VT H0815

Health insurers cannot reduce reimbursement rates for more than one mental health billing code per license type per contract year below the previous year's rate, effective January 1, 2027.

Health insurers and Vermont Medicaid must provide 90 days advance notice before implementing any changes to reimbursement methodology, billing policy, coding alignment, supervised billing requirements, or service authorization for mental health, substance use disorder, or intellectual/developmental disability services.

Prior to policy changes, insurers and Medicaid must publicly identify whether changes are legally required or discretionary, hold at least one public stakeholder meeting, conduct fiscal and access impact analyses, and publish written responses to stakeholder input.

For 12 months after implementing covered policy changes, insurers and Medicaid must post quarterly reports tracking provider network participation, wait times, and service denial rates, and must take corrective action if access declines.

The Department of Financial Regulation and Department of Vermont Health Access must notify legislative health committees at least 60 days before implementing changes that reduce reimbursement, increase administrative burdens, or are expected to reduce service availability.