1. General powers of Department of Health
As herein or elsewhere specified, the Department of Health shall have power to supervise and direct the execution of all laws relating to public health and substance abuse. (Amended 2005, No. 174 (Adj. Sess.),  34a; 2007, No. 15,  8.) 
 11. Coalition for Healthy Activity, Motivation, and Prevention Programs (CHAMPPS)/Fit and Healthy Advisory Council
The Department of Health shall:(1) Form a coalition to be known as CHAMPPS, Coalition for Healthy Activity, Motivation, and Prevention Programs. (2) Include in the coalition interested parties that initially address cardiovascular disease and stroke risk factors, including: legislators; the commissioners, or their respective designees, of State agencies, such as the Departments of Agriculture, Food and Markets; Education; Forests, Parks and Recreation; Public Safety; and Transportation; municipalities; representatives of the business community; the Governors Council on Physical Fitness and Sports; the University of Vermont College of Medicine; hospitals; agricultural and nutritional initiatives; and organizations whose missions are associated with promoting heart health and reducing heart disease and stroke, such as the American Cancer Society, the Diabetes Association, and the Heart Association. As needed, coalition members shall provide technical assistance, data sources, model intervention programs, entry into organizations and populations, and promotional support. (3) Meet, gather testimony and other information, and hold public hearings as necessary to develop the capacity to define the cardiovascular disease and stroke burden on the State, and publish a cardiovascular disease and stroke burden document, which shall include: (A) a description of the burden of cardiovascular disease and stroke and related risk factors; (B) a description of the geographic and demographic distribution of cardiovascular disease and stroke; (C) identification of trends in cardiovascular disease and stroke, including trends in mortality, age of onset of disease, and age at death; and (D) mortality data, hospital discharge data, and behavioral risk factor surveillance system data. (4) Develop an inventory of policy and environmental supports related to cardiovascular and stroke risk factors. (5) Develop a cardiovascular and stroke health State plan, using Healthy Vermonters 2010 as a framework. The plan shall be submitted to the Governor, the Secretary of Human Services, and the General Assembly on or before December 1, 2004, and shall include: (A) a summary of the burdens of cardiovascular disease on the State;(B) challenges or obstacles to chronic disease prevention that require legislative, administrative, and community solutions; (C) strengths and successes contributing to chronic disease prevention;(D) risk factors associated with chronic disease;(E) strategies for promoting cardiovascular health, and reducing the burden of cardiovascular disease and related risk factors; (F) the needs of priority populations; and(G) any other information relevant to eligibility for funding from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, or from other public or private sources to support cardiovascular health programs. (6) Convene a CHAMPPS/Fit and Healthy Advisory Council chaired by the Commissioner of Health or designee and composed of State agencies and private sector partners which shall advise the Commissioner on developing, implementing, and coordinating initiatives to increase physical activity and improve nutrition and reduce overweight and obesity. (A) The functions and duties of the Council shall include:(i) recommending ways that the Department of Health and other State agencies can reach out to communities, schools, worksites, and municipal and regional planners to assist them in creating environments and policies conducive to healthy living for all Vermonters; and (ii) assessing available resources and funding streams, recommending how best to coordinate those initiatives and resources across State agencies and private sector organizations for the greatest impact, and recommending new initiatives and priorities utilizing data and best-practice guidelines. (B) The Department of Health shall review the fit and healthy Vermonters prevention plan and the status of its major initiatives with the Advisory Council at least every three years. The Advisory Council shall advise and make recommendations to the Department of Health as the Department develops an annual work plan setting forth prioritized strategies to implement a three-year prevention plan. (Added 2001, No. 123 (Adj. Sess.),  2, eff. June 5, 2002; amended 2007, No. 203 (Adj. Sess.),  20, eff. June 20, 2008.) 
 12. Provision of information regarding contraceptives
In order to prevent or reduce unintended pregnancies and sexually transmitted diseases, the Department of Health, in partnership with health care providers and health insurers, shall communicate to adolescents and other individuals of reproductive age information regarding contraceptive access and coverage. (Added 2019, No. 157 (Adj. Sess.),  5, eff. Nov. 1, 2020.) 
 2. Definitions
The following words and phrases, as used in this title, will have the following meanings unless the context otherwise requires: (1) Department means the Department of Health.(2) Board means the State Board of Health.(3) Commissioner means the Commissioner of Health or the Commissioners designee.(4) Health officer means Commissioner of Health, the Commissioners designee, or a local or district health officer. (5) Local board of health means the local health officer, with the selectboard of the town or city council of a city. (6) Palliative care means interdisciplinary care given to improve the quality of life of patients and their families facing the problems associated with a serious medical condition. Palliative care through the continuum of illness involves addressing physical, cognitive, emotional, psychological, and spiritual needs and facilitating patient autonomy, access to information, and choice. (7) Permit means any permit or license issued pursuant to this title.(8) Person means any individual, company, corporation, association, partnership, the U.S. government or any department or agency thereof, and the State of Vermont or any department, agency, subdivision, or municipality thereof. (9) Public health hazard means the potential harm to the public health by virtue of any condition or any biological, chemical, or physical agent. In determining whether a health hazard is public or private, the Commissioner shall consider at least the following factors: (A) the number of persons at risk;(B) the characteristics of the person or persons at risk;(C) the characteristics of the condition or agent which is the source of potential harm;(D) the availability of private remedies;(E) the geographical area and characteristics thereof where the condition or agent which is the source of the potential harm or the receptors exist; and (F) Department policy as established by rule or agency procedure.(10) Public health risk means the probability of experiencing a public health hazard.(11) Selectboard, in the context of this title, includes trustees of an incorporated village, or a city council when appropriate. (12) Significant public health risk means a public health risk of such magnitude that the Commissioner or a local health officer has reason to believe that it must be mitigated. The magnitude of the risk is a factor of the characteristics of the public health hazard and the degree and the circumstances of exposure to such public health hazard. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1977, No. 147 (Adj. Sess.); 1985, No. 267 (Adj. Sess.),  2; 2009, No. 25,  2.) 
 32. Loan repayment for health care providers and Health Care Educational Loan Repayment Fund
(a) There is hereby established a special fund to be known as the Vermont Health Care Educational Loan Repayment Fund which shall be used for the purpose of ensuring a stable and adequate supply of health care providers and health care educators to meet the health care needs of Vermonters, with a focus on recruiting and retaining providers and health care educators in underserved geographic and specialty areas. (b) The Fund shall be established and held separate and apart from any other funds or monies of the State and shall be used and administered exclusively for the purpose of this section. The money in the Fund shall be invested in the same manner as permitted for investment of funds belonging to the State or held in the Treasury. The Fund shall consist of the following: (1) such sums as may be appropriated or transferred thereto from time to time by the General Assembly, the State Emergency Board, or the Joint Fiscal Committee during such times as the General Assembly is not in session; (2) interest earned from the investment of fund balances;(3) any other money from any other source accepted for the benefit of the Fund.(c) The Fund shall be administered by the Department of Health, which shall make funds available to the University of Vermont College of Medicine area health education centers (AHEC) program for loan repayment awards. The Commissioner may require certification of compliance with this section prior to the making of an award. (d) AHEC shall administer awards in such a way as to comply with the requirements of Section 108(f) of the Internal Revenue Code.(e) AHEC shall make loan repayment awards in exchange for service commitment by health care providers and health care educators and shall define the service obligation in a contract with the health care provider or health care educator. Payment awards shall be made directly to the educational loan creditor of the health care provider or health care educator. (f) Loan repayment awards shall only be available for a health care provider or health care educator who: (1) is a Vermont resident;(2) serves Vermont;(3) accepts patients with coverage under Medicaid, Medicare, or other State-funded health care benefit programs, if applicable; and (4) has outstanding educational debt acquired in the pursuit of an undergraduate or graduate degree from an accredited college or university that exceeds the amount of the loan repayment award. (g) Additional eligibility and selection criteria will be developed annually by the Commissioner in consultation with AHEC and may include local goals for improved service, community needs, or other awarding parameters. (h) The Commissioner may adopt regulations in order to implement the program established in this section. (i) As used in this section:(1) Health care educator shall mean an individual employed by or contracted by an accredited postsecondary institution in Vermont to teach in a health care profession educational program. (2) Health care provider shall mean an individual licensed, certified, or authorized by law to provide professional health care service in this State to an individual during that individuals medical or dental care, treatment, or confinement. (Added 2005, No. 215 (Adj. Sess.),  331; amended 2019, No. 155 (Adj. Sess.),  7(b), eff. Nov. 1, 2020.) 
 33. University of Vermont College of Medicine; Medical Student Incentive Scholarship
(a) The Department of Health, in collaboration with the Office of Primary Care and Area Health Education Centers Program (AHEC) at the University of Vermont College of Medicine and the Vermont Student Assistance Corporation (VSAC), shall establish a Medical Student Incentive Scholarship Program at the University of Vermont College of Medicine. The purpose of the Program is to strengthen the primary care workforce pipeline and increase the number of new physicians practicing in Vermont to meet the health care needs of Vermonters, with a focus on rural areas and undersupplied medical specialties. (b)(1) Scholarships shall be awarded to up to 10 students annually who commit to practicing in a medical specialty priority area, as set forth in subdivision (c)(2) of this section, in a region of Vermont other than Chittenden County, in a practice site that is not owned by an academic medical center and that accepts patients who are covered by Medicaid, Medicare, or other publicly funded health benefit programs. (2) Students shall be eligible to participate in the Medical Student Incentive Scholarship Program in their third and fourth year of medical school. A student who receives an incentive scholarship for the third year of medical school shall be eligible to receive another incentive scholarship for the fourth year of medical school. (3) Each incentive scholarship award shall be for an amount not less than the in-state tuition rate for the University of Vermont College of Medicine. (c)(1) For each academic year of incentive scholarship received, the recipient shall incur a full-time service obligation of not less than one year in a medical specialty priority area and in a setting that meets the requirements of subdivision (b)(1) of this section. (2) The medical specialty priority area shall be primary care; approved specialties include family medicine, internal medicine, adult primary care, pediatrics primary care, obstetrics-gynecology, and psychiatry. (3) An incentive scholarship recipient who does not fulfill the service obligation commitment to practice in Vermont in accordance with the terms of the award shall be liable for repayment of the full amount of the scholarship, plus interest and penalty. (d)(1) The Medical Student Incentive Scholarship Program shall be administered in compliance with federal financial aid regulations and the Internal Revenue Code. (2) Payments shall be made directly to the recipients University of Vermont student financial services account. (3) The full terms and conditions of the award shall be described in the award contract or promissory note and shall be binding once the contract or note is fully executed. (4) AHEC and VSAC shall enter into a memorandum of understanding establishing their respective responsibilities for administering the Medical Student Incentive Scholarship Program. The memorandum of understanding shall be subject to the approval of the Department of Health. (e)(1) The Commissioner of Health, in consultation with AHEC and VSAC, may establish additional recipient eligibility criteria, selection criteria, award terms and conditions, and evidence-based best practices to meet the purposes of the Medical Student Incentive Scholarship Program on an annual basis to best respond to Vermonts needs for physician workforce and access to health care. (2) The Commissioner of Health may adopt rules in accordance with 3 V.S.A. chapter 25 in order to plan, implement, maintain, and evaluate the Medical Student Incentive Scholarship Program established in this section. (Added 2019, No. 155 (Adj. Sess.),  3, eff. Nov. 1, 2020; amended 2021, No. 74,  E.311.1; repealed on July 1, 2027 by 2019, No. 155 (Adj. Sess.),  7a.) 
 34. Vermont Nursing Forgivable Loan Incentive Program
(a) As used in this section:(1) Corporation means the Vermont Student Assistance Corporation established in 16 V.S.A.  2821.(2) Eligible individual means an individual who satisfies the eligibility requirements under this section for a forgivable loan. (3) Eligible school means an approved postsecondary education institution, as defined under 16 V.S.A.  2822. (4) Forgivable loan means a loan awarded under this section covering tuition, which may also include room, board, and the cost of required books and supplies for up to full-time attendance at an eligible school. (5) Program means the Vermont Nursing Forgivable Loan Incentive Program created under this section. (b) The Vermont Nursing Forgivable Loan Incentive Program is created and shall be administered by the Department of Health in collaboration with the Corporation. The Program provides forgivable loans to students enrolled in an eligible school who commit to working as a nurse in this State and who meet the eligibility requirements in subsection (d) of this section. (c) The Corporation shall disburse forgivable loan funds under the Program on behalf of eligible individuals, subject to the appropriation of funds by the General Assembly for this purpose. (d) To be eligible for a forgivable loan under the Program, an individual, whether a resident or nonresident, shall satisfy all of the following requirements: (1) be enrolled at a nursing program at an eligible school;(2) maintain good standing at the eligible school at which the individual is enrolled;(3) agree to work as a nurse in Vermont employed directly by a Vermont health care provider for a minimum of one year following licensure for each year of forgivable loan awarded; (4) have executed a credit agreement or promissory note that will reduce the individuals forgivable loan benefit, in whole or in part, pursuant to subsection (g) of this section, if the individual fails to complete the period of service required in this subsection; (5) have completed the Programs application form, the Free Application for Federal Student Aid (FAFSA), and the Vermont grant application each academic year of enrollment in accordance with a schedule determined by the Corporation; and (6) have provided such other documentation as the Corporation may require.(e)(1) First priority for forgivable loan funds shall be given to students pursuing a practical nursing certificate who will be eligible to sit for the NCLEX-PN examination upon completion of the certificate. (2) Second priority for forgivable loan funds shall be given to students pursuing an associates degree in nursing who will be eligible to sit for the NCLEX-RN examination upon graduation. (3) Third priority for forgivable loan funds shall be given to students pursuing a bachelor of science degree in nursing. (4) Fourth priority shall be given to students pursuing graduate nursing education.(f) In addition to the priorities established in subsection (e) of this section, students attending an eligible school in Vermont shall receive first priority for forgivable loans. (g)(1) If an eligible individual fails to serve as a nurse in this State for a period that would entitle the individual to the full forgivable loan benefit received by the individual, other than for good cause as determined by the Corporation in consultation with the Vermont Department of Health, then the individual shall receive only partial loan forgiveness for a pro rata portion of the loan pursuant to the terms of the interest-free credit agreement or promissory note signed by the individual at the time of entering the Program. (2) Employment as a traveling nurse shall not be construed to satisfy the service commitment required for a forgivable loan under this section. (h) There shall be no deadline to apply for a forgivable loan under this section. Forgivable loans shall be awarded on a rolling basis as long as funds are available, and any funds remaining at the end of a fiscal year shall roll over and shall be available to the Department of Health and the Corporation in the following fiscal year to award additional forgivable loans as set forth in this section. (i) The Corporation shall adopt policies, procedures, and guidelines necessary to implement the provisions of this section, including maximum forgivable loan amounts. (Added 2021, No. 183 (Adj. Sess.),  23, eff. July 1, 2022.) 
 35. Vermont Health Care Professional Loan Repayment Program
(a) As used in this section:(1) AHEC means the Vermont Area Health Education Centers program.(2) Eligible individual means an individual who satisfies the eligibility requirements for loan repayment under this section. (3) Eligible school means an approved postsecondary education institution, as defined under 16 V.S.A.  2822. (4) Loan repayment means the cancellation and repayment of loans under this section.(5) Loans means education loans guaranteed, made, financed, serviced, or otherwise administered by an accredited educational lender for attendance at an eligible school. (6) Program means the Vermont Health Care Professional Loan Repayment Program created under this section. (b) The Vermont Health Care Professional Loan Repayment Program is created and shall be administered by the Department of Health in collaboration with AHEC. The Program provides loan repayment on behalf of individuals who live and work in this State as a nurse, physician assistant, medical technician, child psychiatrist, or primary care provider and who meet the eligibility requirements in subsection (d) of this section. (c) The loan repayment benefits provided under the Program shall be paid on behalf of the eligible individual by AHEC, subject to the appropriation of funds by the General Assembly for this purpose. (d) To be eligible for loan repayment under the Program, an individual shall satisfy all of the following requirements: (1) have graduated from an eligible school where the individual was awarded a degree in nursing, physician assistant studies, medicine, osteopathic medicine, or naturopathic medicine, or a two- or four-year degree that qualifies the individual to be a medical technician; (2) work in this State as a nurse, physician assistant, medical technician, child psychiatrist, or primary care provider; and (3) be a resident of Vermont.(e)(1) An eligible individual shall be entitled to an amount of loan cancellation and repayment under this section equal to one year of loans for each year of service as a nurse, physician assistant, medical technician, child psychiatrist, or primary care provider in this State. Employment as a traveling nurse shall not be construed to satisfy the service commitment required for loan repayment under this section. (2) AHEC shall award loan repayments in amounts that are sufficient to attract high-quality candidates while also making a meaningful increase in Vermonts health care professional workforce. (Added 2021, No. 183 (Adj. Sess.),  26, eff. July 1, 2022.) 
 36. Nurse Faculty Forgivable Loan Incentive Program
(a) As used in this section:(1) Corporation means the Vermont Student Assistance Corporation established in 16 V.S.A.  2821.(2) Eligible individual means an individual who satisfies the eligibility requirements under this section for a forgivable loan. (3) Eligible school means an approved postsecondary education institution, as defined under 16 V.S.A.  2822. (4) Forgivable loan means a loan awarded under this section covering tuition, which may also cover room, board, and the cost of required books and supplies for up to full-time attendance at an eligible school. (5) Nurse faculty member or member of the nurse faculty means an individual with a masters or doctoral degree that qualifies the individual to teach at a nursing school in this State. (6) Program means the Nurse Faculty Forgivable Loan Program created under this section.(b) The Nurse Faculty Forgivable Loan Program is created and shall be administered by the Department of Health in collaboration with the Corporation. The Program provides forgivable loans to students enrolled in an eligible school who commit to working as a member of the nurse faculty at a nursing school in this State and who meet the eligibility requirements in subsection (d) of this section. (c) The Corporation shall disburse forgivable loan funds under the Program on behalf of eligible individuals, subject to the appropriation of funds by the General Assembly for this purpose. (d) To be eligible for a forgivable loan under the Program, an individual, whether a resident or nonresident, shall satisfy all of the following requirements: (1) be enrolled at an eligible school in a program that leads to a graduate degree in nursing; (2) maintain good standing at the eligible school at which the individual is enrolled;(3) agree to work as a member of the nurse faculty at a nursing school in Vermont for a minimum of one year following licensure for each year of forgivable loan awarded; (4) have executed a credit agreement or promissory note that will reduce the individuals forgivable loan benefit, in whole or in part, pursuant to subsection (e) of this section if the individual fails to complete the period of service required in subdivision (3) of this subsection; (5) have completed the Programs application form and the Free Application for Federal Student Aid (FAFSA), in accordance with a schedule determined by the Corporation; and (6) have provided such other documentation as the Corporation may require.(e) If an eligible individual fails to serve as a nurse faculty member at a nursing school in this State for a period that would entitle the individual to the full forgivable loan benefit received by the individual, other than for good cause as determined by the Corporation in consultation with the Vermont Department of Health, then the individual shall receive only partial loan forgiveness for a pro rata portion of the loan pursuant to the terms of the interest-free reimbursement promissory note signed by the individual at the time of entering the Program. (f) The Corporation shall adopt policies, procedures, and guidelines necessary to implement the provisions of this section, including maximum forgivable loan amounts. (Added 2021, No. 183 (Adj. Sess.),  28, eff. July 1, 2022.) 
 37. Nurse Faculty Loan Repayment Program
(a) As used in this section:(1) AHEC means the Vermont Area Health Education Centers program.(2) Eligible individual means an individual who satisfies the eligibility requirements under this section for loan repayment. (3) Eligible school means an approved postsecondary education institution, as defined under 16 V.S.A.  2822. (4) Loan repayment means the cancellation and repayment of loans under this section.(5) Loans means education loans guaranteed, made, financed, serviced, or otherwise administered by an accredited educational lender for attendance at an eligible school. (6) Nurse faculty member or member of the nurse faculty means a nurse with a masters or doctoral degree that qualifies the individual to teach at a nursing school in this State. (7) Program means the Nurse Faculty Loan Repayment Program created under this section.(b) The Nurse Faculty Loan Repayment Program is created and shall be administered by the Department of Health in collaboration with AHEC. The Program provides loan repayment on behalf of individuals who work as nurse faculty members at a nursing school in this State and who meet the eligibility requirements in subsection (d) of this section. (c) The loan repayment benefits provided under the Program shall be paid on behalf of the eligible individual by AHEC, subject to the appropriation of funds by the General Assembly for this purpose. (d) To be eligible for loan repayment under the Program, an individual shall satisfy all of the following requirements: (1) graduated from an eligible school where the individual was awarded a graduate degree in nursing; (2) work as a member of the nurse faculty at a nursing school in this State; and(3) be a resident of Vermont.(e) An eligible individual shall be entitled to an amount of loan cancellation and repayment under this section equal to one year of loans for each year of service as a member of the nurse faculty at a nursing school in this State. (Added 2021, No. 183 (Adj. Sess.),  29a, eff. July 1, 2022.) 
 38. Vermont Mental Health Professional Forgivable Loan Incentive Program
(a) As used in this section:(1) Corporation means the Vermont Student Assistance Corporation established in 16 V.S.A.  2821.(2) Eligible individual means an individual who satisfies the eligibility requirements under this section for a forgivable loan. (3) Eligible school means an approved postsecondary education institution, as defined under 16 V.S.A.  2822. (4) Forgivable loan means a loan awarded under this section covering tuition, which may also cover room, board, and the cost of required books and supplies for up to full-time attendance at an eligible school. (5) Program means the Vermont Mental Health Professional Forgivable Loan Incentive Program created under this section. (b) The Vermont Mental Health Professional Forgivable Loan Incentive Program is created and shall be administered by the Department of Health in collaboration with the Corporation. The Program provides forgivable loans to students enrolled in a masters program at an eligible school who commit to working as a mental health professional in this State and who meet the eligibility requirements in subsection (d) of this section. (c) The Corporation shall disburse forgivable loan funds under the Program on behalf of eligible individuals, subject to the appropriation of funds by the General Assembly for this purpose. (d) To be eligible for a forgivable loan under the Program, an individual, whether a resident or nonresident, shall satisfy all of the following requirements: (1) be enrolled at an eligible school in a program, whether through in- person or remote instruction, that leads to a masters degree in a mental health field; (2) maintain good standing at the eligible school at which the individual is enrolled;(3) agree to work as a mental health professional in Vermont for a minimum of one year following licensure for each year of forgivable loan awarded; (4) have executed a credit agreement or promissory note that will reduce the individuals forgivable loan benefit, in whole or in part, pursuant to subsection (f) of this section, if the individual fails to complete the period of service required in subdivision (3) of this subsection; (5) have completed the Programs application form and the Free Application for Federal Student Aid (FAFSA), in accordance with a schedule determined by the Corporation; and (6) have provided such other documentation as the Corporation may require.(e)(1) First priority for forgivable loans shall be given to students attending an eligible school in the Vermont State Colleges System. (2) Second priority for forgivable loans shall be given to students attending another eligible school in Vermont. (f) If an eligible individual fails to serve as a mental health professional in this State in compliance with the Program for a period that would entitle the individual to the full forgivable loan benefit received by the individual, other than for good cause as determined by the Corporation in consultation with the Vermont Department of Health, then the individual shall receive only partial loan forgiveness for a pro rata portion of the loan pursuant to the terms of the interest-free reimbursement promissory note signed by the individual at the time of entering the Program. (g) The Corporation shall adopt policies, procedures, and guidelines necessary to implement the provisions of this section, including maximum forgivable loan amounts. (Added 2021, No. 183 (Adj. Sess.),  29c, eff. July 1, 2022.) 
 4. Agencies and employees
The Commissioner, with the approval of the Board, may set up such departmental agencies, to be known as divisions, as may be needed to effect the full purpose of the consolidation herein made, and to make the service rendered by the Department of the highest possible efficiency, and may employ such division directors, such institution superintendents and personnel, and such clerical assistants, not otherwise authorized by law, as may be needed to maintain proper operation of the several departments and functions herein consolidated, and may, subject to the approval of the Board and the Commissioner of Human Resources, fix the compensation and expense allowance of such employees. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2003, No. 156 (Adj. Sess.),  15.) 
 5. Duties of Department of Health
The Department of Health shall:(1) Conduct studies, develop State plans, and administer programs and State plans for hospital survey and construction, hospital operation and maintenance, medical care, and treatment of substance abuse. (2) Provide methods of administration and such other action as may be necessary to comply with the requirements of federal acts and regulations as relate to studies, development of plans and administration of programs in the fields of health, public health, health education, hospital construction and maintenance, and medical care. (3) Appoint advisory councils, with the approval of the Governor.(4) Cooperate with necessary federal agencies in securing federal funds that become available to the State for all prevention, public health, wellness, and medical programs. (5) Seek accreditation through the Public Health Accreditation Board.(6) Create a State Health Improvement Plan and facilitate local health improvement plans in order to encourage the design of healthy communities and to promote policy initiatives that contribute to community, school, and workplace wellness, which may include providing assistance to employers for wellness program grants, encouraging employers to promote employee engagement in healthy behaviors, and encouraging the appropriate use of the health care system. (7) Serve as the leader on State rental housing health laws.(8) Provide policy assistance and technical support to municipalities concerning the implementation and enforcement of State rental housing health and safety laws. (Amended 2011, No. 48,  26, eff. May 26, 2011; amended 2019, No. 48,  5.) 
 6. Interfering with State Board of Health or health officers; penalty
A person who in any way interferes with a member of the Board, a local health officer, or the director, chemist, or inspectors of the State laboratory, in the performance of their duties under this title, shall be fined not more than $50.00 for the first offense and, for each subsequent offense, shall be fined $100.00. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 7. General penalty
A person who violates a provision of this title for which no other penalty is provided shall be fined not more than $100.00 nor less than $50.00. 
 8. Prosecutions; penalties
The States Attorney to whom the Board reports a violation of this title shall cause proceedings to be commenced and prosecution in the proper court without delay, for the enforcement of penalties as in such case provided. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 9. Blood donations
A person who is 16 years of age or over shall have legal capacity, without consent or authorization of the persons parent or guardian, to donate blood and to consent to the withdrawal of blood from his or her body, in connection with any voluntary blood donation program under which no compensation is paid or received. (Added 1973, No. 166 (Adj. Sess.), eff. March 22, 1974; amended 1975, No. 136 (Adj. Sess.),  1, eff. Feb. 17, 1976; 2011, No. 86 (Adj. Sess.),  1, eff. April 24, 2012.) 
 4999. Definitions
As used in this part, unless the context requires otherwise:(1) Issuing agent means a town clerk or duly authorized representative of the State Registrar who issues certified and noncertified copies of birth and death certificates from the Statewide Registration System. (2) Licensed health care professional means a physician, a physician assistant, or an advanced practice registered nurse. (3) Municipality or town means a city, town, village, unorganized town or gore, or town or gore within the unified towns and gores of Essex County. (4) Noncertified copy means a copy of a vital event certificate issued by a public agency as defined in 1 V.S.A.  317, other than a certified copy. (5) Office of Vital Records means an office of the Department of Health responsible for the Statewide Registration System and with the authority over vital records provided by law. (6) Registrant means the individual who is the subject of a vital event certificate.(7) Statewide Registration System or System means:(A) the sole official repository of data from birth and death certificates registered on or after January 1, 1909; and (B) such other data related to vital records as the State Registrar may prescribe.(8) Town clerk or municipal clerk or clerk means a town clerk, a city clerk, a county clerk acting on behalf of an unorganized town or gore, or the supervisor of the unified towns and gores of Essex County, or a town official or employee designated by the same to act on his or her behalf. (9) Vital event certificate means a birth, death, marriage, or civil union certificate or a report of divorce, annulment, or dissolution. Vital event certificate does not include any confidential portion of a report of birth or of death or of a marriage or civil union license or application therefor. (10) Vital record means:(A) a report of birth, death, fetal death, or induced termination of pregnancy or a preliminary report of death; (B) a vital event certificate;(C) a marriage or civil union license;(D) a burial-transit permit; and(E) any other records associated with the creation, registration, processing, modification, or disclosure of the records described in this subdivision (10). (Added 2017, No. 46,  1, eff. July 1, 2019.) 
 5000. State Registrar; duties; authority; Statewide Registration System; issuing agents
(a) The Commissioner shall designate a member of the Department as the State Registrar. The State Registrar shall head the Office of Vital Records and shall provide consultation to town clerks, hospital personnel, licensed health care professionals, midwives, funeral directors, clergy, probate judges, and all other persons involved in vital records for the purpose of promoting uniformity of procedures in order to promote the complete, accurate, timely, and lawful creation, registration, processing, modification, and disclosure of vital records. (b) The Commissioner may exercise any authority granted to or fulfill any duties conferred on the State Registrar under this part or any other provision of law related to vital records, and the State Registrar may delegate the exercise of his or her authority or the performance of his or her duties to a duly authorized representative. (c)(1) The State Registrar shall operate the Statewide Registration System, which shall be the sole official repository of data from birth and death certificates registered on or after January 1, 1909. However, nothing in this part shall be construed to preclude town clerks or other issuing agents from printing from the System and maintaining for public inspection noncertified copies of birth and death certificates. The State Registrar shall create and maintain an index which, at a minimum, will enable the public to search contents of the System by the name of the registrant and by the date of the vital event. (2) On and after July 1, 2019:(A) upon registration of a birth or death in the Statewide Registration System, the System shall automatically notify the town clerk of the town of occurrence and the town clerk of residence of the registrant; (B) upon the correction or amendment of a birth or death certificate registered in the System, or upon issuance of a new birth certificate to replace a birth certificate registered in the System, the System shall automatically notify the town clerk of the town of occurrence and the town clerk of residence of the registrant. (3) Birth and death certificates registered prior to January 1, 1909:(A) shall not be incorporated into the Statewide Registration System;(B) shall be maintained at the offices of town clerks as specified in section 5007 of this title; and (C) shall not be eligible for amendment under this part.(4) The State Registrar shall investigate and attempt to resolve any known discrepancy between the contents of a vital event certificate in the custody of the State Registrar and a vital event certificate maintained in the office of a town clerk. In addition, the State Registrar shall have the authority to change the contents of a birth or death certificate in the System in order to address a known error or to conform the certificate to the requirements of a court order. The State Registrar shall record and maintain in the System the nature and content of a change made in the System, the identity of the person making the change, and the date of the change. (5) Except as authorized under subdivision 5073(a)(3) of this title, and except for corrections, completions, or amendments to address known errors or omissions, the State Registrar shall deny any application under this part requesting a correction, completion, or amendment of a birth or death certificate in order to change a name, and shall change a name only in accordance with a court order. (d)(1) Except as provided in subdivision (2) of this subsection, town clerks in the State shall aid in the efficient administration of the Statewide Registration System and shall act as agents to issue copies of birth and death certificates from the Statewide Registration System in accordance with section 5016 of this title. (2) By filing a written notice with the State Registrar, a town clerk may opt out of serving as an issuing agent. (e) The State Registrar shall, consistent with the requirements of this part:(1) administer the Statewide Registration System and fulfill the duties assigned to him or her under this part; (2) provide for the preservation and security of the official records of the Office of Vital Records, and for the matching of birth and death records in order to prevent the fraudulent use of birth and death certificates of deceased persons; (3) promote uniformity of policy and procedures pertaining to vital records and vital statistics throughout the State; (4) prescribe the contents and form of vital record reports, vital event certificates, and related applications and documents; prescribe the contents and form of burial-transit permits; and distribute the same; (5) maintain a Vital Records Alert System in order to track and prevent misrepresentation, fraud, or illegal activities in connection with vital records; (6) implement audit and quality control procedures as necessary to ensure compliance with vital records filing and reporting requirements; (7) prescribe:(A) the contents and form of applications for a certified copy of a birth or death certificate after consultation with the Vermont Municipal Clerks & Treasurers Association; (B) the manner in which vital records required to be submitted to him or her shall be submitted; (C) physical requirements and security standards for storage of vital event certificates and related supplies, after consideration of best practices issued by state and federal law enforcement and public health organizations; (D) the manner in which the Department of Public Safety shall furnish lists of missing and kidnapped children to the State Registrar; and (E) procedures governing the publics inspection of birth and death certificates, if necessary to protect the integrity of the certificates or to deter fraud; (8) adopt rules governing:(A) acceptable content and limitations on the number of characters on a birth certificate;(B) acceptable forms of identification required in connection with applications for certified copies of birth and death certificates; and (C) the process for denying a certified copy of a birth or death certificate based on a Vital Records Alert System match or evidence of fraud or misrepresentation, notifying affected persons of the denial, and investigating and resolving the issue identified. (f) The State Registrar may adopt rules as may be necessary to carry out his or her duties under this part. (Added 1979, No. 142 (Adj. Sess.),  23; amended 2017, No. 46,  2, eff. July 1, 2019 and  3, eff. May 22, 2017 and July 1, 2019.) 
 5001. Duties of custodians
(a) Beginning on January 1, 2010, all certified copies of vital event certificates shall be issued on unique paper with antifraud features approved by the State Registrar and available from the Office of Vital Records. (b) Town custodians of vital event certificates shall ensure that the following are stored in a fireproof safe or vault: (1) blank copies of antifraud paper;(2) original vital event certificates; and(3) such other records or materials as the State Registrar may prescribe.(c)(1) The State Registrar may audit any municipal or county office that stores or issues vital records to determine its compliance with the requirements of this part and any rules adopted thereunder. The State Registrar may require an office that fails an audit to cease issuing vital records until it passes a new audit. (2) Following a failed audit, upon request, the State Registrar shall conduct a follow-up audit within 30 days of the request. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1965, No. 112,  2, eff. Jan. 1, 1966; 1969, No. 265 (Adj. Sess.),  3; 1999, No. 91 (Adj. Sess.),  6; 2007, No. 110 (Adj. Sess.),  2; 2017, No. 46,  4, eff. July 1, 2019.) 
 5002. Report of vital statistics; preservation of records; authority to issue
The State Registrar shall prepare an annual vital statistics report summarizing reports or returns of births, marriages, deaths, fetal deaths, divorces, annulments, and dissolutions received in the prior calendar year. The State Registrar shall periodically transmit original returns of marriages, divorces, annulments, and dissolutions to the State Archivist, who shall keep the returns on file for use by the public. The State Registrar and the State Archivist shall each, independently of the other, have power to issue certified copies of vital event certificates in their custody. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1969, No. 265 (Adj. Sess.),  4; 1979, No. 56,  7; 1999, No. 91 (Adj. Sess.),  7; 2007, No. 96 (Adj. Sess.),  7; 2017, No. 46,  5, eff. July 1, 2019.) 
 5003. Materials for issuing agents
The State Registrar shall procure and send to issuing agents materials as may be necessary for the issuance of vital event certificates. (Amended 2017, No. 46,  6, eff. July 1, 2019.) 
 5004. Family Division of the Superior Court; divorce and dissolution returns
The Family Division of the Superior Court shall send to the State Registrar, before the 10th day of each month, by county, a report of the number of divorces and dissolutions that became absolute during the preceding month, showing as to each the names of the parties, date of civil marriage or civil union, number of children, grounds for divorce or dissolution, and such other statistical information available from the Family Division as may be required by the State Registrar. (Amended 1965, No. 112,  3, eff. Jan. 1, 1966; 1966, No. 3 (Sp. Sess.); 1979, No. 142 (Adj. Sess.),  1; 1999, No. 91 (Adj. Sess.),  8; 2009, No. 154 (Adj. Sess.),  238; 2017, No. 46,  19, eff. July 1, 2019.) 
 5005. Unorganized towns and gores
The county clerk of a county where an unorganized town or gore is situated shall have the authority, perform the duties, and be subject to the penalties prescribed in this part in relation to vital records with respect to residents of the unorganized town or gore. (Amended 1999, No. 91 (Adj. Sess.),  9; 2017, No. 46,  7, eff. July 1, 2019.) 
 5006. Vital event information published in town reports
Town clerks or auditors may publish in the annual town report nonconfidential information and statistics concerning births, marriages, and deaths of residents during the preceding calendar year. Upon request, the State Registrar shall furnish a town clerk such information and statistics. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1979, No. 142 (Adj. Sess.),  2; 1999, No. 91 (Adj. Sess.),  10; 2017, No. 46,  8, eff. July 1, 2019.) 
 5007. Preservation of records
A town clerk shall receive, number, and file for record certificates of marriages and burial-transit permits returned to the clerk. A town clerk shall permanently preserve at the office of the clerk birth and death certificates registered prior to July 1, 2019 and marriage and civil union certificates. (Amended 1969, No. 265 (Adj. Sess.),  5; 1979, No. 142 (Adj. Sess.),  3; 1999, No. 91 (Adj. Sess.),  11; 2017, No. 46,  9, eff. July 1, 2018; 2018, No. 11 (Sp. Sess.),  I.4, eff. July 1, 2019.) 
 5008. Town clerk; recording and indexing procedures
A town clerk shall file for record and index in volumes all marriage certificates and burial-transit permits received by the town. Each volume or series shall contain an alphabetical index. Civil marriage certificates shall be filed for record in one volume or series, civil union certificates kept in another, and burial-transit permits in another, except that in a town having less than 500 inhabitants, the town clerk may cause civil marriage, civil union, and burial-transit permits to be filed for record in one volume. (Amended 1969, No. 265 (Adj. Sess.),  6; 1979, No. 142 (Adj. Sess.),  4; 1999, No. 91 (Adj. Sess.),  12; 2007, No. 96 (Adj. Sess.),  8; 2009, No. 91 (Adj. Sess.),  16, eff. May 6, 2010; 2017, No. 46,  10, eff. July 1, 2019.) 
 5009. Certified copies to town of residence
On the first day of each month, the town clerk shall make a certified copy of each original, corrected, or amended civil marriage certificate or amended civil union certificate filed in the clerks office during the preceding month, whenever a party to a civil marriage or a civil union was a resident in any other Vermont town at the time of the civil marriage or civil union, and shall transmit the certified copy to the clerk of the other Vermont town, who shall file the same. (Amended 1979, No. 142 (Adj. Sess.),  5; 1999, No. 91 (Adj. Sess.),  13; 2017, No. 46,  11, eff. July 1, 2019.) 
 5010. Transmittal of marriage certificates
The town clerk of each town shall each week transmit to the State Registrar copies, duly certified, of each marriage certificate filed in the town in the preceding week. (Amended 1969, No. 265 (Adj. Sess.),  7; 1979, No. 142 (Adj. Sess.),  6; 1999, No. 91 (Adj. Sess.),  14; 2017, No. 46,  12, eff. July 1, 2019.) 
 5011. Penalty
(a) A town clerk who fails to transmit copies of marriage certificates as provided in section 5010 of this title shall be fined not more than $100.00. (b) The Commissioner or a hearing officer designated by the Commissioner may, after notice and an opportunity for a hearing, impose a civil administrative penalty of not more than $250.00 against a person who fails to perform a duty imposed or violates a prohibition under this part. A hearing under this subsection shall be a contested case subject to the provisions of 3 V.S.A. chapter 25, and the provisions of 3 V.S.A.  809(h), 809a, and 809b related to subpoenas shall extend to the Commissioner, a hearing officer appointed by the Commissioner, and licensed attorneys representing a party. (Amended 1969, No. 265 (Adj. Sess.),  8; 1999, No. 91 (Adj. Sess.),  15; 2017, No. 46,  13, eff. July 1, 2019.) 
 5012. Town clerk to provide general index; marriages and civil unions
Except as provided by 24 V.S.A.  1153, town and county clerks shall prepare and keep a general index to the marriage and civil union records, in alphabetical order and in the following forms, respectively: 
 5014. Confidentiality
(a)(1) A vital record, or information therein, that by law is designated confidential or by a similar term, that by law may only be disclosed to specifically designated persons, or that by law is not a public record, is exempt from inspection and copying under the Public Records Act and shall be kept confidential to the extent provided by law. (2) Records or information described in subdivision (1) of this subsection may be disclosed:(A) for public health or research purposes in accordance with law;(B) to a regulatory or law enforcement agency for enforcement purposes, if the agency has agreed to accept the terms of an agreement with the Office of Vital Records governing use and confidentiality of the information; (C) to the vital records office of another state, if the subject of the vital record was a resident of the other state at the time of the vital event that led to creation of the record; or (D) in a summary, statistical, or other format in which particular individuals are not identified directly or indirectly. (b)(1) Except as otherwise provided in subdivision (a)(2) of this section and subdivision (2) of this subsection, the following information is exempt from public inspection and copying under the Public Records Act, shall be kept confidential, and, in any civil action, shall not be subject to discovery or subpoena or be admissible: (A) Social Security information and information collected only for medical and health purposes in reports of birth; (B) Social Security numbers in reports of death or in preliminary reports of death;(C) prior marriage and legal guardianship information and elections to dissolve a civil union in a marriage or civil union license or license application; (D) such other information contained in a vital record as the State Registrar may designate through a rule adopted pursuant to 3 V.S.A. chapter 25, but only if the designation is necessary to protect the privacy of an individual. (2) The person who is the subject of the record or his or her authorized representative shall be entitled to obtain a copy of the information. (c) Information in or received from the Vital Records Alert System is exempt from public inspection and copying under the Public Records Act and shall be kept confidential, except that, in addition to the exceptions to confidentiality provided in subdivision (a)(2) of this section, such information may be shared with an issuing agent in order to correct and prevent mistakes and criminal activity. (Added 2017, No. 46,  15, eff. July 1, 2019.) 
