The Green Mountain Care Board has done legislative reports and collects reporting on prior authorization. Additionally, GMCB convenes the Primary Care Advisory Group which has developed prior authorization proposals which were presented to GMCB in 2018. Prior authorization means the process used by a health plan to determine the medical necessity, medical appropriateness, or both, of otherwise covered drugs, medical procedures, medical tests, and health care services. The term “prior authorization” includes preadmission review, pretreatment review, and utilization review (18 V.S.A. § 9418(15)).
Below are links to legislative reports by GMCB on prior authorization.
Under 18 V.S.A. § 9418b(h)(2), a health plans shall attest to DFR and GMCB annually on or before September 15 that it has completed the review and appropriate elimination of prior authorization requirements as required by 18 V.S.A. § 9418b(h)(1).
Act 140 of 2020, Section 11: Implementation of pilot program to exempt or streamline prior authorization requirements with a report due on or before January 15, 2023.