Vermont’s special contract governing Medicare payments will continue for at least one more year and likely two, as a new multi-state all-payer agreement is negotiated at the federal level.
The Green Mountain Care Board on Monday unanimously approved an extension of the state’s 2016 agreement with the federal Center for Medicare and Medicaid Innovation, a move already endorsed by Gov. Phil Scott’s administration. The contract’s original term was set to expire at the end of this year.
“This agreement provides consistency and protects our providers from payment disruption at a critical time,” Green Mountain Care Board chair Owen Foster said in a written statement. “We’re proud of the work on this extension we did together with our state partners and providers.”
The motion approved by the board allows Foster to sign off on a second year-long extension without coming back to the full board.
Vermont is one of three states, along with Maryland and Pennsylvania, that have negotiated parallel global payment reform agreements with the federal center over the last decade.
Vermont’s agreement is part of the state’s effort to shift how health care providers are paid. Instead of paying based on a test, procedure or appointment, the goal is to pay based on the quality of care and on health outcomes. These are called “all-payer” agreements because they also require a state to engage in parallel payment reform agreements with the federal Medicaid program and with commercial insurance providers. The extension approved Monday continues the incentives which are intended to drive this shift.
More directly, the contract also allows participating providers to continue to waive certain Medicare requirements related to telehealth, home visits and the transition from a hospital to a skilled nursing facility. It also exempts providers from reporting requirements that would otherwise be required under Medicare’s merit-based Quality Payment Program.
According to the care board, a new multi-state all-payer framework is in development, but likely would not be implemented until 2025.
“Without the extension, Vermont risks returning to Medicare fee-for-service which would be disruptive to long-term health care reform work and could potentially result in the loss of critical Medicare investments in the Blueprint for Health and Support and Services at Home (SASH),” Jenney Samuelson, secretary of the Vermont Agency of Human Services, wrote in a letter to the care board supporting the extension.
The Blueprint for Health payments fund the agency’s “medical home” program, which is active in 134 primary care practices across the state. SASH is a wellness program with about 5,000 participants over age 65 based at 140 affordable-housing communities in Vermont, according to its operator, the nonprofit Cathedral Square. Total federal funds for these programs through the agreement are expected to total $9.1 million in 2022.Â
These types of programs are more tangible to Vermonters than the comparatively abstract, behind-the-scenes efforts to change payment formulas, said Mike Fisher, Vermont Legal Aid’s chief health care advocate. Vermonters will continue to be skeptical of health care reform until they can see results, he said.
“There has to be deliverables that Vermonters can really feel and experience as improvements in their access to care,” Fisher said.