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H 815

An act relating to health insurance and Medicaid reimbursement for certain health care services

2025-2026 Regular Session Introduced by Daisy Berbeco

H.815 protects access to mental health, SUD, and I/DD services by requiring parity in coverage, safeguards on reimbursements, and a robust 90-day public, stakeholder, and impact an

Read first time and referred to the Committee on Health Care
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Bill Summary · H 815

Summary of H.815 (2025-2026) – Vermont

Purpose and intent

  • The bill aims to protect and preserve access to mental health, substance use disorder (SUD), and related services by limiting substantial reductions in reimbursement and ensuring meaningful stakeholder involvement before changes to reimbursement, billing, coding, and service authorization policies.
  • It applies to health insurance plans and Vermont Medicaid, with requirements for notice, public engagement, and evaluation prior to implementing changes that affect mental health, SUD, or intellectual or developmental disability (I/DD) services.

Key provisions and changes

Section 1: Health insurance—mental health coverage protections (8 V.S.A. § 4072)

  • Requires plans to cover treatment of mental conditions and to ensure parity with physical health care in cost-sharing terms:
    • No greater co-payments or cost burdens for mental health care than for comparable physical health care (both primary and specialty services).
  • Protections against network exclusions:
    • Plans may not exclude licensed mental health or SUD providers located within the geographic coverage area if the provider is willing to meet terms for participation.
  • Reimbursement safeguards:
    • Prohibits reducing reimbursement rates for more than one mental health code for the same license type in a contract year relative to the previous year.
  • Financial protections:
    • Deductibles and out-of-pocket limits for mental health care must be comprehensive with physical health coverage.
  • Drug coverage (if the plan includes prescription drug coverage):
    • At least one FDA-approved medication for SUD (including opioid use disorder treatments like methadone, buprenorphine, and naltrexone) must be available on the lowest cost-sharing tier of the formulary.

Section 2: Vermont-specific protections for health plans (new 18 V.S.A. § 9418h)

  • Before implementing any change to reimbursement methodology, billing policy, coding alignment, supervised billing, or service authorization affecting mental health, SUD, or I/DD services, plans must: 1) Identify whether the change is required by law and cite the applicable statute/regulation. 2) Identify which elements are discretionary policy choices. 3) Publish proposed policy language and guidance 90 days prior to implementation, and directly notify providers, advocacy groups, and individuals/families affected, plus the Department of Financial Regulation (DFR). 4) Conduct at least one public stakeholder meeting and solicit public comments. 5) Publish a written response showing how input was considered and incorporated.
  • Pre-implementation requirements include:
    • Public fiscal impact analysis.
    • Public assessment of impact on access to care and provider workforce.
    • Consultation with affected providers, the Office of the Health Care Advocate, Disability Rights Vermont, and representatives of individuals/families.

  • Post-implementation monitoring (12 months):

    • Quarterly public posting of access indicators: provider network participation/withdrawal, wait times, and service denial/reduction rates.
    • If access declines, the plan must take corrective actions to restore prior access levels.

  • Oversight and notice:

    • DFR must provide 60 days’ prior notice to specified legislative committees before implementing any mental health/SUD/I/DD policy change that reduces reimbursement, increases administrative burden, or increases wait times/reduces service availability.

Section 3: Medicaid protections (new 33 V.S.A. § 1905b)

  • Similar to Section 2, but for the Department of Vermont Health Access (DVHA) administering Medicaid:
    • Requires public identification of legal mandates vs. discretionary policy choices.
    • 90-day prior notice to providers and stakeholders for proposed changes; publication of proposed language and guidance.
    • Public stakeholder meeting and comment period; response documenting consideration of input.
    • Pre-implementation fiscal impact analysis and access/workforce impact assessment; consultation with affected parties.
    • 12-month post-implementation monitoring with quarterly access indicators and corrective action if access declines.
  • Legislative notice requirements to House/Senate health-related committees 60 days before implementing changes that affect reimbursement, administrative requirements, or service availability.

Effective dates

  • Section 1 (mental health reimbursement rates) takes effect January 1, 2027.
  • All other sections take effect on passage.

Who is affected

  • Health insurance plans operating in Vermont (including Medicare Advantage-like products if applicable, and commercial plans with mental health coverage).
  • Vermont Medicaid (DVHA) program and its providers.
  • Licensed mental health and substance use disorder treatment providers, independent mental health practitioners, designated and specialized service agencies.
  • Advocacy organizations and representatives of individuals and families receiving services.
  • Department of Financial Regulation and the Department of Vermont Health Access as oversight agencies.

Procedural and timeline notes

  • The bill introduces a robust pre-implementation review process requiring legal/policy clarity, public notice, stakeholder engagement, and published analyses.
  • It mandates ongoing monitoring for 12 months post-change with a mandatory corrective action framework if access declines.
  • The 60- to 90-day notice periods and public comment requirements are designed to increase transparency and stakeholder input prior to policy changes.

Overall, H.815 seeks to safeguard mental health, SUD, and I/DD service access by limiting reimbursement reductions, ensuring parity in cost-sharing, and embedding comprehensive notice, engagement, and evaluation processes around any policy changes.

Compiled from official sources — confirm details with the bill’s official record.

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