§ 911.
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§ 911. Payment rates for providers of community-based services
(a)The Secretary of Human Services shall calculate payment rates for providers of community-based services that are reasonable and adequate to achieve the required outcomes for the populations they serve. When calculating these payment rates, the Secretary:
(1)for informational purposes, shall ensure that the calculations take into account factors that include:
(A)the reasonable cost of any governmental mandate that has been enacted, adopted, or imposed by any State or federal authority; and
(B)a cost adjustment factor to reflect changes in reasonable costs of goods to and services of providers of community-based services, including those attributed to inflation and labor market dynamics; and
(2)may consider geographic differences in wages, benefits, housing, and real estate costs in each region of the State.
(b)The Secretary shall establish a methodology for calculating payment rates for providers of community-based services in accordance with this section. The methodology shall:
(1)provide a schedule for conducting studies of the Medicaid reimbursement rates paid to the providers of community-based services, including the rates’ adequacy and their underlying methodologies, that includes studying the rates paid to providers for each type of service at least once every five years;
(2)set forth a predictable timeline for redetermination of base rates;
(3)include a process for calculating an annual inflationary rate adjustment;
(4)to the extent permitted by the Centers for Medicare and Medicaid Services, take into account the financial needs of providers whose reimbursements may be negatively affected by client absences; and
(5)use Vermont labor market rates and Vermont costs of operation.
(c)The Secretary shall establish a process by which a provider of community-based services whose financial condition places it at imminent risk of closure may request provider stabilization from the Agency.
(d)The Secretary shall recalculate the payment rates for providers of community-based services in accordance with this section at least annually and shall report those rates, and the amounts necessary to fund them, to the House Committees on Appropriations, on Human Services, and on Health Care and the Senate Committees on Appropriations and on Health and Welfare annually as part of the Agency’s budget presentation. (Added 2025, No. 14, § 2, eff. May 13, 2025.)