Vermont Legislation

This bill requires at least one formulation of each MAT drug to be on the lowest tier of the drug formulary. The bill eliminates prior authorization for MAT drugs and associated counseling and therapy for commercial plans and mandates report about the impact of prior authorization in Medicaid.

This bill tries to change the section of the insurance law about behavioral health coverage in the following ways:

• Health plans cannot use a prior authorization process for behavioral health care that differs from the prior authorization process for other medical care unless the health plan can demonstrate that “the requirement is necessary to provide timely and appropriate mental health care, as supported by evidence-based clinical standards.”
• Health plans may no longer use a third-party company to provide behavioral health coverage.
• Health plans must manage behavioral health benefits the same way they do for other medical benefits unless the health plans can demonstrate that the “differentiation is necessary to provide timely and appropriate mental health care, as supported by evidence-based clinical standards”.
• Specifies that the any regulations issued by the Commissioner of the Department of Financial Regulations about behavioral health insurance coverage ensure that behavioral health care is as “accessible” as coverage for other medical care and that any utilization review requirements for behavioral health care are not more burdensome than those in place for other medical care.

This bill tried to change the section of the law that requires health insurers to cover telemedicine services. It adds a section which defines health care provider. The section includes a variety of mental health and substance use disorder providers.

This bill tried to change the section of state law on health coverage for mental health and substance use disorders . Among other things, it requires health plans covering substance use disorder treatment to cover inpatient care for the duration of an enrollee’s withdrawal, unless the provider recommends the enrollee transition to outpatient services prior to completing their detox.

This bill amends the section of state law that addresses prescription drug coverage. It requires that health plans that provide coverage for prescription drugs shall include abuse-deterrent pain relieving medications as s preferred drug on their prescription drug formulary.

This bill tries to change on of the sections of the state insurance law relevant to parity by doing the following:

• Requires plans to use same prior authorization procedures for behavioral health services and other medical services
• Forbids plans from using behavioral health managed care techniques that are different from those used on other medical services
• Requires plans to use only one managed care organization for all medical and behavioral health coverage
• Forbids plans from using utilization review techniques and other non-quantitative treatment limitations (NQTLs) for behavioral health services that are different from those used for other medical services

This bill tried to change a section of the state insurance law relevant to parity by requiring plans to have copayments for behavioral health services that are “no greater” than copayments for other medical services. This bill was adopted into H 559 from the same legislative session. H 559 was signed into law and is summarized above in “Legislation Signed into Law.”

This bill tried to change the section of the state insurance law about autism coverage before that section of the law was substantially changed by a different bill from the same legislative session (S 223). Here are the significant improvements to the autism section of state insurance law that this bill would have made that were not made by S 223:

• Would have allowed an insurance plan to only review a child’s treatment plan once every 12 months

This bill tried to change the section of the state insurance law about autism coverage before that section of the law was substantially changed by a different bill from the same legislative session (S 223). Here are the significant improvements to the autism section of state insurance law that this bill would have made that were not made by S 223

• Would have aged the age limit for coverage to age 22
• Would have allowed an insurance plan to only review a child’s treatment plan once every 12 months