An act relating to claim edit standards and prior authorization requirements
Sponsored By: Alyssa Black (Democratic)
Signed by Governor
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Less prior approval for primary care orders
Health plans cannot require prior approval for admissions, items, services, treatments, or procedures ordered by a qualifying primary care provider. The provider must be contracted and enrolled with the plan as a primary care provider. Prescription drugs and out-of-network care are excluded from this protection. The law took effect March 5, 2025. All plans must implement it as soon as reasonably practicable, with a final deadline of January 1, 2026.
New claim-processing exceptions for Vermont health plans
Beginning January 1, 2026, health plans have three exceptions to Vermont's rules for checking medical claims. Plans can depart from these rules when needed to follow state or federal law or coverage requirements. They can also use rules they find more favorable to providers or address new codes their software does not yet include. Those rules require input from relevant Vermont providers and national provider groups, plus support from nationally recognized standards approved by Vermont's financial regulator. Plans must publish those rules on their websites and in newsletters or equivalent electronic messages. For care outside Vermont, plans need not follow Vermont's claim-checking rules unless the payer and provider agree to apply them. The law does not set a change in patient costs or coverage.
Sponsors & Cosponsors
Sponsor
Alyssa Black
Democratic • House
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
Actions Timeline
House message: Governor approved bill on March 5, 2025
3/11/2025HouseSigned by Governor on March 5, 2025
3/11/2025HouseDelivered to Governor on February 28, 2025
2/28/2025HouseSenate Message: Passed in concurrence
2/26/2025SenateRead 3rd time & passed in concurrence
2/25/2025SenateUnfinished Business/Third Reading
2/25/2025SenateNew Business/Third Reading
2/21/2025SenateReported favorably by Senator Lyons for Committee on Health and Welfare, read 2nd time and 3rd reading ordered
2/19/2025SenateFavorable report by Committee on Health and Welfare
2/19/2025SenateSecond Reading
2/19/2025SenateFavorable report by Committee on Health and Welfare
2/18/2025SenateSecond Reading
2/18/2025SenateEntered on Notice Calendar
2/18/2025SenateRead 1st time & referred to Committee on Health and Welfare
2/6/2025SenateRead third time and passed
2/4/2025HouseAction Calendar: Third Reading
2/4/2025HouseThird Reading ordered
1/31/2025HouseRep. Black of Essex reported for the Committee on Health Care
1/31/2025HouseRead second time
1/31/2025HouseAction Calendar: Favorable
1/31/2025HouseOn Notice Calendar
1/30/2025HouseRead first time and referred to the Committee on Health Care
1/14/2025House
Bill Text
As Enacted (ACT 3)Opens in a new window
3/7/2025
As Passed by Both Chambers
2/27/2025
As Passed by Both Chambers (Unofficial)
2/27/2025
As Passed by the House
2/6/2025
As Passed by the House (Unofficial)
2/6/2025
As Introduced
1/13/2025
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