This measure is important because it allows DVHA to track and monitor spending for services that are paid for outside of the normal fee for service payment construct for the service provided.

The metric shows the number of instances and general categories of services when providers were unwilling to accept Vermont Medicaid’s rates on file for a service needed by a VT Medicaid recipient. In order for the recipient to receive the service, the Reimbursement Unit will enter into negotiations with the provider resulting in the preparation of a letter of agreement (LOA) detailing the terms of payment. In most instances, the request for a special rate comes from an out-of-state provider for services not readily available in Vermont, but, more recently from in-state providers for a specialty service where there are few if any providers enrolled with VT Medicaid.

This metric was created starting in SFY 2022 so historical trends are limited at this time. For SFY 2022, the number of LOAs completed in each quarter has remained relatively steady with a low of 7 in quarter 1 to a high of 11 completed in quarter 3. The highest number of requests for a special rate  was received from providers providing inpatient surgeries and procedures, followed by inpatient rehabilitation. Requests for special rates to deliver specialty dental services, mostly root canals, is on the rise.

Narrative last updated:  09/16/22

• Providers
• DVHA Units including PMR, Clinical, Quality
• Medical/Dental Directors
• DVHA Upper Management
• Gainwell Technologies