• All amounts will be updated monthly to allow for claims run-out
• $ amounts are sum of allowed charges
• All imminent harm codes were not included in the waived list
• Data generated using updated list of procedure codes in MMIS.
• No inferences about the impact of waiving PAs for these codes on their utilization can be made at this time.

This performance measure is important because it shows the fiscal impact of waiving prior authorization for three categories of service (Dental, Imaging, and Durable Medical Equipment (DME) in response to COVID.

During the initial and acute phase of COVID, delivery of health care equipment and services received was reduced in response to COVID. With the adoption and utilization of telemedicine and COVID safety protocols, the delivery of equipment and services began to increase, resulting in an increase in cost of paid claims.  DVHA monitors this data quarterly and current evidence demonstrates stable trending to support continued waiving of prior authorization requirements.  Additionally, administrative burden has been reduced as it is not necessary for providers to submit a request for prior authorization for such services.  

The data demonstrates that the amount of paid claims was noticeably reduced in CY20 due to the acute phase of the public health emergency. It is important to note the PHE “unwind” has resulted in a decrease in Medicaid re-enrollment with fewer members as the primary factor in the overall resulting decline of cost of paid  claims.  However, CY22 trended slightly higher than previous CYs due to an increase in access and utilization of dental services to Vermont Medicaid members.

Last updated: 02/12/24

• AHS Policy
• Clinical Services Team
• DVHA Data Unit

DVHA will continue to monitor the dollar amount of paid claims on a quarterly basis post the public health emergency to evaluate trends in expenditure related to these three service areas no longer requiring prior authorization.