The bill S.194, introduced by Senator Lyons, aims to establish a new payment methodology for designated and specialized service agencies in Vermont by implementing a monthly prospective payment system. This system will require the Secretary of Human Services to issue payments to community-based service providers on the first day of the month for services to be provided, based on per-member per-month amounts derived from the most recently approved independent budgets and the number of individuals with approved individual budgets. The bill also mandates that community-based service providers submit monthly encounter data and invoices to the Agency, which will inform subsequent payments and include an annual reconciliation process to ensure alignment between authorized and actual services delivered.

Additionally, the bill amends existing law by removing the requirement for a schedule to conduct studies of Medicaid reimbursement rates every five years and instead focuses on establishing a more immediate and predictable payment structure. It retains provisions for calculating annual inflationary adjustments and considers the financial needs of providers affected by client absences. The act is set to take effect on July 1, 2026.

Statutes affected:
As Introduced: 33-911