Reimbursement Unit

% of annual fee schedule updates implemented by goal date

100.0%SFY 2020

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Partners
  • Burns and Associates Inc. (consultants)
  • Medicaid Providers
  • Trade associations such as Vermont Association of Hospitals and Health Systems (VAHHS), VNA’s of Vermont and Bi-State, etc.
  • DXC 
  • DVHA Policy Unit
  • DVHA Business Office
  • DVHA Program Integrity Unit
  • Legislature
  • DVHA/AHS Management
  • Medicare – Release of fee schedules
Story Behind the Curve

For the most part, Vermont Medicaid has no written policy outlining the frequency of Medicaid fee schedule or other payment methodology updates. Over the years, as payment methodologies were re-vamped or new ones created to more align with Medicare payment methodologies, Medicaid Reimbursement has sought to update the rates on a more consistent basis, either annually or semi-annually or as prescribed in the State Plan. 

A few years ago, Medicaid Reimbursement sought approval to update the last of the major fee schedules. The fee schedule for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) had not been updated in almost a decade. Approval was granted in 2017 and a new methodology was implemented January 1, 2018.  

To better serve our provider community and as a result our clients through greater access, Medicaid Reimbursement is committed to consistently updating fee schedules on a consistent and predictable basis. The goal of the unit going forward is to work towards greater consistency in updates to all fee schedules and other payment methodologies that the unit oversees.


Last updated:  07/15/2020

Author:  Reimbursement Unit

Strategy

To accomplish this goal, starting in SFY 2018 Medicaid Reimbursement set a target date (i.e. month and day) for when each fee schedule or other payment methodology rate would be updated.  After the end of each SFY a review will be completed to see if the updates were completed by the target date.  The goal is to meet the target implementation date 100% of the time.  The same strategies used in the second performance measure will be used to meet this goal.

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