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.

Reimbursement submits the combined fiscal impact for all fee schedules to a committee for review and awaits a decision on whether funding for rates increases will be included in the budget.  If approval for rate increases is granted, 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 health population while working within budget constraints.

The performance measure lists the fee schedules that were reviewed by Reimbursement for by SFY and depicts which fee schedules were updated for rate changes in MMIS. The measure also shows the fiscal impact of the rate changes that were implemented for each fee schedule.

This is a new metric that was introduced by the unit in SFY 2022 to replace other metrics that were no longer viable so there is no trendline established yet.

Narrative last updated:  09/02/22

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