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Prior Authorization Reports and Resources

The Green Mountain Care Board has done legislative reports and collects reporting on prior authorization. Additionally, GMCB convenes the Primary Care Advisory Group which has developed prior authorization proposals which were presented to GMCB in 2018. Prior authorization means the process used by a health plan to determine the medical necessity, medical appropriateness, or both, of otherwise covered drugs, medical procedures, medical tests, and health care services. The term “prior authorization” includes preadmission review, pretreatment review, and utilization review (18 V.S.A. § 9418(15)).

GMCB Legislative Reports on Prior Authorization

Below are links to legislative reports by GMCB on prior authorization. 

Prior Authorization Reporting from Health Insurance Carriers

Insurer Prior Authorization Review Attestations

Under 18 V.S.A. § 9418b(h)(2), a health plans shall attest to DFR and GMCB annually on or before September 15 that it has completed the review and appropriate elimination of prior authorization requirements as required by 18 V.S.A. § 9418b(h)(1). 

Gold Carding Pilot Program Reports

Act 140 of 2020, Section 11: Implementation of pilot program to exempt or streamline prior authorization requirements with a report due on or before January 15, 2023.

Other Reporting on Prior Authorization

  • The Department of Financial Regulation collects  Health Insurers Annual Reports which include information about utilization review. Those reports can be found here.