circulate proposed language to interested parties, and hospital advocates said they would follow up with the department to refine implementation details.

Committee members and staff noted that some elements of the One Care waiver appeared to function well but that the global-budget structure differs from the ACO framework and could create different billing, enrollment and access considerations. No formal motion or vote on a waiver provision was recorded during the session.

The committee agreed to request additional testimony from DVHA experts and from hospital representatives before deciding whether to add a prior-authorization waiver to the bill. Staff said they expected to continue drafting and could resume markup within days.