Bill
S 194
Establishes monthly, inflation-adjusted payments to community-based service providers in Vermont, tied to approved budgets and caseload, with annual recalculations and reconciling
An act relating to designated and specialized service agency payment methodology
1) Payment rates for community-based service providers
- The Secretary of Human Services must calculate payment rates that are reasonable and adequate to achieve service outcomes.
- informational considerations when calculating rates:
- Include the reasonable cost of government mandates from state or federal authorities.
- Include a cost adjustment factor reflecting changes in reasonable costs (inflation, labor market dynamics).
- May consider regional differences in wages, benefits, housing, and real estate costs.
2) Methodology for calculating rates
- The methodology must:
- Provide a schedule for studies of Medicaid reimbursement rates to ensure adequacy and transparency, with studies at least once every five years.
- Issue a monthly prospective payment to each community-based service provider on the first day of the month for services to be provided, reflecting:
- Per-member per-month amounts calculated from the most recently approved independent budgets.
- The number of individuals with approved individual budgets.
- Establish a predictable timeline for redetermination of base rates.
- Include an annual inflationary rate adjustment.
- When permitted by CMS, account for the financial needs of providers whose reimbursements may be negatively affected by client absences.
- Use Vermont labor market rates and Vermont costs of operation.
3) Provider stabilization
- Creates a process for a provider at imminent risk of closure to request stabilization from the Agency.
4) Annual recalculation and reporting
- The Secretary must recalculate payment rates at least annually.
- Must report rates and the funds needed to support them to:
- Vermont House Committees on Appropriations, on Human Services, and on Health Care
- Vermont Senate Committees on Appropriations and on Health and Welfare
- Reports are to be included as part of the Agency’s budget presentation.
5) Data submission and reconciliation
- Providers shall submit monthly encounter data and invoices to the Agency to inform monthly payments.
- The Agency must conduct an annual reconciliation to ensure alignment between authorized services and actual delivery.
- Reconciliation includes census validation, funding accuracy, and value-based performance metrics.
6) Effective date
- The act would take effect on July 1, 2026.
Compiled from official sources — confirm details with the bill’s official record.
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