 5016. Birth and death certificates; copies; inspection
(a) Access and issuance generally. (1) Except as provided in subdivisions (2) and (3) of this subsection:(A) only the State Registrar and issuing agents may issue certified copies of birth and death certificates registered before July 1, 2019, and such certificates shall only be issued from the Statewide Registration System; and (B) only the State Registrar and issuing agents may issue certified or noncertified copies of birth and death certificates registered on or after July 1, 2019, and such certificates shall only be issued from the Statewide Registration System. (2) Copies of birth and death certificates registered prior to January 1, 1909 shall not be issued from the Statewide Registration System. Any town clerk may issue a certified copy of a pre-1909 birth or death certificate, provided he or she fulfills the requirements of subsection (b) of this section and such additional requirements as the State Registrar may prescribe as necessary to track antifraud paper used to produce such copies. (3) A certified or noncertified birth or death certificate shall only be issued as authorized and prescribed in this section, except that in either of the following circumstances, a public agency may issue a noncertified copy even if it does not follow the requirements of this section governing noncertified copies: (A) if the public agency is an agency other than the Office of Vital Records, the Vermont State Archives and Records Administration, or the office of a town or county, and the public agency has custody of a birth or death certificate acquired in the course of its business; or (B) if the birth or death certificate was filed in the records of a town or county office, such as land records, for a reason unrelated to its official role under law as a repository of registered birth or death certificates. (4) The word illegitimate shall be redacted from any certified or noncertified copy of a birth certificate. (5) If necessary to prevent fraud, the State Registrar may limit the issuance of a certified or noncertified copy of a certificate of live birth for a foreign born child in the same manner as copies of birth certificates are limited under this section. (6) The State Registrar may authorize the issuance of certified birth or death certificates to public agencies, as defined in 1 V.S.A.  317, for official purposes. (b) Certified copies. (1) The State Registrar and issuing agents may issue certified copies of birth and death certificates only upon receipt of a complete application accompanied by a form of identification prescribed in rules adopted by the State Registrar. The State Registrar and issuing agents shall record in a database maintained by the State Registrar any application received. (2) Only the following persons shall be eligible for a certified copy of a birth or death certificate: (A) the registrant or his or her spouse, child, grandchild, parent, sibling, grandparent, or guardian; a person petitioning to open a decedents estate; a court-appointed executor or administrator; or the legal representative of any of these; (B) a specific person pursuant to a court order finding that a noncertified copy is not sufficient for the applicants legal purpose and that a certified copy of the birth or death certificate is needed for the determination or protection of a persons right; (C) an employee of a public agency authorized by the State Registrar as provided in subdivision (a)(6) of this section; or (D) in the case of a death certificate only, additionally to:(i) the individual with authority for final disposition as provided in section 5227 of this title or a funeral home or crematorium acting on the individuals behalf; (ii) the Social Security Administration;(iii) the U.S. Department of Veterans Affairs; or(iv) the deceaseds insurance carrier, if such carrier provides benefits to the decedents survivors or beneficiaries. (3) Certified copies of birth and death certificates shall be issued only on unique paper with antifraud features approved by the State Registrar. (4) A certified copy of a birth or death certificate shall be prima facie evidence of the facts stated therein. (c) Noncertified copies. (1) Form. A noncertified copy of a birth or death certificate issued from the Statewide Registration System shall indicate the term Noncertified on its face and shall not be issued on antifraud paper. (2) Legal effect. A noncertified copy of a birth or death certificate shall not serve as prima facie evidence of the facts stated therein, except that it may be recorded in the land records of a municipality to establish the date of birth or death of a person with an ownership interest in property. (d) Inspection. In addition to the provisions of the Public Records Act, the State Registrar may prescribe procedures governing the inspection of birth and death certificates if necessary to protect the integrity of the certificates or to prevent fraud. (Added 2018, No. 11 (Sp. Sess.),  I.5, eff. July 1, 2019; amended 2021, No. 15,  1.) 
 5017. Fees for copies
For a certified copy of a vital event certificate, the fee shall be $10.00. (Added 2017, No. 46,  18, eff. July 1, 2019.)
 5071. Birth certificates; who to make; return
(a) On or before the fifth business day of each live birth that occurs in this State, the attending physician or designee or midwife or, if no attending physician or midwife is present, a parent of the child or a legal guardian of a mother under 18 years of age shall file with the State Registrar a report of birth in the form and manner prescribed by the State Registrar. The State Registrar shall register the report in the Statewide Registration System if it has been completed properly and filed in accordance with this chapter. The portion of the registered birth report that is not confidential under section 5014 of this title is the birth certificate. (b) At the time of the birth of a child, each parent shall furnish the following information to enable completion of the report of birth required under subsection (a) of this section: the parents name, address, and Social Security number and the name and date of birth of the child. (c)(1) Whoever assumes the custody of a live-born infant of unknown parentage shall file a report of birth with the State Registrar in the form and manner prescribed by the State Registrar. (2) If the child is identified and a certificate of birth is found or obtained, the report and any certificate created under this section and copies thereof shall be deposited with the State Registrar and kept confidential, to be opened upon court order only. (d) The name of the father shall be included on the report of birth and on any birth certificate of the child of unmarried parents only if the father and mother have signed a voluntary acknowledgment of parentage or a court or administrative agency of competent jurisdiction has issued an adjudication of parentage. (e) When a birth certificate is issued, a parent or parents shall be identified with gender-neutral nomenclature. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1979, No. 142 (Adj. Sess.),  7; 1989, No. 220 (Adj. Sess.),  26; 1997, No. 63,  18, eff. Sept. 1, 1997; 2013, No. 183 (Adj. Sess.),  1; 2017, No. 46,  20, eff. July 1, 2019.) 
 5072. Notice to parent for correction or completion
Within three months after each birth that occurs in the State, except for the birth of a child known to have died or to have been surrendered for adoption, the State Registrar shall send a notice of birth registration to the parents of the child. The notice shall contain the pertinent facts such as the childs full name, date and place of birth, and the names of the parents, with instructions and a form on which to apply for corrections or additions. (Amended 1979, No. 142 (Adj. Sess.),  8; 2017, No. 46,  21, eff. July 1, 2019.) 
 5073. Birth certificate corrections, completions
(a)(1) Except as otherwise provided in subdivision (2) of this subsection, within six months after the date of birth, the State Registrar may correct or complete a birth certificate in the Statewide Registration System upon application of a parent, the hospital in which the birth occurred, or the certifying attendant. (2) At any time after the date of birth, the State Registrar may complete a birth certificate to add the name of a parent only upon request of the registrant or his or her parent or guardian and upon the receipt of: (A) a properly executed voluntary acknowledgment of parentage; or(B) a decree of a court or administrative agency of competent jurisdiction adjudicating parentage. (3) Within six months after the date of birth, the State Registrar may complete or change the name of a child upon joint application of the parents or upon application of the parent if only one parent is listed on the birth certificate. A court order shall not be required, except for completions or changes of name more than six months after the date of birth. (b) If the State Registrar determines that a correction or completion requested under this section is unwarranted, he or she may deny an application, in which case the applicant may petition the Probate Division of the Superior Court. The court shall review the petition and relevant evidence de novo to determine if the correction or completion is warranted. The court shall transmit a decree ordering a correction or completion to the State Registrar, who shall correct or complete the certificate in accordance with the decree. (c) A corrected or completed certificate shall be free of any evidence of the change and shall not be marked Amended. However, the State Registrar shall record and maintain in the Statewide Registration System the source of the information, the nature and content of the change, the identity of the person making the change, and the date the change was made. (d) [Repealed.] (Amended 1979, No. 56,  8; 1979, No. 142 (Adj. Sess.),  9; 1985, No. 33,  1; 2017, No. 46,  22, eff. July 1, 2018; 2018, No. 11 (Sp. Sess.),  I.6, eff. July 1, 2019; 2021, No. 15,  2.)
 5074. Penalty
A person who fails to comply with a provision of sections 5071-5073 of this title shall be fined $5.00. 
 5075. Issuance of amended or delayed birth certificate
(a) Except as otherwise provided in subdivision 5073(a)(2) of this title, after six months from the date of birth, any alteration of the birth certificate of a person born in this State shall be deemed an amendment. Upon application by the registrant, his or her parent or guardian, the hospital in which the birth occurred, or the certifying attendant, setting forth the amendment desired and the reason for it, the State Registrar may amend the birth certificate if the application and relevant evidence, if any, show that the amendment is warranted. (b) A person born in this State for whom no certificate of birth was filed during the first year following birth, or his or her parent or guardian, may apply to the State Registrar to determine the facts with respect to the birth and to issue a delayed certificate of birth. (c) If the State Registrar denies an application under this section, the applicant may petition the Probate Division of the Superior Court, which shall review the application and relevant evidence de novo to determine if the amendment or issuance of a delayed certificate is warranted. The court shall transmit a decree ordering an amendment or issuance of a delayed certificate to the State Registrar, who shall amend or issue the certificate in accordance with the decree. (d) The State Registrar shall make any amendment and register any delayed certificate in the Statewide Registration System. Any amended birth certificate issued from the System shall indicate the word Amended and the date of amendment, and any delayed certificate issued from the System shall indicate the word Delayed and the date of registration. The State Registrar shall record and maintain in the System the identity of the person requesting the amendment or delayed certificate, the nature and content of the change made in the System, the person who made the amendment or registered the delayed certificate in the System, and the date of the amendment or registration. (e) [Repealed.] (Added 1979, No. 142 (Adj. Sess.),  10; amended 1997, No. 155 (Adj. Sess.),  64; 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2017, No. 46,  24, eff. July 1, 2018; 2018, No. 11 (Sp. Sess.),  I.7, eff. July 1, 2019; 2021, No. 15,  3.)
 5077a. New birth certificate due to parentage nomenclature on former report of birth form
(a) If a parent of a person born in this State was unable to be listed as a parent on the persons birth certificate due to the lack of gender-neutral nomenclature on former report of birth forms provided by the Department of Health, and the person or the persons parent submits sufficient proof of parentage to the State Registrar, the State Registrar shall complete the birth certificate in the Statewide Registration System. If the State Registrar denies an application under this subsection, the applicant may petition the Probate Division of the Superior Court, which shall review the application and relevant evidence de novo to determine if the issuance of a new birth certificate is warranted. If the court issues a decree ordering the issuance of a new birth certificate, the State Registrar shall update the System in accordance with the decree. The State Registrar shall record in the System the identity of the person requesting the new certificate, the nature and content of the change, the person who made the change, and the date of the change. The State Registrar shall issue a new birth certificate from the System which shall not contain the word Amended or other special designation, and shall notify the town clerk or clerks with custody of the certificate, who shall replace the original with the new certificate and update indexes as directed by the State Registrar. The town clerk or clerks shall send the original to the State Registrar, who shall keep it confidential. (b), (c) [Repealed.] (Added 2013, No. 183 (Adj. Sess.),  2; amended 2017, No. 46,  27, eff. July 1, 2019.)
 5078. Adoption; new and amended birth certificate
(a) When the State Registrar receives a report of adoption, a report of an amended adoption, or a report that an adoption has been set aside as provided in 15A V.S.A.  3-801, or a record of adoption prepared and filed in accordance with the laws of another state or foreign country, he or she shall proceed as prescribed in 15A V.S.A.  3-802. (b) If prior to July 1, 2019 a new birth certificate was issued following an adoption that contains a notation that it was issued by authority of this chapter, contains the filing dates of the original and the new birth certificate, or otherwise contains information that facially distinguishes it from an original, the adoptive parent or the adoptee if 14 years of age or older may apply to the State Registrar to issue a replacement birth certificate that does not contain distinguishing information. The State Registrar shall issue the replacement and notify any town clerk with custody of the version that contains distinguishing information, who shall substitute the latter with the replacement birth certificate. The town clerk shall send the version that contains distinguishing information to the State Registrar, who shall keep it confidential. (c) [Repealed.](d) [Repealed.](e) [Repealed.](f) [Repealed.] (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1979, No. 142 (Adj. Sess.),  13; 1985, No. 229 (Adj. Sess.),  2; 2017, No. 46,  30, eff. July 1, 2018; 2018, No. 11 (Sp. Sess.),  I.8, eff. July 1, 2019.)
 5078a. Certificate of live birth for a foreign born child adopted in Vermont
(a) The State Registrar shall establish in the Statewide Registration System a certificate of live birth for a foreign born child when he or she receives: (1) a written request that the certificate be established:(A) from the adopted person if 14 years of age or older; or(B) from the adoptive parent or parents if the adopted person is under 14 years of age; and (2) a record of adoption issued under 15A V.S.A.  3-801(a).(b) The certificate shall include:(1) the true or probable foreign country of birth and true or probable date of birth;(2) the adoptive parents as though they were natural parents;(3) a notation that it was issued by authority of this chapter;(4) a statement that the certificate is not evidence of U.S. citizenship; and(5) any other information the State Registrar may prescribe.(c) The certificate shall not contain a statement whether the adopted person was illegitimate.(d), (e) [Repealed.] (Added 1985, No. 229 (Adj. Sess.),  3; amended 2017, No. 46,  31, eff. July 1, 2019.)
 5080. Effect of new certificate
A new birth certificate issued under 15A V.S.A.  3-802 and sections 5077a and 5112 of this title shall have the same force and effect as though registered in accordance with the provisions of section 5071 of this title. (Amended 2017, No. 46,  32, eff. July 1, 2019.) 
 5083. Participants in address confidentiality program
(a) If a participant in the program described in 15 V.S.A. chapter 21, subchapter 3 who is the parent of a child born during the period of program participation notifies the physician or midwife who delivers the child, or the hospital at which the child is delivered, not later than 10 days after the birth of the child, that the participants confidential address should not appear on the childs birth certificate, then the address shall not be maintained in the Statewide Registration System and the State Registrar, town clerks, and any other issuing agent shall ensure the confidentiality of the address during the period of program participation in accordance with measures prescribed by the State Registrar. A participant who fails to provide such notice shall be deemed to have waived the provisions of this section. (b) The State Registrar shall notify the Secretary of State that a program participant has given notice under this section. (c) The State Registrar shall maintain a confidential record of the parents actual mailing address and town of residence, which shall be exempt from public inspection and copying under the Public Records Act. (d) Upon the expiration, withdrawal, invalidation, or cancellation of program participation of any parent of whom the Secretary of State received notice from the State Registrar, the Secretary of State shall notify the State Registrar. (e) Upon notice of the expiration, withdrawal, invalidation, or cancellation of program participation, the State Registrar shall update the Statewide Registration System and take such other steps as may be necessary to ensure that the actual mailing address and town of residence on the birth certificate are available for public inspection and copying in accordance with section 5016 of this title. (f) [Repealed.] (Added 1999, No. 134 (Adj. Sess.),  4, eff. Jan. 1, 2001; amended 2015, No. 23,  9; 2017, No. 46,  35, eff. July 1, 2019.)
 5112. Issuance of new birth certificate
(a) It is the policy of the State of Vermont to honor and acknowledge all gender identities and protect public health and dignity of all individuals in Vermont, irrespective of their gender. Accordingly, the State shall adopt a simple process by which an individual may amend the marker on a birth certificate to reflect the individuals gender identity, including a third non-binary marker. (b) Pursuant to 3 V.S.A. chapter 25, the Department shall adopt rules as necessary for the purposes of implementing, administering, or enforcing the requirements of this section. (c) The Department may adopt rules to add gender pronouns to the list of markers on a birth certificate in order to foster a gender literate environment and reflect an individuals gender identity. (d) Except as otherwise required by law, records relating to the amendment of a birth certificate pursuant to this chapter shall be confidential and shall be exempt from public inspection and copying under the Public Records Act. (Added 2011, No. 35,  4, eff. May 18, 2011; amended 2015, No. 23,  10; 2017, No. 46,  38, eff. July 1, 2019; 2021, No. 88 (Adj. Sess.),  2, eff. July 1, 2022.) 
 5131. Issuance of civil marriage license; solemnization; return of civil marriage certificate; registration
(a)(1) Upon receipt of a completed application in a form prescribed by the State Registrar, which shall require both parties to sign the application certifying to the accuracy of the facts contained in the application, a town clerk shall issue to a person a civil marriage license in the form prescribed by the State Registrar only if at least one party has signed the license in the presence of the clerk and shall enter on the license the names of the parties to the proposed marriage and fill out the form as far as practicable. The town clerk shall retain in the clerks office a copy of the license until the marriage certificate is returned by the solemnizer. (2) The application forms shall allow each party to a marriage to be designated bride, groom, or spouse, as each party chooses. This worksheet may be destroyed after the marriage is registered. (3) The license shall be issued by any town clerk in the State.(4)(A) Parties to a civil union certified in Vermont may elect to dissolve their civil union upon marrying one another but are not required to do so to form a civil marriage. The State Registrar shall clearly indicate this option on the civil marriage application form required by subdivision (2) of this subsection. If a couple elects this option, each party to the intended marriage shall sign a statement on the confidential portion of the civil marriage license and certificate form stating that he or she freely and voluntarily agrees to dissolve the civil union between the parties. (B) Dissolution pursuant to this subdivision shall become effective upon solemnization of the marriage between the parties, and the parties shall not be required to file a petition for an uncontested dissolution with the Family Division of the Superior Court pursuant to 15 V.S.A.  1206(d). A dissolution granted pursuant to this subdivision shall be exempt from fees provided in 32 V.S.A.  1431(b)(2). (b) A civil marriage license so issued shall be signed by both parties to the marriage and delivered by one of the parties to the proposed marriage, within 60 days from the date of issue, to a person authorized to solemnize marriages by section 5144 of this title. If the proposed marriage is not solemnized within 60 days from the date of issue, such license shall become void. After the person has solemnized the marriage, he or she shall fill out that part of the form on the license provided for his or her use, sign it, and certify to the occurrence and date of the marriage. Thereafter, the document shall be known as a civil marriage certificate. (c) Such certificate shall be returned within 10 days to the office of the town clerk from which the license issued by the person solemnizing such marriage. The town clerk shall retain and file the original according to sections 5007 and 5008 of this title. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1969, No. 164 (Adj. Sess.),  1; 1979, No. 142 (Adj. Sess.),  14; 1985, No. 204 (Adj. Sess.),  3; 1999, No. 91 (Adj. Sess.),  26; 2009, No. 3,  7, eff. Sept. 1, 2009; 2011, No. 92 (Adj. Sess.),  5; 2017, No. 46,  39, eff. May 22, 2017 and July 1, 2019; 2021, No. 92 (Adj. Sess.),  1, eff. July 1, 2022.) 
 5132. Civil marriage license; participants in address confidentiality program
(a) If a participant in the program described in 15 V.S.A. chapter 21, subchapter 3 notifies the town that the participants confidential address should not appear on the civil marriage license or certificate, then the town clerk shall not disclose such confidential address or the participants town of residence on any public records. A participant who fails to provide such notice shall be deemed to have waived the provisions of this section. If such notice is received, then notwithstanding section 5131 of this title, the town clerk shall file the civil marriage certificate with the State Registrar within 10 days after receipt, without the confidential address or town of residence, and shall not retain a copy of the civil marriage certificate. (b) The State Registrar shall receive and file for record all certificates filed in accordance with this section, and shall ensure that a persons confidential address and town of residence do not appear on the civil marriage certificate during the period that the person is a program participant. A certificate filed in accordance with this section shall be a public document. The State Registrar shall notify the Secretary of State of the receipt of a civil marriage certificate on behalf of a program participant. (c) The Department shall maintain a confidential record of the persons actual mailing address and town of residence. Such record shall be exempt from public inspection and copying under the Public Records Act. (d) Upon the renewal, expiration, withdrawal, invalidation, or cancellation of program participation of any person of whom the Secretary of State received notice from the State Registrar, the Secretary of State shall notify the State Registrar. (e) Upon notice of the expiration, withdrawal, invalidation, or cancellation of program participation, the State Registrar shall enter the actual mailing address and town of residence on the original marriage certificate and shall transmit the completed original civil marriage certificate to the town clerk where the certificate was issued. (f) The town clerk shall process certificates received in this manner in accordance with the provisions of this chapter. (Added 1999, No. 134 (Adj. Sess.),  5, eff. Jan. 1, 2001; amended 2009, No. 3,  12a, eff. Sept. 1, 2009; 2015, No. 23,  11; 2017, No. 113 (Adj. Sess.),  92.) 
 5137. Issuance of license
(a) A town clerk shall issue a civil marriage license to all applicants who have complied with the provisions of section 5131 of this title and who are otherwise qualified under the laws of the State to apply for a license to marry and to contract for such marriage. (b) An assistant town clerk may perform the duties of a town clerk under this chapter. (Amended 1985, No. 114 (Adj. Sess.),  1, eff. April 9, 1986; 1999, No. 91 (Adj. Sess.),  27; 2009, No. 3,  12a, eff. Sept. 1, 2009.)
 5139. Clerks duties; penalty
(a) A town clerk who knowingly issues a civil marriage license without first requiring the applicant to fill out, sign, and certify the accuracy of the application, as provided in section 5131 of this title, shall be fined not more than $50.00 nor less than $20.00. (b) [Repealed.] (Amended 2009, No. 3,  12a, eff. Sept. 1, 2009; 2017, No. 46,  40, eff. July 1, 2019; 2021, No. 92 (Adj. Sess.),  2, eff. July 1, 2022.)
 5140. Penalty for misrepresentation
A person making application to a clerk for a license to marry who makes a material misrepresentation in filling the forms contained in the declaration of intention shall be deemed guilty of perjury and punished accordingly. 
 5141. Confirmation of legal qualifications of parties; penalty
(a) At a minimum, before issuing a civil marriage license to an applicant, the town clerk shall review the license application to confirm that: (1) the information submitted therein does not facially indicate that the parties are prohibited from marrying by the laws of this State; and (2) the parties have certified to the veracity of the information in the application.(b) A clerk who fails to comply with the provisions of this section or who issues a civil marriage license with knowledge that the parties, or either of them, are prohibited from marrying or otherwise have failed to comply with the requirements of the laws of this State, or a person who having authority and having such knowledge solemnizes such a marriage, shall be fined not more than $100.00. (c) [Repealed.] (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1971, No. 184 (Adj. Sess.),  5, eff. March 29, 1972; 2009, No. 3,  12a, eff. Sept. 1, 2009; 2017, No. 46,  42, eff. July 1, 2019.)
 5142. Persons not authorized to marry
The following persons are not authorized to marry, and a town clerk shall not knowingly issue a civil marriage license, when: (1) either party is a person who has not attained majority, unless the town clerk has received in writing the consent of one of the parents of the minor, if there is a parent competent to act, or of the guardian of the minor; (2) either party is under 16 years of age;(3) either of the parties is mentally incapable of entering into marriage as defined in 15 V.S.A.  514; (4) either of the parties is under guardianship, without the written consent of the partys guardian; (5) [Repealed.](6) the parties are prohibited from marrying under 15 V.S.A.  1a on account of consanguinity or affinity;(7) either of the parties has a wife or husband living, as prohibited under 13 V.S.A.  206 (bigamy). (Amended 1965, No. 194,  10, eff. Feb. 1, 1967; 1967, No. 147,  47, eff. Oct. 1, 1968; 1971, No. 90,  13; 1973, No. 201 (Adj. Sess.),  11; 2009, No. 3,  8, eff. Sept. 1, 2009; 2013, No. 96 (Adj. Sess.),  98; 2017, No. 46,  43, eff. July 1, 2019.)
 5143. Penalties
A person who aids in procuring a civil marriage license by falsely pretending to be the parent or guardian having authority to give consent to the marriage of a minor shall be fined not more than $500.00. (Amended 2009, No. 3,  12a, eff. Sept. 1, 2009; 2017, No. 46,  44, eff. July 1, 2019.) 
 5144. Persons authorized to solemnize marriage
(a) Marriages may be solemnized by:(1) a Supreme Court Justice, a Superior judge, a judge of Probate, an assistant judge, a justice of the peace, a magistrate, a Judicial Bureau hearing officer, or an individual who has registered as a temporary officiant with the Vermont Secretary of State pursuant to section 5144a of this title; (2) a member of the clergy ordained, licensed, or otherwise regularly authorized by the published laws or discipline of the general conference, convention, or other authority of his or her faith or denomination who: (A) resides in this State;(B) resides in New Hampshire, Massachusetts, or New York or in the adjacent province of Quebec, Canada, whose parish, church, temple, mosque, or other religious organization lies wholly or in part in this State; or (C) resides in some other state of the United States or in Canada and whose parish, church, temple, mosque, or other religious organization lies wholly outside this State, provided he or she has first secured from the Probate Division of the Superior Court in the unit within which the marriage is to be solemnized a special authorization, authorizing him or her to certify the marriage if the Probate judge determines that the circumstances make the special authorization desirable. (b) Marriage among the Friends or Quakers, the Christadelphian Ecclesia, and the Bahai Faith may be solemnized in the manner used in such societies. (c) This section does not require a member of the clergy authorized to solemnize a marriage as set forth in subsection (a) of this section, nor societies of Friends or Quakers, the Christadelphian Ecclesia, or the Bahai Faith to solemnize any marriage, and any refusal to do so shall not create any civil claim or cause of action. (Amended 1965, No. 194,  10, eff. Feb. 1, 1967; 1971, No. 22, eff. March 23, 1971; 1975, No. 1; 1979, No. 142 (Adj. Sess.),  26; 1981, No. 113 (Adj. Sess.); 1999, No. 91 (Adj. Sess.),  28; 2007, No. 148 (Adj. Sess.),  1; 2009, No. 3,  9, eff. Sept. 1, 2009; 2009, No. 154 (Adj. Sess.),  147; 2013, No. 164 (Adj. Sess.),  1, eff. May 28, 2014; 2017, No. 96 (Adj. Sess.),  1, eff. April 11, 2018.) 
 5144a. Temporary officiant for marriages
(a) By registering with the Secretary of State, an individual may temporarily be authorized to solemnize a marriage in this State. When registering, the individual shall provide: (1) A completed registration form provided by the Secretary of State.(2) A $100.00 fee.(b) Upon registration as a temporary officiant, the individual shall be authorized to solemnize only the civil marriage designated on the registration form, and shall receive proof of that authority from the Secretary of State. The individuals authority to solemnize that civil marriage shall expire at the same time as the corresponding license. (Added 2007, No. 148 (Adj. Sess.),  2.) 
 5145. Civil marriage license required for solemnization
Persons authorized by section 5144 of this title to solemnize marriage shall require a civil marriage license of the parties, before solemnizing such marriage. The license shall afford full immunity to the person who solemnizes the marriage. (Amended 1965, No. 194,  10, eff. Feb. 1, 1967; 1969, No. 164 (Adj. Sess.),  2; 1979, No. 142 (Adj. Sess.),  15; 1987, No. 198 (Adj. Sess.); 1991, No. 198 (Adj. Sess.); 2009, No. 3,  12a, eff. Sept. 1, 2009.) 
 5146. Penalty for solemnization without license or failure to return
A person who solemnizes a marriage without first obtaining of the parties the license required by law, or who fails to properly fill out the form thereon provided for his or her use and return the license and certificate of civil marriage to the clerks office from which it was issued within 10 days from the date of the marriage, shall be fined not less than $10.00. (Amended 2009, No. 3,  12a, eff. Sept. 1, 2009.) 
 5147. Solemnization by unauthorized person; penalty; validity of marriage
(a) An individual who, knowing that he or she is not authorized so to do, undertakes to join others in marriage, shall be imprisoned not more than six months or fined not more than $300.00 nor less than $100.00, or both. (b) A marriage solemnized by an individual who was not authorized to do so under this chapter shall not be void or invalid, provided that the marriage is in other respects lawful and is consummated with a belief on the part of either party so married that the couple were lawfully joined in marriage. (Amended 1981, No. 223 (Adj. Sess.),  23; 2017, No. 46,  46, eff. July 1, 2019.) 
 5148. Evidence of marriage
A copy of the record of the civil marriage made by a person required by law at the time the marriage was solemnized to make and keep the record certified by such person, or by the town or county clerk or the State Registrar or the State Archivist, if the record is in his or her office, shall be in all courts presumptive evidence of the fact of such marriage. (Amended 1979, No. 56,  100; 2007, No. 96 (Adj. Sess.),  9; 2017, No. 46,  58, eff. July 1, 2019.) 
 5150. Correction of civil marriage certificate
(a) Within six months after a marriage is solemnized, the town clerk may correct or complete a civil marriage certificate upon application by a party to the marriage or by the person who solemnized the marriage. The town clerk may correct or complete the certificate accordingly and shall certify thereon that such correction or completion was made pursuant to this section, with the date thereof. In his or her discretion, the town clerk may refuse an application for correction or completion, in which case, the applicant may petition the Probate Division of the Superior Court for such correction or completion. (b) After six months from the date a marriage is solemnized, a civil marriage certificate may only be corrected or amended pursuant to decree of the Probate Division of the Superior Court in which district the original certificate is filed. (c) The Probate Division of the Superior Court to which such application is made shall set a time for hearing thereon and, if such court deems necessary, cause notice of the time and place thereof to be given by posting the same in the Probate Division of the Superior Court office and, after hearing, shall make such findings, with respect to the correction of such civil marriage certificate as are supported by the evidence. The court shall thereupon issue a decree setting forth the facts as found, and transmit a certified copy of such decree to the State Registrar. The State Registrar shall transmit the same to the appropriate town clerk to amend the original or issue a new certificate. The words Court Amended shall be typed, written, or stamped at the top of the new or amended certificate with the date of the decree and the name of the issuing court. (Added 1979, No. 142 (Adj. Sess.),  24; amended 2009, No. 3,  12a, eff. Sept. 1, 2009; 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2017, No. 46,  58, eff. July 1, 2019.) 
 5151. Delayed certificates of civil marriage
(a) A couple married in this State for whom no certificate of civil marriage was filed as required by law, may petition the Probate Division of the Superior Court of the district in which the civil marriage license was obtained to determine the facts with respect to this civil marriage and to order the issuance of a delayed certificate of civil marriage. (b) The Probate Division of the Superior Court shall set a time for hearing on the petition and, if such court deems necessary, cause the notice of the time and place of the hearing to be given by posting a notice in the probate office. After hearing proper and relevant evidence as may be presented, the court shall make findings with respect to the civil marriage of the couple as are supported by the evidence. (c) The court shall issue a decree setting forth the facts as found and transmit a certified copy of said facts to the State Registrar. (d) Where a delayed certificate is to be issued, the State Registrar shall prepare a delayed certificate of civil marriage and transmit it, with the decree, to the clerk of the town where the civil marriage license was issued. This delayed certificate shall have the word Delayed printed at the top and shall certify that the certificate was ordered by a court pursuant to this chapter, with the date of the decree. The town clerk shall file the delayed certificate and, in accordance with the provisions of section 5010 of this title, furnish a copy to the State Registrar. (e) Town clerks receiving new certificates in accordance with this section shall file and index them in the most recent book of marriages and also index them with marriages occurring at the same time. (Added 1987, No. 43, eff. May 13, 1987; amended 2009, No. 3,  12a, eff. Sept. 1, 2009; 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2017, No. 46,  58, eff. July 1, 2019.) 
 5166. Certification by unauthorized person; penalty; validity of civil unions
(a) An unauthorized person who knowingly undertakes to join others in a civil union shall be imprisoned not more than six months or fined not more than $300.00 nor less than $100.00, or both. (b) A civil union certified before a person falsely professing to be a justice or a member of the clergy shall be valid, provided that the civil union is in other respects lawful, and that either of the parties to a civil union believed that he or she was lawfully joined in a civil union. (Added 1999, No. 91 (Adj. Sess.),  5.) 
 5167. Evidence of civil union
A copy of the record of the civil union received from the town or county clerk, the Commissioner of Health, or the State Archivist shall be presumptive evidence of the civil union in all courts. (Added 1999, No. 91 (Adj. Sess.),  5; amended 2007, No. 96 (Adj. Sess.),  10.) 
 5168. Correction of civil union certificate
(a) Within six months after a civil union is certified, the town clerk may correct or complete a civil union certificate, upon application by a party to a civil union or by the person who certified the civil union. The town clerk shall certify that such correction or completion was made pursuant to this section and note the date. The town clerk may refuse an application for correction or completion; in which case, the applicant may petition the Probate Division of the Superior Court for such correction or completion. (b) After six months from the date a civil union is certified, a civil union certificate may only be corrected or amended pursuant to decree of the Probate Division of the Superior Court in the district where the original certificate is filed. (c) The Probate Division of the Superior Court shall set a time for a hearing and, if the court deems necessary, give notice of the time and place by posting such information in the Probate Division of the Superior Court office. After a hearing, the court shall make findings with respect to the correction of the civil union certificate as are supported by the evidence. The court shall issue a decree setting forth the facts as found and transmit a certified copy of the decree to the State Registrar. The State Registrar shall transmit the same to the appropriate town clerk to amend the original or issue a new certificate. The words Court Amended shall be typed, written, or stamped at the top of the new or amended certificate with the date of the decree and the name of the issuing court. (Added 1999, No. 91 (Adj. Sess.),  5; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2017, No. 46,  58, eff. July 1, 2019.) 
 5169. Delayed certificates of civil union
(a) Persons who were parties to a certified civil union ceremony in this State for whom no certificate of civil union was filed as required by law, may petition the Probate Division of the Superior Court of the district in which the civil union license was obtained to determine the facts and to order the issuance of a delayed certificate of civil union. (b) The Probate Division of the Superior Court shall set a time for hearing on the petition and, if the court deems necessary, give notice of the time and place by posting such information in the Probate Court office. After hearing proper and relevant evidence as may be presented, the court shall make findings with respect to the civil union as are supported by the evidence. (c) The court shall issue a decree setting forth the facts as found and transmit a certified copy of said facts to the State Registrar. (d) Where a delayed certificate is to be issued, the State Registrar shall prepare a delayed certificate of civil union and transmit it, with the decree, to the clerk of the town where the civil union license was issued. This delayed certificate shall have the word Delayed printed at the top and shall certify that the certificate was ordered by a court pursuant to this chapter, with the date of the decree. The town clerk shall file the delayed certificate and, in accordance with the provisions of section 5010 of this title, furnish a copy to the State Registrar. (e) Town clerks receiving new certificates in accordance with this section shall file and index them in the most recent book of civil unions and also index them with civil unions occurring at the same time. (Added 1999, No. 91 (Adj. Sess.),  5; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2017, No. 46,  58, eff. July 1, 2019.) 
 5200. Definitions [Effective January 1, 2023]
As used in this chapter:(1) Cemetery has the same meaning as in section 5302 of this title.(2) Cremation has the same meaning as in section 5302 of this title.(3) Disposition facility has the same meaning as in section 5302 of this title.(4) Natural organic reduction has the same meaning as in section 5302 of this title. (Added 2021, No. 169 (Adj. Sess.),  1, eff. January 1, 2023.)
 5201. Permits; removal of bodies; waiting period; investigation into circumstances of death
(a) A dead body shall not be buried, entombed, or removed, or otherwise disposed of without a burial-transit permit issued and signed by a municipal clerk, a county clerk, or a deputy clerk for the municipality or unorganized town or gore in which the dead body is located; a funeral director licensed in Vermont; an owner or designated manager of a licensed disposition facility in Vermont who is registered to perform removals; or a law enforcement officer. (1) The clerk of the municipality shall provide for issuing burial-transit permits when the clerks offices are closed. The municipal clerk shall appoint one or more deputies for this purpose and record the name of the deputy or deputies appointed in the municipal records and notify the Commissioner of Health of the names and residences of the deputy or deputies appointed. (2) The county clerk of a county in which an unorganized town or gore is located shall perform the same duties and be subject to the same penalties as a municipal clerk in respect to issuing burial-transit permits and registering deaths that occur in an unorganized town or gore within the county. (3) A funeral director licensed in Vermont or an owner or designated manager of a licensed disposition facility in Vermont who is registered to perform removals may issue a burial-transit permit for any municipality or unorganized town or gore at any time, including during the normal business hours of a municipal clerk. (4) After a burial-transit permit is issued, the person who issued the permit shall forward the death certificate or preliminary report and the record of the burial-transit permit to the clerk of the municipality, or to the clerk of the county, in the case of an unorganized town or gore, where death occurred on the first official working day thereafter. (5) In cases of death by certain communicable diseases as defined by the Commissioner, the municipal or county clerk, a deputy registrar, a funeral director, a crematory owner or manager, or a law enforcement officer shall not issue a burial-transit permit except in accordance with instructions issued by the Commissioner. (6) A body for which a burial-transit permit has been secured, except one for the body of any person whose death occurred as a result of a communicable disease, as defined by the Commissioner, may be taken through or into another municipality or unorganized town or gore for funeral services without additional permits from the local health officer or the Commissioner. (b) An operator of a disposition facility shall not cremate or process by means of natural organic reduction or allow the cremation or processing by means of natural organic reduction of a dead human body until the passage of at least 24 hours following the death of the decedent, as indicated on the death certificate, unless, if the decedent died from a virulent, communicable disease, a Department of Health rule or order requires the cremation or natural organic reduction to occur prior to the end of that period. If the Attorney General or a States Attorney requests the delay of a cremation or natural organic reduction based upon a reasonable belief that the cause of death might have been due to other than accidental or natural causes, the cremation or natural organic reduction of a dead human body shall be delayed, based upon such request, a sufficient time to permit a civil or criminal investigation into the circumstances that caused or contributed to the death. (c) The person in charge of the body shall not release for cremation or natural organic reduction the body of a person who died in Vermont until the person in charge has received a certificate from the chief, regional, or assistant medical examiner that the medical examiner has made personal inquiry into the cause and manner of death and is satisfied that no further examination or judicial inquiry concerning it is necessary. Upon request of a funeral director, the person in charge of the body, or the operator of a disposition facility, the Chief Medical Examiner shall issue a disposition certificate after the medical examiner has completed an autopsy. The certificate shall be retained by the disposition facility for a period of three years. The person requesting cremation or natural organic reduction shall pay the Department a fee of $25.00. (d)(1) For all cremations or natural organic reductions requested for the body of a person who died outside Vermont, the operator of a disposition facility shall do the following before conducting the cremation or natural organic reduction: (A) obtain a permit for transit, cremation, or natural organic reduction; and(B) comply with the laws of the state in which the person died, including obtaining a copy of a medical examiners permit if one is required. (2) No additional approval from the Vermont medical examiners office is required if compliance with the laws of the state in which the person died is achieved. (Amended 1959, No. 329,  27, eff. March 1, 1961; 1963, No. 102,  1, eff. May 22, 1963; 1969, No. 265,  9; 1979, No. 142 (Adj. Sess.),  16; 1997, No. 40,  22a; 1999, No. 45,  3; 2007, No. 56,  5; 1999, No. 76,  15; 2009, No. 151 (Adj. Sess.),  5, eff. June 1, 2010; 2021, No. 169 (Adj. Sess.),  2, eff. January 1, 2023.) 
 5201. Permits; removal of bodies; cremation; waiting period; investigation into circumstances of death
(a) Burial transfer permit. A dead body shall not be buried, entombed, or removed, or otherwise disposed of without a burial-transit permit issued and signed by a municipal clerk, a county clerk, or a deputy clerk for the municipality or unorganized town or gore in which the dead body is located; a funeral director licensed in Vermont; an owner or designated manager of a crematorium licensed in Vermont who is registered to perform removals; or a law enforcement officer. (1) The clerk of the municipality shall provide for issuing burial-transit permits when the clerks offices are closed. The municipal clerk shall appoint one or more deputies for this purpose and record the name of the deputy or deputies appointed in the municipal records and notify the Commissioner of Health of the names and residences of the deputy or deputies appointed. (2) The county clerk of a county in which an unorganized town or gore is located shall perform the same duties and be subject to the same penalties as a municipal clerk in respect to issuing burial-transit permits and registering deaths that occur in an unorganized town or gore within the county. (3) A funeral director licensed in Vermont or an owner or designated manager of a crematory licensed in Vermont who is registered to perform removals may issue a burial-transit permit for any municipality or unorganized town or gore at any time, including during the normal business hours of a municipal clerk. (4) After a burial-transit permit is issued, the person who issued the permit shall forward the death certificate or preliminary report and the record of the burial-transit permit to the clerk of the municipality, or to the clerk of the county, in the case of an unorganized town or gore, where death occurred on the first official working day thereafter. (5) In cases of death by certain communicable diseases as defined by the Commissioner, the municipal or county clerk, a deputy registrar, a funeral director, a crematory owner or manager, or a law enforcement officer shall not issue a burial-transit permit except in accordance with instructions issued by the Commissioner. (6) A body for which a burial-transit permit has been secured, except one for the body of any person whose death occurred as a result of a communicable disease, as defined by the Commissioner, may be taken through or into another municipality or unorganized town or gore for funeral services without additional permits from the local health officer or the Commissioner. (b) No operator of a crematory facility shall cremate or allow the cremation of a dead body until the passage of at least 24 hours following the death of the decedent, as indicated on the death certificate, unless, if the decedent died from a virulent, communicable disease, a Department of Health rule or order requires the cremation to occur prior to the end of that period. If the Attorney General or a States Attorney requests the delay of a cremation based upon a reasonable belief that the cause of death might have been due to other than accidental or natural causes, the cremation of a dead human body shall be delayed, based upon such request, a sufficient time to permit a civil or criminal investigation into the circumstances that caused or contributed to the death. (c) The person in charge of the body shall not release for cremation the body of a person who died in Vermont until the person in charge has received a certificate from the chief, regional, or assistant medical examiner that the medical examiner has made personal inquiry into the cause and manner of death and is satisfied that no further examination or judicial inquiry concerning it is necessary. Upon request of a funeral director, the person in charge of the body, or the crematory operator, the Chief Medical Examiner shall issue a cremation certificate after the medical examiner has completed an autopsy. The certificate shall be retained by the crematory for a period of three years. The person requesting cremation shall pay the department a fee of $25.00. (d)(1) For all cremations requested for the body of a person who died outside Vermont, the crematory operator shall do the following before conducting the cremation: (A) obtain a permit for transit or cremation;(B) comply with the laws of the state in which the person died, including obtaining a copy of a medical examiners permit if one is required. (2) No additional approval from the Vermont medical examiners office is required if compliance with the laws of the state in which the person died is achieved. (Amended 1959, No. 329,  27, eff. March 1, 1961; 1963, No. 102,  1, eff. May 22, 1963; 1969, No. 265,  9; 1979, No. 142 (Adj. Sess.),  16; 1997, No. 40,  22a; 1999, No. 45,  3; 2007, No. 56,  5; 1999, No. 76,  15; 2009, No. 151 (Adj. Sess.),  5, eff. June 1, 2010.) 
