SmartTranscript of House Health Care - 2024-06-17 - 12:25PM

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[Chair ]: Great. Welcome to House Health Care. I'm a little rusty. It is Monday, June seventeenth, twelve twenty five, and thank you for convening today. We are taking up bill h eight ninety, which I apologize. I don't have [Alyssa ]: the name of it in front of me. Jen, what does it mean? [Jen Harvey ]: Yes. I'm getting to the implementation of certain health insurance claims editing requirements. [Chair ]: Great. So I wanna do a little preamble, and then we're gonna have Jen walk through the bill, and then I'm gonna have Melissa provide a little bit more of an explanation. So first, I wanna say for the record that, we don't I personally and the rest of the leadership team do not take this lightly that we are changing a bill during a veto session, one that was just enacted. But after talking with many, many entities over the last five days, it's imperative that we do make this change for the benefit of everyone involved. So, I know there were some concerns when we talked to some people about process. We don't like it either. I will say the speaker really doesn't like it, but it's it's where we need to be. So with that, I'm gonna have Jen walk us through h eight ninety. And then like [Alyssa ]: I said, we'll have Alyssa give a little bit of an overview of why. [Jen Harvey ]: Great. Good afternoon, Jen and Harvey from the office of legislative council. Nice to see you all again. So we are looking at h eight ninety is on the website. As the chair mentioned, they delay it's I was like, I gave you the title. It delays implementation of certain health insurance claims processing requirements related to claims edits specifically for one year until January first twenty twenty six. So we are looking at what was what we were talking about at h seven sixty six. Now it's been enacted, so it is act one eleven. We're going into that twenty twenty four act. Section nine is the effective date section. Now we're making changes in the effective date section to section two. We're adding in a special, provision just addressing section two. It had been lumped into the, what is now subsection proposed to be section d, which was remaining provisions take effect on January first twenty twenty five. So this would pull out section two for its own treatment and would say that that section, which is the one that has the claims editing language in it, the alignment with Medicare, the ban on prepayment, coding edit coding verification. I'm not getting terminology right. Prepayment coding validation edit review. That's what it is. And some other provisions, it is treating that one a little bit differently than just it takes effect January first twenty twenty five. It would delay implementation of that section, particularly around the claims, edits piece, the alignment with Medicare and some other alignment requirements and, verification of, consistency by DFR, it would delay those provisions until January first twenty twenty six. So delay that full section except a couple of pieces would still take effect on January first twenty twenty five. One of them is that ban on prepayment coding and validation and review in most circumstances and also the claims edit workings that group that is gonna reconvene and talk about what purpose is of mindset, what the insurers are hoping to get out of them and propose potential changes of the money to the legislature. So that's what this does. It delays the effective date of, many of the provisions, many of the subsections in section two for one year beyond where they were originally gonna take. [Alyssa ]: Any questions for Jen on the language [Speaker 3 ]: while the [Alyssa ]: bill's doing? Great. Alyssa. I just think it it it came to our attention. If you think about the claims edit section, which I'm sure you all still think about it every day, the intent was to align, how claims edit software and claims edit systems work between various payers to get them all to align so that they're all sort of using the exact same guidelines. I always say, you know, like if I take out a particular claim in my head, I could code it six different ways, which all would be correct, All would be result in the same payment methodology. But every payer sort of like picks one of their six. And so this section was always about trying to align with that. To align to Medicare, I think that the thought process behind it was that it would be able to sort of be done because Medicare puts out their claims edit standards quarterly, publicly. The problem is, is I think once the payers started looking at Act one hundred and eleven and how to implement it, it just became that their claims edits are tied to multiple different things. They're tied to their payment policies, and they have written payment that hundreds and hundreds of written payment policies, all that have coding guidelines in it. So that would require that all those need to be rewritten and updated. They have specific contracting with payers or providers and hospitals around claims and all those contracting pieces would also have to be redone and updated. And I think the thought was, I mean, it is very clear that their intention is to honor this section. I don't think anyone doesn't want to honor it. It just doesn't want it to be right. And if it's not done correctly, it could lead to even more confusion, which was what we were trying to alleviate with this. So, it is just it is a very, very reasonable request. More than happy. I personally am more than happy to honor this request that we just implemented one year later. And I'm also excited about the opportunity that the claims out working group will still be starting January first of twenty twenty five. That will allow DFR, payers, providers, all to work together on these so that real alignment can happen and that it can be done correctly and then fully implemented in twenty twenty six. It still takes into account that the prepayment review, if you recall, prepayment claims edits is when a clean claim comes in. There's nothing fundamentally wrong with the claim, but the payer will suspend the claim and send a message to the provider asking for documentation. And then it's that whole process of reviewing documentation. We heard deep, long testimony on what problems that had called caused in the provider community this in the last year and