‘Provider burden’ bill passes Senate, despite last-minute effort to pump the brakes

Vermont’s Senate passed a bill Friday aimed at streamlining interactions between health care providers and insurers, after a flurry of last-minute back-and-forth over the legislation.

Lawmakers rejected a push to delay some of the provisions of the bill, H.766, but adopted an 11th-hour amendment changing the language around primary care requirements.

As a whole, H.766 seeks to reduce the amount of bureaucracy and paperwork Vermont health care providers face when dealing with insurance companies.

“We took testimony from providers who indicated they spend as much as two to four hours per day on paperwork,” Sen. Ginny Lyons, D-Chittenden Southeast, said on the Senate floor Wednesday while reporting the bill. “That’s two to four hours of not seeing patients — in the face of overwhelming health care workforce shortages and clinician burnout.”

The legislation, nicknamed the “provider burden” bill , takes aim at some practices that insurers employ when processing orders or claims from clinicians. Sometimes, insurers must sign off on a drug or procedure before a practitioner can administer it, a tactic known as prior authorization.

Another practice, step therapy, requires providers to try patients on cheaper drugs before prescribing more expensive ones. And insurers sometimes make edits to claims sent from providers and pay a separate amount than was originally billed for, a process known as claims editing.

Insurers describe these practices as something of a necessary evil used to control costs. Without them, they say, already fast-growing health insurance prices would rise further.

But providers say that these procedures eat up precious time, harm their ability to care for patients, and drive clinicians out of the workforce.

The legislation comes down strongly on the side of providers. The bill, which is backed by clinicians and medical groups across the state, would prohibit those insurer tactics in some cases and impose time limits on them in others.

Despite opposition from insurance companies and skepticism from the state’s Department of Financial Regulation, the bill has largely cruised through the statehouse, passing the House unanimously last month and clearing the Senate Committee on Health and Welfare last week.

But this week, the bill ran into opposition from several lawmakers in the Senate Finance Committee, who worried that it could hike already swiftly rising health insurance costs.

“It’s got a fair amount of momentum in the Senate,” Sen. Ann Cummings, D-Washington, the chair of the Senate Finance Committee, said in a committee meeting Tuesday. “And we’re bucking that. We’re the nasty money committee that says we’re not sure we can afford it.”

But the committee’s influence over the bill was limited, as it was not asked to review the bill — to the evident frustration of some of its members. And the committee could not come to a consensus on a potential amendment to the legislation.

That left Sen. Randy Brock, R-Franklin and a member of Senate Finance, to lead a last-minute attempt to pump the brakes on the legislation.

On Wednesday, Brock urged lawmakers to accept an amendment that would delay implementation of some of the bill’s provisions until the Department of Financial Regulation could analyze its impact. Without that analysis, Vermont would be plunging into uncharted territory, Brock argued.

“Imagine yourself on the back of a sailing ship,” Brock said Wednesday on the Senate floor. “And you decide that you’re going to jump into some unknown waters — without knowing how deep the water is, or whether or not there’s sharks.”

The Senate ultimately rejected Brock’s amendment by a 12 to 16 vote and passed the bill on second reading Wednesday.

On Friday, Sen. Jane Kitchel, D-Caledonia, proposed another compromise, one that involved limiting the scope of one of the bill’s key provisions.

As initially passed by the House and advanced by the Senate committee on Health and Welfare, the bill would prohibit commercial insurance plans from adopting prior authorization procedures that were “more restrictive” than those used by Vermont Medicaid. (Prescription drugs and out-of-network services would be exempt from that requirement.)

Kitchel, however, proposed applying that language only to prior authorization for services ordered by primary care providers, and not specialists.

“So what I’m proposing here is perhaps a more incremental approach, and that is providing the relief to the providers that are the most burdened, and the ones that we rely on the most in terms of the provision of health care,” she said.

Committee members responded with a counter-offer: why not remove all prior authorization requirements for primary care providers completely?

“The other providers can stay in the current regime, and primary care would be in just, no prior authorization regime, instead of even aligning to Medicaid,” Sen. Ruth Hardy, D-Addison, said.

The committee — and the full Senate — ultimately approved an amendment with that language Friday. The chamber gave the bill final approval around noon Friday.

But that new language did not alleviate everyone’s concerns. In fact, Sara Teachout, a spokesperson for BlueCross BlueShield Vermont, the state’s largest private insurer, said the last-minute amendment might even have a larger effect than the original language.

“We’re not 100% sure of the impact. I’ve got people looking at it now,” she said. “But it appears to be broader than what’s in the underlying House bill. Just eliminating every prior authorization that a primary care provider can order, I think, is going to be big.”

That amendment, Teachout said, amounted to a “massive, massive” change — one, she added, that insurers were not asked to comment on.

Lawmakers in the House and Senate will now have to reconcile their two versions of the bill before it goes to the governor’s desk.

Jason Maulucci, a spokesperson for Gov. Phil Scott, said in a text message that the governor also “does have concerns” about the bill’s effect on costs.

“When the Governor evaluates legislation as bills begin to arrive to his desk, he will be asking a simple question,” Maulucci said. “Does this bill raise costs for Vermonters? If the answer is yes, he is unlikely to support it.”

Read the story on VTDigger here: ‘Provider burden’ bill passes Senate, despite last-minute effort to pump the brakes .