 5202. Report of death; death certificate; duties of licensed health care professional
(a)(1) Within 24 hours after a death, the licensed health care professional who last attended a deceased person shall submit the medical portion of a report of death in a manner prescribed by the State Registrar. If the licensed health care professional who attended the death is unable to state the cause of death, he or she shall immediately notify the licensed health care professional, if any, who was in charge of the patients care, and he or she shall fulfill this requirement. (2) If neither health care professional is able to state the cause of death, the provisions of section 5205 of this title apply. (3) The licensed health care professional may delegate to the funeral director or the person in charge of the body, with that individuals consent, the responsibility of completing the nonmedical portion of the report of death. (4) The State Registrar shall furnish the agency responsible for veterans affairs information as to the deceaseds status as a veteran. (5) The State Registrar shall register the report of death in the Statewide Registration System upon receipt of the required information. The portion of the report of death that is not confidential under section 5014 of this title is the death certificate. (b) When a death certificate is not available prior to burial or transportation of a body, any licensed health care professional who has access to the facts and can certify that the death is not subject to the provisions of section 5205 of this title may complete and sign a preliminary report of death on a form prescribed by the State Registrar. The health care professional may delegate completion of the nonmedical facts to any funeral director or person in charge of the body with access to the nonmedical facts, with that individuals consent. A person authorized to issue a burial-transit permit shall accept a properly completed preliminary report and issue a burial-transit permit. The preliminary report may be destroyed six months after the death certificate has been registered. This subsection does not relieve a licensed health care professional from his or her responsibilities under subsection (a) of this section. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1963, No. 102,  2, eff. May 22, 1963; 1969, No. 265 (Adj. Sess.),  10; 1979, No. 142 (Adj. Sess.),  26; 1997, No. 40,  22b; 2009, No. 151 (Adj. Sess.),  6, eff. Jan. 1, 2012; 2017, No. 46,  47, eff. July 1, 2019.) 
 5202a. Correction, completion, or amendment of death certificate
(a) Corrections; completions. Within six months after the date of death, the State Registrar may correct or complete a death certificate upon application by the certifying licensed health care professional, medical examiner, hospital, nursing home, or funeral director, if the application and relevant evidence, if any, show that the correction or completion is warranted. (b) Amendments. After six months from the date of death, any alteration of a death certificate shall be deemed an amendment. Upon application by a person specified in subsection (a) of this section, the State Registrar may amend the death certificate if the application and relevant evidence, if any, show that the amendment is warranted. (c) Appeal. If the State Registrar denies an application for a correction, completion, or amendment under this section, the applicant may petition the Probate Division of the Superior Court, which shall review the application and relevant evidence de novo to determine if the requested action is warranted. The court shall transmit a decree ordering a correction, completion, or amendment to the State Registrar, who shall take action in accordance with the decree. (d) Documentation of changes. The State Registrar shall make corrections, completions, and amendments in the Statewide Registration System. A corrected or completed certificate issued from the System shall be free of any evidence of the alteration and shall not be marked Amended. Any amended death certificate issued from the System shall indicate the word Amended and the date of amendment. The State Registrar shall enter into and maintain in the System the identity of the person requesting the correction, completion, or amendment, the nature and content of the change, the identity of the person making the change in the System, and the date the change was made. (e) [Repealed.](f) Cause of death. The State Registrar shall only correct, complete, or amend the medical certification of the cause of death upon application by the medical examiner or certifying licensed health care professional. (Added 1979, No. 142 (Adj. Sess.),  25; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2017, No. 46,  52, eff. July 1, 2018; 2018, No. 11 (Sp. Sess.),  I.9, eff. July 1, 2019; 2021, No. 15,  4.) 
 5205. Death certificate when no attending physician and in other circumstances; autopsy
(a) When a person dies from violence, or suddenly when in apparent good health or when unattended by a physician or a recognized practitioner of a well-established church, or by casualty, or by suicide or as a result of injury or when in jail or prison, or any psychiatric hospital, or in any unusual, unnatural, or suspicious manner, or in circumstances involving a hazard to public health, welfare, or safety, the head of the household, the jailer, or the superintendent of a psychiatric hospital where such death occurred, or the next of kin, or the person discovering the body or any doctor notified of the death, shall immediately notify the medical examiner who resides nearest the town where the death occurred and immediately upon being notified, such medical examiner shall notify the States Attorney of the county in which the death occurred. The States Attorney shall thereafter be in charge of the body and shall issue such instructions covering the care or removal of the body as he or she shall deem appropriate until he or she releases same. (b) The medical examiner and a designated law enforcement officer shall thereupon together immediately make a proper preliminary investigation. (c) Unless the cause and manner of death is uncertain, such medical examiner shall complete and sign a certificate of death. The medical examiner and the designated law enforcement officer shall each submit a report of investigation to the States Attorney and the Chief Medical Examiner. If, however, the cause or circumstances of death are uncertain, he or she shall immediately so advise the States Attorney of the county where the death occurred and notify the Chief Medical Examiner. (d) The States Attorney of each county, with the advice of the Commissioner of Public Safety or his or her designee, the sheriff, and the Chief of Police of any established Police Department, shall prepare a list of law enforcement officers in his or her county qualified to make an investigation and report. This list shall be made available to the medical officers concerned and such other persons as the States Attorney deems proper. (e) If an undertaker or embalmer shall, in the course of his or her employment, find evidence of physical violence on the body or evidence of an unlawful act sufficient to indicate to such a person that death might have been the result of an unlawful act, he or she shall immediately notify the States Attorney of the county where the body is then located and shall proceed no further with the preparation and embalming process of such body until permitted to do so by the States Attorney. (f) The States Attorney or Chief Medical Examiner, if either deem it necessary and in the interest of public health, welfare, and safety, or in furtherance of the administration of the law, may order an autopsy to be performed by the Chief Medical Examiner or under the Chief Medical Examiners direction. Upon completion of the autopsy, the Chief Medical Examiner shall submit a report to such States Attorney and the Attorney General and shall submit a report of death to the State Registrar. Upon the written request of a federal prosecutor or a prosecutor in another state, the Chief Medical Examiner shall submit a report of a death to the requesting office. (g) When a person who is committed to the custody of the Department of Corrections or who is under the supervision of the Department of Corrections dies, the Commissioner of Corrections may request to be provided with a copy of any and all reports generated pursuant to subsection (f) of this section. No such request shall be granted where the medical examiner is unable to determine a manner of death or the manner of death is classified as a homicide. In other circumstances, the request shall be granted in the discretion of the Medical Examiner for good cause shown. Reports disclosed pursuant to this subsection shall remain confidential as required by law and shall not be considered to be a public record pursuant to 1 V.S.A.  317. (Amended 1967, No. 254 (Adj. Sess.),  1-3, eff. Feb. 20, 1968; 1969, No. 128,  2; 1969, No. 265 (Adj. Sess.),  12; 1971, No. 33,  7; 1991, No. 191 (Adj. Sess.),  1, eff. May 19, 1992; 2003, No. 128 (Adj. Sess.),  2, eff. May 24, 2004; 2003, No. 157 (Adj. Sess.),  13; 2013, No. 96 (Adj. Sess.),  99; 2017, No. 46,  50, eff. July 1, 2019; 2021, No. 115 (Adj. Sess.),  11, eff. July 1, 2022.) 
 5206. Penalty for failure to submit report of death
A licensed health care professional who fails to cause the medical portion of a report of death to be submitted within 24 hours after the death of a person, containing a true statement of the cause of such death, so far as these facts are obtainable, shall be fined not more than $100.00. (Amended 1963, No. 102,  3, eff. May 22, 1963; 1969, No. 265 (Adj. Sess.),  13; 2017, No. 46,  51, eff. July 1, 2019.) 
 5207. Certificate furnished family; burial-transit permit
Within 24 hours after death, the death certificate shall be made available upon request to the family of the deceased, if any, or the undertaker or person who has charge of the body. The certificate shall be filed with the person issuing the burial-transit permit obtained by the person who has charge of the body before permanent disposition or removal from the town. When the death certificate is so filed, the officer or person shall immediately issue a burial-transit permit under legal restrictions and safeguards. (Amended 2017, No. 46,  53, eff. July 1, 2019; 2021, No. 169 (Adj. Sess.),  3, eff. January 1, 2023.) 
 5207. Certificate furnished family; burial-transit permit
Within 24 hours after death, the death certificate shall be made available upon request to the family of the deceased, if any, or the undertaker or person who has charge of the body. The certificate shall be filed with the person issuing the burial-transit permit obtained by the person who has charge of the body before such dead body shall be buried, entombed, or removed from the town. When the death certificate is so filed, the officer or person shall immediately issue a burial-transit permit under legal restrictions and safeguards. (Amended 2017, No. 46,  53, eff. July 1, 2019.) 
 5208. Department of health; report on statistics
(a) Notwithstanding the provisions of 2 V.S.A.  20(d), beginning October 1, 2011 and every two years thereafter, the Vermont Department of Health shall report to the House Committees on Human Services and on Health Care and the Senate Committee on Health and Welfare regarding the number of persons who died during the preceding two calendar years in hospital emergency rooms, in other hospital settings, in their own homes, in a nursing home, in a hospice facility, and in any other setting for which information is available, as well as whether each decedent received hospice care within the last 30 days of his or her life. Beginning with the 2013 report, the Department shall include information on the number of persons who died in hospital intensive care units, assisted living facilities, or residential care homes during the preceding two calendar years. (b) [Repealed.] (Added 2009, No. 25,  16; amended 2013, No. 75,  18a; 2017, No. 154 (Adj. Sess.),  4b, eff. May 21, 2018.)
 5209. Death out of State; burial permit
Whenever a dead body is brought into this State for burial or entombment accompanied by a removal permit issued under the laws of the state from which such body is brought, such permit shall be received as sufficient authority for burial; but if not accompanied by such permit, the person in charge thereof shall apply to the clerk of the town in which such body is to be buried for a burial permit, and the clerk shall issue such permit when furnished with such information as is required by law of this State as to the identity and cause of death of a person dying in this State. 
 5210. Form of burial or removal permit
If it is desired to bury, entomb, or otherwise dispose of a dead body within the limits of a town where the death occurred, the certificate of permission shall state plainly the time, place, and manner of such burial, entombment, or disposition. If it is desired to remove a dead body from the town where the death occurred, the certificate of permission shall contain the essential facts contained in the certificate of death on which it is issued, shall accompany the body to its destination, and may be accepted as a permit for permanent disposition by a sexton or other person having the care of a cemetery, burial ground, tomb, or receiving vault. (Added 1951, No. 170,  267; amended 2021, No. 169 (Adj. Sess.),  4, eff. January 1, 2023.) 
 5210. Form of burial or removal permit
If it is desired to bury, entomb, or otherwise dispose of a dead body within the limits of a town where the death occurred, the certificate of permission shall state plainly the time, place, and manner of such burial, entombment, or disposition. If it is desired to remove a dead body from the town where the death occurred, the certificate of permission shall contain the essential facts contained in the certificate of death on which it is issued, shall accompany the body to its destination, and may be accepted as a permit for burial or entombment by a sexton or other person having the care of a cemetery, burial ground, tomb, or receiving vault. (Added 1951, No. 170,  267.) 
 5211. Unauthorized burial or removal; penalty
A person who buries, entombs, transports, or removes the dead body of a person without a burial-transit permit so to do, or in any other manner or at any other time or place than as specified in such permit, shall be imprisoned not more than five years or fined not more than $1,000.00, or both. (Amended 1969, No. 265 (Adj. Sess.),  14; 2017, No. 46,  54, eff. July 1, 2019.) 
 5212. Permit to remove dead bodies
(a) A person desirous of disinterring or removing the body of a human being from one cemetery to another cemetery or to another part of the same cemetery or from a tomb or receiving vault elsewhere shall apply to the clerk of the municipality in which the dead body is interred or entombed for a removal permit. (b) An applicant for a removal permit shall publish notice of his or her intent to remove the remains. This notice shall be published for two successive weeks in a newspaper of general circulation in the municipality in which the body is interred or entombed. The notice shall include a statement that the spouse, child, parent, sibling, or descendant of the deceased, or that the cemetery commissioner or other municipal authority responsible for cemeteries in the municipality may object to the proposed removal by filing a complaint in the Probate Division of the Superior Court of the district in which the body is located as provided in section 5212a of this title. (c) The municipal clerk shall issue a removal permit 45 days after the date on which notice was last published pursuant to subsection (b) of this section or, if an objection is made pursuant to section 5212a, of this title upon order of the court. (d) Notwithstanding the provisions of subsections (b) and (c) of this section, a removal permit shall be issued upon application: (1) when removal is necessary because of temporary entombment; or(2) to a federal, state, county, or municipal official acting pursuant to official duties; or (3) if the applicant has written permission to remove the remains from all persons entitled to object under section 5212a of this title. (e) This section does not apply to:(1) Unmarked burial sites that are subject to the provisions of subchapter 1 of this chapter.(2) The removal of historic remains, which has the same meaning as in subdivision 5217(a)(1) of this title. (Amended 1985, No. 206 (Adj. Sess.),  1, eff. June 2, 1986; 2009, No. 151 (Adj. Sess.),  3; 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 5212a. Removal; objections
(a) Unless removal is otherwise authorized by law, a spouse, child, parent, or sibling of the deceased may, within 30 days after the date notice was last published under section 5212 of this title, object to the proposed removal by filing a complaint in the Probate Division of the Superior Court of the district in which the body is interred or entombed. A copy of the complaint shall be filed with the clerk of the town where the body is interred or entombed. (b) The Probate Division of the Superior Court shall, after hearing, issue its order authorizing removal of the body unless: (1) removal would be contrary to the expressed intent of the deceased;(2) removal is objected to by the surviving spouse of the deceased;(3) removal is objected to by an adult son or daughter of the deceased and there is no surviving spouse of the deceased; (4) removal is objected to by a parent of the deceased and there is no surviving spouse or son or daughter of the deceased; or (5) removal is objected to by an adult sibling of the deceased and there is no surviving spouse, son or daughter, or parent of the deceased. (Added 1985, No. 206 (Adj. Sess.),  2, eff. June 2, 1986; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 5212b. Unmarked Burial Sites Special Fund; reporting of unmarked burial sites
(a) The Unmarked Burial Sites Special Fund is established in the State Treasury for the purpose of protecting, preserving, moving, or reinterring human remains discovered in unmarked burial sites. (b) The Fund shall be composed of any monies appropriated to the Fund by the General Assembly or received from any other source, private or public. Interest earned on the Fund, and any balance remaining in the Fund at the end of a fiscal year, shall be retained in the Fund. This Fund shall be maintained by the State Treasurer, and shall be managed in accordance with 32 V.S.A. chapter 7, subchapter 5. (c) The Commissioner of Housing and Community Development may authorize disbursements from the Fund for use in any municipality in which human remains are discovered in unmarked burial sites, in accordance with a process approved by the Commissioner. The Commissioner may approve any process developed through consensus or agreement of the interested parties, including the municipality, a Native American group historically based in Vermont with a connection to the remains, owners of private property on which there are known or likely to be unmarked burial sites, and any other appropriate interested parties, provided the Commissioner determines that the process is likely to be effective, and includes all the following: (1) Methods for determining the presence of unmarked burial sites, including archaeological surveys and assessments and other nonintrusive techniques. (2) Methods for handling development and excavation on property on which it is known that there is or is likely to be one or more unmarked burial sites. (3) Options for owners of property on which human remains in unmarked burial sites are discovered or determined to be located. (4) Procedures for protecting, preserving, or moving unmarked burial sites and human remains, subject, where applicable, to the permit requirement and penalties of this chapter. (5) Procedures for resolving disputes.(d) If unmarked burial sites and human remains are removed, consistent with the process set forth in this section and any permit required by this chapter, there shall be no criminal liability under 13 V.S.A.  3761. (e) The funds shall be used for the following purposes relating to unmarked burial sites:(1) To monitor excavations.(2) To protect, preserve, move, or reinter unmarked burial sites and human remains.(3) To perform archaeological assessments and archaeological site or field investigations, including radar scanning and any other nonintrusive technology or technique designed to determine the presence of human remains. (4) To provide mediation and other appropriate dispute resolution services.(5) To acquire property or development rights, provided the Commissioner of Housing and Community Development determines that disbursements for this purpose will not unduly burden the Fund, and further provided the Commissioner shall expend funds for this purpose only with the concurrence of the Secretary of Commerce and Community Development and after consultation with the legislative bodies of any affected municipality or municipalities. (6) Any other appropriate purpose determined by the Commissioner to be consistent with the purposes of this Fund. (f) When an unmarked burial site is first discovered, the discovery shall be reported immediately to a law enforcement agency. If, after completion of an investigation pursuant to section 5205 of this title, a law enforcement agency determines that the burial site does not constitute evidence of a crime, the law enforcement agency shall immediately notify the State Archeologist, who may authorize appropriate action regarding the unmarked burial site. (Added 2001, No. 149 (Adj. Sess.),  57, eff. June 27, 2002; amended 2003, No. 63,  36, eff. June 11, 2003; 2009, No. 135 (Adj. Sess.),  10; 2009, No. 151 (Adj. Sess.),  1, eff. June 1, 2010; 2017, No. 74,  28.) 
 5213. Removal; form and disposition of permit
Such permit shall state specifically the location of the bodys permanent disposition and the time and manner of its removal. A town clerk issuing such a permit shall make it in duplicate if the body is to be removed from the town, one copy of which shall be delivered to the person having charge of the cemetery or tomb from which the body is to be taken, and the other shall be delivered to the person having charge of the cemetery or tomb wherein it is desired to place the body. (Amended 1979, No. 142 (Adj. Sess.),  17; 2021, No. 169 (Adj. Sess.),  5, eff. January 1, 2023.) 
 5213. Removal; form and disposition of permit
Such permit shall state specifically where such body is to be buried, cremated, or entombed and the time and manner of its removal. A town clerk issuing such a permit shall make it in duplicate if the body is to be removed from the town, one copy of which shall be delivered to the person having charge of the cemetery or tomb from which the body is to be taken and the other shall be delivered to the person having charge of the cemetery or tomb wherein it is desired to place the body. (Amended 1979, No. 142 (Adj. Sess.),  17.) 
 5214. Duties of sexton; no burial or removal without permit
A sexton or other person having the care of a cemetery, tomb, or receiving vault shall not receive or permit the burial or entombment of a dead body, or the remains thereof, in the cemetery or tomb of which he or she has charge, or the removal of a body therefrom, until there is delivered to him or her a certificate of permission issued in accordance with the provisions of this chapter. 
 5215. Burial returns
A sexton or other person having charge of a cemetery, tomb, or receiving vault, during the first week of each month, shall deliver to the clerk of the town in which such cemetery, tomb, or vault is located the burial-transit and removal permits, properly certified, which he or she received during the preceding month. (Amended 1969, No. 265 (Adj. Sess.),  15.) 
 5216. Penalty
A sexton or other person having charge of a cemetery, tomb, or receiving vault who violates a provision of sections 5214 and 5215 of this title shall be fined not more than $500.00 nor less than $20.00. 
 5217. Removal of marked historic remains
(a) As used in this section:(1) Historic remains means remains of a human being who has been deceased for 100 years or more, and the remains are marked and located in a publicly known or marked burial ground or cemetery. (2) Public good means actions that will benefit the municipality and the property where the remains are located. (3) Remains means cremated human remains that are in a container or the bodily remains of a human being. (4) Removal means the transporting of human remains from one location to another premises.(b) A person may apply for a removal permit to disinter or remove historic remains by filing an application with the clerk for the municipality in which the historic remains are located. The application shall include all the following: (1) Identification of the specific location and marking of the remains.(2) Identification of the specific location in which the remains will be reburied.(3) The reasons for removal of the remains, including a statement of the public good that will result from the removal. (c) An applicant for a removal permit shall send notice by first-class mail to all the following: (1) The cemetery commissioner or other municipal authority responsible for cemeteries in the municipality in which the historic remains are located. (2) All historical societies located within the municipality in which the historic remains are located. (3) Any descendant known to the applicant. The applicant shall contact the Vermont Historical Society, the Vermont Old Cemetery Association, the Vermont Cemetery Association, and any veterans organization operating within the county in which the historic remains are located in order to ascertain the whereabouts of any known descendants. (4) The State Archeologist.(d) A cemetery commissioner or municipal authority responsible for cemeteries, a historical society, a descendant, or the State Archeologist may file an objection to the proposed removal of historic remains with the Probate Court in the district in which the historic remains are located and with the clerks of the municipality in which the historic remains are located within 30 days after the date the notice was mailed. (e) If no objection is received within 30 days after the date the notice was last published as required by subsection (c) of this section, the municipal clerk shall issue a removal permit. (f) If the Probate Court receives an objection within the 30-day period, the court shall notify the clerk for the municipality in which the historic remains are located and schedule a hearing on whether to allow removal as described in the application. (g) The Probate Court, after hearing, shall order the municipal clerk to grant or deny a permit for removal of the historic remains. The court shall consider the impact of the removal on the public good. (h) The permit shall require that all remains, markers, and relevant funeral-related materials associated with the burial site be removed, and the permit may require that the removal be conducted or supervised by a qualified professional archeologist in compliance with standard archeological process. All costs associated with the removal shall be paid by the applicant. (Added 2009, No. 151 (Adj. Sess.),  4, eff. June 1, 2010; amended 2017, No. 113 (Adj. Sess.),  93.) 
 5218. Determination of death
An individual who has sustained either irreversible cessation of all functions of the entire brain, including the brain stem, or irreversible cessation of circulatory and respiratory functions is dead. A determination of death must be in accordance with accepted medical standards. (Added 1981, No. 62, eff. April 30, 1981.) 
 5219. Persons missing and presumed dead; issuance of presumptive death certificate
(a) On application of a spouse, parent, child, or other near relative, the Probate Division of the Superior Court may direct the Chief Medical Examiner to complete and sign a certificate of presumed death of a person who was a resident of the probate district and who has been absent for a continuous period of five years during which, after diligent search, the person has not been heard of or from or seen and whose absence has not been satisfactorily explained. (b) On application of a spouse, parent, child, or other near relative, the Superior Court may direct the Chief Medical Examiner to complete and sign a certificate of presumed death of a person who has been exposed to a specific peril of death and after diligent search, has not been heard of or from or seen. (Added 1989, No. 236 (Adj. Sess.),  1, eff. June 4, 1990; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 5221. Definitions
For the purposes of this subchapter:(1) Fetal death means a death prior to the complete expulsion or extraction from the mother of a product of conception; the death is indicated by the fact that after such separation, the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. (Added 1973, No. 99,  1.) 
 5222. Reports
(a) The following fetal deaths shall be reported by the hospital, physician, or funeral director directly to the Commissioner within seven days after delivery on forms prescribed by the board: (1) All fetal deaths of 20 or more weeks of gestation or, if gestational age is unknown, of 400 or more grams, 15 or more ounces, fetal weight shall be reported; (2) All therapeutic or induced abortions, as legally authorized to be performed, of any length gestation or weight shall be reported; (3) Spontaneous abortions and ectopic pregnancies of less than 20 weeks gestation are not required to be reported. (b) The physician who treats a woman as a result of a miscarriage or abortion shall report the fetal death if it is not known to be previously reported under subsection (a) of this section. If there is evidence of violence or other unusual or suspicious circumstances, the medical examiner shall be immediately notified, and he or she shall complete at least the medical items on the report. If a funeral director is to be involved, the physician may delegate to the funeral director the responsibility for completing items other than those of a medical nature. Similarly, the physician may delegate the responsibility for completion of nonmedical items to appropriate personnel having access to records containing the information. (c) If a fetal death occurs on a moving conveyance, the place of occurrence shall be given as the town or city where removal from the vehicle took place. (d) Fetal death reports are for statistical purposes only and are not public records. They shall be destroyed after five years. (Added 1973, No. 99,  1.) 
 5223. Unidentified fetus
A medical examiner shall investigate an unidentified fetus and shall prepare and file a report. If it cannot otherwise be determined, the place where the fetus was found shall be entered as place of fetal death. (Added 1973, No. 99,  1.) 
 5224. Disposition of remains; permits
(a) Fetal remains shall be disposed of by burial, cremation, or natural organic reduction unless released to an educational institution for scientific purposes or disposed of by the hospital or as directed by the attending physician in a manner that will not create a public health hazard. Permission shall be obtained from one of the parents, if competent, for disposition in all cases where a funeral director is not involved. One copy of the fetal death report shall be printed in such manner that completion and signing by the physician or medical examiner shall constitute permission to make permanent disposition of the fetal remains. (b) When a funeral director is involved or when the fetal remains are to be privately buried or disposed of by a disposition facility, the funeral director or other person taking charge of the remains shall obtain from the hospital or physician the disposition permit portion of the report and shall deliver it to the sexton or other person having care of the cemetery, tomb, vault, or disposition facility before burial or other disposition takes place. These permits shall be delivered each month to the clerk of the town in which burial or disposition took place, in the same manner as permits for burial of dead bodies; so also shall all other provisions of sections 5209-5216 of this title be applicable to fetal remains as are applicable to dead bodies. (c) When disposition of fetal remains is by means other than those specified in subsection (b) of this section and a funeral director is not involved, the disposition permit copy of the report shall be completed by the appropriate official of the hospital or by the physician or other person in charge of disposition and sent to the Commissioner within 10 days of such disposition. These permits may be destroyed after five years. (Added 1973, No. 99,  1; amended 2021, No. 169 (Adj. Sess.),  6, eff. January 1, 2023.) 
 5224. Disposition of remains; permits
(a) Fetal remains shall be disposed of by burial or cremation unless released to an educational institution for scientific purposes or disposed of by the hospital or as directed by the attending physician in a manner which will not create a public health hazard. Permission shall be obtained from one of the parents, if competent, for disposition in all cases where a funeral director is not involved. One copy of the fetal death report shall be printed in such manner that completion and signing by the physician or medical examiner shall constitute permission to make final disposition of the fetal remains. (b) When a funeral director is involved or when the fetal remains are to be privately buried or disposed of by a commercial crematory, the funeral director or other person taking charge of the remains shall obtain from the hospital or physician the disposition permit portion of the report and shall deliver it to the sexton or other person having care of the cemetery, tomb, vault, or crematory before burial or other disposition takes place. These permits shall be delivered each month to the clerk of the town in which burial or disposition took place, in the same manner as permits for burial of dead bodies; so also shall all other provisions of sections 5209-5216 of this title be applicable to fetal remains as are applicable to dead bodies. (c) When disposition of fetal remains is by means other than those specified in subsection (b) of this section and a funeral director is not involved, the disposition permit copy of the report shall be completed by the appropriate official of the hospital or by the physician or other person in charge of disposition and sent to the Commissioner within 10 days of such disposition. These permits may be destroyed after five years. (Added 1973, No. 99,  1.) 
 5225. Penalty
A person who violates a provision of this subchapter, unless another penalty is otherwise provided, shall be fined not more than $500.00. (Added 1973, No. 99,  1.) 
 5226. Definitions
For purposes of this subchapter:(1) Estranged means a physical and emotional separation from the decedent at the time of death, which has existed for a period of time that demonstrates an absence of affection, trust, and regard for the decedent.(2) Near relative means the individuals listed in subdivisions 5227(a)(2) through (5) of this title.(3) Right to disposition means the right to determine the disposition of the remains of a decedent, including the location, manner, and conditions of disposition and arrangements for funeral goods and services. (Added 2007, No. 56,  1.)
 5227. Right to disposition
(a) If there is no written directive of the decedent, in the following order of priority, one or more competent adults shall have the right to determine the disposition of the remains of a decedent, including the location, manner, and conditions of disposition and arrangements for funeral goods and services:(1) an individual appointed to arrange for the disposition of decedents remains pursuant to chapter 231 (advance directives) of this title;(2) a surviving spouse of the decedent;(3) a sole surviving child of the decedent or a majority of the surviving children, except as provided for in subdivision (b)(1) of this section, provided that if the child is a minor, his or her interest may only be effected by a legal guardian appointed by the Probate Division of the Superior Court;(4) in the case of a minor or a disabled adult, the custodial parent or the parent who had been providing the primary physical care of the decedent; or, if not applicable, a sole surviving parent, or both parents, of the decedent; or either parent as provided for in subdivision (b)(2) of this section;(5) a sole surviving sibling of the decedent or a majority of the surviving siblings, except as provided for in subdivision (b)(3) of this section;(6) any other family member, in descending order of kinship under the laws of descent and distribution, except that if there is more than one family member of the same degree of relation, a majority of family members of that degree, except as provided in subdivision (b)(4) of this section, may exercise the right of disposition;(7) a guardian of the decedent at the time of death;(8) any other individual willing to assume the responsibilities to act and arrange the final disposition of the decedents remains, including the representative of the decedents estate, after attesting in writing that a good faith but unsuccessful effort has been made to contact the individuals described in subdivisions (1) through (7) of this subsection or that those individuals have waived any interest in exercising their rights under this subchapter;[Subdivision (a)(9) effective until January 1, 2023; see also subdivision (a)(9) effective January 1, 2023 set out below.](9) the funeral director or crematory operator with custody of the body, after attesting in writing that a good faith effort has been made to contact the individuals described in subdivisions (1) through (8) of this subsection; or[Subdivision (a)(9) effective January 1, 2023; see also subdivision (a)(9) effective until January 1, 2023 set out above.](9) the funeral director or disposition facility operator with custody of the body, after attesting in writing that a good faith effort has been made to contact the individuals described in subdivisions (1) through (8) of this subsection; or(10) the Office of the Chief Medical Examiner when it has jurisdiction and custody of the body, after attesting in writing that a good faith effort has been made to contact the individuals described in subdivisions (1) through (8) of this subsection.(b)(1) If there is more than one surviving child of the decedent and a majority of the children is unable to be contacted, less than a majority of the surviving children may make the decisions if they have made prompt, reasonable efforts to contact all other surviving children and prompt efforts to notify them of the proposed decisions, and do not know of any opposition to those decisions.(2) If one parent is unable to be contacted, the remaining parent may make the decisions if that parent has made prompt, reasonable efforts to contact the other parent and is not aware of any opposition by the other parent to those decisions.(3) If there is more than one surviving sibling of the decedent and a majority of the siblings is unable to be contacted, less than a majority of the surviving siblings may make the decisions if they have made prompt, reasonable efforts to contact all other surviving siblings and prompt efforts to notify them of the proposed decisions, and do not know of any opposition to those decisions.(4) If there is more than one family member in the highest applicable order of kinship under the laws of descent and distribution and a majority of these family members is unable to be contacted, less than a majority of the surviving family members in this order may make the decisions if they have made prompt, reasonable efforts to contact all other surviving family members in this order and prompt efforts to notify them of the proposed decisions, and do not know of any opposition to those decisions.[Subsection (c) effective until January 1, 2023; see also subsection (c) effective January 1, 2023 set out below.](c)(1) If the disposition of the remains of a decedent is determined under subdivision (a)(9) of this section and the funeral director or crematory operator has cremated the remains, the funeral director or crematory operator shall retain the remains for three years and, if no interested party as provided in subdivisions (a)(1) through (8) of this section claims the decedents remains after three years, the funeral director or crematory operator shall arrange for the final disposition of the cremated remains consistent with any applicable law and standard funeral practices.(2) Notwithstanding any provision of subdivision (1) of this subsection to the contrary, a funeral director or crematory operator may determine that the unclaimed cremated remains of a deceased veteran shall be interred at the Vermont Veterans Memorial Cemetery pursuant to 20 V.S.A.  1586 if:(A) at least 180 days have passed since the funeral director or crematory operator cremated the remains;(B) the funeral director or crematory operator either:(i) has actual knowledge that there is no interested party as provided in subdivisions (a)(1) through (8) of this section to claim the decedents remains; or(ii) after making reasonable efforts, has been unable to locate and contact any known interested party as provided in subdivisions (a)(1) through (8) of this section; and(C) the funeral director or crematory operator has confirmed with the Office of Veterans Affairs that the deceased veteran is eligible to be interred at the Vermont Veterans Memorial Cemetery.[Subsection (c) effective January 1, 2023; see also subsection (c) effective until January 1, 2023 set out above.](c)(1) If the disposition of the remains of a decedent is determined under subdivision (a)(9) of this section and the funeral director or disposition facility operator has cremated or processed the remains, as applicable, the funeral director or disposition facility operator shall retain the remains for three years and, if no interested party as provided in subdivisions (a)(1) through (8) of this section claims the decedents remains after three years, the funeral director or disposition facility operator shall arrange for the permanent disposition of the remains consistent with any applicable law and standard funeral practices.(2) Notwithstanding any provision of subdivision (1) of this subsection to the contrary, a funeral director or disposition facility operator may determine that the unclaimed remains of a deceased veteran shall be interred at the Vermont Veterans Memorial Cemetery pursuant to 20 V.S.A.  1586 if:(A) at least 180 days have passed since the funeral director or disposition facility operator cremated or processed the remains;(B) the funeral director or disposition facility operator either:(i) has actual knowledge that there is no interested party as provided in subdivisions (a)(1) through (8) of this section to claim the decedents remains; or(ii) after making reasonable efforts, has been unable to locate and contact any known interested party as provided in subdivisions (a)(1) through (8) of this section; and(C) the funeral director or disposition facility operator has confirmed with the Office of Veterans Affairs that the deceased veteran is eligible to be interred at the Vermont Veterans Memorial Cemetery.[Subdivision (d)(1) effective until January 1, 2023; see also subdivision (d)(1) effective January 1, 2023 set out below.](d)(1) If the disposition of the remains of a decedent is determined under subdivision (a)(10) of this section, the Office of the Chief Medical Examiner may contract with a funeral director or crematory operator to cremate the remains of the decedent.[Subdivision (d)(1) effective January 1, 2023; see also subdivision (d)(1) effective until January 1, 2023 set out above.](d)(1) If the disposition of the remains of a decedent is determined under subdivision (a)(10) of this section, the Office of the Chief Medical Examiner may contract with a funeral director or disposition facility operator to cremate the remains of the decedent.(2)(A) If the cremation of the decedent is arranged and paid for under 33 V.S.A.  2301, the Department for Children and Families shall pay the cremation expenses to the funeral home, up to the maximum payment permitted by rule by the Department for Children and Families.(B) If the cremation of the decedent is not arranged and paid for under 33 V.S.A.  2301, the Department of Health shall pay the cremation expenses to the funeral home, up to the maximum payment permitted by rule by the Department for Children and Families.[Subdivision (d)(3) effective until January 1, 2023; see also subdivision (d)(3) effective January 1, 2023 set out below.](3) The cremated remains shall be returned to the Office of the Chief Medical Examiner. The Office shall retain the remains for three years, and if no interested party, as described in subdivisions (a)(1) through (8) of this section, claims the decedents remains after three years, the Office shall arrange for the final disposition of the cremated remains consistent with any applicable law and standard funeral practices.[Subdivision (d)(3) effective January 1, 2023; see also subdivision (d)(3) effective until January 1, 2023 set out above.](3) The cremated remains shall be returned to the Office of the Chief Medical Examiner. The Office shall retain the remains for three years, and if no interested party, as described in subdivisions (a)(1) through (8) of this section, claims the decedents remains after three years, the Office shall arrange for the permanent disposition of the cremated remains consistent with any applicable law and standard funeral practices.(4) Notwithstanding any provision of subdivision (3) of this subsection to the contrary, the Office of the Chief Medical Examiner may determine that the unclaimed cremated remains of a deceased veteran shall be interred at the Vermont Veterans Memorial Cemetery pursuant to 20 V.S.A.  1586 if:(A) at least 180 days have passed since the remains were cremated;(B) the Office of the Chief Medical Examiner either:(i) has actual knowledge that there is no interested party as provided in subdivisions (a)(1) through (8) of this section to claim the decedents remains; or(ii) after making reasonable efforts, has been unable to locate and contact any known interested party as provided in subdivisions (a)(1) through (8) of this section; and(C) the Office of the Chief Medical Examiner has confirmed with the Office of Veterans Affairs that the deceased veteran is eligible to be interred at the Vermont Veterans Memorial Cemetery. (Added 2007, No. 56,  1; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2013, No. 32,  2; 2015, No. 23,  45; 2019, No. 9,  2 eff. April 23, 2019; 2021, No. 169 (Adj. Sess.),  7, eff. January 1, 2023.)
 5228. Forfeiture
An individual recognized under section 5227 of this title to have a right of disposition shall forfeit that right in the following circumstances:[Subdivision (1) effective until January 1, 2023; see also subdivision (1) effective January 1, 2023 set out below.](1) the individual is identified by a law enforcement agency as a person of interest and likely to be prosecuted or is under prosecution for first or second degree murder or voluntary manslaughter in connection with the decedents death, if the status of the investigation or the prosecution is known to the funeral director or crematory operator, except that if the prosecution is not pursued or the individual is acquitted of the alleged crime before the remains are disposed of, the individual shall regain the right;[Subdivision (1) effective January 1, 2023; see also subdivision (1) effective until January 1, 2023 set out above.](1) the individual is identified by a law enforcement agency as a person of interest and likely to be prosecuted or is under prosecution for first or second degree murder or voluntary manslaughter in connection with the decedents death, if the status of the investigation or the prosecution is known to the funeral director or disposition facility operator, except that if the prosecution is not pursued or the individual is acquitted of the alleged crime before the remains are disposed of, the individual shall regain the right;(2) the individual does not exercise the right of disposition within three days of notification of the death or within five days of the decedents time of death, whichever is earlier;(3) the Probate Division of the Superior Court pursuant to section 5231 of this title determines that the individual entitled to the right of disposition and the decedent were estranged at the time of death; or(4) as otherwise ordered by the Probate Division of the Superior Court. (Added 2007, No. 56,  1; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2021, No. 169 (Adj. Sess.),  7, eff. January 1, 2023.)
 5229. Cost of disposition
The cost for the disposition of remains and funeral goods or services shall be borne by the decedents estate, subject to the limits for insolvent estates imposed by 14 V.S.A.  1205, or by any individual who agrees to pay the costs. Nothing in this subchapter shall be construed to require a funeral director or crematory operator to provide goods or services for which there is no payment. (Added 2007, No. 56,  1.)
 5229. Cost of disposition
The cost for the disposition of remains and funeral goods or services shall be borne by the decedents estate, subject to the limits for insolvent estates imposed by 14 V.S.A.  1205, or by any individual who agrees to pay the costs. Nothing in this subchapter shall be construed to require a funeral director or disposition facility operator to provide goods or services for which there is no payment. (Added 2007, No. 56,  1; amended 2021, No. 169 (Adj. Sess.),  7, eff. January 1, 2023.)
 5230. Rights of funeral director or operator of a disposition facility
A funeral director or disposition facility operator may determine the permanent disposition of remains and may file a civil action in Probate Division of the Superior Court against a person, estate, banking institution, governmental agency, or other entity that may have liability for the permanent disposition, either:(1) to seek a declaratory judgment that the directors or operators proposed action would be in compliance with the applicable provisions of law; or(2) to seek a judgment that the director or operators action is in compliance with the applicable provisions of law and to recover reasonable costs and fees for the permanent disposition when:(A) the funeral director or disposition facility operator has actual knowledge that there is no surviving family member, guardian, or individual appointed to arrange for the disposition of decedents remains pursuant to chapter 231 of this title;(B) the funeral director or disposition facility operator has made reasonable efforts to locate and contact any known family member, guardian, or agent; and(C) the appropriate local or State authority, if any, fails to assume responsibility for disposition of the remains within 36 hours of written notice, which may be delivered by hand, U.S. mail, facsimile transmission, electronic means, or telegraph. (Added 2007, No. 56,  1; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2021, No. 169 (Adj. Sess.),  7, eff. January 1, 2023.)
 5230. Rights of funeral director or crematory operator
A funeral director or crematory operator may determine the final disposition of remains and may file a civil action in Probate Division of the Superior Court against a person, estate, banking institution, governmental agency, or other entity which may have liability for the final disposition, either:(1) to seek a declaratory judgment that the directors or operators proposed action would be in compliance with the applicable provisions of law; or(2) to seek a judgment that the director or operators action is in compliance with the applicable provisions of law and to recover reasonable costs and fees for the final disposition when:(A) the funeral director or crematory operator has actual knowledge that there is no surviving family member, guardian, or individual appointed to arrange for the disposition of decedents remains pursuant to chapter 231 of this title;(B) the funeral director or crematory operator has made reasonable efforts to locate and contact any known family member, guardian, or agent; and(C) the appropriate local or State authority, if any, fails to assume responsibility for disposition of the remains within 36 hours of written notice, which may be delivered by hand, U.S. mail, facsimile transmission, electronic means, or telegraph. (Added 2007, No. 56,  1; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.)
 5231. Civil action
(a) Any individual who is a near relative of the decedent or the custodian of the decedents remains may file an action in the Probate Division of the Superior Court requesting the court to appoint an individual to make decisions regarding the disposition of the decedents remains or to resolve a dispute regarding the appropriate disposition of remains, including any decisions regarding funeral goods and services. The court or the individual filing the action may move to join any necessary person under the jurisdiction of the court as a party. The Agency of Human Services may also be joined as a party if it is suggested on the record that there will be insufficient financial resources to pay for funeral goods and services.(b) In making its decision, the court shall consider the following factors:(1) the decedents expressed directions or wishes;(2) the decedents religious affiliation or beliefs;(3) the cost and practicality of the proposed arrangements and disposition and the ability of the responsible party or parties to pay for the proposed arrangements and disposition;(4) the relationship between the decedent and any individual claiming the right of disposition, including whether the individual and the decedent were estranged;(5) the wishes of any individual willing to pay the cost of the proposed arrangements and disposition;(6) whether the proposed arrangements are inclusive of the desires of the family; and(7) any other information the court, in its discretion, deems relevant.(c) Except as provided for under subdivision (b)(4) of this section, an individual who has paid or agreed to pay for all or part of the funeral arrangements or final disposition does not have greater priority to the right to disposition than as set forth in section 5227 of this title.(d)(1) A funeral director or crematory operator may refuse to accept bodily remains, to inter or otherwise dispose of bodily remains, or to complete the arrangements for the final disposition until such time as the court issues an order or the parties to the action submit a final stipulation approved by the court regarding the disposition of remains.(2) If the funeral director or crematory operator retains the remains for final disposition while an action is pending, the funeral director or crematory operator may refrigerate or shelter the remains while awaiting a preliminary or final order of the court. The cost of refrigeration or sheltering shall be the responsibility of the party or parties who contracted with the funeral director or crematory operator, the person or entity who is otherwise liable for the costs of final disposition, or the estate as ordered by the court, or any combination of these, and the court may include in the order a decision concerning which of these shall be responsible for paying these costs.(e) If a funeral director or crematory operator commences an action under this section, the funeral director or crematory operator may ask the court to include an order against the estate or the parties for reasonable legal fees and costs. If the estate is insolvent and no other person should be responsible for the filing fee, the court may waive the filing fee. The court, in its discretion, may order a party or parties to pay the reasonable costs of final disposition as a condition of the appointment to make disposition decisions. The court may order that a party, or parties, including the petitioner, pay reasonable legal fees and costs associated with the action.(f) Any appeal from the probate court shall be on the record to the Civil Division of the Superior Court. There shall be no appeal as a matter of right to the Supreme Court. (Added 2007, No. 56,  1; amended 2009, No. 154 (Adj. Sess.),  148, eff. Feb. 1, 2011.)
