To support Vermont Medicaid-enrolled providers in providing health care services for Vermont Medicaid members in a safe and timely way, and to ensure Vermonters have access to necessary care, Vermont Medicaid instituted the following changes in 2021, and communicated the following in response to requests from providers for additional guidance:
- Although the State of Emergency was lifted for Vermont, the federal COVID-19 public health emergency and associated waivers are still in place. Prior authorizations that are currently waived continue to be waived under the federal public health emergency.
- In addition, and effective June 1, 2021, prior authorizations will no longer be required for imaging services, most durable medical equipment and supplies through the medical benefit, and most dental services.
- Prior authorizations are still required for services with the potential to cause imminent harm; services found on the Fee Schedule indicating a prior authorization is required; and for items not found on the Waived Prior Authorization List (updated October 28, 2021).
- For pharmacy prior authorization requirements, refer to the Preferred Drug List and Clinical Criteria.
- Beginning January 1, 2021, the Department ceased extending existing pharmacy prior authorizations beyond their normal expiration date. Refer to the communication, Important Information about Prior Authorization Extensions.
Information can be found at:
AHS Global Commitment Register, policy GCR 20-039.