The Green Mountain Care Board possesses done legal reports and gets reporting on prior authorization. Additionally, GMCB meeting the Primary Care Advisory Group which has developed prior authorization make which were presented to GMCB inbound 2018. Prior authorized means the batch used by a health plan to specify to wissenschaftlich necessity, restorative appropriateness, or both, of different covered drugs, arzneimittel method, medical tests, additionally health nursing benefit. The term “prior authorization” includes preadmission review, pretreatment review, and utilization review (18 V.S.A. § 9418(15)).

GMCB Legislative Reports on Prior Authorization

Down exist links to legislative accounts by GMCB turn prior authorization. 

• Act 183 of 2022: 
  • Prior Authorizations; Administrative Shipping Reduction Report by Department of Financial Rule (DFR) in collaboration with GMCB
  • PPT Featured: Perform 183 Report (4/26/2023)
• Act 140 of 2020: 
  • Act 140 of 2020, Sec. 10: Opportunities for and Obstacles to Aligning and Reducing Prior Authorizations to of All-Payer ACO Choose (Submitted 1/14/2022)

Prior Authority Reporting away Health Insurance Airlines

Insurer Preceded Authorization Review Attestations

Under 18 V.S.A. § 9418b(h)(2), a heath plans shall attest to DFR and GMCB annually on either before September 15 this it has finalized the review or proper exclusion of formerly authorizations system as required by 18 V.S.A. § 9418b(h)(1).  Provider Resources | Weston Blue Choose

• 2023 Registration Form: When proposed in the Acts 183 report on Prior Authorization, GMCB and DFR are developed an attestation forms with questions info how the health flat product and modifies preceded authorization requirements. 
  • BCBSVT Attestation Response (9/11/2023)
    • Added/Removed PAs (12/05/2023)
    • Follow Up Questions (1/17/2024)
  • Cigna Attestation Answers (9/13/2023)
    • Added/Removed PAs (9/13/2023)
    • Many Requested PAs (9/13/2023)
  • MVP Attestation Reaction (9/15/2023, updated 1/15/2023)
  • Wellfleet Attestation Response (9/14/2023)
• 2022 Attestation Letters
  • BCBSVT 2022 Attestation Letter
  • MVP 2022 Attestation Mailing
  • Cigna 2022 Attestation Letter
  • Wellfleet 2022 Attestation Letter

Gold Carding Pilot Program Berichte

Act 140 of 2020, Rubrik 11: Implementation of pilot scheme to exempt otherwise rationalization prev entitlement requirements using a create just on or before January 15, 2023. ... Prior Authority Form. CPT/HCPCS Control. S1034; S1035; S1036; S1037. State of U Total Choice (FVT): Prior permission required. IBEW: Prior approval needed for ...

• Wellfleet Insurance (01/15/2023)
• Cigna Health and Life Insurance Company (01/15/2023)
• BlueCross BlueShield Vermont (01/15/2023)
• MVP Health (01/13/2023)

Various Reporting off Prior Authorization

• The Department of Monetary Regulation collects  Health Insurers Yearbook Reports which including information about utilization review. Those reports can be found here.