 5231. Civil action
(a) Any individual who is a near relative of the decedent or the custodian of the decedents remains may file an action in the Probate Division of the Superior Court requesting the court to appoint an individual to make decisions regarding the disposition of the decedents remains or to resolve a dispute regarding the appropriate disposition of remains, including any decisions regarding funeral goods and services. The court or the individual filing the action may move to join any necessary person under the jurisdiction of the court as a party. The Agency of Human Services may also be joined as a party if it is suggested on the record that there will be insufficient financial resources to pay for funeral goods and services.(b) In making its decision, the court shall consider the following factors:(1) the decedents expressed directions or wishes;(2) the decedents religious affiliation or beliefs;(3) the cost and practicality of the proposed arrangements and disposition and the ability of the responsible party or parties to pay for the proposed arrangements and disposition;(4) the relationship between the decedent and any individual claiming the right of disposition, including whether the individual and the decedent were estranged;(5) the wishes of any individual willing to pay the cost of the proposed arrangements and disposition;(6) whether the proposed arrangements are inclusive of the desires of the family; and(7) any other information the court, in its discretion, deems relevant.(c) Except as provided for under subdivision (b)(4) of this section, an individual who has paid or agreed to pay for all or part of the funeral arrangements or permanent disposition does not have greater priority to the right to disposition than as set forth in section 5227 of this title.(d)(1) A funeral director or disposition facility operator may refuse to accept bodily remains, to inter or otherwise dispose of bodily remains, or to complete the arrangements for the permanent disposition until such time as the court issues an order or the parties to the action submit a final stipulation approved by the court regarding the disposition of remains.(2) If the funeral director or disposition facility operator retains the remains for permanent disposition while an action is pending, the funeral director or disposition facility operator may refrigerate or shelter the remains while awaiting a preliminary or final order of the court. The cost of refrigeration or sheltering shall be the responsibility of the party or parties who contracted with the funeral director or disposition facility operator, the person or entity who is otherwise liable for the costs of permanent disposition, or the estate as ordered by the court, or any combination of these, and the court may include in the order a decision concerning which of these shall be responsible for paying these costs.(e) If a funeral director or disposition facility operator commences an action under this section, the funeral director or disposition facility operator may ask the court to include an order against the estate or the parties for reasonable legal fees and costs. If the estate is insolvent and no other person should be responsible for the filing fee, the court may waive the filing fee. The court, in its discretion, may order a party or parties to pay the reasonable costs of permanent disposition as a condition of the appointment to make disposition decisions. The court may order that a party, or parties, including the petitioner, pay reasonable legal fees and costs associated with the action.(f) Any appeal from the Probate Division shall be on the record to the Civil Division of the Superior Court. There shall be no appeal as a matter of right to the Supreme Court.(Added 2007, No. 56,  1; amended 2009, No. 154 (Adj. Sess.),  148, eff. Feb. 1, 2011; 2021, No. 169 (Adj. Sess.),  7, eff. January 1, 2023.)
 5232. Procedures generally
(a) Any action filed under this subchapter shall be summary in nature, and a hearing shall be held as soon as practicable. The Probate Division of the Superior Court may order interim, ex parte relief based on available information. In extraordinary circumstances, the court may authorize use of discovery, subject to the inherent time constraints required because of the subject matter. The Vermont Rules of Evidence shall not apply, except for those rules respecting privilege. Affidavits of parties and witnesses shall be admissible evidence that may be rebutted by witnesses or affidavits offered by other parties. Other evidence is admissible if it is of a type commonly relied upon by reasonably prudent persons in the conduct of their daily affairs. Telephone testimony shall be authorized unless otherwise ordered for good cause shown. Any person shall be entitled, but not required, to be represented by an attorney. (Added 2007, No. 56,  1; amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.)
 5233. Limited liability
A funeral director or crematory operator shall not be subject to civil liability or subject to disciplinary action for carrying out the disposition of the remains if he or she relied in good faith on a funeral service contract or authorization or for following the instructions of an individual whom the funeral director or crematory operator reasonably believes or believed holds the right of disposition. (Added 2007, No. 56,  1.)
 5233. Limited liability
A funeral director or disposition facility operator shall not be subject to civil liability or subject to disciplinary action for carrying out the disposition of the remains if he or she relied in good faith on a funeral service contract or authorization or for following the instructions of an individual who the funeral director or disposition facility operator reasonably believes or believed holds the right of disposition. (Added 2007, No. 56,  1; amended 2021, No. 169 (Adj. Sess.),  7, eff. January 1, 2023.)
 5234. Organ Donation Special Fund
There is created the Organ Donation Special Fund, which shall be a special fund established and managed pursuant to 32 V.S.A. chapter 7, subchapter 5. The Organ Donation Special Fund shall consist of any federal funds, grants, and private donations solicited by the Commissioner of Health for use within the Fund. The Organ Donation Special Fund shall be used for activities related to increasing organ donations in Vermont. (Added 2013, No. 32,  5.)
 601. Local health officials
(a) The Commissioner shall appoint, upon recommendation of the selectboard, a local health officer for each town or city, and the Commissioner shall give such officer a certificate of appointment. The Commissioner may appoint one or more deputy local health officers for a town or city upon written request of the local board of health. In case the selectboard neglect or refuse to recommend to the Commissioner a local health officer, the Commissioner after 30 days notice in writing to the selectboard shall appoint a local health officer. (b) With the approval of the Commissioner, towns and cities may combine to form health districts. The towns and cities in such districts, through their selectboards, may recommend to the Commissioner the appointment of a district health officer. They may establish an advisory district board of health and provide for appointment and terms of service of members who shall be representative citizens of the towns in the health district. The district health officer may perform the duties of local health officer in any town or city in the district at any time after written notice to the selectboard. The district health officer, when authorized by the selectboard of each town or city in the health district and with the advice of the district board of health, may employ such persons as may be necessary to assist such officer in carrying on a preventive, protective, and promotional health program in his or her district. Towns in a district may use local tax revenues for the support of the district health officer, advisory board, employees, and programs, and the district board of health may accept grants for those purposes. (c) The Commissioner may remove a local health officer at any time for cause. Vacancies shall be filled in the same manner as the original appointment was made. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1961, No. 39; 1985, No. 267 (Adj. Sess.),  17.) 
 602. Compensation of health officers
(a) All compensation for services rendered by local health officers appointed under section 601 of this title shall be provided by and under the control of the selectboard. (b) The selectboard may reimburse local health officers appointed under section 601 of this title for all reasonable expenses incurred by such local health officers in the execution of their duties. (Amended 1985, No. 267 (Adj. Sess.),  18.) 
 602a. Duties of local health officers
(a) A local health officer, within his or her jurisdiction, shall:(1) upon receipt of information regarding a condition that may be a public health hazard, conduct an investigation; (2) enforce the provisions of this title, the rules promulgated, and permits issued thereunder;(3) prevent, remove, or destroy any public health hazard or mitigate any significant public health risk in accordance with the provisions of this title; (4) in consultation with the Department, take the steps necessary to enforce all orders issued pursuant to chapter 3 of this title; and (5) have the authority to assist the Department of Public Safety in inspecting rental housing pursuant to 20 V.S.A. chapter 172, provided that if the local health officer inspects a rental property without an inspector from the Division, the officer shall issue an inspection report in compliance with 20 V.S.A  2677(b)(2). (b) Upon discovery of violation or a public health hazard or public health risk that involves a public water system, a food or lodging establishment, or any other matter regulated by Department rule, the local health officer shall immediately notify the Division of Environmental Health. Upon discovery of any other violation, public health hazard, or public health risk, the local health officer shall notify the Division of Environmental Health within 48 hours of discovery of such violation or hazard and of any action taken by the officer. (Added 1985, No. 267 (Adj. Sess.),  19; amended 2017, No. 188 (Adj. Sess.),  4; 2021, No. 181 (Adj. Sess.),  3, eff. July 1, 2022.) 
 604. Local Board of Health
The local health officer, with the selectboard of the town, or the city council of a city, shall constitute a local board of health for such town or city. (Amended 1985, No. 267 (Adj. Sess.),  20.) 
 605. Local health officer as secretary and executive officer of local board
The local health officer shall be the secretary and executive officer of the local board of health, and shall hold office for three years, and until a successor is appointed. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1985, No. 267 (Adj. Sess.),  21.) 
 608. Inspection of schoolhouses and public buildings
The health officer, under the direction of the Board, shall make a sanitary survey of each schoolhouse, all school lunch facilities, and any building used for public purposes, and annually in the month of February report to the Board, and to the city council or the annual town meeting, as the case may be. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 613. Powers of local board
(a) A local board of health may make and enforce rules in such town or city relating to the prevention, removal, or destruction of public health hazards and the mitigation of public health risks, provided that such rules have been approved by the Commissioner. Such rules shall be posted and published in the same manner that ordinances of the municipality are required to be posted and published. (b) A local boards jurisdiction over sewage disposal includes emergent conditions which create a risk to the public health as a result of sewage treatment and disposal, or its effects on water supply, but does not include the power to adopt ordinances, rules, or regulations relating to design standards for on-site sewage disposal systems. The board may act to abate nuisances affecting public health caused by the failure of a sewage disposal system to: (1) prevent surfacing of sewage and the creation of a health hazard; or(2) prevent the pollution or contamination of drinking water supplies, groundwater, and surface water; or (3) maintain sanitary and healthful conditions during operation.(c) All rules or ordinances adopted by a local board of health shall be consistent with the purposes, policies, and provisions of this title. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1983, No. 117 (Adj. Sess.),  3; 1985, No. 267 (Adj. Sess.),  22; 2017, No. 113 (Adj. Sess.),  54.) 
 615. Approval of selectboard
A local health officer shall not incur significant expense to the town or city for the prevention, removal, or destruction of any public health hazard or the mitigation of any public health risk without the consent and approval of the selectboard of such town or city. (Amended 1985, No. 267 (Adj. Sess.),  23.) 
 617. Assistance by officers; penalty for neglect
(a) The local health officer or local board of health may call upon sheriffs, constables, and police officers to assist it in the proper discharge of its duties. A sheriff, constable, or police officer who neglects or refuses to render such assistance shall be fined not more than $200.00. (b) A local health officer may call upon State health officials for technical or other assistance. (Amended 1985, No. 267 (Adj. Sess.),  24.) 
 622. Health officers for unorganized towns and gores
The Commissioner shall have power to designate a local health officer of a town adjoining an unorganized town or gore as the local health officer of such unorganized town or gore. Such health officer shall report to the Commissioner every violation of this title or any rule adopted, permit or order issued thereunder, and any public health hazard or public health risk of which such officer has knowledge as existing in such unorganized town or gore, and, in such unorganized town or gore, shall perform all acts required of the local health officer of a town. Upon receiving such information from such health officer, the Commissioner shall perform all acts in relation to such cases the same as if such information came from the local health officer of a town. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1985, No. 267 (Adj. Sess.),  25.) 
 623. Compensation and expenses
The services and expenses of a local health officer of unorganized towns and gores, with the approval of the Commissioner, shall be paid by the State from the taxes collected from such unorganized town or gore wherein the services were rendered or the expense incurred. The Commissioner of Finance and Management shall issue a warrant therefor. (Amended 1959, No. 328 (Adj. Sess.),  8; 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1983, No. 195 (Adj. Sess.),  5(b); 1985, No. 267 (Adj. Sess.),  26.) 
 624. Actions against local health officers
Actions taken by local health officers or by any other person given authority by chapters 3 and 11 of this title shall be considered to be actions taken by State employees for the purposes of 3 V.S.A. chapter 29 and 12 V.S.A. chapter 189 if such actions occurred within the scope of such persons duties. (Added 1985, No. 267 (Adj. Sess.),  27.) 
 5250a. Short title
This chapter may be cited as the Revised Uniform Anatomical Gift Act. (Added 2009, No. 119 (Adj. Sess.),  1.)
 5250b. Definitions
As used in this chapter:(1) Adult means an individual who is at least 18 years of age.(2) Agent means an individual:(A) authorized to make health care decisions on the principals behalf by an advance directive executed pursuant to chapter 231 of this title or by a health care power of attorney executed pursuant to the laws of this or another state; or (B) expressly authorized to make an anatomical gift on the principals behalf by any other record signed by the principal. (3) Anatomical gift means a donation of all or part of a human body to take effect after the donors death for the purpose of transplantation, therapy, research, or education. (4) Decedent means a deceased individual whose body or part is or may be the source of an anatomical gift. The term includes a stillborn infant and, subject to restrictions imposed by law other than this chapter, a fetus. (5) Disinterested witness means a witness other than the spouse, reciprocal beneficiary, child, parent, sibling, grandchild, grandparent, or guardian of the individual who makes, amends, revokes, or refuses to make an anatomical gift, or another adult who exhibited special care and concern for the individual. The term does not include a person to which an anatomical gift could pass under section 5250k of this title. (6) Document of gift means a donor card or other record used to make an anatomical gift. The term includes a statement or symbol on a drivers license or nondriver identification card or an inclusion in a donor registry. (7) Donor means an individual whose body or part is the subject of an anatomical gift.(8) Donor registry means a database that identifies donors and complies with the provisions of section 5250t of this title. (9) Drivers license means a license or permit issued by the Vermont Department of Motor Vehicles to operate a vehicle, whether or not conditions are attached to the license or permit. (10) Emancipated with respect to a minor shall have the same meaning as in 12 V.S.A.  7151.(11) Eye bank means a person that is licensed, accredited, or regulated under federal or state law to engage in the recovery, screening, testing, processing, storage, or distribution of human eyes or portions of human eyes. (12) Guardian means a person appointed by a court to make decisions regarding the support, care, education, health, or welfare of an individual. The term does not include a guardian ad litem. (13) Hospital means a facility licensed as a hospital under the law of any state or a facility operated as a hospital by the United States, a state, or a subdivision of a state. (14) Know means to have actual knowledge.(15) Minor means an individual who is under 18 years of age.(16) Nondriver identification card means a nondriver identification card issued by the Vermont Department of Motor Vehicles pursuant to 23 V.S.A.  115. (17) Organ procurement organization means a person designated by the Secretary of the U.S. Department of Health and Human Services as an organ procurement organization. (18) Parent means a parent whose parental rights have not been terminated.(19) Part means an organ, an eye, or tissue of a human being. The term does not include the whole body. (20) Person means an individual, corporation, business trust, estate, trust, partnership, limited liability company, association, joint venture, public corporation, government or governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. (21) Physician means an individual authorized to practice medicine or osteopathy under the law of any state. (22) Procurement organization means an eye bank, an organ procurement organization, or a tissue bank. (23) Prospective donor means an individual who is dead or near death and has been determined by a procurement organization to have a part that could be medically suitable for transplantation, therapy, research, or education. The term does not include an individual who has made a refusal. (24) Reasonably available means able to be contacted by a procurement organization without undue effort and willing and able to act in a timely manner consistent with existing medical criteria necessary for the making of an anatomical gift. (25) Recipient means an individual into whose body a decedents part has been or is intended to be transplanted. (26) Record means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in perceivable form. (27) Refusal means a record created under section 5250g of this title that expressly states an intent to bar other persons from making an anatomical gift of an individuals body or part. (28) Sign means, with the present intent to authenticate or adopt a record:(A) to execute or adopt a tangible symbol; or(B) to attach to or logically associate with the record an electronic symbol, sound, or process. (29) State means a state of the United States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, or any territory or insular possession subject to the jurisdiction of the United States. (30) Technician means an individual determined to be qualified to remove or process parts by an appropriate organization that is licensed, accredited, or regulated under federal or state law. The term includes an enucleator. (31) Tissue means a portion of the human body other than an organ or an eye. The term does not include blood unless the blood is donated for the purpose of research or education. (32) Tissue bank means a person that is licensed, accredited, or regulated under federal or state law to engage in the recovery, screening, testing, processing, storage, or distribution of tissue. (33) Transplant hospital means a hospital that furnishes organ transplants and other medical and surgical specialty services required for the care of transplant patients. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250c. Applicability
This chapter applies to an anatomical gift or amendment to, revocation of, or refusal to make an anatomical gift, whenever made. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250d. Who may make anatomical gift before donors death
Subject to section 5250h of this title, an anatomical gift of a donors body or part may be made during the life of the donor for the purpose of transplantation, therapy, research, or education in the manner provided in section 5250e of this title by: (1) the donor, if the donor is an adult or if the donor is a minor and is either:(A) emancipated; or(B) authorized under State law to apply for a drivers license or nondriver identification card and is at least 16 years of age; (2) an agent of the donor, unless the advance directive or other record prohibits the agent from making an anatomical gift; (3) a parent of the donor, if the donor is an unemancipated minor; or(4) the donors guardian. (Added 2009, No. 119 (Adj. Sess.),  1.)
 5250e. Manner of making anatomical gift before donors death
(a) A donor may make an anatomical gift:(1) by authorizing a statement or symbol indicating that the donor has made an anatomical gift to be imprinted on the donors drivers license or nondriver identification card; (2) in an advance directive executed pursuant to chapter 231 of this title;(3) in a will;(4) during a terminal illness or injury of the donor, by any form of communication addressed to at least two adults, at least one of whom is a disinterested witness; or (5) as provided in subsection (b) of this section.(b) A donor or other person authorized to make an anatomical gift under section 5250d of this title may make a gift by a donor card or other record signed by the donor or other person making the gift or by authorizing that a statement or symbol indicating that the donor has made an anatomical gift be included on a donor registry. If the donor or other person is physically unable to sign a record, the record may be signed by another individual at the direction of the donor or other person and must: (1) be witnessed by at least two adults, at least one of whom is a disinterested witness, who have signed at the request of the donor or the other person; and (2) state that it has been signed and witnessed as provided in subdivision (1) of this subsection. (c) Revocation, suspension, expiration, or cancellation of a drivers license or nondriver identification card upon which an anatomical gift is indicated does not invalidate the gift. (d) An anatomical gift made by will takes effect upon the donors death whether or not the will is probated. Invalidation of the will after the donors death does not invalidate the gift. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250f. Amending or revoking anatomical gift before donors death
(a) Subject to section 5250h of this title, a donor or other person authorized to make an anatomical gift under section 5250d of this title may amend or revoke an anatomical gift by: (1) a record signed by:(A) the donor;(B) the other person; or(C) subject to subsection (b) of this section, another individual acting at the direction of the donor or the other person if the donor or other person is physically unable to sign; or (2) a later-executed document of gift that amends or revokes a previous anatomical gift or portion of an anatomical gift, either expressly or by inconsistency. (b) A record signed pursuant to subdivision (a)(1)(C) of this section must:(1) be witnessed by at least two adults, at least one of whom is a disinterested witness, who have signed at the request of the donor or the other person; and (2) state that it has been signed and witnessed as provided in subdivision (1) of this subsection. (c) Subject to section 5250h of this title, a donor or other person authorized to make an anatomical gift under section 5250d of this title may revoke an anatomical gift by the destruction or cancellation of the document of gift, or the portion of the document of gift used to make the gift, with the intent to revoke the gift. (d) A donor may amend or revoke an anatomical gift that was not made in a will by any form of communication during a terminal illness or injury addressed to at least two adults, at least one of whom is a disinterested witness. (e) A donor who makes an anatomical gift in a will may amend or revoke the gift in the manner provided for amendment or revocation of wills or as provided in subsection (a) of this section. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250g. Refusal to make anatomical gift; effect of refusal
(a) An individual may refuse to make an anatomical gift of the individuals body or part by: (1) an advance directive executed pursuant to chapter 231 of this title;(2) a record signed by:(A) the individual; or(B) subject to subsection (b) of this section, another individual acting at the direction of the individual if the individual is physically unable to sign; (3) the individuals will, whether or not the will is admitted to probate or invalidated after the individuals death; or (4) any form of communication made by the individual during the individuals terminal illness or injury addressed to at least two adults, at least one of whom is a disinterested witness. (b) A record signed pursuant to subdivision (a)(2)(B) of this section must:(1) be witnessed by at least two adults, at least one of whom is a disinterested witness, who have signed at the request of the individual; and (2) state that it has been signed and witnessed as provided in subdivision (1) of this subsection. (c) An individual who has made a refusal may amend or revoke the refusal:(1) in the manner provided in subsection (a) of this section for making a refusal;(2) by subsequently making an anatomical gift pursuant to section 5250e of this title that is inconsistent with the refusal; or (3) by destroying or canceling the record evidencing the refusal, or the portion of the record used to make the refusal, with the intent to revoke the refusal. (d) Except as otherwise provided in subsection 5250h(h) of this title, in the absence of an express, contrary indication by the individual set forth in the refusal, an individuals unrevoked refusal to make an anatomical gift of the individuals body or part bars all other persons from making an anatomical gift of the individuals body or part. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250h. Preclusive effect of anatomical gift, amendment, or revocation
(a) Except as otherwise provided in subsection (g) of this section and subject to subsection (f) of this section, in the absence of an express, contrary indication by the donor, a person other than the donor is barred from making, amending, or revoking an anatomical gift of a donors body or part if the donor made an anatomical gift of the donors body or part under section 5250e of this title or an amendment to an anatomical gift of the donors body or part under section 5250f of this title. (b) A donors revocation of an anatomical gift of the donors body or part under section 5250f of this title is not a refusal and does not bar another person specified in section 5250d or 5250i of this title from making an anatomical gift of the donors body or part under section 5250e or 5250j of this title. (c) If a person other than the donor makes an unrevoked anatomical gift of the donors body or part under section 5250e of this title or an amendment to an anatomical gift of the donors body or part under section 5250f of this title, another person may not make, amend, or revoke the gift of the donors body or part under section 5250j of this title. (d) A revocation of an anatomical gift of a donors body or part under section 5250f of this title by a person other than the donor does not bar another person from making an anatomical gift of the body or part under section 5250e or 5250j of this title. (e) In the absence of an express, contrary indication by the donor or other person authorized to make an anatomical gift under section 5250d of this title, an anatomical gift of a part is neither a refusal to give another part nor a limitation on the making of an anatomical gift of another part at a later time by the donor or another person. (f) In the absence of an express, contrary indication by the donor or other person authorized to make an anatomical gift under section 5250d of this title, an anatomical gift of a part for one or more of the purposes set forth in that section is not a limitation on the making of an anatomical gift of the part for any of the other purposes by the donor or any other person under section 5250e or 5250j of this title. (g) If a donor who is an unemancipated minor dies, a parent of the donor who is reasonably available may revoke or amend an anatomical gift of the donors body or part. (h) If an unemancipated minor who signed a refusal dies, a parent of the minor who is reasonably available may revoke the minors refusal. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250i. Who may make anatomical gift of decedents body or part
(a) Subject to subsections (b) and (c) of this section and unless barred by section 5250g or 5250h of this title, an anatomical gift of a decedents body or part for purpose of transplantation, therapy, research, or education may be made by any member of the following classes of persons who is reasonably available, in the order of priority listed: (1) an agent of the decedent at the time of death who could have made an anatomical gift under subdivision 5250d(2) of this title immediately before the decedents death; (2) the spouse of the decedent;(3) [Repealed.](4) adult children of the decedent;(5) parents of the decedent;(6) adult siblings of the decedent;(7) adult grandchildren of the decedent;(8) grandparents of the decedent;(9) an adult who exhibited special care and concern for the decedent;(10) the persons who were acting as the guardians of the person of the decedent at the time of death; and (11) any other person having the authority to dispose of the decedents body.(b) If there is more than one member of a class listed in subdivision (a)(1), (4), (5), (6), (7), (8), or (10) of this section entitled to make an anatomical gift, an anatomical gift may be made by a member of the class unless that member or a person to which the gift may pass under section 5250k of this title knows of an objection by another member of the class. If an objection is known, the gift may be made only by a majority of the members of the class who are reasonably available. (c) A person may not make an anatomical gift if, at the time of the decedents death, a person in a prior class under subsection (a) of this section is reasonably available to make or to object to the making of an anatomical gift. (Added 2009, No. 119 (Adj. Sess.),  1; amended 2015, No. 23,  46.) 
 5250j. Manner of making, amending, or revoking anatomical gift of decedents body or part
(a) A person authorized to make an anatomical gift under section 5250i of this title may make an anatomical gift by a document of gift signed by the person making the gift or by that persons oral communication that is electronically recorded or is contemporaneously reduced to a record and signed by the individual receiving the oral communication. (b) Subject to subsection (c) of this section, an anatomical gift by a person authorized under section 5250i of this title may be amended or revoked orally or in a record by any member of a prior class who is reasonably available. If more than one member of the prior class is reasonably available, the gift made by a person authorized under section 5250i of this title may be: (1) amended only if a majority of the reasonably available members agree to the amending of the gift; or (2) revoked only if a majority of the reasonably available members agree to the revoking of the gift or if they are equally divided as to whether to revoke the gift. (c) A revocation under subsection (b) of this section is effective only if, before an incision has been made to remove a part from the donors body or before invasive procedures have begun to prepare the recipient, the procurement organization, transplant hospital, or physician or technician knows of the revocation. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250k. Persons that may receive anatomical gift; purpose of anatomical gift
(a) An anatomical gift may be made to the following persons named in the document of gift:(1) a hospital; accredited medical school, dental school, college, or university; organ procurement organization; or other appropriate person, for research or education; (2) subject to subsection (b) of this section, an individual designated by the person making the anatomical gift if the individual is the recipient of the part; (3) an eye bank or tissue bank.(b) If an anatomical gift to an individual under subdivision (a)(2) of this section cannot be transplanted into the individual, the part passes in accordance with subsection (g) of this section in the absence of an express, contrary indication by the person making the anatomical gift. (c) If an anatomical gift of one or more specific parts or of all parts is made in a document of gift that does not name a person described in subsection (a) of this section but identifies the purpose for which an anatomical gift may be used, the following rules apply: (1) If the part is an eye and the gift is for the purpose of transplantation or therapy, the gift passes to the appropriate eye bank. (2) If the part is tissue and the gift is for the purpose of transplantation or therapy, the gift passes to the appropriate tissue bank. (3) If the part is an organ and the gift is for the purpose of transplantation or therapy, the gift passes to the appropriate organ procurement organization as custodian of the organ. (4) If the part is an organ, an eye, or tissue and the gift is for the purpose of research or education, the gift passes to the appropriate procurement organization. (d) For the purpose of subsection (c) of this section, if there is more than one purpose of an anatomical gift set forth in the document of gift but the purposes are not set forth in any priority, the gift shall be used for transplantation or therapy, if suitable for those purposes. If the gift cannot be used for transplantation or therapy, the gift may be used for research or education. (e) If an anatomical gift of one or more specific parts is made in a document of gift that does not name a person described in subsection (a) of this section and does not identify the purpose of the gift, the gift shall pass in accordance with subsection (g) of this section, and the parts shall be used for transplantation or therapy, if suitable for those purposes; if not suitable for transplantation or therapy, the gift may be used for research or education. (f) If a document of gift specifies only a general intent to make an anatomical gift by words such as donor, organ donor, or body donor, or by a symbol or statement of similar import, the gift shall pass in accordance with subsection (g) of this section, and the parts shall be used for transplantation or therapy, if suitable for those purposes; if not suitable for transplantation or therapy, the gift may be used for research or education. (g) For purposes of subsections (b), (e), and (f) of this section, the following rules apply: (1) If the part is an eye, the gift passes to the appropriate eye bank.(2) If the part is tissue, the gift passes to the appropriate tissue bank.(3) If the part is an organ, the gift passes to the appropriate organ procurement organization as custodian of the organ. (h) An anatomical gift of an organ for transplantation or therapy, other than an anatomical gift under subdivision (a)(2) of this section, passes to the organ procurement organization as custodian of the organ. (i) If an anatomical gift does not pass pursuant to subsections (a) through (h), inclusive, of this section, or the decedents body or part is not used for transplantation, therapy, research, or education, custody of the body or part passes to the person under obligation to dispose of the body or part. (j) A person may not accept an anatomical gift if the person knows that the gift was not effectively made under section 5250e or 5250j of this title or if the person knows that the decedent made a refusal under section 5250g of this title that was not revoked. For purposes of this subsection, if a person knows that an anatomical gift was made on a document of gift, the person is deemed to know of any amendment or revocation of the gift or any refusal to make an anatomical gift on the same document of gift. (k) Except as otherwise provided in subdivision (a)(2) of this section, nothing in this chapter affects the allocation of organs for transplantation or therapy. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250l. Search and notification
(a) The following persons shall make a reasonable search of an individual who the person reasonably believes is dead or near death for a document of gift or other information identifying the individual as a donor or as an individual who made a refusal: (1) a law enforcement officer, firefighter, paramedic, or other emergency rescuer finding the individual; and (2) if no other source of the information is immediately available, a hospital, as soon as practical after the individuals arrival at the hospital. (b) If a document of gift or a refusal to make an anatomical gift is located by the search required by subdivision (a)(1) of this section and the individual or deceased individual to whom it relates is taken to a hospital, the person responsible for conducting the search shall send the document of gift or refusal to the hospital. (c) A person is not subject to criminal or civil liability for failing to discharge the duties imposed by this section but may be subject to administrative sanctions. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250m. Delivery of document of gift not required; right to examine
(a) A document of gift need not be delivered during the donors lifetime to be effective.(b) Upon or after an individuals death, a person in possession of a document of gift or a refusal to make an anatomical gift with respect to the individual shall allow examination and copying of the document of gift or refusal by a person authorized to make or object to the making of an anatomical gift with respect to the individual or by a person to which the gift could pass under section 5250k of this title. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250n. Rights and duties of procurement organization and others
(a) When a hospital refers an individual at or near death to a procurement organization, the organization shall make a reasonable search of the records of the Vermont Donor Registry and any other donor registry that it knows exists for the geographical area in which the individual resides to ascertain whether the individual has made an anatomical gift. (b) A procurement organization must be allowed reasonable access to the Vermont Donor Registry established pursuant to section 5250t of this title to ascertain whether an individual at or near death is a donor. (c) When a hospital refers an individual at or near death to a procurement organization, the organization may conduct any reasonable examination necessary to assess the medical suitability of a part that is or could be the subject of an anatomical gift for transplantation, therapy, research, or education from a donor or a prospective donor. During the examination period, measures necessary to maintain the potential medical suitability of the part may not be withdrawn unless the hospital or procurement organization knows that the individual expressed a contrary intent. (d) Unless prohibited by law other than this chapter, at any time after a donors death, the person to which a part passes under section 5250k of this title may conduct any reasonable examination necessary to assess the medical suitability of the body or part for its intended purpose. (e) Unless prohibited by law other than this chapter, an examination under subsection (c) or (d) of this section may include serological and blood and tissue compatibility testing, as well as an examination of all medical and dental records of the donor or prospective donor. (f) Upon the death of a minor who was a donor or had signed a refusal, unless a procurement organization knows the minor is emancipated, the procurement organization shall conduct a reasonable search for the parents of the minor and provide the parents with an opportunity to revoke or amend the anatomical gift or revoke the refusal. (g) Upon referral by a hospital under subsection (a) of this section, a procurement organization shall make a reasonable search for any person listed in section 5250i of this title having priority to make an anatomical gift on behalf of a prospective donor. If a procurement organization receives information that an anatomical gift to any other person was made, amended, or revoked, it shall promptly advise the other person of all relevant information. (h) Subject to subsection 5250k(i) and section 5250w of this title, the rights of the person to which a part passes under section 5250k are superior to the rights of all others with respect to the part. The person may accept or reject an anatomical gift in whole or in part. Subject to the terms of the document of gift and this chapter, a person that accepts an anatomical gift of an entire body may allow embalming, burial or cremation, and use of remains in a funeral service. If the gift is of a part, the person to which the part passes under section 5250k of this title, upon the death of the donor and before embalming, burial, or cremation, shall cause the part to be removed without unnecessary mutilation. (i) Neither the physician who attends the decedent at death nor the physician who determines the time of the decedents death may participate in the procedures for removing or transplanting a part from the decedent. As used in this section, procedures include actual physical removal and transplantation of a part but do not include the consent, process, disposal, preservation, quality measures, storage, transportation, or research involving a part. (j) A physician or technician may remove a donated part from the body of a donor that the physician or technician is qualified to remove. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250o. Coordination of procurement and use
Each hospital in this State shall enter into agreements or affiliations with procurement organizations for coordination of procurement and use of anatomical gifts. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250p. Sale or purchase of parts prohibited
(a) Except as otherwise provided in subsection (b) of this section, no person shall, for valuable consideration, knowingly purchase or sell a part for transplantation or therapy if removal of a part from an individual is intended to occur after the individuals death. (b) A person may charge a reasonable amount for the removal, processing, preservation, quality control, storage, transportation, implantation, or disposal of a part. (c) A person who violates subsection (a) of this section shall be imprisoned not more than five years or fined not more than $50,000.00, or both. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250q. Other prohibited acts
(a) No person shall, in order to obtain a financial gain, intentionally falsify, forge, conceal, deface, or obliterate a document of gift, an amendment or revocation of a document of gift, or a refusal. (b) A person who violates subsection (a) of this section shall be imprisoned not more than five years or fined not more than $50,000.00, or both. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250r. Immunity
(a) A person who acts in accordance with this chapter or with the applicable anatomical gift law of another state or attempts in good faith to do so is not liable for the act in a civil action, criminal prosecution, or administrative proceeding. An act that relies upon a document of gift in a donor registry, a signed statement by a donor in an advance directive, or a donor card shall be presumed to be in good faith. (b) Neither the person making an anatomical gift nor the donors estate is liable for any injury or damage that results from the making or use of the gift. (c) In determining whether an anatomical gift has been made, amended, or revoked under this chapter, a person may rely upon representations of an individual listed in subdivision 5250i(a)(2), (3), (4), (5), (6), (7), (8), or (9) of this title relating to the individuals relationship to the donor or prospective donor, unless the person knows that the representation is untrue. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250s. Law governing validity; choice of law as to execution of document of gift; presumption of validity
(a) A document of gift is valid if executed in accordance with:(1) this chapter;(2) the laws of the state or country where it was executed; or(3) the laws of the state or country where the person making the anatomical gift was domiciled, has a place of residence, or was a national at the time the document of gift was executed. (b) If a document of gift is valid under this section, the law of this State governs the interpretation of the document of gift. (c) A person may presume that a document of gift or amendment of an anatomical gift is valid unless that person knows that it was not validly executed or was revoked. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250t. Donor registry
(a) The Department of Health shall ensure that a registry is developed and maintained to identify people who have authorized a document of gift. (b) The Department of Motor Vehicles is authorized to enter into a data use agreement with an organ procurement organization for the purpose of transmitting information identifying persons who have authorized a document of gift at the time of issuance of a drivers license or drivers license renewal and incorporating such information into a donor registry maintained by the organ procurement organization. Such information shall constitute the Vermont Donor Registry. The Department of Motor Vehicles may secure grants from public and private sources, and receive and disburse funds that are assigned, donated, or bequeathed to the Department to cover the costs of receiving and transmitting the document of gift data. As funds become available, documents of gift may be accepted and data forwarded from persons 16 and 17 years of age and persons being issued nondriver identification cards. (c) The Vermont Donor Registry shall:(1) contain a database that includes donors who have authorized an anatomical gift and provide a mechanism for an anatomical gift to be removed from the database; (2) be accessible to other organ procurement organizations to allow them to obtain relevant information from the donor registry to determine, at or near the time of the death of the donor or a prospective donor, whether the donor or prospective donor has authorized an anatomical gift; and (3) be accessible 24 hours per day, seven days per week for the purposes specified in subdivisions (1) and (2) of this subsection. (d) No later than January 15, 2011, the Department of Motor Vehicles shall submit a report on its implementation of a data use agreement with a qualified organ procurement organization to the House and Senate Committees on Government Operations, the House Committee on Human Services, and the Senate Committee on Health and Welfare. (e) Personally identifiable information contained in a donor registry about a donor or prospective donor may not be used or disclosed by any organ procurement organization except with the express consent of the donor, prospective donor, or other person making the anatomical gift for any purpose other than to determine, at or near the time of the death of the donor or prospective donor, whether such donor or prospective donor has made, amended, or revoked an anatomical gift. (f) Nothing in this section shall be construed to prohibit any person from creating or maintaining a donor registry that is not established under this section, provided that any such registry shall comply with the provisions of subsections (c) and (e) of this section. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250v. Cooperation between Medical Examiner and procurement organization
The Chief Medical Examiner shall cooperate with procurement organizations to maximize the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research, or education, except when the Chief Medical Examiner believes such cooperation would be inconsistent with death investigation procedures or would negatively affect a death investigation. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250x. Honoring donor intent
A persons decision to make a donation of that persons own organ or tissue after death shall be honored. In the absence of a revocation or amendment of an anatomical gift, health care providers and procurement organizations shall act in accordance with the donors decision and may take appropriate actions to effect the anatomical gift. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250y. Uniformity of application and construction
In applying and construing this uniform act, consideration must be given to the need to promote uniformity of the law with respect to its subject matter among states that enact it. (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5250z. Relation to electronic signatures in Global and National Commerce Act
This act modifies, limits, and supersedes the Electronic Signatures in Global and National Commerce Act, 15 U.S.C. Section 7001 et seq., but does not modify, limit, or supersede Section 101(a) of that act, 15 U.S.C. Section 7001, or authorize electronic delivery of any of the notices described in Section 103(b) of that act, 15 U.S.C. Section 7003(b). (Added 2009, No. 119 (Adj. Sess.),  1.) 
 5281. Definitions
As used in this chapter:(1) Bona fide physician-patient relationship means a treating or consulting relationship in the course of which a physician has completed a full assessment of the patients medical history and current medical condition, including a personal physical examination. (2) Capable means that a patient has the ability to make and communicate health care decisions to a physician, including communication through persons familiar with the patients manner of communicating if those persons are available. (3) Health care facility shall have the same meaning as in section 9432 of this title.(4) Health care provider means a person, partnership, corporation, facility, or institution, licensed or certified or authorized by law to administer health care or dispense medication in the ordinary course of business or practice of a profession. (5) Impaired judgment means that a person does not sufficiently understand or appreciate the relevant facts necessary to make an informed decision. (6) Interested person means:(A) the patients physician;(B) a person who knows that he or she is a relative of the patient by blood, civil marriage, civil union, or adoption; (C) a person who knows that he or she would be entitled upon the patients death to any portion of the estate or assets of the patient under any will or trust, by operation of law, or by contract; or (D) an owner, operator, or employee of a health care facility, nursing home, or residential care facility where the patient is receiving medical treatment or is a resident. (7) Palliative care shall have the same definition as in section 2 of this title.(8) Patient means a person who is 18 years of age or older, a resident of Vermont, and under the care of a physician. (9) Physician means an individual licensed to practice medicine under 26 V.S.A. chapter 23 or 33. (10) Terminal condition means an incurable and irreversible disease which would, within reasonable medical judgment, result in death within six months. (11) Health care services means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. (12) Telemedicine means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191. (Added 2013, No. 39,  1, eff. May 20, 2013; amended 2021, No. 97 (Adj. Sess.),  1, eff. April 27, 2022.) 
 5282. Right to information
The rights of a patient under section 1871 of this title to be informed of all available options related to terminal care and under 12 V.S.A.  1909(d) to receive answers to any specific question about the foreseeable risks and benefits of medication without the physicians withholding any requested information exist regardless of the purpose of the inquiry or the nature of the information. A physician who engages in discussions with a patient related to such risks and benefits in the circumstances described in this chapter shall not be construed to be assisting in or contributing to a patients independent decision to self-administer a lethal dose of medication, and such discussions shall not be used to establish civil or criminal liability or professional disciplinary action. (Added 2013, No. 39,  1, eff. May 20, 2013.) 
