This measure is important because it captures adherence to the Policy, Budget and Reimbursement (PBR) process prior to implementing significant Medicaid changes.
The PBR form provides a tool to support the systematic coordination of AHS departments and units and provides essential documentation regarding the change. The routine use of the PBR form creates a process that serves as an internal safeguard against any unintended consequences of proposed changes.
Changes to Medicaid programs, services, and policies require a coordinated review to ensure alignment with federal and state regulations, as well as Vermont Medicaid policies and practices. The goal is to have approval from all before the change is effective and to issue public notice, if required.
If we are not finalizing PBRs prior to their effective dates, we are at risk for the following:
- Poor budgeting
- Loss of, or inability to, receive federal match
- Non-compliance with state and federal policies
- Public engagement
- Cost of mistakes (e.g. MMIS programming)
SFY20 Quarters 3 and 4 show a significant decrease of finalized PBRs prior to implementation, which is a direct result of staffing resources shifting to COVID-19 response across the Agency. During these two quarters, 32 COVID PBRs were finalized using an expedited process in order rapidly respond to the public health emergency. SFY21 Q1 shows a rebound - late July 2020 and after much of the initial COVID policy response had been addressed, the Policy Unit reinstated the full PBR process, requiring completion in advance of implementation.
Narrative last updated: 01/21/2021