When Reimbursement refers to a review of a fee schedule that means that the unit has reviewed the utilization for the program and applied the most recent pricing available at the time of the review resulting in a fiscal impact.  The fiscal impact calculates the amount of funding that will be needed to update the fee schedule based on the most recent pricing available.

Reimbursement submits the combined fiscal impact for all fee schedules reviewed to DVHA Senior Management.  DVHA/AHS management and the Budget Committee reviews fiscal needs in a global context across all AHS departments and determines what funding to include in the Governor’s proposed budget for the following state fiscal year (SFY) and Budget Adjustment Act.  If the legislature appropriates the funding for rate updates, Reimbursement will proceed with updating fee schedules which includes the completion of a PBR, updating of language in the state plan and provider manuals, the posting of public comment in the Global Commitment Register, and the implementation of the new rates in MMIS.

This measure is important because Vermont Medicaid wants to be a predictable and reliable payer for services provided to our Vermont residents resulting in high quality care and a healthy population while working within budget constraints.

The performance measure lists the fee schedules that were reviewed by Reimbursement by State Fiscal Year (SFY) and depicts which fee schedules were updated for rate changes in MMIS. When analyzing the results of this measure it is important to understand that a Reimbursement review of a fee schedule results in a fiscal impact, essentially meaning that funding will be needed to implement a rate increase. If funding is not allocated or the amount of the change cannot be absorbed within the DVHA budget, then the fee schedule will not be updated. The measure also shows the fiscal impact of rate changes that were implemented for each SFY broken down by fee schedule. 

In SFY 23 and SFY 24 a total of 15 fee schedules were reviewed each year resulting in 14 and 11 schedules updated, respectively.  The drop in trendline can be attributed to two fee schedules that were reviewed during the SFY, but the update will take place in the following SFY as noted in the table. The data shows that although 93.3% of SFY 23 schedules were updated versus 73.3% in SFY 24 there was a significant increase in funding allocated for 2024. The allocation of funds for SFY 23 rate increases was $3,711,064 while for SFY 24 it was $40,820,728, an increase of $37,109,644 or an almost 10-fold increase.  Providers reimbursed through the Ambulance, Assistive Community Care Services, Dental, FQHC/RHC and the RBRVS fee schedules saw large increases in reimbursement for services provided in SFY 24. 

Narrative last updated:  09/05/24

• Burns and Associates, DVHA Consultants
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• DVHA/AHS Upper Management/Legislature/Govenor's Budget