 5283. Requirements for prescription and documentation; immunity
(a) A physician shall not be subject to any civil or criminal liability or professional disciplinary action if the physician prescribes to a patient with a terminal condition medication to be self-administered for the purpose of hastening the patients death and the physician affirms by documenting in the patients medical record that all of the following occurred: (1) The patient made an oral request to the physician in the physicians physical presence or by telemedicine, if the physician determines the use of telemedicine to be clinically appropriate, for medication to be self- administered for the purpose of hastening the patients death. (2) Not fewer than 15 days after the first oral request, the patient made a second oral request to the physician in the physicians physical presence or by telemedicine, if the physician determines the use of telemedicine to be clinically appropriate, for medication to be self-administered for the purpose of hastening the patients death. (3) At the time of the second oral request, the physician offered the patient an opportunity to rescind the request. (4) The patient made a written request for medication to be self-administered for the purpose of hastening the patients death that was signed by the patient in the presence of two or more witnesses who were not interested persons, who were at least 18 years of age, and who signed and affirmed that the patient appeared to understand the nature of the document and to be free from duress or undue influence at the time the request was signed. (5) The physician determined that the patient:(A) was suffering a terminal condition, based on the physicians review of the patients relevant medical records and a physicians physical examination of the patient; (B) was capable;(C) was making an informed decision;(D) had made a voluntary request for medication to hasten the patients own death; and(E) was a Vermont resident.(6) The physician informed the patient in person or by telemedicine, both verbally and in writing, of all the following: (A) the patients medical diagnosis;(B) the patients prognosis, including an acknowledgement that the physicians prediction of the patients life expectancy was an estimate based on the physicians best medical judgment and was not a guarantee of the actual time remaining in the patients life, and that the patient could live longer than the time predicted; (C) the range of treatment options appropriate for the patient and the patients diagnosis;(D) if the patient was not enrolled in hospice care, all feasible end-of-life services, including palliative care, comfort care, hospice care, and pain control; (E) the range of possible results, including potential risks associated with taking the medication to be prescribed; and (F) the probable result of taking the medication to be prescribed.(7) The physician referred the patient to a second physician for medical confirmation of the diagnosis, prognosis, and a determination that the patient was capable, was acting voluntarily, and had made an informed decision. (8) The physician either verified that the patient did not have impaired judgment or referred the patient for an evaluation by a psychiatrist, psychologist, or clinical social worker licensed in Vermont for confirmation that the patient was capable and did not have impaired judgment. (9) If applicable, the physician consulted with the patients primary care physician with the patients consent. (10) The physician informed the patient that the patient may rescind the request at any time and in any manner and offered the patient an opportunity to rescind after the patients second oral request. (11) The physician ensured that all required steps were carried out in accordance with this section and confirmed, immediately prior to writing the prescription for medication, that the patient was making an informed decision. (12) The physician wrote the prescription after the last to occur of the following events:(A) the patients written request for medication to hasten the patients own death;(B) the patients second oral request; and(C) the physicians offering the patient an opportunity to rescind the request.(13) The physician either:(A) dispensed the medication directly, provided that at the time the physician dispensed the medication, the physician was licensed to dispense medication in Vermont, had a current Drug Enforcement Administration certificate, and complied with any applicable administrative rules; or (B) with the patients written consent:(i) contacted a pharmacist and informed the pharmacist of the prescription; and(ii) delivered the written prescription personally or by mail or facsimile to the pharmacist, who dispensed the medication to the patient, the physician, or an expressly identified agent of the patient. (14) The physician recorded and filed the following in the patients medical record:(A) the date, time, and wording of all oral requests of the patient for medication to hasten the patients own death; (B) all written requests by the patient for medication to hasten the patients own death;(C) the physicians diagnosis, prognosis, and basis for the determination that the patient was capable, was acting voluntarily, and had made an informed decision; (D) the second physicians diagnosis, prognosis, and verification that the patient was capable, was acting voluntarily, and had made an informed decision; (E) the physicians attestation that the patient was enrolled in hospice care at the time of the patients oral and written requests for medication to hasten the patients own death or that the physician informed the patient of all feasible end-of-life services; (F) the physicians verification that the patient either did not have impaired judgment or that the physician referred the patient for an evaluation and the person conducting the evaluation has determined that the patient did not have impaired judgment; (G) a report of the outcome and determinations made during any evaluation which the patient may have received; (H) the date, time, and wording of the physicians offer to the patient to rescind the request for medication at the time of the patients second oral request; and (I) a note by the physician indicating that all requirements under this section were satisfied and describing all of the steps taken to carry out the request, including a notation of the medication prescribed. (15) After writing the prescription, the physician promptly filed a report with the Department of Health documenting completion of all of the requirements under this section. (b) This section shall not be construed to limit civil or criminal liability for gross negligence, recklessness, or intentional misconduct. (Added 2013, No. 39,  1, eff. May 20, 2013; amended 2021, No. 97 (Adj. Sess.),  2, eff. April 27, 2022.) 
 5284. No duty to aid
A patient with a terminal condition who self-administers a lethal dose of medication shall not be considered to be a person exposed to grave physical harm under 12 V.S.A.  519, and no person shall be subject to civil or criminal liability solely for being present when a patient with a terminal condition self-administers a lethal dose of medication or for not acting to prevent the patient from self-administering a lethal dose of medication. (Added 2013, No. 39,  1, eff. May 20, 2013.) 
 5285. Limitations on actions
(a) A physician, nurse, pharmacist, or other person shall not be under any duty, by law or contract, to participate in the provision of a lethal dose of medication to a patient. (b) A health care facility or health care provider shall not subject a physician, nurse, pharmacist, or other person to discipline, suspension, loss of license, loss of privileges, or other penalty for actions taken in good faith reliance on the provisions of this chapter or refusals to act under this chapter. (c) No physician, nurse, pharmacist, or other person licensed, certified, or otherwise authorized by law to deliver health care services in this State shall be subject to civil or criminal liability or professional disciplinary action for acting in good faith compliance with the provisions of this chapter. (d) Except as otherwise provided in this section and sections 5283, 5289, and 5290 of this title, nothing in this chapter shall be construed to limit liability for civil damages resulting from negligent conduct or intentional misconduct by any person. (Added 2013, No. 39,  1, eff. May 20, 2013; amended 2021, No. 97 (Adj. Sess.),  3, eff. April 27, 2022.) 
 5286. Health care facility exception
A health care facility may prohibit a physician from writing a prescription for a dose of medication intended to be lethal for a patient who is a resident in its facility and intends to use the medication on the facilitys premises, provided the facility has notified the physician in writing of its policy with regard to the prescriptions. Notwithstanding subsection 5285(b) of this title, any physician who violates a policy established by a health care facility under this section may be subject to sanctions otherwise allowable under law or contract. (Added 2013, No. 39,  1, eff. May 20, 2013.) 
 5287. Insurance policies; prohibitions
(a) A person and his or her beneficiaries shall not be denied benefits under a life insurance policy, as defined in 8 V.S.A.  3301, for actions taken in accordance with this chapter. (b) The sale, procurement, or issue of any medical malpractice insurance policy or the rate charged for the policy shall not be conditioned upon or affected by whether the physician is willing or unwilling to participate in the provisions of this chapter. (Added 2013, No. 39,  1, eff. May 20, 2013.) 
 5288. No effect on palliative sedation
This chapter shall not limit or otherwise affect the provision, administration, or receipt of palliative sedation consistent with accepted medical standards. (Added 2013, No. 39,  1, eff. May 20, 2013.) 
 5291. Safe disposal of unused medications
The Department of Health shall adopt rules providing for the safe disposal of unused medications prescribed under this chapter. (Added 2013, No. 39,  1, eff. May 20, 2013.) 
 5292. Statutory construction
Nothing in this chapter shall be construed to authorize a physician or any other person to end a patients life by lethal injection, mercy killing, or active euthanasia. Action taken in accordance with this chapter shall not be construed for any purpose to constitute suicide, assisted suicide, mercy killing, or homicide under the law. This section shall not be construed to conflict with section 1553 of the Patient Protection and Affordable Care Act, Pub.L. No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub.L. No. 111-152. (Added 2013, No. 39,  1, eff. May 20, 2013.) 
 5293. Reporting requirements
(a) The Department of Health shall adopt rules pursuant to 3 V.S.A. chapter 25 to facilitate the collection of information regarding compliance with this chapter, including identifying patients who filled prescriptions written pursuant to this chapter. Except as otherwise required by law, information regarding compliance shall be confidential and shall be exempt from public inspection and copying under the Public Records Act. (b) Beginning in 2018, the Department of Health shall generate and make available to the public a biennial statistical report of the information collected pursuant to subsection (a) of this section, as long as releasing the information complies with the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191. (Added 2015, No. 27,  2, eff. May 20, 2015.) 
 5300. Statutory purposes
The statutory purpose of the exemption for cemeteries in sections 5317 and 5376 of this title is to lower the cost of establishing and maintaining cemeteries. (Added 2013, No. 200 (Adj. Sess.),  11.) 
 5301. Application of chapter
This chapter shall be applicable to all agencies now engaged in, or which shall hereafter engage in any business of a cemetery within this State, and to all property used or intended to be used for the permanent disposition of the human dead. 
 5302. Definitions [Effective January 1, 2023]
As used in this chapter and unless otherwise required by the context:(1) Agencies means town cemeteries; religious or ecclesiastical society cemeteries; cemetery associations; and any person, firm, corporation, or unincorporated association engaged in the business of a cemetery. (2) Cemetery means any plot of ground used or intended to be used for the burial or permanent disposition of the remains of the human dead in a grave, a mausoleum, a columbarium, a vault, or other receptacle. (3) Cemetery association means any corporation now or hereafter organized that is or shall be authorized by its articles to conduct the business of a cemetery. (4) Columbarium means a structure or room or other space in a building or structure of durable and lasting fireproof construction, containing niches, used or intended to be used, to contain the permanent disposition of human remains. (5) Community mausoleum means a structure or building of durable and lasting construction used or intended to be used for the permanent disposition of the remains of deceased persons in crypts or spaces, provided such crypts or spaces are available to or may be obtained by individuals or the public for a price in money or its equivalent. (6) Cremated remains means remains of a deceased person after incineration in a disposition facility. (7) Cremation means the reducing of the remains of deceased persons, by the use of retorts, to cremated remains and the disposal thereof in a columbarium, niche, mausoleum, grave, or in any other manner not contrary to law. (8) Crypt means the chamber in a mausoleum of sufficient size to contain the remains of deceased persons. (9) Disposition facility means a building or structure for the reducing of human remains by means of cremation, alkaline hydrolysis, or natural organic reduction. (10) Ecological land management practices means utilization of land stewardship decision-making processes that account for the best available understanding of ecosystem functions and biological diversity. (11) Natural burial ground means a cemetery maintained using ecological land management practices and without the use of vaults for the burial of unembalmed human remains or human remains embalmed using nontoxic embalming fluids and that rest in either no burial container or in a nontoxic, nonhazardous, plant-derived burial container or shroud. (12) Natural organic reduction means the contained, accelerated conversion of human remains to soil. (13) Niche means a recess in a columbarium used, or intended to be used, for the permanent disposition of human remains of one or more deceased persons. (14) Temporary receiving vault means a vault or crypt in a structure of durable and lasting construction used, or intended to be used, for the temporary deposit of the remains of a deceased person for a period of time not exceeding one year. (Amended 2015, No. 24,  1; 2017, No. 113 (Adj. Sess.),  94; 2021, No. 169 (Adj. Sess.),  8, eff. January 1, 2023.) 
 5302. Definitions [Effective until January 1, 2023]
As used in this chapter and unless otherwise required by the context:(1) Agencies means town cemeteries, religious or ecclesiastical society cemeteries, cemetery associations, and any person, firm, corporation, or unincorporated association engaged in the business of a cemetery. (2) Cemetery means any plot of ground used or intended to be used for the burial or disposition permanently of the remains of the human dead in a grave, a mausoleum, a columbarium, a vault, or other receptacle. (3) Cemetery association means any corporation now or hereafter organized which is or shall be authorized by its articles to conduct the business of a cemetery. (4) Columbarium means a structure or room or other space in a building or structure of durable and lasting fireproof construction, containing niches, used or intended to be used, to contain cremated human remains. (5) Community mausoleum means a structure or building of durable and lasting construction used or intended to be used for the permanent disposition of the remains of deceased persons in crypts or spaces, provided such crypts or spaces are available to or may be obtained by individuals or the public for a price in money or its equivalent. (6) Cremated remains means remains of a deceased person after incineration in a crematory.(7) Cremation means the reducing of the remains of deceased persons, by the use of retorts, to cremated remains and the disposal thereof in a columbarium, niche, mausoleum, grave, or in any other manner not contrary to law. (8) Crematory means a building or structure containing one or more retorts, used or intended to be used, for the reducing of the bodies of deceased persons to cremated remains. (9) Crypt means the chamber in a mausoleum of sufficient size to contain the remains of deceased persons. (10) Ecological land management practices means utilization of land stewardship decision-making processes that account for the best available understanding of ecosystem functions and biological diversity. (11) Natural burial ground means a cemetery maintained using ecological land management practices and without the use of vaults for the burial of unembalmed human remains or human remains embalmed using nontoxic embalming fluids and that rest in either no burial container or in a nontoxic, nonhazardous, plant-derived burial container or shroud. (12) Niche means a recess in a columbarium used, or intended to be used for the permanent disposition of the cremated remains of one or more deceased persons. (13) Temporary receiving vault means a vault or crypt in a structure of durable and lasting construction, used or intended to be used, for the temporary deposit of the remains of a deceased person for a period of time not exceeding one year. (Amended 2015, No. 24,  1; 2017, No. 113 (Adj. Sess.),  94.) 
 5303. Policy declared
The object, purposes, and activities of a cemetery shall be restricted to those acts only that are necessary to enable it to accomplish the purposes for which it is created. It shall not be conducted for the purpose of private gain either directly or indirectly to any of the members of the agencies engaged in such business. Lawfully organized cemeteries may be conducted and operated by those agencies now engaged in their conduct and operation, by churches, by religious and ecclesiastical societies, by cemetery associations incorporated as hereinafter provided, and by no others. However, this chapter is not intended to apply to any agency organized, existing, and operating the business of a cemetery prior to June 1, 1933, under any existing law, nor to affect any vested rights acquired thereunder. Insofar, however, as the provisions of this chapter do not violate any vested rights, so acquired, it shall apply to all such agencies. 
 5304. Limitation of powers
The business of cemeteries shall not include among its corporate powers, either by express grant or as an incident thereto, the right to engage in any business enterprise or occupation such as is usually pursued by private individuals. Nevertheless, this provision shall not exclude the right of cemeteries to sell corner posts and other implements to define the boundaries of lots or other subdivisions of such cemeteries, and articles incident to the care and maintenance of lots and burial spaces, and the right of cemeteries to furnish or sell materials necessary for a complete cemetery burial service. 
 5305. Right to make rules and regulations
The right of an agency engaged in the business of a cemetery, community mausoleum, or columbarium to make rules and regulations for the use, care, management, and protection thereof is hereby affirmed, and such agencies may by rule or regulation determine who may be buried or deposited therein. 
 5306. Perpetual care funds
An agency engaged in the cemetery business shall have the right to acquire by gift, devise, or otherwise, land and property of every name and nature and to set aside surplus funds, to be held in trust as a perpetual care fund, the income thereof to be used according to the directions of the trust, where such directions are given, and where no specific directions are given, or, where given, and the purpose is incapable of performance, or there is a surplus of income after the directions of the trust have been fully complied with and performed, to use the same for the purpose of building, repairing, maintaining, adorning, and beautifying buildings or parts thereof, fences, graves, vaults, mausoleums, monuments, walks, cemetery lots, grounds, drives, or avenues, as the interests of the lot owners and cemetery shall appear. The duty upon all agencies organized to establish a perpetual care fund according to the terms hereinafter set forth is hereby imposed. 
 5307. Rule against perpetuities
A trust having one or more purposes provided under this chapter shall not be declared invalid by reason of indefiniteness as to the termination thereof, nor by the rule against perpetuities. 
 5308. Custodian of funds; bond
When such funds are not deposited with a bank chartered by the State or a national bank, the custodian or depositary thereof, unless otherwise directed by the terms of the trust or other provisions of this chapter, shall be the treasurer of the agency owning, operating, or controlling the cemetery in which lots or burial spaces are sold, or in which mausoleums or columbariums are located, who shall furnish and file with such agency, at its expense, a good and sufficient bond or bonds with surety or sureties approved by the Probate Division of the Superior Court, indemnifying and securing such agency against loss occasioned by the failure of the treasurer to properly protect, preserve, and administer such funds under his or her control. Such funds shall be invested and the income therefrom expended upon the written orders of the directors or trustees of such agency. (Amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 5309. Investment of funds
The principal sum of such funds shall be invested in bonds of the United States or the State of Vermont, or in the bonds or in notes issued in anticipation of taxes and authorized by vote of any town, village, or city in this State, or loaned upon first mortgage on real estate in this State a sum not in excess of 60 percent of the value of such real estate, or upon collateral of any of the above securities of equal value with the loan, or in shares of a savings and loan association of this State or share accounts of a federal savings and loan association with its principal office in this State and to the extent to which the withdrawal or repurchase value of such shares or accounts may be insured by the Federal Savings and Loan Insurance Corporation, or stock in a federal bank, a safe deposit company, or a national bank or state bank or trust company organized and doing business in the United States. Up to 35 percent of the associations assets may be invested in common or preferred stocks of corporations organized and existing under the laws of any state of the United States of America, or may be invested in the manner required for the investment of trust funds, unless otherwise authorized by the donor. No assets of the association may be loaned to a member, officer, trustee, or director of any such cemetery agency. (Amended 1979, No. 144 (Adj. Sess.).) 
 5310. Plats
An agency engaged in any business of a cemetery, community mausoleum, or columbarium shall cause to be made a plat of its grounds, showing the part thereof improved or in use and that part held for future cemetery use. The plat of the improved part shall show the land laid out in sections, lots, driveways, walks, and paths, sections to be designated by symbols, and the lots shall be numbered. All additions to such improved areas, and all new cemetery grounds hereafter established, shall be platted in the manner provided above. It is further provided that in case of a community mausoleum or columbarium, every agency shall cause to be made a plat thereof on which shall be set forth the sections, halls, rooms, corridors, elevators, or other subdivisions thereof with their descriptive names and numbers. The agency making such plat shall file the same for record in the office of the town clerk of the town in which the cemetery, community mausoleum, or columbarium is located. 
 5311. Recording of plats
It shall be the duty of the town clerk to receive and insert or bind in a book provided for that purpose all original plats or photostatic copies thereof, made in accordance with the provisions of this chapter, of such cemetery, community mausoleum, or columbarium, which shall constitute the recording thereof. The fees therefor shall not exceed the cost of the work of such recording, plus $3.00. The making or recording of a cemetery plat by any agency other than those specified in this chapter, or the recording of any cemetery plat which does not conform to and with the provisions of this chapter shall be void and of no effect. 
 5312. Limitation of sales
A lot, section, subdivision, crypt, niche, or any part of the cemetery, community mausoleum, or columbarium shall not be sold, contracted for sale, or offered for sale, until and unless a plat shall be made and recorded in accordance with the terms of this chapter. 
 5313. Records; burial records open to public
An agency engaged in the business of a cemetery, community mausoleum, or columbarium shall provide and maintain a suitable place of deposit for the records and files of such cemetery, community mausoleum, or columbarium, of such character as will safely keep and preserve such records and files from loss and destruction, and it shall make and file proper records in such place. The record of the permanent disposition of human remains shall at all reasonable times be open to the public. (Amended 2021, No. 169 (Adj. Sess.),  9, eff. January 1, 2023.) 
 5313. Records; burial records open to public
An agency engaged in the business of a cemetery, community mausoleum, or columbarium shall provide and maintain a suitable place of deposit for the records and files of such cemetery, community mausoleum, or columbarium, of such character as will safely keep and preserve such records and files from loss and destruction, and it shall make and file proper records in such place. The record of burials, interments, and cremations shall at all reasonable times be open to the public. 
 5314. Sale of property for interment purposes; disposition of receipts
After recording the plat as hereinbefore provided, and subject to the further provisions of this chapter relating to the sale of lots, crypts, and niches, the sale of lots, crypts, and niches may be made for the sole purpose of interments under such rules and regulations as may be imposed by the agency owning the cemetery, community mausoleum, or columbarium, and no part of the proceeds from such sales or other income shall ever be divided among its members, but shall be used exclusively for the purposes of the cemetery, community mausoleum, or columbarium, or placed in the perpetual care fund thereof, the income thereof to be so used. 
 5315. Sale of property for other than burial purposes; disposition of proceeds
Either before or after the recording of the plat, as hereinbefore provided, whenever it is determined that such lands acquired for cemetery purposes, except those acquired by condemnation proceedings, are unsuitable for the permanent disposition of human remains, such lands may be sold for purposes other than permanent disposition and conveyed in fee simple in such manner and upon such terms as may be provided by the agencies owning the same. The proceeds thereof shall be applied to the purchase of other lands or to general cemetery purposes. When such sales are made, the land so sold shall be returned by the agencies to the tax lists for taxation. In the case of land acquired by condemnation proceedings, it shall be disposed of under the law governing the disposal of land acquired by condemnation proceedings. (V.S. 1947,  4021. 1947, No. 202,  4022. P.L.  3853. 1933, No. 49,  16; amended 2021, No. 169 (Adj. Sess.),  10, eff. January 1, 2023.) 
 5315. Sale of property for other than burial purposes; disposition of proceeds
Either before or after the recording of the plat, as hereinbefore provided, whenever it is determined that such lands acquired for cemetery purposes, except those acquired by condemnation proceedings, are unsuitable for burial purposes, such lands may be sold for purposes other than interment and conveyed in fee simple in such manner and upon such terms as may be provided by the agencies owning the same. The proceeds thereof shall be applied to the purchase of other lands or to general cemetery purposes. When such sales are made, the land so sold shall be returned by the agencies to the tax lists for taxation. In the case of land acquired by condemnation proceedings, it shall be disposed of under the law governing the disposal of land acquired by condemnation proceedings. (V.S. 1947,  4021. 1947, No. 202,  4022. P.L.  3853. 1933, No. 49,  16.) 
 5316. Encumbrance of cemetery property prohibited
A public mausoleum, crematorium, columbarium, the land or lot or right of burial shall not be mortgaged, pledged, or in any manner encumbered by the agency owning or controlling the same. 
 5317. Tax exemptions
Except as otherwise provided in this chapter, all cemetery lands, buildings, and property, and the proceeds thereof, as defined in this chapter, which have been platted and devoted to or held exclusively for cemetery purposes, including donations or gifts and held in trust or otherwise, and all other funds held for the improvement, maintenance, repair, and ornamentation of such cemetery, together with the income therefrom and all other revenues and income shall be exempt from taxation. 
 5318. Public use of cemetery for other purposes
A public highway or railroad shall not be laid through such burial ground without the consent of the town, association, or the General Assembly, and no portion of such burial ground shall be taken for public use without special authority from the General Assembly. 
 5319. Disposition of remains of dead
(a)(1) The permanent disposition of human remains shall be by: (A) interment in the earth;(B) deposit in a chamber, vault, or tomb formed wholly or partly above the surface of the ground of a cemetery conducted and maintained pursuant to the laws of the State; (C) deposit in a crypt of a mausoleum;(D) cremation; or(E) natural organic reduction.(2) However, this shall not be construed to prevent a private individual from setting aside a portion of his or her premises owned in fee by him or her and using the premises as a burial space for the members of his or her immediate family, provided his or her use for such purpose is not in violation of the health laws and regulations of the State and the town in which the land is situated. (b)(1) Interment of any human body in the earth shall not be made unless the distance from the bottom of the outside coffin or body shall be at least three and one-half feet below the natural surface of the ground. Nothing in this subdivision shall be construed to prohibit the interment of a human body at a depth greater than three and one-half feet below the surface of the ground. (2) The burial boundaries of a new or expanded cemetery shall be located:(A) not less than 200 feet up gradient of a drilled bedrock well or a drilled well in a confined aquifer that is part of an exempt or permitted potable water supply or a transient noncommunity public water system source; (B) not less than 500 feet up gradient from any other groundwater source that is part of an exempt or permitted potable water supply or a transient noncommunity public water system; (C) not less than 150 feet cross or down gradient from any groundwater source that is part of an exempt or permitted potable water supply or transient noncommunity public water system; (D) outside zone one or two of the source protection area for an existing or permitted public community water system; (E) outside the source protection area for an existing or permitted nontransient, noncommunity public water system; (F) outside a river corridor as defined in 10 V.S.A.  1422 and delineated by the Agency of Natural Resources; and(G) outside a flood hazard area as defined in 10 V.S.A.  752, and delineated by the Federal Emergency Management Agency, National Flood Insurance Program. (c) With the exception of human remains processed by natural organic reduction, the permanent disposition of human remains shall not be made in a single chamber, vault, or tomb wholly or partly above the surface of the ground unless the part thereof below the natural surface of the ground be of a permanent character, constructed of materials capable of withstanding extreme climatic conditions, be waterproof and air tight, and can be sealed permanently so as to prevent all escape of effluvia. That portion of the same above the natural surface of the ground shall be constructed of natural stone of a standard not less than that required by the U.S. government for monuments erected in national cemeteries, of durability sufficient to withstand all conditions of weather, and of a character to ensure its permanence. (d) The remains of a human body after cremation or natural organic reduction may be deposited in a niche of a columbarium or a crypt of a mausoleum, buried, or disposed of in any manner not contrary to law. (Amended 2015, No. 24,  2; 2017, No. 19,  1; 2021, No. 169 (Adj. Sess.),  11, eff. January 1, 2023.) 
 5319. Disposition of remains of dead
(a) The permanent disposition of human remains shall be by interment in the earth or deposit in a chamber, vault, or tomb formed wholly or partly above the surface of the ground of a cemetery conducted and maintained pursuant to the laws of the State, or by deposit in a crypt of a mausoleum, or by cremation. However, this shall not be construed to prevent a private individual from setting aside a portion of his or her premises owned in fee by him or her and using the premises as a burial space for the members of his or her immediate family, so long as his or her use for such purpose is not in violation of the health laws and regulations of the State and the town in which the land is situated. (b)(1) Interment of any human body in the earth shall not be made unless the distance from the bottom of the outside coffin or body shall be at least three and one-half feet below the natural surface of the ground. Nothing in this subdivision shall be construed to prohibit the interment of a human body at a depth greater than three and one-half feet below the surface of the ground. (2) The burial boundaries of a new or expanded cemetery shall be located:(A) not less than 200 feet up gradient of a drilled bedrock well or a drilled well in a confined aquifer that is part of an exempt or permitted potable water supply or a transient noncommunity public water system source; (B) not less than 500 feet up gradient from any other groundwater source that is part of an exempt or permitted potable water supply or a transient noncommunity public water system; (C) not less than 150 feet cross or down gradient from any groundwater source that is part of an exempt or permitted potable water supply or transient noncommunity public water system; (D) outside zone one or two of the source protection area for an existing or permitted public community water system; (E) outside the source protection area for an existing or permitted nontransient, noncommunity public water system; (F) outside a river corridor as defined in 10 V.S.A.  1422 and delineated by the Agency of Natural Resources; and(G) outside a flood hazard area as defined in 10 V.S.A.  752, and delineated by the Federal Emergency Management Agency, National Flood Insurance Program. (c) No deposit of the remains of the human dead shall be made in a single chamber, vault, or tomb wholly or partly above the surface of the ground unless the part thereof below the natural surface of the ground be of a permanent character, constructed of materials capable of withstanding extreme climatic conditions, be waterproof and air tight, and can be sealed permanently so as to prevent all escape of effluvia. That portion of the same above the natural surface of the ground shall be constructed of natural stone of a standard not less than that required by the U.S. government for monuments erected in national cemeteries, of durability sufficient to withstand all conditions of weather, and of a character to ensure its permanence. (d) The remains of a human body after cremation may be deposited in a niche of a columbarium, in a crypt of a mausoleum, be buried or disposed of in any manner not contrary to law. (Amended 2015, No. 24,  2; 2017, No. 19,  1.) 
 5320. Temporary vaults
A town may construct and maintain, on land owned by such town, temporary receiving vaults for the temporary disposition of dead bodies, if approved by a majority of voters present and voting at an annual or special town meeting duly warned for that purpose. Such temporary disposition shall be for a period not to exceed one year. 
 5321. Improvement of private burial grounds; duties of officers
When the use and care of a private burial ground has been abandoned and such ground becomes unsightly from any cause, or when headstones or monuments have been displaced, the selectboard or board of cemetery commissioners having charge of the public cemeteries in the town where such burial ground is located, on written request of three legally qualified voters of such town, shall forthwith cause a notice to be published once a week on the same day of the week for three successive weeks in some newspaper circulating therein, calling upon any person interested in such burial ground to cause the same to be put in proper condition within three months from the date of such notice. At the expiration of such time, if such demand is not complied with, the selectboard or board shall proceed then and thereafter as if such ground were a public burial place. (Amended 1989, No. 142 (Adj. Sess.),  9.) 
 5322. Temporary access to cemeteries
(a) Any person wishing to have a temporary right of entry over private land in order to enter a graveyard enclosure to which there is no public right-of-way may apply in writing to the selectboard or cemetery commissioners, as the case may be, state the reason for such request and the period of time for which such right is to be exercised. The applicant shall also notify in writing an owner or occupier of the land over which the right-of-way is desired. If the selectboard or cemetery commissioners find that the request is reasonable, they shall issue a permit for a temporary right of entry designating the particular place where, and the manner in which, the land may be crossed. The owner or occupier of the land may recommend a place of crossing which, if reasonable, shall be the place designated by the selectboard or cemetery commissioners. (b) An owner or occupier of the land who refuses to comply with a permit issued under subsection (a) of this section may be liable for reasonable costs and attorneys fees expended to enforce the permit. (Added 1989, No. 142 (Adj. Sess.),  10; amended 1993, No. 128 (Adj. Sess.),  1.) 
 5323. Natural burial grounds; exemptions
(a) A natural burial ground shall not be subject to the following provisions of this chapter:(1) section 5310 of this title with regard to the method of platting so as to allow the use of any nonstandard method of locating human remains that enables demarcation in the town land record of the exact location and identity of each buried body, such as by mapping, surveying, or use of a global positioning system; (2) section 5362 of this title;(3) section 5364 of this title, to the extent that selectboard members or cemetery commissioners need not maintain or repair a fence around a public natural burial ground so long as the perimeter of the natural burial ground is marked in a less obtrusive manner, such as by survey markers; and (4) section 5371, unless the regulations governing a particular natural burial ground require a marker on a persons grave, in which case the selectboard members of the town or the aldermen of a city where the person is buried shall cause to be erected on the persons grave a marker in keeping with the regulations of that natural burial ground. (b)(1) A person shall not construct improvements on property used as a natural burial ground, except for improvements that serve as a winter storage facility or that are either educational or devotional in nature and maintain the character of the land. (2) A deed transferring rights in property used as a natural burial ground shall set forth the prohibition in subdivision (1) of this subsection. (Added 2015, No. 24,  3.) 
 5361. Appropriations and regulations by towns
A town may vote sums of money necessary for purchasing, holding, improving, and keeping in repair suitable grounds and other conveniences for permanent disposition of the dead. The selectboard may make necessary regulations concerning public burial grounds and for fencing and keeping the same in proper order. (Amended 2021, No. 157 (Adj. Sess.),  7, eff. July 1, 2022;  12.) 
 5361. Appropriations and regulations by towns
A town may vote sums of money necessary for purchasing, holding, improving, and keeping in repair suitable grounds and other conveniences for burying the dead. The selectboard may make necessary regulations concerning public burial grounds and for fencing and keeping the same in proper order. (Amended 2021, No. 157 (Adj. Sess.),  7, eff. July 1, 2022.) 
 5362. Repair; expense; notice
(a) When lots or walks in a public burial ground become unsightly with weeds or by an unchecked growth of grass or from any other cause, or when headstones or monuments have become displaced or out of repair, the selectboard or board of cemetery commissioners shall cause such lots and walks to be cleared of weeds and grass, the headstones or monuments to be replaced or repaired, or other disfigurements removed, and may draw orders on the town treasurer for the expenses incurred. (b) When a headstone or monument is to be replaced, the selectboard or board of cemetery commissioners shall notify relatives of the deceased, if known, of the date of the removal and that the relative may claim the removed headstone or monument within 30 days after the date of the notice. (Amended 1993, No. 128 (Adj. Sess.),  2; 2015, No. 85 (Adj. Sess.),  1, eff. May 4, 2016.) 
 5363. Penalty
A selectboard member, cemetery commissioner, or trustee, who violates a provision of this chapter, or willfully neglects any of the duties imposed by this chapter, for which other penalties are not provided, shall be fined not more than $200.00. (Amended 1989, No. 142 (Adj. Sess.),  11.) 
 5364. Fences; penalty
When the selectboard or cemetery commissioners neglect to keep in repair the fence around a public burial ground, the town may be prosecuted for such neglect and fined not more than $400.00. The fine shall be expended in repairing the fences around such burial grounds under the direction of a commissioner appointed by the court. (Amended 1989, No. 142 (Adj. Sess.),  12.) 
 5365. Damages for want of fence; liability
When a person or estate is damaged by cattle, horses, sheep, or swine breaking into a public burial ground and injuring a grave, headstone, monument, shrubbery, or flowers, for want of a legal fence around such burial ground, such person or estate may recover of the town double the amount of damages, in a civil action. 
 5366. Not liable until notified
A town shall not be charged for not keeping in repair the fence around a burial ground, or be liable for damage done, unless the selectboard, or cemetery commissioners, as the case may be, had notice in writing 20 days previous that the fence was out of repair. (Amended 1989, No. 142 (Adj. Sess.),  13.) 
 5367. Duties of selectboard
When a town neglects to place one or more of its public burial grounds under the charge of a board of cemetery commissioners, the selectboard shall have power to sell and convey lots in such burial grounds. They shall apply the proceeds of such sales and accept for the town and use legacies, bequests, and gifts for improving and embellishing the grounds. 
 5368. Exceptions
Sections 5361-5367 of this title shall not apply to a burial ground which is subject to other control than that of the selectboard or the board of cemetery commissioners. 
 5369. Removal
When it is impracticable to preserve a burial ground in proper condition, and the removal of the remains of the dead therein is required, the selectboard, in their discretion, may cause such remains to be removed and interred in a more suitable public burial ground. 
 5370. Notice; headstones
When remains of the dead are removed, the selectboard, if necessary, shall cause suitable headstones or monuments to be erected to the memory of the deceased, or to designate the place of interment. Such remains shall not be so removed if there are known kindred of the deceased residing in the State, until after 30 days notice of the intention so to do. When kindred do not reside in the State, and known kindred reside without the State, then the remains shall not be so removed, until after 60 days notice to one of such kindred. Such notice shall be given personally or by registered mail. 
 5371. Town or city to furnish headstone
In case of the burial of a person not having known estate, and not having a suitable marker or headstone erected at his or her grave within three years from the date of such burial, the selectboard of the town or the aldermen of a city, as the case may be, wherein such person is buried, shall cause to be erected at such persons grave, at the expense of such town or city, a suitable marker or headstone with the inscription thereon of the name of the deceased and dates of his or her birth and death, if the same are known. 
 5372. Appropriation for cemetery associations
At a legal meeting of the voters thereof, when an article for such purpose has been duly inserted in the warning for such meeting, a town may appropriate such sums of money as it deems necessary for an incorporated cemetery association owning or in control of a cemetery in such town, for the purposes of such cemetery. 
 5373. Cemetery commissioners
When a town votes to place its public burial grounds under the charge of cemetery commissioners, it shall elect separately a board of three or five cemetery commissioners, who shall have the care and management of such burial ground and exercise all the powers, rights, and duties with respect to such care and management and all responsibility on the part of the selectboard shall cease. 
 5374. Term
The commissioner first chosen shall hold office five years, the next four years, the next three years, the next two years, and the last one year. When the term of office of each commissioner expires, a successor shall be chosen for five years. Vacancies in the board may be filled by the remaining commissioners until the next annual meeting. However, a town so voting at an annual town meeting may limit the number of the board to three members and the term of office to three years. 
 5375. Laying out and improving grounds; burial without charge
The board of cemetery commissioners may set apart such portion of the burial grounds placed under its charge as it deems proper, as a place for the burial of persons without charge therefor, under such regulations as it prescribes. It may lay out the remaining unoccupied portions in suitable lots, with necessary paths, avenues, or other reserved places, and may plant and embellish the same with trees, shrubs, and flowers. 
 5376. Sale of lots; tax exemption
The board of cemetery commissioners, by one of the commissioners appointed by it for that purpose, in the name of the town, by deed, may grant and convey lots in such burial grounds to be used for the permanent disposition of the dead and on which tombs, cenotaphs, and other monuments are to be erected. Such lots shall be exempt from taxation. The deeds thereof shall be recorded in the office of the town clerk of the town wherein such lots lie. (Amended 2021, No. 169 (Adj. Sess.),  13, eff. January 1, 2023.) 
 5376. Sale of lots; tax exemption
The board, by one of the commissioners appointed by it for that purpose, in the name of the town, by deed, may grant and convey lots in such burial grounds to be used for the burial of the dead and on which tombs, cenotaphs, and other monuments are to be erected. Such lots shall be exempt from taxation. The deeds thereof shall be recorded in the office of the town clerk of the town wherein such lots lie.  5376. Sale of lots; tax exemptionThe board of cemetery commissioners, by one of the commissioners appointed by it for that purpose, in the name of the town, by deed, may grant and convey lots in such burial grounds to be used for the permanent disposition of the dead and on which tombs, cenotaphs, and other monuments are to be erected. Such lots shall be exempt from taxation. The deeds thereof shall be recorded in the office of the town clerk of the town wherein such lots lie. (Amended 2021, No. 169 (Adj. Sess.),  13, eff. January 1, 2023.) 
 5377. Proceeds of sale; expenditure
The proceeds of such sale of lots shall be paid into the town treasury and kept separate from other funds of the town and subject to the order of the board. Such proceeds, with the income thereof, shall be devoted to maintaining, improving, and embellishing such burial grounds. If the town so votes, the board may sell lots upon condition that the proceeds therefrom shall be paid into the town treasury in trust and the income thereof be expended in caring for such lots and the structures thereon. The board shall fix the prices for such lots and make regulations in respect to the sale and care thereof. 
 5378. Bylaws and regulations
The board of cemetery commissioners may make necessary bylaws and regulations in respect to such burial grounds, and permanent disposition of the dead not inconsistent with law, and may alter the same. Such bylaws and regulations shall be recorded in the office of the town clerk. A bylaw or regulation shall not be adopted to restrain a person in the free exercise of his or her religious sentiments as to the permanent disposition of the dead. (Amended 2021, No. 169 (Adj. Sess.),  14, eff. January 1, 2023.) 
 5378. Bylaws and regulations
The board may make necessary bylaws and regulations in respect to such burial grounds, and interment of the dead not inconsistent with law, and may alter the same. Such bylaws and regulations shall be recorded in the office of the town clerk. A bylaw or regulation shall not be adopted to restrain a person in the free exercise of his or her religious sentiments as to the burial of the dead. 
 5379. Report of cemetery commissioners
The board shall submit annually a written report to the town auditors as to the condition and needs of the burial grounds under its charge and of its doings, including a detailed statement of its receipts and expenditures and of the amount and disposition of the funds in its hands or subject to its control. 
 5380. Auditors
The town auditors shall audit such statement, file it in the office of the town clerk, and include the whole or a summary thereof in their annual report. 
 5381. Transfer of care from commissioners to selectboard
By vote, a town may take its burial grounds out of the charge of the board of cemetery commissioners and place the same under the charge of the selectboard. When a town so votes, the office of cemetery commissioners shall terminate. 
 5382. Town trust fundsAcceptance of property
A town may take and hold in trust grants, gifts, or bequests of property and apply the same or the income thereof for the care, improvement, or embellishment of its burial grounds or a part thereof, or for the erection, preservation, or removal of a monument, fence, or other structure in or around the same according to the terms of the grant, gift, or bequest. 
 5383. Acceptance of money in trust
A town may vote to receive and hold money in trust, the income of which is to be used for the care and improvement of its burial grounds, or of private lots within such burial grounds or elsewhere. 
 5384. Payment to treasurer; record; investment
(a) Unless otherwise directed by the donor, all monies received by a town for cemetery purposes shall be paid to the town treasurer, who shall give a receipt therefor, which shall be recorded in the office of the town clerk in a book kept for that purpose. The book shall also state the amount received from each donor, the time when, and the specific purpose for which it is appropriated. (b)(1) All monies so received by the town may be invested and reinvested by the treasurer, with the approval of the selectboard, by deposit in: (A) certificates of deposit and other evidences of deposit at Vermont, national, or federal chartered banks, and savings and loan associations that are guaranteed or insured by the Federal Deposit Insurance Corporation or its successor; (B) obligations of the United States, its agencies, and instrumentalities, which have a liquid market with readily determinable market value; (C) investment-grade obligations of state or local governments, instrumentalities, and public authorities; and (D) the shares of an investment company or an investment trust, such as a mutual fund, closed-end fund, or unit investment trust, that is registered under the federal Investment Company Act of 1940, as amended, if such fund has been in operation for at least five years and has net assets of at least $100,000,000.00. (2)(A) However, in a town that elects trustees of public funds, cemetery funds shall be invested by the trustees in any of the securities enumerated in this section, and the income thereof paid to the proper officers as the same falls due. (B) Investment income shall be expended for the purpose and in the manner designated by the donor. The provisions of this section as to future investments shall not require the liquidation or disposition of securities legally acquired and held. (3) The treasurer, selectboard, or trustees of public funds may delegate management and investment of town cemetery funds to the extent that it is prudent under the terms of the trust or endowment, and in accordance with section 3415 (delegation of management and investment functions) of the Uniform Prudent Management of Institutional Funds Act, 14 V.S.A. chapter 120. Notwithstanding the limitations on investments set forth in this subsection, an agent exercising a delegated management or investment function, if investing, shall invest cemetery funds in a publicly traded security that is: (A) registered with the Securities and Exchange Commission pursuant to 15 U.S.C.  78l and listed on a national securities exchange;(B) issued by an investment company registered pursuant to 15 U.S.C.  80a-8;(C) a corporate bond registered as an offering with the Securities and Exchange Commission pursuant to 15 U.S.C.  78l and issued by an entity whose stock is a publicly traded security; (D) a municipal security;(E) a deposit in federally insured financial institutions as defined in 8 V.S.A.  11101(32); or(F) a security issued, insured, or guaranteed by the United States.(4) If the municipality has adopted an investment policy, the treasurer, selectboard, or trustees of public funds shall invest in accordance with the provisions of the municipal policy that do not conflict with this section. (Amended 2017, No. 26,  1; 2017, No. 123 (Adj. Sess.),  3, eff. May 3, 2018; 2021, No. 84 (Adj. Sess.),  1, eff. July 1, 2022.) 
 5385. Accounts; expenditures
The town treasurer shall keep a separate account of each such trust fund unless the same is in charge of the trustees of public funds. The income therefrom shall be subject to the order of the selectboard or board of cemetery commissioners as the case may be. Such boards shall expend such income pursuant to the conditions of the trust. When such boards neglect to expend the income pursuant to the conditions of the trust, the town may be indicted for such neglect and upon conviction be fined not more than $100.00. 
 5386. Report
The town treasurer or trustees of public funds shall annually report the condition of such funds to the town. 
 5387. Money received prior to 1895
Sections 5383-5386 of this title shall not be construed to affect the action of a town in respect to money received in trust for the purpose named by the donor, prior to February 1, 1895. 