a half, and that will still go into effect. And and I will say that testimony by the the the only payer currently that this would affect, they have indicated that they are stopping that procedure anyways. So this doesn't really affect anyone. It just allows that starting on January twenty five, no other payer can start doing something like that again. So Great. [Jen Harvey ]: Thank you. Thank you, Alyssa. Mari. [Mari ]: Thank you, Alyssa. And I understand it. I support it. And I was, in the group with you that was reviewing this with the insurers. And so my my only question is a process question. Why didn't this come to us sooner? [Chair ]: So I'm gonna answer that. And I really think if you remember, a lot of focus was on the prior authorization section and not as much the claim section. That doesn't really give an explanation. Yes. We should have vetted this more thoroughly, and it's something for all of us to think about and remember when we take up bills again if we're back in these seats. But I will say, you know, to find it now and remedy the solution when we have this opportunity, I [Mari ]: think, is really important. Definitely. Yeah. I'm I'm thinking more of the insurer, but I can just leave it at that. [Jen Harvey ]: Leslie, I just wanna make sure [Alyssa ]: I understand it right. So in the claim and its procedure, the the claim can be edited by an insurer. Each individual claim that's per submitted can be edited by an insurer. Is that how it works? So no. A claim comes into an insurer, and it rolls through their claims at software. And, I mean, this is a [Jen Harvey ]: And we're gonna keep it. [Chair ]: I mean, I I mean, high level. I I just said because I wanna remember we did review all of this back when we reviewed the bill. So high level, and then if there's specific questions about what insurers do with claims, there are insurers in the room, and I think we asked them after. [Jen Harvey ]: It's not that the claims it's not that the claims [Alyssa ]: are edited. [Jen Harvey ]: It's not that the claims [Alyssa ]: are edited by the payer. Okay. It's that the payer looks at the claim to see if it is essentially coded correctly and if the pertinent information is on the claim in order to adjudicate and pay the claim. And there are various edits around coding that payers can use turn on, turn off, to say we want to see this, we don't want to see that. That's what it is. It's not that the insurance is is changing it. It's that the insurance requires different each insurer requires things be good in different ways, all which sort of mean the same things. And remember when we passed seven sixty six, it was alignment, the line of the keyboard, and that's what we're trying to get to. This will just ensure that that alignment happens correctly and appropriately over a longer time. Art? [Speaker 3 ]: Yeah. I always have a question about stuff like this. And what it is, I have no problem with it. I I get it. But I but I always wonder why we need legislation to do stuff like this. It seems to me that reasonable people could you the insurer could say, hey. I need another year, and whatever agents handles that could just say, okay. And here we go. And without having to go through this machination, which bothers me at some level because the session ended. [Alyssa ]: Right. And [Speaker 3 ]: when we get it to back in there, we vote on bills, I'm gonna be a no because we're done. I'll make that. Okay. So that's my only I I don't like what you said that the speaker doesn't like any of her back. I don't like this So kind of going back. Although I understand why, and I'll support her. Right. But [Chair ]: So when the session isn't over, because the session wasn't over on May tenth because we're here. Right? So that's one p. But, also, I had a conversation, with DFR who's in Froome. I'm I'm not gonna put you on the spot, but I did have a conversation with d DFR asking that same question. Could they review the legislation and based on this, you know, need that all parties are agreeing to, could they issue a bulletin? You know, could there be some way that as a regulator, they could and their legal staff said, no, that the legislation didn't give them an opportunity to change the date that it would take a legislative act to do that. But I asked the same question. Jen, sorry, go ahead. Yes. [Jen Harvey ]: No. That's okay. I just wanted it's actually a constitutional matter. So there is a provision article fifteen of the Vermont constitution, which I have on the screen, says the power of suspending laws or the execution of laws ought to never ought never to be exercised but by the legislature or by authority derived from it to be exercised in particular cases as the constitution and legislature shall provide for it. Which means only the legislature can say you can delay a year before communication. You can't have when when you've sent out a law, change the law to take effect on a certain date. [Speaker 3 ]: There's the actual issue. Is the effective way to actually say the use of the law? [Jen Harvey ]: Yes. That's part of the actual rule by that. It's fresh. It doesn't get modified with session one. [Alyssa ]: Thanks, Kylie. Any other comments or questions or comments before we vote? Who's sponsoring? [Chair ]: Alyssa is the will be the reporter since she did seven sixty six. We sponsored the bill. [Alyssa ]: The three of you? Yes. Yeah. Right. Do I [Mari ]: hear a motion? I move that we approve, h eight ninety delaying implementation of certain health insurance claims processing requirements. That's fine. [Alyssa ]: Great. Alright. Ready? No more discussion. We can call the roll. [Mari ]: Representative Rebecca. Yes. Representative Carpenter. [Alyssa ]: Yes. [Mari ]: Representative Portis. Yes. Representative DeMar. Yes. Representative Farley's Rubio. Yes. Representative Goldman. Yes. Representative Peterson. Yes. Representative Black. Yes. Representative McFawn. Yes. Representative Houghton? Yes. [Alyssa ]: It it passes unanimously. Great. Thank you, Mari. And so I will work with Alyssa on how to get it to the clerk's office again. I thank everyone. This is not something that I we take lightly, but I think it is very important. So I [Chair ]: appreciate your time. And we are adjourned, and we'll see you on the floor at one thirty. [Alyssa ]: I was on live. [Jen Harvey ]: We don't see you today.
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