Reimbursement Unit

What We Do

The DVHA Medicaid Reimbursement Unit oversees rate setting, pricing, participate in quarterly code changes, provider payments, and reimbursement methodologies for a large array of services provided under Vermont Medicaid. The Reimbursement Unit is primarily responsible for implementing and managing prospective payment reimbursement methodologies developed to align with CMS Medicare methodologies for outpatient and inpatient services.

In addition, the Reimbursement Unit oversees a complementary set of specialty fee schedules including, but not limited to:  RBRVS (professional services), durable medical equipment, ambulance and transportation, clinical laboratory, physician administered drugs, dental, and home health. The unit also manages the FQHC and RHC payment process as well as supplemental payment administration such as the DSH and GME programs.

Who We Serve

Through our work with Medicaid providers and their stakeholders in implementing payment pricing and policy DVHA Reimbursement has an impact on and serve all Vermont Medicaid recipients.  

How We Impact

The unit works with Medicaid providers and other stakeholders to support equitable, transparent, and predictable payment policy to ensure efficient and appropriate use of Medicaid resources. The unit is involved with addressing the individual and special circumstantial needs of members by working closely with clinical staff from within DVHA and partner agencies to ensure that needed services are provided in an efficient and timely manner. We work closely and collaboratively on reimbursement policies for specialized programs with AHS sister departments, including Disabilities, Aging and Independent Living (DAIL), the Vermont Department of Health (VDH), the Vermont Department of Mental Health (DMH), and the Department for Children and Families (DCF). 

Action Plan

The top priorities/initiatives for the Reimbursement Unit in SFY20 are:

  • Continue working with suppliers and stakeholders on the update to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies fee schedule.  

  • Continue efforts to work with stakeholders to support equitable, transparent, and predictable payment policy to ensure efficient and appropriate use of Medicaid resources.

  • Continued focus on resolution of timely filing requests.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy