Vermont Medicaid proposal would end home health prior authorization and raise adult therapy coverage to 60 visits

The Vermont Agency of Human Services will hold a public hearing Monday, Nov. 9, at noon on two proposed Medicaid rules: one that would remove the prior-authorization requirement for home health services, and one that would double the visits of physical, occupational and speech-language therapy that Medicaid covers for adults each year, from 30 to 60. Written comments on both are due Monday, Nov. 16, according to the Secretary of State's rules postings.

The hearing is at the Waterbury State Office Complex, Ash 49, Room A213, 280 State Drive, and online through Microsoft Teams. The agency posted both rules Oct. 7. Ashley Berliner is the contact for questions about the content of each rule. Comments can be emailed to AHS.MedicaidPolicy@vermont.gov or mailed to the Medicaid Policy Unit, Agency of Human Services, 280 State Drive, Center Building, Waterbury, VT 05671-1000, according to the agency.

Home health services

Rule 26P032 amends the Health Care Administrative Rule 4.231, which sets the criteria for Medicaid coverage of home health services. The agency's summary says the amendments include removing the requirement for prior authorization and allowing coverage when medically necessary.

Rehabilitative therapy

Rule 26P031 amends Medicaid covered services rule 7317, "Rehabilitative Therapy Services," and adopts it as Health Care Administrative Rule 4.219. Under the proposed text, Medicaid would cover 60 therapy visits per calendar year for members 21 and older without prior authorization, up from 30; additional visits would require prior authorization. The 60-visit total counts any visits an outside insurer covered. Service limits would not apply to members under 21 when care is medically necessary. The rule also clarifies terms that were not previously defined, clarifies conditions for coverage and specifies services that are not covered.

What the agency says about cost and scope

In its filings, the agency says neither rule increases or lessens an economic burden on any person or entity, with no impact on the state's gross annualized budget, and that the changes conform the rules to current coverage criteria. It lists Medicaid beneficiaries, providers, and health law and advocacy groups, including the Office of Health Care Advocate, as affected parties.

The rules are part of a multi-year effort in which the agency says it is revising all of its Medicaid rules and adopting them under the title Health Care Administrative Rules. The agency posts annotated and clean copies of both proposed rules on its proposed rules page.