Vermont 2025-2026 Regular Session Status: Enacted 1 D cosponsors

H 31 — An act relating to claim edit standards and prior authorization requirements

Last action — House message: Governor approved bill on March 5, 2025

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed House
  4. ✓
    Passed Senate
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced January 14, 2025. Enacted.

Signed by Governor Phil Scott (Republican) on March 11, 2025.

Prognosis

Advancing 52% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 1 sponsor

    1 primary, 0 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (1 D).

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Bill Text

What changed in the latest version

61 added · 53 removed

Plain-language change summary

The latest version of Bill H.31 has clarified the situations in which healthcare payers do not have to adhere to certain edit standards. Key sections were slightly reordered for clarity, but the conditions under which these standards can be bypassed remain the same. This change matters because it helps ensure that providers can still work under beneficial conditions and adapt to new healthcare codes, improving flexibility in care delivery. Overall, it aims to protect both providers and patients by ensuring that necessary quality standards can still be met.

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AS PASSED BY HOUSE H.31 Page 1 of 3 H.31 An act relating to claim edit standards and prior authorization requirements It is hereby enacted by the General Assembly of the State of Vermont:
BILL AS PASSED BY THE HOUSE H.31 Page 1 of 3 H.31 Introduced by Representative Black of Essex Referred to Committee on Date:
Subject:
Health;
health insurance;
health care providers;
claim edits;
place of service;
prior authorization;
primary care providers Statement of purpose of bill as introduced:
This bill proposes to specify that otherwise applicable health insurance claim edit standards do not apply when a health care service is delivered outside Vermont, unless otherwise agreed to by the health insurer and the out-of-state provider.
It would also modify the definition of a primary care provider for purposes of determining which health care providers’ orders are exempt from prior authorization requirements.
An act relating to claim edit standards and prior authorization requirements It is hereby enacted by the General Assembly of the State of Vermont:
§ 9418a is amended to read:
§ 9418a is amended to read:
PROCESSING CLAIMS, DOWNCODING, AND ADHERENCE TO CODING RULES * * * (c) Adherence to the edit standards in subsection (b) of this section is not required:
PROCESSING CLAIMS, DOWNCODING, AND ADHERENCE TO CODING RULES * * * BILL AS PASSED BY THE HOUSE H.31 Page 2 of 3 (c) Adherence to the edit standards in subsection (b) of this section is not required:
or VT LEG #380576 v.1 AS PASSED BY HOUSE H.31 Page 2 of 3 (3) when adjudicating claims for health care services that were delivered outside the State of Vermont, unless the payer and the out-of-state provider agree that one or more of the edit standards set forth in subsection (b) of this section will apply.
or (3) when adjudicating claims for health care services that were delivered outside the State of Vermont, unless the payer and the out-of-state provider agree that one or more of the edit standards set forth in subsection (b) of this section will apply.
§ 9418b is amended to read:
§ 9418b is amended to read:
PRIOR AUTHORIZATION * * * (c)(1)(A) Except as provided in subdivision (B) of this subdivision (1), a health plan shall not impose any prior authorization requirement for any admission, item, service, treatment, or procedure ordered by a primary care provider.
PRIOR AUTHORIZATION BILL AS PASSED BY THE HOUSE H.31 Page 3 of 3 * * * (c)(1)(A) Except as provided in subdivision (B) of this subdivision (1), a health plan shall not impose any prior authorization requirement for any admission, item, service, treatment, or procedure ordered by a primary care provider.
* * * VT LEG #380576 v.1 AS PASSED BY HOUSE H.31 Page 3 of 3 Sec.
* * * Sec.
§ 9418b) shall take effect on passage and shall be implemented by all health plans as soon as reasonably practicable after that date, but in no event later than January 1, 2026.
§ 9418b) shall take effect on passage and shall be implemented by all health plans as soon as reasonably practicable after that date, but in no event later than January 1, 2026.
VT LEG #380576 v.1
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  • As Passed by Both House and Senate (OfficialOpens in a new window) View text pdf
  • As Passed by Both House and Senate (UnofficialOpens in a new window) View text pdf
  • As EnactedOpens in a new window View text pdf
  • Act SummaryOpens in a new window View text Current pdf
  • Introduced As IntroducedOpens in a new window pdf

Action History

  1. House message: Governor approved bill on March 5, 2025

  2. Signed by Governor on March 5, 2025

  3. Delivered to the Governor on February 28, 2025

  4. Senate Message: Passed in concurrence

  5. Read 3rd time & passed in concurrence

  6. Unfinished Business/Third Reading

  7. New Business/Third Reading

  8. Reported favorably by Senator Lyons for Committee on Health and Welfare, read 2nd time and 3rd reading ordered

  9. Favorable report by Committee on Health and Welfare

  10. Second Reading

  11. Favorable report by Committee on Health and Welfare

  12. Second Reading

  13. Entered on Notice Calendar

  14. Read 1st time & referred to Committee on Health and Welfare

  15. Read third time and passed

  16. Action Calendar: Third Reading

  17. Third Reading ordered

  18. Rep. Black of Essex reported for the Committee on Health Care

  19. Read second time

  20. Action Calendar: Favorable

  21. On Notice Calendar

  22. Read first time and referred to the Committee on Health Care

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 189 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (189)

189 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
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Frequently asked questions

Who sponsors H 31?
H 31 is sponsored by Alyssa Black (Democrat).
What is the current status of H 31?
This bill has been enacted into law. Introduced January 14, 2025. Enacted.
Where can I track H 31?
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