 5431. Cemetery associations; corporations
Every cemetery established after June 1, 1933, which is not owned and operated by a town or by a religious or ecclesiastical society shall be established, owned, and operated by a corporation as hereinafter prescribed. 
 5432. Organization and operation
Such corporation shall be organized, and the affairs of the corporation shall be governed and controlled under the provisions of 11 V.S.A. chapter 1, under those sections thereof which provide for the organization and management of corporations not for profit. 
 5433. Authority; powers
Upon filing the articles of incorporation, the incorporators and other members, if any, from the date of such filing, shall be and constitute a body corporate with perpetual succession and with capacity to perform all acts within the State not repugnant to law or the provisions of this chapter. 
 5434. Penalty for doing business as a cemetery association without authority
A person, firm, corporation, or association, or a trust, trustee, or trustees of any person, firm, corporation, or association, who, without authority of this chapter so to do, shall exercise or attempt to exercise any powers, privileges, or franchises that are specified or may be granted under this chapter to incorporated cemetery associations, or who shall by any device attempt to evade the provisions of this chapter applicable to cemetery associations in respect to the sale of lots or spaces for the permanent disposition of human remains and the disposition of the proceeds thereof, shall be fined not less than $1,000.00 nor more than $10,000.00, and may be enjoined from further doing of such acts at the suit of any taxpayer of the State. However, the provisions of this section shall not affect or impair the rights of a person, firm, corporation, or association or a trust, trustee, or trustees of such person, firm, corporation, or association under any existing contract or contracts between such parties and incorporated cemetery associations, nor shall the performance of the provisions of such contract or contracts subject parties thereto to the penalties imposed by this section. (V.S. 1947,  4068; P.L.  3900; 1933, No. 49,  21; amended 2021, No. 169 (Adj. Sess.),  15, eff. January 1, 2023.) 
 5434. Penalty for doing business as a cemetery association without authority
A person, firm, corporation, or association, or a trust, trustee, or trustees of any person, firm, corporation, or association, who, without authority of this chapter so to do, shall exercise or attempt to exercise any powers, privileges, or franchises which are specified or may be granted under this chapter to incorporated cemetery associations, or who shall by any device attempt to evade the provisions of this chapter applicable to cemetery associations in respect to the sale of burial lots or burial spaces and the disposition of the proceeds thereof, shall be fined not less than $1,000.00 nor more than $10,000.00, and may be enjoined from further doing of such acts at the suit of any taxpayer of the State. However, the provisions of this section shall not affect or impair the rights of a person, firm, corporation, or association or a trust, trustee, or trustees of such person, firm, corporation, or association under any existing contract or contracts between such parties and incorporated cemetery associations, nor shall the performance of the provisions of such contract or contracts subject parties thereto to the penalties imposed by this section. (V.S. 1947,  4068; P.L.  3900; 1933, No. 49,  21.) 
 5435. Sales of lots, crypts, and niches; how income applied; rules
 [Subsection (a) effective until January 1, 2023; see also subsection (a) effective January 1, 2023 set out below.] (a) The income of a cemetery association whether derived from the sale of lots, burial spaces, crypts, or niches, from donations, or otherwise, shall be exclusively applied to paying for the land or other cemetery property, laying out, preserving, protecting, and embellishing the cemetery and avenues leading thereto, the erection of buildings necessary for cemetery purposes, the establishing of a fund to care permanently for the cemetery, the repair and upkeep of mausoleums, vaults, columbariums, crypts, and niches therein, and to paying the necessary expenses of the cemetery association. A debt shall not be contracted in anticipation of future receipts, except for the original purchase of the land, community mausoleum, or columbarium, laying out, enclosing, and embellishing the grounds and avenues therein and to a sum not exceeding $50,000.00 in the whole, to be paid out of future income. No part of the proceeds from the sale of lots, burial spaces, crypts, or niches, or other income of such association, shall ever be divided among its members. All its income shall be used exclusively for the purposes of the association, as provided in this chapter, or invested in a fund the income of which shall be so used. Such association may adopt such reasonable rules and regulations as it deems expedient for disposing of and conveying burial lots, spaces, crypts, and niches.  [Subsection (a) effective January 1, 2023; see also subsection (1) effective until January 1, 2023 set out above.] (a) The income of a cemetery association, whether derived from the sale of lots, spaces, crypts, or niches for the permanent disposition of human remains, from donations, or otherwise, shall be exclusively applied to paying for the land or other cemetery property; laying out, preserving, protecting, and embellishing the cemetery and avenues leading thereto; the erection of buildings necessary for cemetery purposes; the establishing of a fund to care permanently for the cemetery; the repair and upkeep of mausoleums, vaults, columbariums, crypts, and niches therein; and to paying the necessary expenses of the cemetery association. A debt shall not be contracted in anticipation of future receipts, except for the original purchase of the land, community mausoleum, or columbarium, laying out, enclosing, and embellishing the grounds and avenues therein and to a sum not exceeding $50,000.00 in the whole, to be paid out of future income. The proceeds from the sale of lots, spaces, crypts, or niches for the permanent disposition of human remains, or other income of such association, shall not be divided among its members. All its income shall be used exclusively for the purposes of the association, as provided in this chapter, or invested in a fund the income of which shall be so used. Such association may adopt such reasonable rules and regulations as it deems expedient for disposing of and conveying lots, spaces, crypts, and niches for the permanent disposition of human remains. (b) At a regular meeting or at a special meeting duly called for that purpose, a cemetery corporation may adopt bylaws respecting improvements upon its lots and grounds as to the embellishment and beautifying of the same. It may also provide that the cost of such improvements be paid out of the regular funds of the corporation. (Amended 2021, No. 169 (Adj. Sess.),  16, eff. January 1, 2023.) 
 5436. Perpetual care fund
A cemetery association established prior to June 1, 1933 may create a perpetual care fund out of surplus money on hand or that has been given to it by will, deed, or otherwise. A cemetery association established after such date shall create such a perpetual care fund by applying thereto from the initial proceeds received from the sale of lots or spaces for the permanent disposition of human remains a sum that shall be equivalent to and not less than 20 percent of the sale price of each lot or space so sold, and such association may at any time increase the same by the addition of surplus money or property received by it by will, deed, or otherwise. (V.S. 1947,  4071; 1947, No. 202,  4072; P.L.  3903; 1933, No. 49,  24; amended 2021, No. 169 (Adj. Sess.),  17, eff. January 1, 2023.) 
 5436. Perpetual care fund
A cemetery association established prior to June 1, 1933 may create a perpetual care fund out of surplus money on hand or which has been given to it by will, deed, or otherwise. A cemetery association established after such date shall create such a perpetual care fund by applying thereto from the initial proceeds received from the sale of lots or burial spaces a sum which shall be equivalent to and not less than 20 percent of the sale price of each lot or burial space so sold, and such association may at any time increase the same by the addition of surplus money or property received by it by will, deed, or otherwise. (V.S. 1947,  4071; 1947, No. 202,  4072; P.L.  3903; 1933, No. 49,  24.) 
 5437. Investment
A cemetery association shall invest trust funds in the same manner as town cemeteries pursuant to section 5384 of this title and may delegate the management and investment of cemetery association funds pursuant to subdivision (b)(3) of that section. (Amended 2021, No. 84 (Adj. Sess.),  2, eff. July 1, 2022.) 
 5438. Cemetery accounts; annual reports
(a) A cemetery association shall keep and maintain adequate and correct accounts of its business transactions, which at all reasonable times shall be open to the inspection of every member of such corporation. It shall keep separate and apart from its other funds all monies and property received by it for the perpetual care of the cemetery, community mausoleum, or columbarium which is owned by it or for the lots therein, and it shall keep accurate accounts of such perpetual care funds separate and apart from its accounts of other funds. (b) The treasurer of such corporation shall make, sign, and file at the annual meeting a report countersigned by the president, concerning the affairs of the corporation and the perpetual care funds, which report shall contain, among other things, a statement as to the amount of the treasurers bond and a true statement of the total amount of the fund or funds received and set apart for the perpetual care of the lots, cemetery, community mausoleum, and columbarium. Such report shall contain a list of the securities in which such fund or funds are invested, the income received therefrom, all disbursements from such income, and the balance of money or property held and on hand in such fund or funds, and copies thereof shall forthwith be filed with the town clerk of the town and with the Probate Division of the Superior Court for the district wherein the cemetery, community mausoleum, or columbarium is situated. (Amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 5439. Dissolution of cemetery associations
A cemetery association, which is not owned and operated by a church or by a religious or ecclesiastical society, may be dissolved under the provisions of 11B V.S.A. chapter 14. Upon dissolution, all lands owned or held by it for cemetery purposes and all perpetual care funds, trust funds, and all other property held or owned by it, less dissolution expenses, may be transferred to the town in which the lands are located, and thereafter these lands may become public burial grounds, and the town shall hold the perpetual care funds and trust funds in trust for the care, improvement, and embellishment of the lots therein, according to the terms upon which they were held by the association. (Amended 1975, No. 74.) 
 5440. Merger of cemetery associations
(a) An incorporated cemetery association or society, whether chartered by special act of the General Assembly or organized under articles of association, may merge with another incorporated association or society in the same town, thereby forming a new corporation under such name as may be designated in the articles of association hereinafter referred to. (b) Such merger shall be made by vote of a majority of the trustees or directors of each corporation. When so made, certified copies of the proceedings shall be forwarded to the Secretary of State. (c) The trustees of each such corporation may authorize the secretary thereof to sign the name of such corporation to the articles of association of the new corporation, and authorize one or more other persons to sign such articles of association. Such articles shall be filed with the Secretary of State. The articles shall set forth the name of the new corporation and they shall conform generally to the provisions of 11B V.S.A. chapter 1. When such articles are filed and recorded by the Secretary of State, all right, title, and interest in all property owned by each, and in trust funds held by each, shall vest in such new corporation, and the corporate functions of each of the corporations so merged shall cease after such new corporation has completed its organization. 
 5481. Acquisition of land and propertyPurchase or gift
The right to acquire land and property for cemetery purposes, either by purchase or gift, by towns, churches, religious or ecclesiastical societies, and cemetery associations is hereby affirmed under the conditions and restrictions set forth in this chapter. 
 5482. Eminent domain
The right to acquire land and property for cemetery purposes by condemnation proceedings by towns and cemetery associations is hereby granted under the conditions and restrictions set forth in this chapter. 
 5483. Acquisition of land by town
When it is necessary to enlarge a public burial ground or to establish a new one, three or more freeholders of the town may apply in writing to the selectboard, setting forth such necessity with a description of the land necessary for the purpose. The selectboard shall thereupon proceed as in case of an application by three or more freeholders to lay out a highway. 
 5484. Acquisition of gravel by town or association
(a) When public necessity requires that a burial ground be raised or portions thereof filled up with gravel or earth, and the town or association owning or managing the same cannot agree with the owner of such gravel or earth for its purchase, three or more owners of lots in such burial ground may apply in writing to the selectboard, setting forth such necessity. The selectboard shall thereupon proceed as in case of an application to them by three or more freeholders to lay out a highway. If in their opinion such necessity exists, they shall authorize, in writing, such town or association to take and remove such gravel or earth, use the same for the purposes aforesaid, and appraise the damage to the owner thereof. (b) Before such town or association takes or removes gravel or earth, as provided in subsection (a) of this section, it shall pay or tender to the owner the amount of damages as appraised by the selectboard. 
 5485. Appeal to Superior Court
When, in accordance with the provisions of this chapter, a person owning or having an interest in lands taken for a burial ground, or gravel or earth for the same, is dissatisfied with such taking or with the damages awarded to him or her by the selectboard in such proceedings, he or she may petition the Superior Court of the county in which such lands lie in the same manner as in case of an appeal as to the laying out of a highway by the selectboard, and thereupon the same proceedings shall be had on such petition. (Amended 1973, No. 193 (Adj. Sess.),  3, eff. April 9, 1974.) 
 5487. Acquisition of land by cemetery associations generally
A cemetery association may acquire by gift, purchase at its fair cash market value, or devise, such lands as may be necessary for its cemetery purposes. If the consent of the selectboard and local board of health is first had and obtained in writing, such association may devote the same to such cemetery purposes. When it is necessary to acquire lands by condemnation proceedings, such proceedings shall be taken therefor as provided in sections 5488-5494 of this title. 
 5488. Enlargement of cemeteries by associationsPetition to Superior Court to acquire land
When an incorporated cemetery association wishes to enlarge the limits of its burial ground, and votes to purchase additional land for permanent disposition purposes and the owner of such land refuses to convey the same to the cemetery association for a reasonable compensation, the trustees or president of such association, by a petition in writing, may apply to the Superior Court in the county in which such burial ground is located for the appointment of commissioners. (Amended 1973, No. 193 (Adj. Sess.),  3, eff. April 9, 1974; 2021, No. 169 (Adj. Sess.),  18, eff. January 1, 2023.) 
 5488. Enlargement of cemeteries by associationsPetition to Superior Court to acquire land
When an incorporated cemetery association wishes to enlarge the limits of its burial ground, and votes to purchase additional land for burial purposes and the owner of such land refuses to convey the same to such cemetery association for a reasonable compensation, the trustees or president of such association, by a petition in writing, may apply to the Superior Court in the county in which such burial ground is located for the appointment of commissioners. (Amended 1973, No. 193 (Adj. Sess.),  3, eff. April 9, 1974.) 
 5489. Service of petition; appointment of commissioners
The petition with a citation shall be served on the owner of such land like a summons. On such application, the court may appoint three disinterested persons residing in some other town as commissioners. 
 5490. Notice; hearing
The commissioners shall appoint a time and place for examination of the premises and appraisal of the damages. They shall give six days notice thereof to the president or to one or more of the trustees of such association, and to the owner or occupant of such land either personally or by written notice left at the residence of such owner or occupant, and shall examine the premises and inquire into the public necessity and convenience of such enlargement. 
 5491. Survey; damages
When the commissioners decide that public necessity and convenience require the enlargement of such burial grounds, and the amount needed, they shall cause the same to be surveyed, and shall ascertain what damages will be sustained by the owner of such land. 
 5492. Report, filing
When the commissioners have completed their inquiries, they shall make report, stating their doings and decision, with their survey and appraisal of damages. Such report shall be returned to and filed in the office of the clerk of the court within 30 days after the completion of such inquiry. 
 5493. Judgment on report; costs
The court may accept or reject the report, render judgment thereon, tax costs as it deems just, and issue execution for damages and costs. 
 5494. Title to lands taken
Such cemetery association shall not take possession of such lands until the damages and costs are paid. When so paid, a valid title to the lands so taken shall vest in such association, and the same may be used for burial purposes. 
 5531. Disposal of lot by will; descent; burial rights of husband and wife
(a) The owner of a cemetery lot may dispose of same by will to any one of his or her relatives who may survive him or her, or to any agency owning and conducting the cemetery in which the lot is situated, in trust, for the use and benefit of any person or persons designated in such will. When no express disposition or other mention is made in a will of a cemetery lot owned by the testator at his or her decease, and wherein he or she or any member of his or her family is buried, the ownership of the lot shall not pass from his or her lawful heirs by any residuary or other general clause of the will, but shall descend to his or her heirs, as if he or she had died intestate. (b) A wife shall be entitled to a right of interment for her own body in any burial lot or tomb of sufficient size and space to permit such interment, of which her husband was seized at any time during coverture, which shall be exempt from the operation of the laws regulating conveyance, descent and devise, but may be released by her in the same manner as dower. A husband shall have the same rights in the burial lot or tomb of his wife as a wife has in that of her husband. A husband or wife living separate from the other, and owning a burial lot or tomb in which the other but for this section would have no right of burial or interment, at least 30 days before the death of the other, may file with the agency conducting the cemetery in which such burial lot or tomb is located a written objection to the interment of the other and thereupon there shall be no right of interment of such husband or wife under this section. (c) The Probate Division of the Superior Court shall have jurisdiction to determine all questions arising under the provisions of this section. (d) Nothing contained in this section shall be construed as a limitation of the right of any agency owning and conducting a cemetery, either by rule and regulation, or by deed or contract, to define or limit the persons or classes of persons having the right of burial upon any lot in the cemetery of such agency, or to prohibit or restrict the resale of any such lot or burial space. (Amended 2009, No. 154 (Adj. Sess.),  149, eff. Feb. 1, 2011.) 
 5532. Escheat of cemetery lotsDefinition
For the purposes of sections 5532-5537 of this title, the term agency shall mean town cemeteries, religious or ecclesiastical society cemeteries, and any person, firm, corporation, or unincorporated association engaged in the business of a cemetery. 
 5533. Escheat when owners whereabouts unknown
When the whereabouts of a person or his or her heirs, having legal title or color of title to a wholly unoccupied burial lot in any cemetery has been unknown for 20 years, such lot shall escheat to the agency upon petition brought by the agency and hearing and judgment had thereon as provided in sections 5534-5537 of this title. 
 5534. Petition; hearing
The cemetery commissioners or other proper officers may file a petition in behalf of the agency with the Probate Division of the Superior Court of the district where said agency is located for an inquisition in the premises. The Probate Division of the Superior Court shall thereupon appoint a time and place of hearing and deciding on such petition, and cause a notice thereof to be published in some newspaper circulating in the vicinity where the cemetery is located. (Amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 5535. Notice; publication
Such notice shall recite the substance of the facts set forth in the petition, and the time and place at which persons claiming the burial lot may appear and be heard before the court, and shall be published at least three weeks successively, the last of which publications shall be not less than six months before the time appointed by the court for making the inquisition. 
 5536. Order
If sufficient cause is not shown to the contrary, at the time appointed for that purpose, the court shall order and decree that such lot shall escheat to the agency. 
 5537. Heirs
If an heir or other person entitled to such lot appears within 17 years from the date of such decree and files a claim with the Probate Division of the Superior Court which made such decree, and establishes his or her claim to such lot, he or she shall have possession of the same, or if sold, the agency shall be accountable for the avails of such sale, without interest, to the persons entitled thereto, after deducting charges and costs incurred by the agency in connection therewith. A claim not made within 17 years shall be barred. (Amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 5571. Location
A community mausoleum, as hereinbefore defined, other than structures containing crypts erected or controlled by churches and religious societies and used only as a repository for the remains of the clergy or dignitaries of such churches or religious societies and every columbarium or other structure intended to hold or contain the bodies or remains of the dead, the spaces, crypts, or niches of which are available to the public, shall be located only within the confines of an established cemetery, containing not less than five acres, and which shall have been in existence and operation for a period of at least five years immediately preceding the time of the erection thereof. 
 5572. Plats
Before commencing the building, construction, or erection of any such building, the agency constructing the same shall make and file a plat of such structure in accordance with the provisions of sections 5310 and 5311 of this title. 
 5573. Construction requirements
(a) A community mausoleum or columbarium, the crypts or niches of which are available to the public, shall be constructed and erected only with the consent and approval of the legislative body of the municipality and local board of health. (b) Before commencing the building, construction, or erection of any such structure, full detailed plans and specifications shall be presented to the State Board of Health. The approval of plans and specifications shall be evidenced by a certificate in writing, signed by the legislative body of the municipality and the local board of health. (c) A community mausoleum, columbarium, or any structure intended to hold or contain permanently the bodies of the dead, and to which the public shall have access, shall not be constructed or erected without the approvals required by this section. A building not used for the permanent disposition of the human dead shall not be altered or changed to be used for the permanent disposition of the human dead, and an addition shall not be made to any existing community mausoleum or columbarium, unless constructed of material and workmanship as will ensure its durability and permanence as well as the safety, convenience, comfort, and health of the community in which it is located, as dictated and determined at the time by modern mausoleum construction and engineering science. (d) Construction shall be managed and supervised by a person with experience in modern mausoleum construction and engineering. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 113 (Adj. Sess.),  95; 2021, No. 15,  5.) 
 5575. Use before completion prohibited
A community mausoleum, columbarium, crypt, niche, or structure so erected as aforesaid shall not be used for the purpose of depositing therein the remains of any dead body until the same is finally completed and the maintenance fund required by this chapter has been provided for in accordance with the provisions hereof. 
 5576. Sales before the completion of building; bond
A crypt or room in a community mausoleum, or niche in a columbarium, shall not be sold or offered for sale before such structure is entirely completed, unless and until the agency selling such crypts or niches enters into an agreement whereby it agrees to refund to each and every purchaser of crypts, rooms, and niches all sums of money paid by each, together with legal interest thereon, in the event it fails to complete such mausoleum or columbarium within a reasonable time thereafter, which agreement shall be entered into with a bank or trust company as trustee for the purchasers of crypts, rooms, and niches. The agency shall also deposit with the trustee a good and sufficient bond or other security which shall guarantee the faithful performance of the agreement. The selection of the bank or trust company, the trust agreement, and the bond or other security herein provided for shall be submitted to and be subject to the approval of the Probate Division of the Superior Court of the district wherein such community mausoleum or columbarium is located. (Amended 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 5577. Mausoleum becoming untenable
If a mausoleum, vault, crypt, or structure containing one or more deceased human bodies becomes a hazard to public health, and the owner or owners of the structure fail to remedy or remove the same to the satisfaction of the Department of Health, a court of competent jurisdiction may order the person, firm, or corporation owning the structure to remove the body or bodies for interment in some suitable cemetery at the expense of the person, firm, or corporation owning the mausoleum, vault, or crypt. When the person, firm, or corporation cannot be found in the county where the mausoleum, vault, or crypt is located, then the removal and interment shall be at the expense of the cemetery, cemetery association, city, or town where the mausoleum, vault, or crypt is situated. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2021, No. 15,  5.) 
 5578. Perpetual care funds
There shall be established and maintained a fund for the perpetual care and maintenance of such community mausoleum and columbarium by applying in the case of a community mausoleum not less than the sum of $100.00 from the proceeds received from the sale of each crypt and 10 percent of the proceeds received from the sale of each room; and in case of niches in a community mausoleum or columbarium, used as a repository for the remains of deceased persons after cremation, a sum which shall be equivalent to 10 percent of the sale price of each niche. In event sales of crypts or rooms in a community mausoleum, or sales of niches in a community mausoleum or columbarium are made upon partial payments, there shall be set apart and applied to such fund from each partial payment the percentage that the amount of the partial payment bears to the total purchase price of the crypt, room, or niche. (Amended 2017, No. 113 (Adj. Sess.),  96.) 
 5579. Penalties
A person who violates a provision of sections 5571-5578 of this title shall be fined not less than $100.00 nor more than $500.00 or be imprisoned in the State correctional facility not less than 10 days nor more than three months, or both, for each offense. (Amended 1967, No. 345 (Adj. Sess.),  30, eff. April 1, 1969.) 
 701. Definitions
As used in this chapter:(1) Blueprint for Health or Blueprint means the States program for integrating a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination and management. (2) Board means the Green Mountain Care Board established in chapter 220 of this title.(3) Chronic care means health services provided by a health care professional for an established clinical condition that is expected to last a year or more and that requires ongoing clinical management attempting to restore the individual to highest function, minimize the negative effects of the condition, prevent complications related to chronic conditions, engage in advanced care planning, and promote appropriate access to palliative care and pain and symptom management. Examples of chronic conditions include diabetes, hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental condition or psychiatric disability, spinal cord injury, hyperlipidemia, dementia, and chronic pain. (4) Chronic care information system means the electronic database developed under the Blueprint for Health that shall include information on all cases of a particular disease or health condition in a defined population of individuals. (5) Chronic care management means a system of coordinated health care interventions and communications for individuals with chronic conditions, including significant patient self-care efforts, systemic supports for licensed health care practitioners and their patients, and a plan of care emphasizing, on an ongoing basis and with the goals of improving overall health and meeting patients needs: (A) prevention of complications utilizing evidence-based practice guidelines;(B) patient empowerment strategies;(C) evaluation of clinical, humanistic, and economic outcomes; and(D) advance care planning, palliative care, pain management, and hospice services, as appropriate. (6) Global payment means a payment from a health insurer, Medicaid, Medicare, or other payer for the health services of a defined population of patients for a defined period of time. Such payments may be adjusted to account for the populations underlying risk factors, including severity of illness and socioeconomic factors that may influence the cost of health care for the population. (7) Health care professional means an individual, partnership, corporation, facility, or institution licensed or certified or authorized by law to provide professional health care services. (8) Health benefit plan shall have the same meaning as health insurance plan in 8 V.S.A.  4088h.(9) Health insurer shall have the same meaning as in section 9402 of this title.(10) Health service means any treatment or procedure delivered by a health care professional to maintain an individuals physical or mental health or to diagnose or treat an individuals physical or mental condition or intellectual disability, including services ordered by a health care professional, chronic care management, preventive care, wellness services, and medically necessary services to assist in activities of daily living. (11) Hospital shall have the same meaning as in section 9451 of this title.(12) Integrated delivery system means a group of health care professionals, associated either through employment by a single entity or through a contractual arrangement, that provides health services for a defined population of patients and is compensated through a global payment. (13) Payment reform means modifying the method of payment from a fee for-service basis to one or more alternative methods for compensating health care professionals, health care provider bargaining groups created pursuant to section 9409 of this title, integrated delivery systems and other health care professional arrangements, manufacturers of prescribed products, medical supply companies, and other companies providing health services or health supplies, for the provision of high-quality and efficient health services, products, and supplies while measuring quality and efficiency. The term may include shared savings agreements, bundled payments, episode-based payments, and global payments. (14) Preventive care means health services provided by health care professionals to identify and treat asymptomatic individuals who have risk factors or preclinical disease, but in whom the disease is not clinically apparent, including immunizations and screening, counseling, treatment, and medication determined by scientific evidence to be effective in preventing or detecting a condition. (15) Wellness services means health services, programs, or activities that focus on the promotion or maintenance of good health. (Added 2005, No. 191 (Adj. Sess.),  5; amended 2009, No. 25,  8; 2009, No. 128 (Adj. Sess.),  13; 2011, No. 48,  3c; 2011, No. 60,  5, eff. June 1, 2011; 2011, No. 171 (Adj. Sess.),  37, eff. May 16, 2012; 2013, No. 96 (Adj. Sess.),  90.) 
 702. Blueprint for Health; strategic plan
(a)(1) The Department of Vermont Health Access shall be responsible for the Blueprint for Health. (2) The Director of the Blueprint, in collaboration with the Commissioners of Health, of Mental Health, of Vermont Health Access, and of Disabilities, Aging, and Independent Living, shall oversee the development and implementation of the Blueprint for Health, including a strategic plan describing the initiatives and implementation timelines and strategies. Whenever private health insurers are concerned, the Director shall collaborate with the Commissioner of Financial Regulation and the Chair of the Green Mountain Care Board. (b)(1)(A) The Commissioner of Vermont Health Access shall establish an executive committee to advise the Director of the Blueprint on creating and implementing a strategic plan for the development of the statewide system of chronic care and prevention as described under this section. The Executive Committee shall include: (i) the Commissioner of Health;(ii) the Commissioner of Mental Health;(iii) a representative from the Green Mountain Care Board;(iv) a representative from the Department of Vermont Health Access;(v) an individual appointed jointly by the President Pro Tempore of the Senate and the Speaker of the House of Representatives; (vi) a representative from the Vermont Medical Society;(vii) a representative from the Vermont Nurse Practitioners Association;(viii) a representative from a statewide quality assurance organization;(ix) a representative from the Vermont Association of Hospitals and Health Systems;(x) two representatives of private health insurers;(xi) a consumer;(xii) a representative of the complementary and alternative medicine professions;(xiii) a primary care professional serving low-income or uninsured Vermonters;(xiv) a licensed mental health professional with clinical experience in Vermont;(xv) a representative of the Vermont Council of Developmental and Mental Health Services;(xvi) a representative of the Vermont Assembly of Home Health Agencies who has clinical experience; (xvii) a representative from a self-insured employer who offers a health benefit plan to its employees; and (xviii) a representative of the State employees health plan, who shall be designated by the Commissioner of Human Resources and who may be an employee of the third-party administrator contracting to provide services to the State employees health plan. (B) The Executive Committee shall engage a broad range of health care professionals who provide health services, health insurers, professional organizations, community and nonprofit groups, consumers, businesses, school districts, and State and local government in developing recommendations over time for modifications to statewide implementation of the Blueprint. (2)(A) [Repealed.](B) The Director shall convene a payer implementation work group, which shall meet no fewer than six times annually, to design the medical home and community health team enhanced payments, including modifications over time, and to make recommendations to the Executive Committee. The work group shall include representatives of the participating health insurers, representatives of participating medical homes and community health teams, and the Commissioner of Vermont Health Access or designee. The work group shall comply with open meeting and public record requirements in 1 V.S.A. chapter 5. (c) The Blueprint shall be developed and implemented to further the following principles:(1) The Blueprint community health team should serve a central role in the coordination of medical care and social services and shall be compensated appropriately for this effort. (2) Use of information technology should be maximized.(3) Local service providers should be used and supported, whenever possible.(4) Transition plans should be developed by all involved parties to ensure a smooth and timely transition from the current model to the Blueprint model of health care delivery and payment. (5) Implementation of the Blueprint in communities across the State should be accompanied by payment to providers sufficient to support care management activities consistent with the Blueprint, recognizing that interim or temporary payment measures may be necessary during early and transitional phases of implementation. (6) Interventions designed to prevent chronic disease and improve outcomes for persons with chronic disease should be maximized, should target specific chronic disease risk factors, and should address changes in individual behavior; the physical, mental, and social environment; and health care policies and systems. (7) Providers should assess trauma and toxic stress to ensure that the needs of the whole person are addressed and opportunities to build resilience and community supports are maximized. (d) The Blueprint for Health shall include the following initiatives:(1) Technical assistance as provided for in section 703 of this title to implement:(A) a patient-centered medical home;(B) community health teams; and(C) a model for uniform payment for health services by health insurers, Medicaid, Medicare if available, and other entities that encourage the use of the medical home and the community health teams. (2) Collaboration with Vermont Information Technology Leaders established in section 9352 of this title to assist health care professionals and providers to create a statewide infrastructure of health information technology in order to expand the use of electronic medical records through a health information exchange and a centralized clinical registry on the Internet. (3) In consultation with employers, consumers, health insurers, and health care providers, the development, maintenance, and promotion of evidence-based, nationally recommended guidelines for greater commonality, consistency, and coordination among health insurers in care management programs and systems. (4) The adoption and maintenance of clinical quality and performance measures for each of the chronic conditions included in Medicaids care management program established in 33 V.S.A.  1903a. These conditions include asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes, and coronary artery disease. (5) The adoption and maintenance of clinical quality and performance measures, aligned with, but not limited to, existing indicators related to outcomes set forth in 3 V.S.A.  2311 that are relevant to the Agency of Human Services, to be reported by health care professionals, providers, or health insurers and used to assess and evaluate the impact of the Blueprint for Health and cost outcomes. In accordance with a schedule established by the Blueprint Executive Committee, all clinical quality and performance measures shall be reviewed for consistency with those used by the Medicare program and updated, if appropriate. (6) The adoption and maintenance of clinical quality and performance measures for pain management, palliative care, and hospice care. (7) The use of surveys to measure satisfaction levels of patients, health care professionals, and health care providers participating in the Blueprint. (8) The use of quality improvement facilitation and other means to support quality improvement activities, including using integrated clinical and claims data, where available, to evaluate patient outcomes and promoting best practices regarding patient referrals and care distribution between primary and specialty care. (e) The strategic plan developed under subsection (a) of this section shall be reviewed biennially and amended as necessary to reflect changes in priorities. Amendments to the plan shall be included in the report established under section 709 of this title. (Added 2005, No. 191 (Adj. Sess.),  5; amended 2007, No. 70,  21; 2007, No. 71,  5; 2009, No. 128 (Adj. Sess.),  13; 2009, No. 156 (Adj. Sess.),  I.19; 2011, No. 63,  G.101; 2011, No. 171 (Adj. Sess.),  28, eff. May 16, 2012; 2015, No. 11,  17; 2017, No. 204 (Adj. Sess.),  6; 2019, No. 128 (Adj. Sess.),  7; 2021, No. 167 (Adj. Sess.),  6, eff. June 1, 2022.) 
 703. Health prevention; chronic care management
(a) The Director shall develop a model for integrating a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination and management through an integrated system, including a patient-centered medical home and a community health team; and uniform payment for health services by health insurers, Medicaid, Medicare if available, and other entities that encourage the use of the medical home and the community health teams. (b) When appropriate, the model may include the integration of social services provided by the Agency of Human Services or may include coordination with a team at the Agency of Human Services to ensure the individuals comprehensive care plan is consistent with the Agencys case management plan for that individual or family. (c) In order to maximize the participation of federal health care programs and to maximize federal funds available, the model for care coordination and management may meet the criteria for medical home, community health team, or other related demonstration projects established by the U.S. Department of Health and Human Services and the criteria of any other federal program providing funds for establishing medical homes, community health teams, or associated payment reform. (d) The model for care coordination and management shall include the following components:(1) A process for identifying individuals with or at risk for chronic disease and to assist in the determination of the risk for or severity of a chronic disease, as well as the appropriate type and level of care management services needed to manage those chronic conditions. (2) Evidence-based clinical practice guidelines, which shall be aligned with the clinical quality and performance measures provided for in section 702 of this title. (3) Models for the collaboration of health care professionals in providing care, including through a community health team. (4) Education for patients on how to manage conditions or diseases, including prevention of disease; programs to modify a patients behavior; and a method of ensuring compliance of the patient with the recommended behavioral change. (5) Education for patients on health care decision-making, including education related to advance directives, palliative care, hospice care, and timely referrals to palliative and hospice care, when appropriate. (6) Measurement and evaluation of the process and health outcomes of patients.(7) A method for all health care professionals treating the same patient on a routine basis to report and share information about that patient. (8) Requirements that participating health care professionals and providers have the capacity to implement health information technology that meets the requirements of 42 U.S.C.  300jj in order to facilitate coordination among members of the community health team, health care professionals, and primary care practices; and, where applicable, to report information on quality measures to the Director of the Blueprint. (9) A sustainable, scalable, and adaptable financial model reforming primary care payment methods through medical homes supported by community health teams that lead to a reduction in avoidable emergency room visits and hospitalizations and a shift of health insurer expenditures from disease management contracts to financial support for local community health teams in order to promote health, prevent disease, and manage care in order to increase positive health outcomes and reduce costs over time. (e) The Director of the Blueprint shall provide technical assistance and training to health care professionals, health care providers, health insurers, and others participating in the Blueprint. (Added 2009, No. 128 (Adj. Sess.),  13; amended 2011, No. 60,  6, eff. June 1, 2011.) 
 704. Medical home
(a) Consistent with federal law to ensure federal financial participation, a health care professional providing a patients medical home shall: (1) provide comprehensive prevention and disease screening for his or her patients and managing his or her patients chronic conditions by coordinating care; (2) enable patients to have access to personal health information through a secure medium, such as through the Internet, consistent with federal health information technology standards; (3) use a uniform assessment tool provided by the Blueprint in assessing a patients health;(4) collaborate with the community health teams, including by developing and implementing a comprehensive plan for participating patients; (5) ensure access to a patients medical records by the community health team members in a manner compliant with the Health Insurance Portability and Accountability Act, 12 V.S.A.  1612, sections 1852, 7103, 9332, and 9351 of this title, and 21 V.S.A.  516; and (6) meet regularly with the community health team to ensure integration of a participating patients care. (b) A naturopathic physician licensed pursuant to 26 V.S.A. chapter 81 may serve as a patients medical home. (Added 2009, No. 128 (Adj. Sess.),  13; amended 2011, No. 96 (Adj. Sess.),  3, eff. May 2, 2012.) 
 705. Community health teams
(a) Consistent with federal law to ensure federal financial participation, the community health team shall consist of health care professionals from multiple disciplines, including obstetrics and gynecology, pharmacy, nutrition and diet, social work, behavioral and mental health, chiropractic, other complementary and alternative medical practice licensed by the State, home health care, public health, and long-term care. (b) The Director shall assist communities to identify the service areas in which the teams work, which may include a hospital service area or other geographic area. (c) Health care professionals participating in a community health team shall:(1) Collaborate with other health care professionals and with existing State agencies and community-based organizations in order to coordinate disease prevention, manage chronic disease, coordinate social services if appropriate, and provide an appropriate transition of patients between health care professionals or providers. Priority may be given to patients willing to participate in prevention activities or patients with chronic diseases or conditions identified by the Director of the Blueprint. (2) Support a health care professional or practice which operates as a medical home, including by: (A) assisting in the development and implementation of a comprehensive care plan for a patient that integrates clinical services with prevention and health promotion services available in the community and with relevant services provided by the Agency of Human Services. Priority may be given to patients willing to participate in prevention activities or patients with chronic diseases or conditions identified by the Director of the Blueprint; (B) providing a method for health care professionals, patients, caregivers, and authorized representatives to assist in the design and oversight of the comprehensive care plan for the patient; (C) coordinating access to high-quality, cost-effective, culturally appropriate, and patient- and family-centered health care and social services, including preventive services, activities which promote health, appropriate specialty care, inpatient services, medication management services provided by a pharmacist, and appropriate complementary and alternative (CAM) services; (D) providing support for treatment planning, monitoring the patients health outcomes and resource use, sharing information, assisting patients in making treatment decisions, avoiding duplication of services, and engaging in other approaches intended to improve the quality and value of health services; (E) assisting in the collection and reporting of data in order to evaluate the Blueprint model on patient outcomes, including collection of data on patient experience of care, and identification of areas for improvement; and (F) providing a coordinated system of early identification and referral for children at risk for developmental or behavioral problems such as through the use of health information technology or other means as determined by the Director of the Blueprint. (3) Provide care management and support when a patient moves to a new setting for care, including by: (A) providing on-site visits from a member of the community health team, assisting with the development of discharge plans and medication reconciliation upon admission to and discharge from the hospital, nursing home, or other institution setting; (B) generally assisting health care professionals, patients, caregivers, and authorized representatives in discharge planning, including by assuring that postdischarge care plans include medication management as appropriate; (C) referring patients as appropriate for mental and behavioral health services;(D) ensuring that when a patient becomes an adult, his or her health care needs are provided for; and (E) serving as a liaison to community prevention and treatment programs. (Added 2009, No. 128 (Adj. Sess.),  13.)
 706. Health insurer participation
(a) As provided for in 8 V.S.A.  4088h, health insurance plans shall be consistent with the Blueprint for Health as determined by the Commissioner of Financial Regulation. (b) No later than January 1, 2011, health insurers shall participate in the Blueprint for Health as a condition of doing business in this State as provided for in this section and in 8 V.S.A.  4088h. Under 8 V.S.A.  4088h, the Commissioner of Financial Regulation may exclude or limit the participation of health insurers offering a stand-alone dental plan or specific disease or other limited benefit coverage in the Blueprint for Health. Health insurers shall be exempt from participation if the insurer only offers benefit plans which are paid directly to the individual insured or the insureds assigned beneficiaries and for which the amount of the benefit is not based upon potential medical costs or actual costs incurred. (c)(1) The Blueprint payment reform methodologies shall include per-person per-month payments to medical home practices by each health insurer and Medicaid for their attributed patients and for contributions to the shared costs of operating the community health teams. Per-person per-month payments to practices shall be based on the official National Committee for Quality Assurances Physician Practice Connections-Patient Centered Medical Home (NCQA PPC-PCMH) score to the extent practicable and shall be in addition to their normal fee-for-service or other payments. (2) Consistent with recommendations of the Blueprint Executive Committee, the Director of the Blueprint may recommend to the Commissioner of Vermont Health Access changes to the payment amounts or to the payment reform methodologies described in subdivision (1) of this subsection, including by providing for enhanced payment to health care professional practices that operate as a medical home, including primary care naturopathic physicians practices; payment toward the shared costs for community health teams; or other payment methodologies required by the Centers for Medicare and Medicaid Services (CMS) for participation by Medicaid or Medicare. (3) Health insurers shall modify payment methodologies and amounts to health care professionals and providers as required for the establishment of the model described in sections 703 through 705 of this title and this section, including any requirements specified by the Centers for Medicare and Medicaid Services (CMS) in approving federal participation in the model to ensure consistency of payment methods in the model. (4) In the event that the Secretary of Human Services is denied permission from the Centers for Medicare and Medicaid Services (CMS) to include financial participation by Medicare, health insurers shall not be required to cover the costs associated with individuals covered by Medicare. (d) An insurer may appeal a decision to require a particular payment methodology or payment amount to the Commissioner of Vermont Health Access, who shall provide a hearing in accordance with 3 V.S.A. chapter 25. An insurer aggrieved by the decision of the Commissioner may appeal to the Superior Court for the Washington District within 30 days after the Commissioner issues his or her decision. (Added 2009, No. 128 (Adj. Sess.),  13; amended 2011, No. 78 (Adj. Sess.),  2, eff. April 2, 2012; 2011, No. 96 (Adj. Sess.),  4, eff. May 2, 2012; 2015, No. 172 (Adj. Sess.),  E.306.2; 2019, No. 128 (Adj. Sess.),  8.) 
 707. Participation by health care professionals and hospitals
(a) No later than July 1, 2011, hospitals shall participate in the Blueprint for Health by creating or maintaining connectivity to the States Health Information Exchange Network as provided in this section and in section 9456 of this title. (b) The Director of Health Care Reform or designee shall ensure hospitals have access to State and federal resources to support connectivity to the States Health Information Exchange Network. (c) The Director of the Blueprint shall engage health care professionals and providers to encourage participation in the Blueprint, including by providing information and assistance. (Added 2009, No. 128 (Adj. Sess.),  13; amended 2013, No. 79,  33, eff. June 7, 2013.) 
 709. Annual report
(a) The Director of the Blueprint shall report annually, on or before January 31, on the status of implementation of the Vermont Blueprint for Health for the prior calendar year and shall provide the report to the House Committee on Health Care, the Senate Committee on Health and Welfare, and the Health Reform Oversight Committee. (b) The report required by subsection (a) of this section shall include the number of participating insurers, health care professionals, and patients; the progress made in achieving statewide participation in the chronic care management plan, including the measures established under this subchapter; the expenditures and savings for the period; the results of health care professional and patient satisfaction surveys; the progress made toward creation and implementation of privacy and security protocols; information on the progress made toward the requirements in this subchapter; and other information as requested by the Committees. The provisions of 2 V.S.A.  20(d) (expiration of required reports) shall not apply to the report to be made under subsection (a) of this section. (Added 2009, No. 128 (Adj. Sess.),  13; amended 2011, No. 63,  G.102; 2011, No. 171 (Adj. Sess.),  41c; 2013, No. 142 (Adj. Sess.),  33; 2017, No. 113 (Adj. Sess.),  55.) 
 901. Policy
It is the policy of the State of Vermont that all persons who suffer sudden and unexpected illness or injury should have access to the emergency medical services system in order to prevent loss of life or the aggravation of the illness or injury, and to alleviate suffering. (1) The system should include competent emergency medical treatment provided by adequately trained, licensed, and equipped personnel acting under appropriate medical control. (2) Persons involved in the delivery of emergency medical care should be encouraged to maintain and advance their levels of training and licensure, and to upgrade the quality of their vehicles and equipment. (Added 1981, No. 61; amended 2011, No. 155 (Adj. Sess.),  32; 2019, No. 100 (Adj. Sess.),  3, eff. May 14, 2020.) 
 902. Definitions
As used in this chapter, unless the context requires otherwise words and phrases shall have the meaning given in 24 V.S.A.  2651. (Added 1981, No. 61; amended 1983, No. 226 (Adj. Sess.),  15.) 
 903. Authorization for provision of emergency medical services
Notwithstanding any other provision of law, including provisions of 26 V.S.A. chapter 23, persons who are affiliated with an affiliated agency and licensed to provide emergency medical treatment pursuant to the requirements of this chapter and the rules adopted under it are hereby authorized to provide such care without further certification, registration, or licensing. (Added 1981, No. 61; amended 2011, No. 155 (Adj. Sess.),  33; 2019, No. 100 (Adj. Sess.),  3, eff. May 14, 2020; 2019, No. 166 (Adj. Sess.),  29, eff. Oct. 1, 2020.) 
 904. Administrative provisions
(a) In order to carry out the purposes and responsibilities of this chapter, the Department of Health may contract for the provision of specific services. (b) The Secretary of Human Services, upon the recommendation of the Commissioner of Health, may adopt rules to carry out the purposes and responsibilities of this chapter. (Added 1981, No. 61; amended 2011, No. 155 (Adj. Sess.),  34; 2017, No. 113 (Adj. Sess.),  56; 2019, No. 166 (Adj. Sess.),  29, eff. Oct. 1, 2020.) 
 906. Emergency Medical Services Division; responsibilities
To implement the policy of section 901 of this chapter, the Department of Health shall be responsible for: (1) Developing and implementing minimum standards for training emergency medical personnel in basic life support and advanced life support, and licensing emergency medical personnel according to their level of training and competence. The Department shall establish by rule at least three levels of emergency medical personnel instructors and the education required for each level. (2) Developing and implementing minimum standards for vehicles used in providing emergency medical care, designating the types and quantities of equipment that must be carried by these vehicles, and registering those vehicles according to appropriate classifications. (3) Developing a statewide system of emergency medical services, including planning, organizing, coordinating, improving, expanding, monitoring, and evaluating emergency medical services. (4) [Repealed.](5) Developing volunteer and career response time standards for urban and rural requests for emergency services. (6) Training, or assisting in the training of, emergency medical personnel.(7) Assisting hospitals in the development of programs that will improve the quality of in-hospital services for persons requiring emergency medical treatment. (8) Developing and implementing procedures to ensure that emergency medical services are rendered only with appropriate medical control. For the provision of advanced life support, appropriate medical control shall include at a minimum: (A) written protocols between the appropriate officials of receiving hospitals and emergency medical services districts defining their operational procedures; (B) where necessary and practicable, direct communication between emergency medical personnel and a physician or person acting under the direct supervision of a physician; (C) when such communication has been established, a specific order from the physician or person acting under the direct supervision of the physician to employ a certain medical procedure; (D) use of advanced life support, when appropriate, only by emergency medical personnel who are certified by the Department of Health to employ advanced life support procedures. (9) Establishing requirements for the collection of data by emergency medical personnel and hospitals as may be necessary to evaluate emergency medical treatment. (10) Establishing, by rule, license levels for emergency medical personnel. The Commissioner shall use the guidelines established by the National Highway Traffic Safety Administration (NHTSA) in the U.S. Department of Transportation as a standard or other comparable standards, except that a felony conviction shall not necessarily disqualify an applicant. The rules shall also provide that: (A) An individual may apply for and obtain one or more additional licenses, including licensure as an advanced emergency medical technician or as a paramedic. (B) An individual licensed by the Commissioner as an emergency medical technician, advanced emergency medical technician, or paramedic, who is affiliated with an affiliated agency, shall be able to practice fully within the scope of practice for such level of licensure as defined by NHTSAs National EMS Scope of Practice Model consistent with the license level of the affiliated agency, and subject to the medical direction of the emergency medical services district medical advisor. (C)(i) Unless otherwise provided under this section, an individual seeking any level of licensure shall be required to pass an examination approved by the Commissioner for that level of licensure, except that any psychomotor skills testing for emergency medical responder, or emergency medical technician licensure shall be accomplished either by the demonstration of those skills competencies as part of the education required for that license level as approved by the Department or by the National Registry of Emergency Medical Technicians psychomotor examination. (ii) Written and practical examinations shall not be required for relicensure; however, to maintain licensure, all individuals shall complete a specified number of hours of continuing education as established by rule by the Commissioner. The Commissioner shall ensure that continuing education classes are available online and provided on a regional basis to accommodate the needs of volunteers and part-time individuals, including those in rural areas of the State. (D) If there is a hardship imposed on any applicant for a license under this section because of unusual circumstances, the applicant may apply to the Commissioner for a temporary or permanent waiver of one or more of the licensure requirements, which the Commissioner may grant for good cause. (E) An applicant who has served as a hospital corpsman or a medic in the U.S. Armed Forces, or who is licensed as a registered nurse or a physician assistant shall be granted a permanent waiver of the training requirements to become a licensed emergency medical technician, an advanced emergency medical technician, or a paramedic, provided the applicant passes the applicable examination approved by the Commissioner for that level of licensure and is affiliated with an affiliated agency. (F) An applicant who is registered on the National Registry of Emergency Medical Technicians as an emergency medical technician, an advanced emergency medical technician, or a paramedic shall be granted licensure as a Vermont emergency medical technician, an advanced emergency medical technician, or a paramedic without the need for further testing, provided he or she is affiliated with an affiliated agency or is serving as a medic with the Vermont National Guard. (G) [Repealed.](11) In addition to the licenses established under subdivision (10) of this section, the Department shall establish by rule an entry-level certification for Vermont EMS first responders. (Added 1981, No. 61; amended 2009, No. 78 (Adj. Sess.),  10e, eff. April 15, 2010; 2009, No. 142 (Adj. Sess.),  18, eff. June 1, 2010; 2011, No. 155 (Adj. Sess.),  35; 2015, No. 97 (Adj. Sess.),  46a; 2019, No. 100 (Adj. Sess.),  3, eff. May 14, 2020; 2019, No. 166 (Adj. Sess.),  29, eff. Oct. 1, 2020.) 
 906a. Relicensure; grace period
A person certified or licensed as an emergency medical provider shall have six months after his or her certification or license has expired to resubmit the necessary information for renewal of the certificate or license. (Added 2011, No. 155 (Adj. Sess.),  36.) 
 906c. Veterans and service members returning from deployment; prior positions
(a) As used in this section:(1) Service member means an individual who is an active duty member of:(A) the U.S. Armed Forces;(B) a reserve component of the U.S. Armed Forces;(C) the U.S. Coast Guard; or(D) the National Guard of any state.(2) Veteran means a former service member who received an honorable discharge or a general discharge under honorable conditions from active duty. (b)(1) A veteran or service member who held a position as an emergency medical provider prior to his or her most recent military deployment but whose license or certification lapsed as a direct result of that deployment shall be permitted to return to that same position at the same rate of compensation upon his or her return from deployment once licensure is renewed, so long as all other requirements for employment are met. (2) The provisions of subdivision (1) of this subsection shall apply to such a veteran or service member until the expiration of six months after his or her return from deployment or the renewal cycle during which he or she returns from deployment, whichever is later. (Added 2013, No. 177 (Adj. Sess.),  2.) 
 906d. Renewal requirements; sunset review
(a) Not less than once every five years, the Department shall review emergency medical personnel continuing education and other continuing competency requirements. The review results shall be in writing and address the following: (1) the renewal requirements of the profession;(2) the renewal requirements in other jurisdictions, particularly in the Northeast region;(3) the cost of the renewal requirements for emergency medical personnel; and(4) an analysis of the utility and effectiveness of the renewal requirements with respect to public protection. (b) The Department shall amend its rules or propose any necessary statutory amendments to revise any emergency medical personnel continuing education and other continuing competency requirements that are not necessary for the protection of the public health, safety, or welfare. (Added 2019, No. 166 (Adj. Sess.),  29, eff. Oct. 1, 2020.) 
 907. Automated external defibrillators
(a) As used in this section:(1) Automated external defibrillator (AED) means a medical device approved by the U.S. Food and Drug Administration, that: (A) is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia; (B) is capable of determining whether defibrillation should be performed on an individual;(C) upon determination that defibrillation should be performed, automatically charges and requests delivery of an electrical impulse to an individuals heart; and (D) then, upon action by an operator, delivers an appropriate electrical impulse to the patients heart to perform defibrillation. (b) [Repealed.](c) Any person who owns or leases an AED, or to whom an AED is donated, shall:(1) notify the Department and the persons regional ambulance service or first responder service of the existence, location, and type of device the person possesses; and (2) maintain and test the device in accordance with the applicable standards of the manufacturer.(d)(1) Any person, other than a person defined as a health care provider by subdivision 9432(9) of this title or as emergency medical personnel by 24 V.S.A.  2651(6) acting in the normal course of his or her duties as a health care provider or as emergency medical personnel, who acts in good faith and who renders emergency care by the use of an AED, acquires an AED, owns a premises on which an AED is located, or provides a training course in the operation of an AED shall not be liable for civil damages for that persons acts or omissions with respect to such use, ownership, or training in the operation of an AED unless those acts or omissions were grossly negligent or willful and wanton. As used in this subdivision (d)(1), ownership shall not include the maintenance and testing of the device in accordance with the applicable standards of the manufacturer as required by subdivision (c)(2) of this section. (2) This subsection shall not relieve an AED manufacturer, designer, developer, distributor, installer, or seller of any liability under any applicable statute or rule of law. (e) This section shall not be construed to create a duty to act under 12 V.S.A.  519 for any person. (Added 1999, No. 136 (Adj. Sess.),  2; amended 2009, No. 7,  1, eff. May 1, 2009; 2017, No. 8,  1, eff. April 25, 2017.)
 908. Emergency Medical Services Special Fund
(a) The Emergency Medical Services Fund is established pursuant to 32 V.S.A. chapter 7, subchapter 5 comprising revenues received by the Department from the Fire Safety Special Fund, pursuant to 32 V.S.A.  8557(a), that are designated for this Special Fund and public and private sources as gifts, grants, and donations together with additions and interest accruing to the Fund. The Commissioner of Health shall administer the Fund to the extent funds are available to support online and regional training programs, data collection and analysis, and other activities relating to the training of emergency medical personnel and delivery of emergency medical services and ambulance services in Vermont, as determined by the Commissioner, after consulting with the EMS Advisory Committee established under section 909 of this title. Any balance at the end of the fiscal year shall be carried forward in the Fund. (b) From the funds in the Emergency Medical Services Special Fund, the Commissioner of Health shall develop and implement by September 1, 2012 online training opportunities and offer regional classes to enable individuals to comply with the requirements of subdivision 906(10)(C) of this title. (Added 2011, No. 155 (Adj. Sess.),  38; amended 2013, No. 73,  3, eff. June 5, 2013.) 
 909. EMS Advisory Committee; EMS Education Council
(a) The Commissioner shall establish the Emergency Medical Services Advisory Committee to advise on matters relating to the delivery of emergency medical services (EMS) in Vermont. (b) The Committee shall include the following members:(1) One representative from each EMS district in the State, each representative being appointed by the EMS Board in his or her district. (2) A representative from the Vermont Ambulance Association or designee.(3) A representative from the Initiative for Rural Emergency Medical Services program at the University of Vermont or designee. (4) A representative from the Professional Firefighters of Vermont or designee.(5) A representative from the Vermont Career Fire Chiefs Association or designee.(6) A representative from the Vermont State Firefighters Association or designee.(7) An emergency department nurse manager or emergency department director of a Vermont hospital appointed by the Vermont Association of Hospitals and Health Systems. (8) The Commissioner or designee.(9) A local government member not affiliated with emergency medical services, firefighter services, or hospital services, appointed by the Vermont League of Cities and Towns. (c) The Committee shall select from among its members a chair who is not an employee of the State. (d) The Committee shall meet not less than quarterly and may be convened at any time by the Chair or at the request of 11 Committee members. Not more than two meetings each year shall be held in the same EMS district. One meeting each year shall be held at a Vermont EMS conference. (e) Annually, on or before January 1, the Committee shall report on the EMS system to the House Committees on Government Operations, on Commerce and Economic Development, and on Human Services and to the Senate Committees on Government Operations, on Economic Development, Housing and General Affairs, and on Health and Welfare. The Committees reports shall include information on the following: (1) whether every Vermont municipality should be required to have in effect an emergency medical services plan providing for timely and competent emergency responses; (2) whether the State should establish directives addressing when an agency can respond to a nonemergency request for transportation of a patient if doing so will leave the service area unattended or unable to respond to an emergency call in a timely fashion; (3) how the EMS system is functioning statewide and the current state of recruitment and workforce development; (4) each EMS districts response times to 911 emergencies in the previous year, based on information collected from the Vermont Department of Healths Division of Emergency Medical Services; (5) funding mechanisms and funding gaps for EMS personnel and providers across the State, including for the funding of infrastructure, equipment, and operations and costs associated with initial and continuing training and licensure of personnel; (6) the nature and costs of dispatch services for EMS providers throughout the State, including the annual number of mutual aid calls to an emergency medical service area that come from outside that area, and suggestions for improvement; (7) legal, financial, or other limitations on the ability of EMS personnel with various levels of training and licensure to engage in lifesaving or health-preserving procedures; (8) how the current system of preparing and licensing EMS personnel could be improved, including the role of Vermont Technical Colleges EMS program; whether the State should create an EMS academy; and how such an EMS academy should be structured; and (9) how EMS instructor training and licensing could be improved.(f) In addition to its report set forth in subsection (e) of this section, the Committee shall identify EMS resources and needs in each EMS district and provide that information to the Green Mountain Care Board to inform the Boards periodic revisions to the Health Resource Allocation Plan developed pursuant to subsection 9405(b) of this title. (g) The Committee shall establish from among its members the EMS Education Council, which may: (1) sponsor training and education programs required for emergency medical personnel licensure in accordance with the Department of Healths required standards for that training and education; and (2) provide advice to the Department of Health regarding the standards for emergency medical personnel licensure and any recommendations for changes to those standards. (Added 2011, No. 155 (Adj. Sess.),  39; amended 2017, No. 202 (Adj. Sess.),  1, eff. May 30, 2018; 2019, No. 100 (Adj. Sess.),  3, eff. May 14, 2020; 2019, No. 166 (Adj. Sess.),  29, eff. Oct. 1, 2020.) 
 7101. Definitions
As used in this part of this title, the following words, unless the context otherwise requires, shall have the following meanings: (1) Board means the Board of Mental Health.(2) Commissioner means the Commissioner of Mental Health.(3) Custody means safekeeping, protection, charge, or care.(4) Designated hospital means a hospital or other facility designated by the Commissioner as adequate to provide appropriate care for the mentally ill patient. (5) Elopement means the leaving of a designated hospital or designated program or training school without lawful authority. (6) Head of a hospital means the administrator or persons in charge at any time.(7) Hospital means a public or private hospital or facility or part thereof, equipped and otherwise qualified to provide inpatient care and treatment for persons with mental conditions or psychiatric disabilities. (8) Individual means a resident of or a person in Vermont.(9) Interested party means a guardian, spouse, parent, adult child, close adult relative, responsible adult friend, or person who has the individual in his or her charge or care. It also means a mental health professional, a law enforcement officer, a licensed physician, or a head of a hospital. (10) Law enforcement officer means a sheriff, deputy sheriff, constable, municipal police officer, or State Police. (11) Licensed physician means a physician legally qualified and licensed to practice as a physician in Vermont. (12) [Repealed.](13) Mental health professional means a person with professional training, experience, and demonstrated competence in the treatment of mental illness, who shall be a physician, psychologist, social worker, mental health counselor, nurse, or other qualified person designated by the Commissioner. (14) Mental illness means a substantial disorder of thought, mood, perception, orientation, or memory, any of which grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life, but shall not include intellectual disability. (15) Patient means a resident of or person in Vermont qualified under this title for hospitalization or treatment as a person with a mental illness or intellectual disability. (16) A patient in need of further treatment means:(A) a person in need of treatment; or(B) a patient who is receiving adequate treatment, and who, if such treatment is discontinued, presents a substantial probability that in the near future his or her condition will deteriorate and he or she will become a person in need of treatment. (17) A person in need of treatment means a person who has a mental illness and, as a result of that mental illness, his or her capacity to exercise self-control, judgment, or discretion in the conduct of his or her affairs and social relations is so lessened that he or she poses a danger of harm to himself, to herself, or to others: (A) A danger of harm to others may be shown by establishing that:(i) he or she has inflicted or attempted to inflict bodily harm on another; or(ii) by his or her threats or actions he or she has placed others in reasonable fear of physical harm to themselves; or (iii) by his or her actions or inactions he or she has presented a danger to persons in his or her care. (B) A danger of harm to himself or herself may be shown by establishing that:(i) he or she has threatened or attempted suicide or serious bodily harm; or(ii) he or she has behaved in such a manner as to indicate that he or she is unable, without supervision and the assistance of others, to satisfy his or her need for nourishment, personal or medical care, shelter, or self-protection and safety, so that it is probable that death, substantial physical bodily injury, serious mental deterioration, or serious physical debilitation or disease will ensue unless adequate treatment is afforded. (18) Resident of Vermont means:(A) A person who has lived continuously in Vermont for one year immediately preceding his or her admission as a patient or immediately preceding his or her becoming a proposed patient. (B) A person who has a present intention to make Vermont his or her home for an indefinite period of time. This intention may be evidenced by prior statements or it may be implied from facts which show that the person does in fact make Vermont his or her permanent home. A married woman shall be capable of establishing a legal residence apart from her husband, and a child under 18 years shall take legal residence of the parent or guardian with whom he or she is actually living. (19) Retreat means the Brattleboro Retreat.(20) Secretary means the Secretary of Human Services.(21), (22) [Repealed.](23) Vermont means the State of Vermont.(24) Voluntary patient means an individual admitted to a hospital voluntarily or an individual whose status has been changed from involuntary to voluntary. (25) Children and adolescents with a severe emotional disturbance means those persons defined as such under 33 V.S.A.  4301(3). (26) No refusal system means a system of hospitals and intensive residential recovery facilities under contract with the Department of Mental Health that provides high intensity services, in which the facilities shall admit any individual for care if the individual meets the eligibility criteria established by the Commissioner in contract. (27) Participating hospital means a hospital under contract with the Department of Mental Health to participate in the no refusal system. (28) Successor in interest means the mental health hospital owned and operated by the State that provides acute inpatient care and replaces the Vermont State Hospital. (29) Peer means an individual who has a personal experience of living with a mental health condition or psychiatric disability. (30) Peer services means support services provided by trained peers or peer-managed organizations focused on helping individuals with mental health and other co-occurring conditions to support recovery. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1973, No. 107,  3; 1977, No. 245 (Adj. Sess.),  2; 1977, No. 248 (Adj. Sess.),  7; 1977, No. 252 (Adj. Sess.),  2; 1977, No. 257 (Adj. Sess.),  1, 4; 1977, No. 264 (Adj. Sess.),  6; 1989, No. 187 (Adj. Sess.),  5; 1995, No. 174 (Adj. Sess.),  3; 2005, No. 174 (Adj. Sess.),  35, 140; 2007, No. 15,  9; 2011, No. 79 (Adj. Sess.),  17, eff. April 4, 2012; 2013, No. 96 (Adj. Sess.),  100; 2013, No. 161 (Adj. Sess.),  72; 2013, No. 192 (Adj. Sess.),  1.) 
 7102. Out-of-state patients
Nothing in this part of this title shall be deemed to alter or impair the application or availability to any patient, while hospitalized in a state outside Vermont pursuant to contractual arrangements under subdivision 7401(6) of this title, of any rights, remedies, or protective safeguards provided by the law of that state or by the Interstate Compact on Mental Health where applicable. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7103. Disclosure of information
(a) All certificates, applications, records, and reports, other than an order of a court made for the purposes of this part of this title, and directly or indirectly identifying a patient or former patient or an individual whose hospitalization or care has been sought or provided under this part, together with clinical information relating to such persons shall be kept confidential and shall not be disclosed by any person except insofar: (1) as the individual identified, the individuals health care agent under section 5264 of this title, or the individuals legal guardian, if any or, if the individual is an unemancipated minor, his or her parent or legal guardian shall consent in writing; (2) as disclosure may be necessary to carry out any of the provisions of this part;(3) as a court may direct upon its determination that disclosure is necessary for the conduct of proceedings before it and that failure to make disclosure would be contrary to the public interest; or (4) as the disclosure is made to comply with the reporting requirements of section 7617a of this title or 13 V.S.A.  4824. (b) Nothing in this section shall preclude disclosure, upon proper inquiry, of information concerning medical condition to the individuals family, clergy, physician, attorney, the individuals health care agent under section 5264 of this title, a person to whom disclosure is authorized by a validly executed durable power of attorney for health care, or to an interested party. (c) Any person violating this section shall be fined not more than $2,000.00 or imprisoned for not more than one year, or both. (d) Nothing in 12 V.S.A.  1612(a) shall affect the provisions of this section.(e) Mandatory disclosure to home providers.(1) With the written consent of the individual or his or her guardian, an agency designated by the Department of Disabilities, Aging, and Independent Living or of Health to provide developmental disability and mental health services shall disclose all relevant information, in writing, to a potential home care provider for that individual so that the provider has the opportunity to make a fully informed decision prior to the placement. (2) If the individual or his or her guardian does not consent to the disclosure, the placement will not occur unless the home care provider agrees, in writing, to the placement, absent disclosure. (3) A home care provider must furnish to any person providing respite care, the individuals relevant information obtained from the agency designated by the Department of Disabilities, Aging, and Independent Living or of Health to provide developmental disability and mental health services, as provided in this subsection. Where the home care provider has agreed to placement without disclosure, the home care provider shall inform the respite provider of that fact. (4) Home care and respite providers, whether or not they agree to a placement, shall be subject to the confidentiality and disclosure requirements of subsections (a), (b), and (c) of this section. (5) As used in this subsection:(A) Home care provider means a person or entity paid by an agency designated by the Department of Disabilities, Aging, and Independent Living or of Health to provide developmental disability and mental health services, to provide care in his or her home. (B) Relevant information means information needed to protect the individual and others from harm, including any relevant history of violent behavior or conduct causing danger of harm to others, as defined in subdivision 7101(17)(A) of this title, any medications presently prescribed to the individual, and any known precursors of dangerous behavior that may cause future harm. (C) Respite provider means a person, paid by a home care provider, to provide care by the day or overnight in the persons home. (6) Any written disclosure of relevant information under this subsection shall also include notice of the confidentiality and disclosure requirements of this section. (7) Where the individual has consented to disclosure, an agency designated by the Department of Disabilities, Aging, and Independent Living or of Health to provide developmental disability and mental health services shall provide updated information regarding the individual to the home care provider. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1981, No. 221 (Adj. Sess.),  3; 2001, No. 103 (Adj. Sess.),  1, eff. May 15, 2002; 2005, No. 174 (Adj. Sess.),  36; 2015, No. 14,  5, eff. Oct. 1, 2015.) 
 7104. Wrongful hospitalization or denial of rights; fraud; elopement
A person shall be fined not more than $500.00 or imprisoned not more than one year, or both, if he or she willfully causes, or conspires with or assists another to cause: (1) the hospitalization of an individual knowing that the individual is not mentally ill or in need of hospitalization or treatment as an individual with a mental illness or intellectual disability; or (2) the denial to any individual of any rights granted to him or her under this part of this title; or (3) the voluntary admission to a hospital of an individual, knowing that he or she is not mentally ill or eligible for treatment, thereby attempting to defraud the State; or (4) the elopement of any patient from a hospital or who knowingly harbors any patient who has eloped, or who aids in abducting a patient who has been conditionally discharged from the person or persons in whose care and service that patient has been legally placed. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2013, No. 96 (Adj. Sess.),  100; 2019, No. 131 (Adj. Sess.),  123.) 
 7105. Arrest of eloped persons
Any sheriff, deputy sheriff, constable, or officer of state or local police, and any officer or employee of any designated hospital or designated program may arrest any person who has eloped from a designated hospital or designated program and return such person. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1987, No. 248 (Adj. Sess.),  8; 2017, No. 113 (Adj. Sess.),  97.) 
 7106. Notice of hospitalization and discharge
Whenever a patient has been admitted to a hospital other than upon his or her own application, the head of the hospital shall immediately notify the patients legal guardian, spouse, parent, or parents, or nearest known relative or interested party, if known. If the involuntary hospitalization or admission was without court order, notice shall also be given to the Superior Court judge for the Family Division of the Superior Court in the unit wherein the hospital is located. If the hospitalization or admission was by order of any court, the head of the hospital admitting or discharging an individual shall forthwith make a report thereof to the Commissioner and to the court which entered the order for hospitalization or admission. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  3; 2009, No. 154 (Adj. Sess.),  150.) 
 7107. Extramural work
Any hospital in the State dealing with mental health may do, or procure to be done, extramural work in the way of prevention, observation, care, and consultation with respect to mental health. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 2017, No. 113 (Adj. Sess.),  98.) 
 7109. Sale of articles; revolving fund
(a) The superintendent of a hospital or training school may sell articles made by the patients or students in the handiwork or occupational therapy departments of the institution and the proceeds thereof shall be credited to a revolving fund. When it is for their best interest, the superintendent may, with the consent of the patients or their legal representatives, employ patients or students or permit them to be employed on a day placement basis. (b) The consent of the patient or the legal representative of the patient or student shall, in consideration of the undertaking of the superintendent, contain the further agreement that one-half the earnings of the patient or student shall be credited to the personal account of the patient or student so employed at interest for benefit of the patient or student and the balance shall be credited to the fund. The superintendent shall hold and expend the fund for the purchase of equipment and materials for the handicraft or group therapy departments and for the educational and recreational welfare of the patient or student group. He or she shall submit an annual report of the fund to the Commissioner. Balances remaining in it at the end of a fiscal year shall be carried forward and be available for the succeeding fiscal year. (c) For purposes of this section the legal representative of the patient or student shall be the duly appointed guardian, the spouse, the parents, or the next of kin legally responsible for the patient or student. In their absence, the Commissioner shall be the legal representative. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 146 (Adj. Sess.),  2.) 
 7110. Certification of mental illness
A certification of mental illness by a licensed physician required by section 7504 of this title shall be made by a board eligible psychiatrist, a board certified psychiatrist, or a resident in psychiatry, under penalty of perjury. In areas of the State where board eligible psychiatrists, board certified psychiatrists, or residents in psychiatry are not available to complete admission certifications to the Vermont State Hospital or its successor in interest, the Commissioner may designate other licensed physicians as appropriate to complete certification for purposes of section 7504 of this title. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 145 (Adj. Sess.),  1; 1995, No. 154 (Adj. Sess.),  1; 2011, No. 79 (Adj. Sess.),  19, eff. April 4, 2012.) 
 7111. Right to legal counsel
In any proceeding before, or notice to, a court of this State involving a patient or student, or a proposed patient or student, that person shall be afforded counsel, and if the patient or student or proposed patient or student is unable to pay for counsel, compensation shall be paid by the State to counsel assigned by the court; however, this section shall not apply to a proceeding under section 7505 of this title. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  4.) 
 7112. Appeals
A patient may appeal any decision of the Board. The appeal shall be to the Family Division of the Superior Court of the county wherein the hospital is located. The appeal shall be taken in such manner as the Supreme Court may by rule provide, except that there shall not be any stay of execution of the decision appealed from. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1971, No. 185 (Adj. Sess.),  187, eff. March 29, 1972; 1973, No. 244 (Adj. Sess.),  1; 1977, No. 252 (Adj. Sess.),  5; 2009, No. 154 (Adj. Sess.),  150a.) 
 7113. Independent examination; payment
Whenever a court orders an independent examination by a mental health professional or a qualified developmental disabilities professional pursuant to this title or 13 V.S.A.  4822, the cost of the examination shall be paid by the Department of Disabilities, Aging, and Independent Living or of Health. The mental health professional or qualified developmental disabilities professional may be selected by the court but the Commissioner of Disabilities, Aging, and Independent Living or of Mental Health may adopt a reasonable fee schedule for examination, reports, and testimony. (Added 1991, No. 231 (Adj. Sess.),  8; amended 1995, No. 174 (Adj. Sess.),  3; 2005, No. 174 (Adj. Sess.),  37; 2007, No. 15,  10; 2013, No. 96 (Adj. Sess.),  100.) 
 7114. Safety policies for employees delivering direct social or mental health services
(a) The Secretary of Human Services, in consultation with each department of the Agency, shall establish and maintain a workplace violence prevention and crisis response policy for the benefit of employees delivering direct social or mental health services pursuant to 33 V.S.A.  8201. (b) The Secretary shall ensure that the Agencys contracts with providers described in 33 V.S.A.  8201(a)(2) require the providers to establish and maintain a written workplace violence prevention and crisis response policy for the benefit of employees delivering direct social or mental health services pursuant to 33 V.S.A.  8201. (Added 2015, No. 109 (Adj. Sess.),  2, eff. Jan. 1, 2017.) 
 7201. Mental health
(a) The Department of Mental Health, as the successor to the Division of Mental Health Services of the Department of Health, shall centralize and more efficiently establish the general policy and execute the programs and services of the State concerning mental health, and integrate and coordinate those programs and services with the programs and services of other departments of the State, its political subdivisions, and private agencies, so as to provide a flexible comprehensive service to all citizens of the State in mental health and related problems. (b) The Department shall ensure equal access to appropriate mental health care in a manner equivalent to other aspects of health care as part of an integrated, holistic system of care. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1989, No. 187 (Adj. Sess.),  5; 1995, No. 174 (Adj. Sess.),  3; 2005, No. 174 (Adj. Sess.),  38; 2007, No. 15,  11; 2017, No. 200 (Adj. Sess.),  12.) 
 7202. Coordination
The Department of Mental Health shall be responsible for coordinating efforts of all agencies and services, government and private, on a statewide basis in order to promote and improve the mental health of individuals through outreach, education, and other activities. The Department of Disabilities, Aging, and Independent Living shall be responsible for coordinating the efforts of all agencies and services, government and private, on a statewide basis in order to promote and improve the lives of individuals with developmental disabilities. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1987, No. 264 (Adj. Sess.),  7; 2005, No. 174 (Adj. Sess.),  38; 2007, No. 15,  11.) 
 7204. Planning; grants; clinics
The Department is the authority in this State for planning a comprehensive mental health program. It may apply for and receive grants from the federal government and other sources for that planning. It shall operate such clinics and other mental health units as it may consider necessary and shall fulfill the States responsibilities as to community mental health services, so far as practical. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7205. Supervision of institutions
(a) The Department of Mental Health shall operate the Vermont State Hospital or its successor in interest and shall be responsible for patients receiving involuntary treatment. (b) The Commissioner of the Department of Mental Health, in consultation with the Secretary, shall appoint a Chief Executive Officer of the Vermont State Hospital or its successor in interest to oversee the operations of the hospital. The Chief Executive Officer position shall be an exempt position. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 2005, No. 174 (Adj. Sess.),  38; 2007, No. 15,  11; 2011, No. 63,  E.315.1; 2011, No. 79 (Adj. Sess.),  20, eff. April 4, 2012.) 
 7206. Recommendations and reports
The Department shall from time to time study comprehensively the mental health problems of the State, develop programs for mental health services, and recommend as to the integration within the Department of any other related agencies and services as it considers proper. It shall also periodically review and evaluate the mental health programs. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 2005, No. 174 (Adj. Sess.),  38.) 
 7207. Commissioner of Mental Health; appointment; qualifications
The Secretary shall appoint a Commissioner of Mental Health, as provided in 3 V.S.A.  3051, who shall be a mental health care professional who has had educational and practical experience in the field of mental health. (Added 2007, No. 15,  13.) 
 7208. Definitions
As used in this chapter:(1) Adult foster care shall have the same meaning as in 33 V.S.A.  502.(2) Home care services shall have the same meaning as in 33 V.S.A.  502. (Added 2007, No. 37,  2.)
 7251. Principles for mental health care reform
The General Assembly adopts the following principles as a framework for reforming the mental health care system in Vermont: (1) The State of Vermont shall meet the needs of individuals with a mental condition or psychiatric disability, including the needs of individuals in the custody of the Commissioner of Corrections, and the States mental health system shall reflect excellence, best practices, and the highest standards of care. (2) Long-term planning shall look beyond the foreseeable future and present needs of the mental health community. Programs shall be designed to be responsive to changes over time in levels and types of needs, service delivery practices, and sources of funding. (3) Vermonts mental health system shall provide a coordinated continuum of care by the Departments of Mental Health and of Corrections, designated hospitals, designated agencies, and community and peer partners to ensure that individuals with a mental condition or psychiatric disability receive care in the most integrated and least restrictive settings available. Individuals treatment choices shall be honored to the extent possible. (4) The mental health system shall be integrated into the overall health care system and ensure equal access to appropriate mental health care in a manner equivalent to other aspects of health care as part of an integrated, holistic system of care. (5) Vermonts mental health system shall be geographically and financially accessible. Resources shall be distributed based on demographics and geography to increase the likelihood of treatment as close to the patients home as possible. All ranges of services shall be available to individuals who need them, regardless of individuals ability to pay. (6) The States mental health system shall ensure that the legal rights of individuals with a mental condition or psychiatric disability are protected. (7) Oversight and accountability shall be built into all aspects of the mental health system. (8) Vermonts mental health system shall be adequately funded and financially sustainable to the same degree as other health services. (9) Individuals with a psychiatric disability or mental condition who are in the custody or temporary custody of the Commissioner of Mental Health and who receive treatment in an acute inpatient hospital unit, an intensive residential recovery facility, or a secure residential recovery facility shall be afforded rights and protections that reflect evidence-based best practices aimed at reducing the use of emergency involuntary procedures. (Added 2011, No. 79 (Adj. Sess.),  1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.),  101; 2015, No. 21,  2, eff. May 13, 2015; 2017, No. 200 (Adj. Sess.),  13.) 
 7252. Definitions
As used in this chapter:(1) Adult outpatient services means flexible services responsive to individuals preferences, needs, and values that are necessary to stabilize, restore, or improve the level of social functioning and well-being of individuals with a mental condition, including individual and group treatment, medication management, psychosocial rehabilitation, and case management services. (2) Designated agency means a designated community mental health and developmental disability agency as described in subsection 8907(a) of this title. (3) Designated area means the counties, cities, or towns identified by the Department of Mental Health that are served by a designated agency. (4) Enhanced programming means targeted, structured, and specific intensive mental health treatment and psychosocial rehabilitation services for individuals in individualized or group settings. (5) Intensive residential recovery facility means a licensed program under contract with the Department of Mental Health that provides a safe, therapeutic, recovery-oriented residential environment to care for individuals with one or more mental conditions or psychiatric disabilities who need intensive clinical interventions to facilitate recovery in anticipation of returning to the community. This facility shall be for individuals not in need of acute inpatient care and for whom the facility is the least restrictive and most integrated setting. (6) Mobile support team means professional and peer support providers who are able to respond to an individual where he or she is located during a crisis situation. (7) Noncategorical case management means service planning and support activities provided for adults by a qualified mental health provider, regardless of program eligibility criteria or insurance limitations. (8) No refusal system means a system of hospitals and intensive residential recovery facilities under contract with the Department of Mental Health that provides high-intensity services, in which the facilities shall admit any individual for care if the individual meets the eligibility criteria established by the Commissioner in contract. (9) Participating hospital means a hospital under contract with the Department of Mental Health to participate in the no refusal system. (10), (11) [Repealed.](12) Psychosocial rehabilitation means a range of social, educational, occupational, behavioral, and cognitive interventions for increasing the role performance and enhancing the recovery of individuals with a serious mental condition or psychiatric disability, including services that foster long-term recovery and self-sufficiency. (13) Recovery-oriented means a system or services that emphasize the process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. (14) Serious bodily injury means the same as in section 1912 of this title.(15) Warm line means a nonemergency telephone response line operated by trained peers for the purpose of active listening and assistance with problem-solving for persons in need of such support. (Added 2011, No. 79 (Adj. Sess.),  1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.),  101; 2013, No. 192 (Adj. Sess.),  1a.) 
 7253. Clinical resource management and oversight
The Commissioner of Mental Health, in consultation with health care providers as defined in section 9432 of this title, including designated hospitals, designated agencies, individuals with mental conditions or psychiatric disabilities, and other stakeholders, shall design and implement a clinical resource management system that ensures the highest quality of care and facilitates long-term, sustained recovery for individuals in the custody of the Commissioner. (1) For the purpose of coordinating the movement of individuals across the continuum of care to the most appropriate services, the clinical resource management system shall: (A) Ensure that all individuals in the care and custody of the Commissioner receive the highest quality and least restrictive care necessary. (B) Develop a process for receiving direct input from persons receiving services on treatment opportunities and the location of services. (C) Use State-employed clinical resource management coordinators to work collaboratively with community partners, including designated agencies, hospitals, individuals with mental conditions or psychiatric disabilities, and peer groups, to ensure access to services for individuals in need. Clinical resource management coordinators or their designees shall be available 24 hours a day, seven days a week to assist emergency service clinicians in the field to access necessary services. (D) Use an electronic, web-based bed board to track in real time the availability of bed resources across the continuum of care. (E) Use specific level-of-care descriptions, including admission, continuing stay, and discharge criteria, and a mechanism for ongoing assessment of service needs at all levels of care. (F) Specify protocols for medical clearance, bed location, transportation, information sharing, census management, and discharge or transition planning. (G) Coordinate transportation resources so that individuals may access the least restrictive mode of transport consistent with safety needs. (H) Ensure that to the extent patients protected health information pertaining to any identifiable person that is otherwise confidential by State or federal law is used within the clinical resource management system, the health information exchange privacy standards and protocols as described in subsection 9351(e) of this title shall be followed. (I) Review the options for the use of ambulance transport, with security as needed, as the least restrictive mode of transport consistent with safety needs required pursuant to section 7511 of this title. (J) Ensure that individuals under the custody of the Commissioner being served in designated hospitals, intensive residential recovery facilities, and the secure residential recovery facility shall have access to a mental health patient representative. The patient representative shall advocate for persons receiving services and shall also foster communication between persons receiving services and health care providers. The Department of Mental Health shall contract with an independent, peer-run organization to staff the full-time equivalent of a representative of persons receiving services. (2) For the purpose of maintaining the integrity and effectiveness of the clinical resource management system, the Department of Mental Health shall: (A) require a designated team of clinical staff to review the treatment received and clinical progress made by individuals within the Commissioners custody; (B) coordinate care across the mental and physical health care systems as well as ensure coordination within the Agency of Human Services, particularly the Department of Corrections, the Department of Healths Division of Substance Use Programs, and the Department of Disabilities, Aging, and Independent Living; (C) coordinate service delivery with Vermonts Blueprint for Health and health care reform initiatives, including the health information exchange as defined in section 9352 of this title and the Health Benefit Exchange as defined in 33 V.S.A.  1803; (D) use quality measures, manageable data requirements, and quality improvement processes to monitor, evaluate, and continually improve the results for individuals and the performance of the clinical resource management system; (E) actively engage stakeholders and providers in oversight processes; and(F) provide mechanisms for dispute resolution. (Added 2011, No. 79 (Adj. Sess.),  1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.),  101; 2015, No. 11,  18; 2021, No. 115 (Adj. Sess.),  4, eff. July 1, 2022.)
 7254. Integration of the treatment for mental health, substance abuse, and physical health
(a) The Director of Health Care Reform and the Commissioners of Mental Health, of Health, and of Vermont Health Access and the Green Mountain Care Board or designees shall ensure that the redesign of the mental health delivery system established in this chapter is an integral component of the health care reform efforts coordinated pursuant to 3 V.S.A.  3027. Specifically, the Director, Commissioners, and Board shall confer on planning efforts necessary to ensure that the following initiatives are coordinated and advanced: (1) any health information technology projects;(2) the integration of health insurance benefits in the Vermont Health Benefit Exchange to the extent feasible under federal law; (3) the integration of coverage under Green Mountain Care;(4) the Blueprint for Health;(5) the reformation of payment systems for health services to the extent allowable under federal law or under federal waivers; and (6) other initiatives as necessary.(b) The Department of Financial Regulation shall ensure that private payers are educated about their obligation to reimburse providers for less restrictive and less expensive alternatives to hospitalization. (Added 2011, No. 79 (Adj. Sess.),  1a, eff. April 4, 2012; amended 2011, No. 78 (Adj. Sess.),  2, eff. April 2, 2012; 2017, No. 85,  F.8, eff. June 28, 2017.) 
 7255. System of care
The Commissioner of Mental Health shall coordinate a geographically diverse system and continuum of mental health care throughout the State that shall include at least the following: (1) comprehensive and coordinated community services, including prevention, to serve children, families, and adults at all stages of mental condition or psychiatric disability; (2) peer services, which may include:(A) a warm line;(B) peer-provided transportation services;(C) peer-supported crisis services; and(D) peer-supported hospital diversion services;(3) alternative treatment options for individuals seeking to avoid or reduce reliance on medications; (4) recovery-oriented housing programs;(5) intensive residential recovery facilities;(6) appropriate and adequate psychiatric inpatient capacity for voluntary patients;(7) appropriate and adequate psychiatric inpatient capacity for involuntary inpatient treatment services, including persons receiving treatment through court order from a civil or criminal court; and (8) a secure residential recovery facility. (Added 2011, No. 79 (Adj. Sess.),  1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.),  101.)
