Bill H.815, introduced by Representative Berbeco, aims to enhance the reimbursement framework for mental health services under health insurance and Medicaid in Vermont. The bill proposes to limit health insurers from reducing reimbursement rates for mental health services, specifically stating that they cannot lower the reimbursement rate for more than one mental health code for the same professional license type in any contract year below the previous year's rate. Additionally, it mandates that health insurers and Vermont Medicaid must provide advance notice and engage stakeholders before making any changes to reimbursement methodologies, billing policies, or service authorization requirements that affect mental health, substance use disorder, or intellectual and developmental disability services.

The bill also introduces new requirements for health plans and the Department of Vermont Health Access regarding changes to reimbursement and coding policies. These include conducting fiscal impact analyses, assessing the impact on access to care, and holding public stakeholder meetings prior to implementation. Furthermore, the Department must monitor access indicators for 12 months following any policy change and report quarterly on these metrics. If access is found to have decreased, corrective actions must be taken. The effective date for the mental health reimbursement rate provisions is set for January 1, 2027, while the other sections will take effect upon passage.

Statutes affected:
As Introduced: 8-4072