Vermont Legislature SmartTranscripts:

[Rep. Alyssa Black (Chair)]: Hi, welcome. It is April, HealthCare. Really briefly, we are touching on S-one 154, which is the biomarker testing that we, which essentially was a study, I think. Yes. Come down to a study. And we have Mary Black from DFR.

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: For the record, Mary Black, Deputy Commissioner of Insurance for DFR. A couple of comments with respect to 154. It's a study at this point. It would help us It is a very, very specifically detailed study right now, which we're going have to bring in outside help. Would give us somewhat if it was more flexible and less specific. We know that other states have looked at this issue, other organizations have looked at this issue. If we were able to leverage some of that, that would obviously help. But the way it's written right now, you must look at X, Y, and Z. So that's one thing. The other thing just to point out is if we decide to go down this road, this will result in defraile. Can you explain to the committee what defraile is? Defraile means that if we add a mandate that was not previously in the benchmark, a new benefit, the state is required to pay the difference in the cost of that mandate, the cost of the premium for that mandate to the insurers essentially so that it does not impact the insurance. So the cost of that, whatever it costs in premium for that mandate, we will have to pay. Can you give us an example of a possible mandate? Well, this is a mandate. So if this was passed Okay, so the whole If this thing is a new benefit

[Rep. Alyssa Black (Chair)]: Okay, okay. I want to be clear that Yeah. If it's not a mandate now, But if the legislature in the future looked at it and said, the other one is not a mandate. The other

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: one was the coverage for the prosthetics and orthotics. That also would have been a mandate that we would have had to pay the costs. The state would have had to pay the costs for. One cautionary item, as we consider defrails and adding mandates and so forth. In the 2027 notice of benefit and payment parameters, which is CMS's document that tells us what the rules of the road are going to be for 2027, they have proposed requiring defraile for every mandate that has been passed since So if they keep that in there, we will have two options and they have very clearly said this and we had a conversation with them actually when we were at the NAICSpring meeting. We will either have to reverse our mandates or we will pay the cost for everything that was mandated that is over and above the ACA requirements since 2011. My

[Rep. Alyssa Black (Chair)]: history is vague on this. I know that we did a few years ago, we did hearing aid coverage. We're making a list. I thought we had to have approval to change our benchmark plan, not CMS.

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: There's a difference between changing the benchmark plan and having mandates. Mandates don't necessarily have to be in the benchmark plan. Right now, most of our mandates are in the benchmark plan because oddly enough, during the Biden administration, there was grant money that allowed us to go through a bunch of steps and tests and all kinds of things to incorporate our mandates into our benchmark plan. We jumped through all the hoops. They gave us grant money. We jumped through all the hoops. We did everything we're supposed to do, and we incorporated everything into the benchmark plan. And now the Trump administration is completely reversing course on that, or at least proposing to reverse course on that. We have written a comment letter objecting to this as many states have. But if they decide to move forward, then we would have to calculate the cost of defraud for everything we've added since 2011.

[Rep. Alyssa Black (Chair)]: Can you give us something other than the hearing aid coverage? Else have we?

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: Portion coverage, gender affirming care. I can't remember. We're literally making a list so that we can figure it out. Because unfortunately, even if it doesn't come to pass this year, everybody's pushing really hard for at a minimum a delay. I suspect it will come to pass at some point in the next year or so before the Trump administration leaves office. So we're going to make a list and start figuring out how much it's going to cost.

[Rep. Alyssa Black (Chair)]: We're figuring out, I'm assuming, each individual item. We'll have to get actuaries fixed, calculate it. So that's

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: something else to consider as we consider whether we want to spend money figuring out whether we want to add or submit a mandate that we will need to do defraisal.

[Rep. Alyssa Black (Chair)]: Can I ask some quick questions? Sure. So, explaining defraisal to us. Sorry for the fun. Poor thing in the morning. Completely forget until So, if this would come to pass, dating back to 2011, would we have to pay clawback to pay?

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: No, we would pay the frail going forward, I believe. It doesn't talk about clawback. We would need to include everything that we added from that point and then calculate the defraile going forward. You know, thankfully, so far, there's nothing in the notice that it seems to say we have to back pay.

[Rep. Alyssa Black (Chair)]: Okay. Thank you.

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: That would be crazy.

[Rep. Alyssa Black (Chair)]: Wow. Wow. Yeah. But let's be clear, this bill doesn't do that.

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: This bill doesn't do it yet. Okay. This bill will, we will need to spend some money to do this study. And then when we come back next year, we will either know whether deferral has come to pass or whether they're proposing it again, because they do a notice of benefit and payment parameters every year right around February, March.

[Rep. Alyssa Black (Chair)]: So, said that there's a lot of specifics in here.

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: Normally, I'm happy to look at biomarker testing and the impact on premium and the cost of defraile. It's just the way b, has us analyzing costs associated with requiring health insurance coverage and Medicaid coverage, which I can't speak to, obviously, for biomarker testing for the purposes blah blah blah blah blah, including, and then there's all of these very specific things that we will need to look at. Label indications for tests approved or cleared, that's for FDA drugs, warnings. Other states have looked at sort of biomarker more generally and other organizations. So we might be able to pull some of those studies in and use some of that, but it won't get at these things, which means we'd have to do these things separately. So if it was just a more general, a lot of times when you see a study, we'll study the impact of enacting biomarker testing requirements.

[Rep. Alyssa Black (Chair)]: It's like we first just really want to

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: know how will it affect rates. How will it affect rates and will we have to defray? I mean, those are the two biggest things I think you'd want to know.

[Rep. Alyssa Black (Chair)]: Okay. All right. Questions? Anything else?

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: So basically, it's just going to pretty much take you to insurance care and Medicaid coverage. Yeah, I think you want to know for both what would it do to the premiums and would there be to frail. Where did this come from? The biomarker? Yeah. It came from, yeah, I don't know who

[Rep. Alyssa Black (Chair)]: I don't know who the

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: sponsor was. I think it was a healthcare organization, like a, I want to say it was maybe the

[Rep. Alyssa Black (Chair)]: Alzheimer's Association. I was

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: going say, yeah.

[Rep. Alyssa Black (Chair)]: And we will have Alzheimer's, I think we're working on Alzheimer's Association, and it was American Cancer Society. Yeah. We're going to have them in.

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: Yeah, and I think you have at least Blue Cross coming in, they can talk about-

[Rep. Alyssa Black (Chair)]: That's up. This afternoon. They can talk

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: about the coverage they already provide because they do provide coverage for some biomarker testing. They can give you the distinctions. Some of this testing is somewhat speculative and experimental, and other states have had issues there. Arizona had an issue where they mandated the use of a particular test that turned out to be fraudulent. It cost you large sum of

[Rep. Alyssa Black (Chair)]: think that's why some of these things are in here that the Senate put in?

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: I think those are maybe things you'd want to put into a bill if we were going to actually mandate it to establish what the criteria would be for what's in and what's out. But to just study it probably doesn't need to be that specific. Okay.

[Rep. Alyssa Black (Chair)]: Would you have proposed language for a proposed study?

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: I think it would just pulling out the specifics and just saying to, you know, to study the impact on premiums and the impact on and possible defrayal.

[Rep. Alyssa Black (Chair)]: I'm I'm assuming you testified in the senate.

[Mary Black, Deputy Commissioner of Insurance, Vermont Department of Financial Regulation]: We did not. Oh, you did not? Don't think we did.

[Rep. Alyssa Black (Chair)]: Oh, okay. All right. Any other questions for Mary? Thank you. Thank you. Thanks so much. All right. We're gonna take a break until our next witness. Fifteen minutes. Oh, my god. He's exhausted. No. We need a break. Thank you, Mary. I really do appreciate coming in. So we're gonna