 7256. Reporting requirements
Notwithstanding 2 V.S.A.  20(d), the Department of Mental Health shall report annually on or before January 15 to the Senate Committee on Health and Welfare and the House Committee on Human Services regarding the extent to which individuals with a mental health condition or psychiatric disability receive care in the most integrated and least restrictive setting available. The Department shall consider measures from a variety of sources, including the Joint Commission, the National Quality Forum, the Centers for Medicare and Medicaid Services, the National Institute of Mental Health, and the Substance Abuse and Mental Health Services Administration. The report shall address: (1) use of services across the continuum of mental health services;(2) adequacy of the capacity at each level of care across the continuum of mental health services; (3) individual experience of care and satisfaction;(4) individual recovery in terms of clinical, social, and legal results;(5) performance of the States mental health system of care as compared to nationally recognized standards of excellence; (6) ways in which patient autonomy and self-determination are maximized within the context of involuntary treatment and medication; (7) performance measures that demonstrate results and other data on individuals for whom petitions for involuntary medication are filed; and (8) progress on alternative treatment options across the system of care for individuals seeking to avoid or reduce reliance on medications, including supported withdrawal from medications. (Added 2011, No. 79 (Adj. Sess.),  1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.),  101; 2013, No. 192 (Adj. Sess.),  2; 2015, No. 11,  19.) 
 7257. Reportable adverse events
(a) An acute inpatient hospital, an intensive residential recovery facility, a designated agency, or a secure residential facility shall report to the Department of Mental Health instances of death or serious bodily injury to individuals with a mental condition or psychiatric disability in the custody or temporary custody of the Commissioner. (b) An acute inpatient hospital shall report to the Department of Mental Health any staff injuries caused by a person in the custody or temporary custody of the Commissioner that are reported to both the Department of Labor and to the hospitals workers compensation carrier. (Added 2011, No. 79 (Adj. Sess.),  1a, eff. April 4, 2012; amended 2013, No. 96 (Adj. Sess.),  101; 2013, No. 192 (Adj. Sess.),  3.) 
 7257a. Mental Health Crisis Response Commission
(a) There is created the Mental Health Crisis Response Commission within the Office of the Attorney General for the following purposes: (1) to conduct reviews of law enforcement interactions with persons acting in a manner that created reason to believe a mental health crisis was occurring and resulted in a fatality or serious bodily injury to any party to the interaction; (2) to identify where increased or alternative supports or strategic investments within law enforcement, designated agencies, or other community service systems could improve outcomes; (3) to educate the public, service providers, and policymakers about strategies for intervention in and prevention of mental health crises; (4) to recommend policies, practices, and services that will encourage collaboration and increase successful interventions between law enforcement and persons acting in a manner that created reason to believe a mental health crisis was occurring; (5) to recommend training strategies for public safety, emergency, or other crisis response personnel that will increase successful interventions; and (6) to make recommendations based on the review of cases before the Commission.(b)(1) Each incident involving an interaction between law enforcement and a person acting in a manner that created reason to believe a mental health crisis was occurring that results in a death or serious bodily injury to any party shall be referred to the Office of the Attorney General by the relevant law enforcement agency for review, analysis, and recommendations within 60 days of the incident. Interactions not resulting in death or serious bodily injury may be referred for optional review to the Commission, including review of interactions with positive outcomes that could serve to provide guidance on effective strategies. A law enforcement officer or mental health crisis responder involved in such an interaction is encouraged to refer it to the Commission. (2) The review process shall not commence until any criminal prosecution arising out of the incident is concluded or the Attorney General and States Attorney provide written notice to the Commission that no criminal charges shall be filed. (c)(1) The Commission shall comprise the following members:(A) the Attorney General or designee from a division other than that investigating the interaction; (B) the Commissioner of Mental Health or designee;(C) a member of the Vermont State Police, appointed by the Commissioner of Public Safety;(D) a representative of frontline local law enforcement, appointed by the Vermont Association of Chiefs of Police; (E) the Executive Director of the Vermont Criminal Justice Council or designee;(F) a representative of the designated agencies, appointed by Vermont Care Partners;(G) the director of Disability Rights Vermont or designee;(H) an individual who has a personal experience of living with a mental condition or psychiatric disability, appointed by Vermont Psychiatric Survivors; (I) a family member of an individual who experienced or is experiencing a mental condition or psychiatric disability, appointed by the Vermont chapter of the National Alliance on Mental Illness; and (J) two regionally diverse at-large members, appointed by the Governor, who are not representative of subdivisions (A)-(G) of this subdivision (c)(1), such as an emergency dispatcher, specialist in interactions between law enforcement and individuals with a perceived mental condition, or a representative of the Vermont Human Rights Commission or Vermont Legal Aid. (2) The members of the Commission specified in subdivision (1) of this subsection shall serve two-year terms. Any vacancy on the Commission shall be filled in the same manner as the original appointment. The replacement member shall serve for the remainder of the unexpired term. (3) Members who are part of an organization involved in an interaction under review shall recuse themselves from that review and shall not access any information related to it. The Commission may appoint an interim replacement member to fill the category represented by the recused member for review of that interaction. (d)(1) The Attorney General or designee shall call the first meeting of the Commission to occur on or before September 30, 2017. (2) The Commission shall select a chair and vice chair from among its members at the first meeting, and annually thereafter. (3) The Commission shall meet at such times as may reasonably be necessary to carry out its duties, but at least once in each calendar quarter. (e) In any case under review by the Commission, upon written request of the Commission, a person who possesses information or records that are necessary and relevant to review an interaction shall, as soon as practicable, provide the Commission with the information and records. The Commission may subpoena information or records necessary and relevant to the review of an interaction from any person who does not provide information or records in his or her possession to the Commission upon receiving an initial written request. A person who provides information or records upon request of the Commission is not criminally or civilly liable for providing information or records in compliance with this section. (f) The proceedings and records of the Commission are confidential and are not subject to subpoena, discovery, or introduction into evidence in a civil or criminal action. The Commission shall not use the information, records, or data for purposes other than those designated by subsections (a) and (i) of this section. (g) To the extent permitted under federal law, the Commission may enter into agreements with nonprofit organizations and private agencies to obtain otherwise confidential information. (h) Commission meetings are confidential and shall be exempt from 1 V.S.A. chapter 5, subchapter 2 (the Vermont Open Meeting Law). Commission records are exempt from public inspection and copying under the Public Records Act and shall be kept confidential. (i) Notwithstanding 2 V.S.A.  20(d), the Commission shall report its conclusions and recommendations to the Governor, General Assembly, and Chief Justice of the Vermont Supreme Court as the Commission deems necessary, but no less frequently than once per calendar year. The report shall disclose individually identifiable health information only to the extent necessary to convey the Commissions conclusions and recommendations, and any such disclosures shall be limited to information already known to the public. The report shall be available to the public through the Office of the Attorney General. (Added 2017, No. 45,  1; amended 2017, No. 113 (Adj. Sess.),  99.) 
 7257b. Emergency Service Provider Wellness Commission
(a) As used in this section:(1) Chief executive of an emergency service provider organization means a person in charge of an organization that employs or supervises emergency service providers in their official capacity. (2) Emergency service provider means a person:(A) currently or formerly recognized by a Vermont fire department as a firefighter;(B) currently or formerly licensed by the Department of Health as an emergency medical technician, emergency medical responder, advanced emergency medical technician, or paramedic; (C) currently or formerly certified as a law enforcement officer by the Vermont Criminal Justice Council, including constables and sheriffs; (D) currently or formerly employed by the Department of Corrections as a probation, parole, or correctional facility officer; (E) currently or formerly certified by the Vermont Enhanced 911 Board as a 911 call taker or employed as an emergency communications dispatcher providing service for an emergency service provider organization; or (F) currently or formerly registered as a ski patroller at a Vermont ski resort with the National Ski Patrol or Professional Ski Patrol Association. (3) Licensing entity means a State entity that licenses or certifies an emergency service provider. (b) There is created the Emergency Service Provider Wellness Commission within the Agency of Human Services that, in addition to the purposes listed below, shall consider the diversity of emergency service providers on the basis of gender, race, age, ethnicity, sexual orientation, gender identity, disability status, and the unique needs that emergency service providers who have experienced trauma may have as a result of their identity status: (1) to identify where increased or alternative supports or strategic investments within the emergency service provider community, designated or specialized service agencies, or other community service systems could improve the physical and mental health outcomes and overall wellness of emergency service providers; (2) to identify how Vermont can increase capacity of qualified clinicians in the treatment of emergency service providers to ensure that the services of qualified clinicians are available throughout the State without undue delay; (3) to create materials and information, in consultation with the Department of Health, including a list of qualified clinicians, for the purpose of populating an electronic emergency service provider wellness resource center on the Department of Healths website; (4) to educate the public, emergency service providers, State and local governments, employee assistance programs, and policymakers about best practices, tools, personnel, resources, and strategies for the prevention and intervention of the effects of trauma experienced by emergency service providers; (5) to identify gaps and strengths in Vermonts system of care for both emergency service providers who have experienced trauma and their immediate family members to ensure access to support and resources that address the impacts of primary and secondary trauma; (6) to recommend how peer support services and qualified clinician services can be delivered regionally or statewide; (7) to recommend how to support emergency service providers in communities that are resource challenged, remote, small, or rural; (8) to recommend policies, practices, training, legislation, rules, and services that will increase successful interventions and support for emergency service providers to improve health outcomes, job performance, and personal well-being and reduce health risks, violations of employment, and violence associated with the impact of untreated trauma, including whether to amend Vermonts employment medical leave laws to assist volunteer emergency service providers in recovering from the effects of trauma experienced while on duty; and (9) to consult with federal, State, and municipal agencies, organizations, entities, and individuals in order to make any other recommendations the Commission deems appropriate. (c)(1) The Commission shall comprise the following members and, to the extent feasible, include representation among members that reflects the gender, gender identity, racial, age, ethnic, sexual orientation, social, and disability status of emergency service providers in the State: (A) the Chief of Training of the Vermont Fire Academy or designee;(B) a representative, appointed by the Vermont Criminal Justice Council;(C) the Commissioner of Health or designee;(D) the Commissioner of Public Safety or designee;(E) the Commissioner of Corrections or designee;(F) the Commissioner of Mental Health or designee;(G) the Commissioner of Human Resources or designee;(H) a law enforcement officer who is not a chief or sheriff, appointed by the President of the Vermont Police Association; (I) a representative, appointed by the Vermont Association of Chiefs of Police;(J) a representative, appointed by the Vermont Sheriffs Association;(K) a volunteer firefighter, appointed by the Vermont State Firefighters Association;(L) a representative of the designated and specialized service agencies, appointed by Vermont Care Partners; (M) a representative, appointed by the Vermont State Employees Association;(N) a representative, appointed by the Vermont Troopers Association;(O) a professional firefighter, appointed by the Professional Firefighters of Vermont;(P) a clinician associated with a peer support program who has experience in treating workplace trauma, appointed by the Department of Mental Health; (Q) a professional emergency medical technician or paramedic, appointed by the Vermont State Ambulance Association; (R) a volunteer emergency medical technician or paramedic, appointed by the Vermont State Ambulance Association; (S) a person who serves or served on a peer support team, appointed by the Department of Mental Health; (T) a representative, appointed by the Vermont League of Cities and Towns;(U) a Chief, appointed by the Vermont Career Fire Chiefs Association;(V) a Chief, appointed by the Vermont Fire Chiefs Association;(W) a representative, appointed by the Vermont Association for Hospitals and Health Systems;(X) the Executive Director of the Enhanced 911 Board or designee; and(Y) a member of the National Ski Patrol appointed by consensus agreement of the National Ski Patrol Northern Vermont and Southern Vermont Regional Directors. (2) The term of office of each member shall be three years. Of the members first appointed, 10 shall be appointed for a term of one year, 10 shall be appointed for a term of two years, and the remainder shall be appointed for a term of three years. Members shall hold office for the term of their appointments and until their successors have been appointed. All vacancies shall be filled for the balance of the unexpired term in the same manner as the original appointment. Members are eligible for reappointment. (3) Commission members shall recuse themselves from any discussion of an event or circumstance that the member believes may involve an emergency service provider known by the member and shall not access any information related to it. The Commission may appoint an interim replacement member to fill the category represented by the recused member for review of that interaction. (d)(1) The Commissioner of Health or designee shall call the first meeting of the Commission to occur on or before September 30, 2021. (2) The Commission shall select a chair and vice chair from among its members at the first meeting and annually thereafter. (3) The Commission shall meet at such times as may reasonably be necessary to carry out its duties but at least once in each calendar quarter. (4) The Department of Health shall provide technical, legal, and administrative assistance to the Commission. (e) The Commissions meetings shall be open to the public in accordance with 1 V.S.A. chapter 5, subchapter 2. Notwithstanding 1 V.S.A.  313, the Commission may go into executive session in the event a circumstance or an event involving a specific emergency service provider is described, regardless of whether the emergency service provider is identified by name. (f) Commission records describing a circumstance or an event involving a specific emergency service provider, regardless of whether the emergency service provider is identified by name, are exempt from public inspection and copying under the Public Records Act and shall be kept confidential. (g) To the extent permitted under federal law, the Commission may enter into agreements with agencies, organizations, and individuals to obtain otherwise confidential information. (h) Notwithstanding 2 V.S.A.  20(d), the Commission shall report its conclusions and recommendations to the Governor and General Assembly as the Commission deems necessary but not less frequently than once per calendar year. The report shall disclose individually identifiable health information only to the extent necessary to convey the Commissions conclusions and recommendations, and any such disclosures shall be limited to information already known to the public. The report shall be available to the public through the Department of Health. (Added 2021, No. 37,  1; amended 2021, No. 134 (Adj. Sess.),  7a, eff. May 24, 2022.) 
 7258. Review of adverse community events
The Department of Mental Health shall establish a system that ensures the comprehensive review of a death or serious bodily injury occurring outside an acute inpatient hospital when the individual causing or victimized by the death or serious bodily injury is in the custody of the Commissioner or had been in the custody of the Commissioner within six months of the event. The Department shall review each event for the purpose of determining whether the death or serious bodily injury was the result of inappropriate or inadequate services within the mental health system and, if so, how the failure shall be remedied. (Added 2011, No. 79 (Adj. Sess.),  1a, eff. April 4, 2012.) 
 7259. Mental Health Care Ombudsman
(a) The Department of Mental Health shall establish the Office of the Mental Health Care Ombudsman within the agency designated by the Governor as the protection and advocacy system for the State pursuant to 42 U.S.C.  10801 et seq. The agency may execute the duties of the Office of the Mental Health Care Ombudsman, including authority to assist individuals with mental health conditions and to advocate for policy issues on their behalf; provided, however, that nothing in this section shall be construed to impose any additional duties on the agency in excess of the requirements under federal law. (b) The agency may provide a report annually to the General Assembly regarding the implementation of this section. (c) In the event the protection and advocacy system ceases to provide federal funding to the agency for the purposes described in this section, the General Assembly may allocate sufficient funds to maintain the Office of the Mental Health Care Ombudsman. (d) The Department of Mental Health shall provide a copy of the certificate of need for all emergency involuntary procedures performed on a person in the custody or temporary custody of the Commissioner to the Office of the Mental Health Care Ombudsman on a monthly basis. (Added 2011, No. 171 (Adj. Sess.),  11f; amended 2013, No. 192 (Adj. Sess.),  4.) 
 7301. Creation
The State Board of Mental Health is created. It shall consist of seven persons, two of whom are physicians and one an attorney. A member may not be a trustee, officer, or employee of any institution for mental patients. Biennially the Governor shall appoint, with the advice and consent of the senate, two or three members for terms of six years in such manner that three terms expire in each third biennial year and two in other biennial years. The Board, with the advice of the Commissioner, shall make Department policy. Biennially or when a vacancy occurs the Board shall elect a Chair and a Secretary. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7302. Subcommittee on institutions
The Board may delegate to a subcommittee on institutions, composed of two doctors and a lawyer, its functions under sections 7305, 7306, and 7308-7313 of this title; and the action of a majority of the subcommittee shall be that of the Board. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7304. Persons not hospitalized
The Board shall have general jurisdiction of persons with an intellectual disability or mental illness who have been discharged from a hospital by authority of the Board. It shall also have jurisdiction of persons with a mental illness or intellectual disability of the State not hospitalized, so far as concerns their physical and mental condition and their care, management, and medical treatment and shall make such orders therein as each case duly brought to its attention requires. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2013, No. 96 (Adj. Sess.),  102; 2017, No. 113 (Adj. Sess.),  100.) 
 7305. Powers of Board
The Board may administer oaths, summon witnesses before it in a case under investigation, and discharge by its order, in writing, any person confined as a patient in a hospital whom it finds on investigation to be wrongfully hospitalized or in a condition to warrant discharge. The Board shall discharge patients, not criminals, who have eloped from a hospital and have not been apprehended at the expiration of six months from the time of their elopement. The Board shall not order the discharge of a patient without giving the superintendent of the hospital an opportunity to be heard. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7309. Referrals from Governor
The Governor may refer the case of a patient in a hospital to the Board for its investigation. The Board shall investigate the case and by its order grant such relief as each case requires. If the Board is without power to grant the necessary relief it shall cause proceedings to be commenced in a court of competent jurisdiction at the expense of the State, in order to obtain the necessary relief and promote the ends of justice and humanity. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7310. Petition for inquiry
The attorney or guardian of a patient or any other interested party may apply to the Board to inquire into the treatment and hospitalization of a patient, and the Board shall take appropriate action upon the application. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7311. Investigation
If, in the judgment of the Board, an investigation is necessary, it shall appoint a time and place for hearing and give the patients attorney, guardian, spouse, parent, adult child, or interested party, if any, in that order, and the head of the hospital reasonable notice thereof. At the time appointed, it shall conduct a hearing and make any lawful order the case requires. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 2017, No. 113 (Adj. Sess.),  101.) 
 7312. Penalty; failure to obey summons
A person legally summoned as a witness before the Board on behalf of the State, or summoned by other parties with a tender of his or her fees, which shall be the same as those allowed witnesses in a Criminal Division of the Superior Court, who willfully and wrongfully refuses to attend or testify shall be imprisoned not more than six months or fined not more than $100.00 nor less than $10.00, or both. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 2009, No. 154 (Adj. Sess.),  238.) 
 7313. Board shall visit institution
The Board shall ascertain by examination and inquiry whether the laws relating to individuals in custody or control are properly observed and may use all necessary means to collect all desired information. It shall carefully inspect every part of the hospital or training school visited with reference to its cleanliness and sanitary condition, determine the number of patients or students in seclusion or restraint, the diet of the patients or students, and any other matters which it considers material. It shall offer to every patient or student an opportunity for an interview with its visiting members or agents, and shall investigate those cases which in its judgment require special investigation, and particularly shall ascertain whether any individuals are retained at any hospital or training school who ought to be discharged. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7314. Reciprocal agreements
The Board may enter into reciprocal agreements with corresponding state agencies of other states regarding the interstate transportation or transfer of persons with a psychiatric or intellectual disability and arrange with the proper officials in this State for the acceptance, transfer, and support of residents of this State who are temporarily detained or receiving care in public institutions of other states in accordance with the terms of such agreements. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2013, No. 96 (Adj. Sess.),  103.) 
 7315. Definition
As used in this chapter, the term hospital shall include a secure residential recovery facility as defined in subsection 7620(e) of this title. (Added 2011, No. 160 (Adj. Sess.),  1, eff. May 17, 2012.) 
 7401. Powers and duties
Except insofar as this part of this title specifically confers certain powers, duties, and functions upon others, the Commissioner shall be charged with its administration. The Commissioner may: (1) With the approval of the Governor, organize the Agency, including the creation, rearrangement, and abolition of divisions and lesser units and control and coordinate services as to most efficiently carry out the purposes of this part. (2) Adopt, amend, and repeal and enforce rules and regulations not inconsistent with this part as are reasonably necessary for its operation. (3) Designate, control, and supervise the property, affairs, and operation of hospitals and institutions equipped and otherwise qualified to provide inpatient care and treatment for individuals who are mentally ill. (4) Supervise the operation of community mental health units.(5) Supervise the care and treatment of individuals within his or her custody.(6) Provide for the hospitalization of mentally ill patients in designated hospitals or institutions of Vermont or negotiate and enter into contracts which shall incorporate safeguards consistent with this part of this title, with any hospital or institution for the care and treatment of patients in any other state. (7) Prescribe the form of applications, records, reports, and medical certificates required by the statutes, and the information to be contained therein and supply them to physicians and the Probate Division of the Superior Courts. (8) Require reports from the head of a hospital or other institution concerning the care of patients. (9) Visit each hospital or institution and review methods of care for all patients.(10) Investigate complaints made by a patient, his or her attorney, or an interested party on his or her behalf. (11) Establish rates, charges, and fees for the care of patients in hospitals and determine ability to pay, liability for payments, and amounts to be paid and bill for and collect those amounts with the aid of the Attorney General. (12) Receive gifts and bequests of real and personal estate made for the use and benefit of any State hospital and invest any monies so received in safe, interest-bearing securities in the corporate name of the hospital. (13) Delegate to any officer or agency of Vermont any of the duties and powers imposed upon him or her by this part of this title. The delegation of authority and responsibility shall not relieve the Commissioner of accountability for the proper administration of this part of this title. (14) Plan and coordinate the development of community services which are needed to assist children and adolescents with or at risk for a severe emotional disturbance and individuals with a mental condition or psychiatric disability to become as financially and socially independent as possible. These services shall consist of residential, vocational, rehabilitative, day treatment, inpatient, outpatient, and emergency services, as well as client assessment, prevention, family, and individual support services, and such other services as may be required by federal law or regulations. (15) Contract with community mental health centers to assure that children and adolescents with or at risk for a severe emotional disturbance or individuals with a mental condition or psychiatric disability can receive information, referral, and assistance in obtaining those community services which they need and to which they are lawfully entitled. (16) Contract with accredited educational or health care institutions for psychiatric services at the Vermont State Hospital or its successor in interest. (17) Ensure the provision of services to children and adolescents with or at risk for a severe emotional disturbance in coordination with the Secretary of Education and the Commissioner for Children and Families in accordance with the provisions of 33 V.S.A. chapter 43. (18) Ensure the development of community-based prevention and early intervention services for children and adults and ensure the coordination of these services throughout all parts of the public and private health care delivery systems. (19) Ensure the development of chronic care services, addressing mental health and substance abuse, for children and adults and ensure the coordination of these services with other chronic care initiatives, including the Blueprint for Health, and the care coordination and case management programs of the Department of Vermont Health Access. (20) Ensure the coordination of mental health, physical health, and substance abuse services provided by the public and private health care delivery systems. (21) Ensure the coordination of public mental health and substance abuse services with mental health and substance abuse services offered through the private health care delivery system, including services offered by primary care physicians. (22) Oversee and seek to have patients receive treatment in secure residential recovery facilities as defined in subsection 7620(e) of this title. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  3, 4; 1985, No. 225 (Adj. Sess.),  15; 1987, No. 264 (Adj. Sess.),  8, 9; 2005, No. 174 (Adj. Sess.),  39; 2007, No. 15,  13a; 2009, No. 146 (Adj. Sess.),  C11; 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2009, No. 156 (Adj. Sess.),  I.24; 2011, No. 79 (Adj. Sess.),  23, eff. April 4, 2012; 2011, No. 160 (Adj. Sess.),  2, eff. May 17, 2012; 2013, No. 92 (Adj. Sess.),  257, 302, eff. Feb. 14, 2014; 2013, No. 96 (Adj. Sess.),  104.) 
 7402. Records and reports
The Commissioner shall keep records of all commitments and admissions to a hospital and shall secure compliance with the laws relating thereto. The Commissioner shall report biennially to the Governor and the General Assembly on the condition of hospitals, on the physical and medical treatment of patients therein, on the need for community services to former patients and persons with a mental condition or psychiatric disability not hospitalized, and on any other matters the Commissioner deems advisable. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  2; 2005, No. 174 (Adj. Sess.),  39; 2013, No. 92 (Adj. Sess.),  302; 2013, No. 96 (Adj. Sess.),  104.) 
 7404. Accounts of receipts and expenditures
The Commissioner shall cause to be kept a true and just account of all receipts and expenditures. His or her report shall contain the account together with a tabulated statement of the work done by the State hospital during the preceding two years. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7405. Property in trust
The Commissioner may take and hold in trust for the State any grant or devise of land or donation or bequest of money, or other personal property, to be applied to the maintenance of persons who are mentally ill. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  39.) 
 7406. Contracts
The Commissioner, with the approval of the Governor, may enter into contracts with the federal government or its agencies for the care, treatment, or observation of those mentally ill entitled to support by the federal government or agency as the Commissioner may deem desirable. The receipts from those contracts shall be paid by the Superintendent to the State Treasurer to be applied to the General Fund. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  39.) 
 7407. Mental health advisor
The Commissioner, upon the request of the Commissioner of Motor Vehicles, shall designate an appropriate professional member of the Department to serve as advisor to the Commissioner of Motor Vehicles on the mental health aspects of the licensing of motor vehicle operators. (Added 1971, No. 147 (Adj. Sess.), eff. Feb. 14, 1972.) 
 7408. Electroconvulsive therapy
The Commissioner shall oversee the use of electroconvulsive therapy in Vermont and may adopt rules to govern the practice of electroconvulsive therapy. The Commissioners duties shall include: (1) establishment of a uniform informed consent process, forms, and materials;(2) oversight and monitoring of all facilities administering electroconvulsive therapy; and (3) the collection of statistical data on the use of electroconvulsive therapy from all treating facilities. (Added 1999, No. 92 (Adj. Sess.),  1.) 
 7501. Authority to receive patients
The head of a hospital which has been officially designated by the Commissioner may receive therein for observation, diagnosis, care, and treatment any individual whose admission is sought on proper application. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7502. Control and treatment of patients
A person admitted to a hospital shall be subject to the control and treatment of the head of the hospital and the Board until his or her condition warrants his or her release, or until he or she has been lawfully removed or otherwise discharged. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7503. Application for voluntary admission
(a) Any person 14 years of age or over may apply for voluntary admission to a designated hospital for examination and treatment. (b) Before the person may be admitted as a voluntary patient, the person shall give consent in writing on a form adopted by the Department. The consent shall include a representation that: (1) the person understands that treatment will involve inpatient status;(2) the person desires to be admitted to the hospital;(3) the person consents to admission voluntarily, without any coercion or duress; and(4) the person understands that inpatient treatment may be on a locked unit, and a requested discharge may be deferred if the treating physician determines that the person is a person in need of treatment pursuant to section 7101 of this title. (c) If the person is under 14 years of age, he or she may be admitted as a voluntary patient if he or she consents to admission, as provided in subsection (b) of this section, and if a parent or guardian makes written application. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  6; 2021, No. 30,  1.) 
 7504. Application and certificate for emergency examination
(a) Upon written application by an interested party made under the pains and penalties of perjury and accompanied by a certificate by a licensed physician who is not the applicant, a person shall be held for admission to a hospital for an emergency examination to determine if he or she is a person in need of treatment. The application and certificate shall set forth the facts and circumstances that constitute the need for an emergency examination and that show that the person is a person in need of treatment. (b) The application and certificate shall be authority for transporting the person to a hospital for an emergency examination, as provided in section 7511 of this title. (c) For the purposes of admission of an individual to a designated hospital for care and treatment under this section, a head of a hospital, as provided in subsection (a) of this section, may include a person designated in writing by the head of the hospital to discharge the authority granted in this section. A designated person must be an official hospital administrator, supervisory personnel, or a licensed physician on duty on the hospital premises other than the certifying physician under subsection (a) of this section. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1969, No. 33,  2, eff. April 1, 1969; 1973, No. 107,  4; 1977, No. 252 (Adj. Sess.),  7; 2003, No. 122 (Adj. Sess.),  141f; 2013, No. 192 (Adj. Sess.),  5, eff. Nov. 1, 2014.) 
 7505. Warrant and certificate for emergency examination
(a) In emergency circumstances where certification by a physician is not available without serious and unreasonable delay, and when personal observation of the conduct of a person constitutes reasonable grounds to believe that the person is a person in need of treatment, and he or she presents an immediate risk of serious injury to himself or herself or others if not restrained, a law enforcement officer or mental health professional may make an application, not accompanied by a physicians certificate, to any Superior judge for a warrant for an emergency examination. (b) The law enforcement officer or mental health professional may take the person into temporary custody and shall apply to the court without delay for the warrant. (c) If the judge is satisfied that a physicians certificate is not available without serious and unreasonable delay, and that probable cause exists to believe that the person is in need of an emergency examination, he or she may order the person to submit to an evaluation by a physician for that purpose. (d) If necessary, the court may order the law enforcement officer or mental health professional to transport the person to a hospital for an evaluation by a physician to determine if the person should be certified for an emergency examination. (e) A person transported pursuant to subsection (d) of this section shall be evaluated as soon as possible after arrival at the hospital. If after evaluation the licensed physician determines that the person is a person in need of treatment, he or she shall issue an initial certificate that sets forth the facts and circumstances constituting the need for an emergency examination and showing that the person is a person in need of treatment. Once the physician has issued the initial certificate, the person shall be held for an emergency examination in accordance with section 7508 of this title. If the physician does not certify that the person is a person in need of treatment, he or she shall immediately discharge the person and cause him or her to be returned to the place from which he or she was taken, or to such place as the person reasonably directs. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  8; 2013, No. 192 (Adj. Sess.),  6, eff. Nov. 1, 2014.) 
 7508. Emergency examination and second certification
(a) When an initial certification is issued for an emergency examination of a person in accordance with section 7504 or subsection 7505(e) of this title, he or she shall be examined and certified by a psychiatrist as soon as practicable, but not later than 24 hours after initial certification. (b) If the person is held for admission on an application and physicians certificate, the examining psychiatrist shall not be the same physician who signed the certificate. (c) If the psychiatrist does not issue a second certification stating that the person is a person in need of treatment, he or she shall immediately discharge or release the person and cause him or her to be returned to the place from which he or she was taken or to such place as the person reasonably directs. (d) If the psychiatrist does issue a second certification that the person is a person in need of treatment, the person may continue to be held for an additional 72 hours, at which time the person shall be discharged or released, unless within that period: (1) the person has accepted voluntary admission under section 7503 of this title; or(2) an application for involuntary treatment is filed with the appropriate court under section 7612 of this title, in which case the patient shall continue to be held pending the courts finding of probable cause on the application. (e)(1)(A) A person shall be deemed to be in the temporary custody of the Commissioner when the first of the following occurs: (i) a physician files an initial certification for the person while the person is in a hospital; or (ii) a person is certified by a psychiatrist to be a person in need of treatment during an emergency examination. (B) Temporary custody under this subsection shall continue until the court issues an order pursuant to subsection 7617(b) of this title or the person is discharged or released. (2) The Commissioner shall make every effort to ensure that a person held for an emergency examination pending a hospital admission is receiving temporary care and treatment that: (A) uses the least restrictive manner necessary to protect the safety of both the person and the public; (B) respects the privacy of the person and other patients; and(C) prevents physical and psychological trauma.(3) All persons admitted or held for admission shall receive a notice of rights as provided for in section 7701 of this title, which shall include contact information for Vermont Legal Aid, the Office of the Mental Health Care Ombudsman, and the mental health patient representative. The Department of Mental Health shall develop and regularly update informational material on available peer-run support services, which shall be provided to all persons admitted or held for admission. (4) A person held for an emergency examination may be admitted to an appropriate hospital at any time. (Added 1977, No. 252 (Adj. Sess.),  15; amended 2013, No. 192 (Adj. Sess.),  7, eff. Nov. 1, 2014.) 
 7509. Treatment; right of access
(a) Upon admission to the hospital pursuant to section 7503, 7508, 7617, or 7624 of this title, the person shall be treated with dignity and respect and shall be given such medical and psychiatric treatment as is indicated. (b) All persons admitted or held for admission shall be given the opportunity, subject to reasonable limitations, to communicate with others, including visits by a peer or other support person designated by the person, presence of the support person at all treatment team meetings the person is entitled to attend, the reasonable use of a telephone, and the reasonable use of electronic mail and the Internet. (c) The person shall be requested to furnish the names of persons he or she may want notified of his or her hospitalization and kept informed of his or her status. The head of the hospital shall see that such persons are notified of the status of the patient, how he or she may be contacted and visited, and how they may obtain information concerning him or her. (Added 1977, No. 252 (Adj. Sess.),  16; amended 1997, No. 114 (Adj. Sess.),  1a; 2013, No. 192 (Adj. Sess.),  8.) 
 7510. Preliminary hearing
(a) Within five days after a person is admitted to a designated hospital for emergency examination, he or she may request the Superior Court to conduct a preliminary hearing to determine whether there is probable cause to believe that he or she was a person in need of treatment at the time of his or her admission. (b) The court shall conduct the hearing within three working days of the filing of the request. The court shall cause timely notice of the preliminary hearing to be given to the patient or his or her attorney, the hospital, and the attorney for the applicant. (c) The individual has the right to be present and represented by legal counsel at the preliminary hearing. (d) If probable cause to believe that the individual was a person in need of treatment at the time of his or her admission is established at the preliminary hearing, the individual shall be ordered held for further proceedings in accordance with the law. If probable cause is not established, the individual shall be ordered discharged from the hospital and the court shall order him or her returned to the place from which he or she was transported or to his or her home. (e) Upon a showing of need, the court may grant a reasonable continuance to either the patients attorney or the attorney for the State. (Added 1977, No. 252 (Adj. Sess.),  17; amended 2009, No. 154 (Adj. Sess.),  238; 2019, No. 167 (Adj. Sess.),  20, eff. Oct. 7, 2020.) 
 7511. Transportation
(a) The Commissioner shall ensure that all reasonable and appropriate measures consistent with public safety are made to transport or escort a person subject to this chapter to and from any inpatient setting, including escorts within a designated hospital or the Vermont State Hospital or its successor in interest or otherwise being transported under the jurisdiction of the Commissioner in any manner which: (1) prevents physical and psychological trauma;(2) respects the privacy of the individual; and(3) represents the least restrictive means necessary for the safety of the patient.(b) The Commissioner shall have the authority to designate the professionals or law enforcement officers who may authorize the method of transport of patients under the Commissioners care and custody. (c) When a professional or law enforcement officer designated pursuant to subsection (b) of this section decides an individual is in need of secure transport with mechanical restraints, the reasons for such determination shall be documented in writing. (d) It is the policy of the State of Vermont that mechanical restraints are not routinely used on persons subject to this chapter unless circumstances dictate that such methods are necessary. (Added 2003, No. 122 (Adj. Sess.),  141e; amended 2005, No. 180 (Adj. Sess.),  2; 2007, No. 15,  14; 2011, No. 79 (Adj. Sess.),  24, eff. April 4, 2012.) 
 7611. Involuntary treatment
No person may be made subject to involuntary treatment unless he or she is found to be a person in need of treatment or a patient in need of further treatment. (Added 1977, No. 252 (Adj. Sess.),  18.) 
 7612. Application for involuntary treatment
(a) An interested party may, by filing a written application, commence proceedings for the involuntary treatment of an individual by judicial process. (b) The application shall be filed in the Family Division of the Superior Court.(c) If the application is filed under section 7508 or 7620 of this title, it shall be filed in the unit of the Family Division of the Superior Court in which the hospital is located. In all other cases, it shall be filed in the unit in which the proposed patient resides. In the case of a nonresident, it may be filed in any unit. The court may change the venue of the proceeding to the unit in which the proposed patient is located at the time of the trial. (d) The application shall contain:(1) The name and address of the applicant.(2) A statement of the current and relevant facts upon which the allegation of mental illness and need for treatment is based. The application shall be signed by the applicant under penalty of perjury. (e) The application shall be accompanied by:(1) a certificate of a licensed physician, which shall be executed under penalty of perjury stating that he or she has examined the proposed patient within five days of the date the petition is filed and is of the opinion that the proposed patient is a person in need of treatment, including the current and relevant facts and circumstances upon which the physicians opinion is based; or (2) a written statement by the applicant that the proposed patient refused to submit to an examination by a licensed physician. (f) Before an examining physician completes the certificate of examination, he or she shall consider available alternative forms of care and treatment that might be adequate to provide for the persons needs without requiring hospitalization. The examining physician shall document on the certificate the specific alternative forms of care and treatment that he or she considered and why those alternatives were deemed inappropriate, including information on the availability of any appropriate alternatives. (Added 1977, No. 252 (Adj. Sess.),  19; amended 2009, No. 154 (Adj. Sess.),  238; 2013, No. 192 (Adj. Sess.),  9.) 
 7612a. Probable cause review
(a) Within three days after an application for involuntary treatment is filed, the Family Division of the Superior Court shall conduct a review to determine whether there is probable cause to believe that the person was a person in need of treatment at the time of his or her admission. The review shall be based solely on the application for an emergency examination and accompanying certificate by a licensed physician and the application for involuntary treatment. (b) If, based on a review conducted pursuant to subsection (a) of this section, the court finds probable cause to believe that the person was a person in need of treatment at the time of his or her admission, the person shall be ordered held in the temporary custody of the Commissioner for further proceedings in accordance with Part 8 of this title. If probable cause is not established, the person shall be ordered discharged or released from the hospital and returned to the place from which he or she was transported or to such place as the person may reasonably direct. (c) An application for involuntary treatment shall not be dismissed solely because the probable cause review is not completed within the time period required by this section if there is good cause for the delay. (Added 2013, No. 192 (Adj. Sess.),  10.) 
 7613. NoticeAppointment of counsel
(a) When the application is filed, the court shall appoint counsel for the proposed patient and transmit a copy of the application, the physicians certificate, if any, and a notice of hearing to the proposed patient, his or her attorney, guardian, or any person having custody and control of the proposed patient, the States Attorney, or the Attorney General, and any other person the court believes has a concern for the proposed patients welfare. A copy of the notice of hearing shall also be transmitted to the applicant and certifying physician. (b) The notice of hearing shall set forth the date and time of the hearing and shall contain a list of the proposed patients rights at the hearing. (c) If the court has reason to believe that notice to the proposed patient will be likely to cause injury to the proposed patient or others, it shall direct the proposed patients counsel to give the proposed patient oral notice prior to written notice under circumstances most likely to reduce likelihood of injury. (Added 1977, No. 252 (Adj. Sess.),  20.) 
 7614. Psychiatric examination
As soon as practicable after notice of the commencement of proceedings is given, the court on its own motion or upon the motion of the proposed patient or his or her attorney or the State of Vermont shall authorize examination of the proposed patient by a psychiatrist other than the physician making the original certification. The examination and subsequent report or reports shall be paid for by the State of Vermont. The physician shall report his or her finding to the party requesting the report or to the court if it requested the examination. (Added 1977, No. 252 (Adj. Sess.),  21.) 
 7615. Hearing on application for involuntary treatment
(a)(1) Upon receipt of the application, the court shall set a date for the hearing to be held within 10 days from the date of the receipt of the application or 20 days from the date of the receipt of the application if a psychiatric examination is ordered under section 7614 of this title unless the hearing is continued by the court pursuant to subsection (b) of this section. (2)(A) The applicant or a person who is certified as a person in need of treatment pursuant to section 7508 of this title may file a motion to expedite the hearing. The motion shall be supported by an affidavit, and the court shall rule on the motion on the basis of the filings without holding a hearing. The court: (i) shall grant the motion if it finds that the person demonstrates a significant risk of causing the person or others serious bodily injury as defined in 13 V.S.A.  1021 even while hospitalized, and clinical interventions have failed to address the risk of harm to the person or others; (ii) may grant the motion if it finds that the person has received involuntary medication pursuant to section 7624 of this title during the past two years and, based upon the persons response to previous and ongoing treatment, there is good cause to believe that additional time will not result in the person establishing a therapeutic relationship with providers or regaining competence. (B) If the court grants the motion for expedited hearing pursuant to this subdivision, the hearing shall be held within ten days from the date of the order for expedited hearing. (3) If a hearing on the application for involuntary treatment has not occurred within 60 days from the date of the courts receipt of the application, the Commissioner shall request that the court and both parties attorneys provide the reasons for the delay. The Commissioner shall submit a report to the court, the Secretary of Human Services, and the patients attorney that either explains why the delay was warranted or makes recommendations as to how delays of this type can be avoided in the future. (b)(1) For hearings held pursuant to subdivision (a)(1) of this section, the court may grant each party a onetime extension of up to seven days for good cause. (2) The court may grant one or more additional seven-day continuances if:(A) the court finds that the proceeding or parties would be substantially prejudiced without a continuance; or (B) the parties stipulate to the continuance.(c) The hearing shall be conducted according to the Vermont Rules of Evidence, and to an extent not inconsistent with this part, the Vermont Rules of Civil Procedure shall be applicable. (d) The applicant and the proposed patient shall have a right to appear at the hearing to testify. The attorney for the State and the proposed patient shall have the right to subpoena, present, and cross-examine witnesses, and present oral arguments. The court may, at its discretion, receive the testimony of any other person. (e) The proposed patient may at his or her election attend the hearing, subject to reasonable rules of conduct, and the court may exclude all persons, except a peer or other support person designated by the proposed patient, not necessary for the conduct of the hearing. (Added 1977, No. 252 (Adj. Sess.),  22; amended 2009, No. 154 (Adj. Sess.),  238; 2013, No. 192 (Adj. Sess.),  11.) 
 7616. Appearance by State; burden of proof
(a) The State shall appear and be represented by the States Attorney for the county in which the hearing takes place or by the Attorney General at his or her discretion. (b) The State shall have the burden of proving its case by clear and convincing evidence.(c) The Attorney for the State shall have the authority to dismiss the application at any stage of the proceeding. (Added 1977, No. 252 (Adj. Sess.),  23.) 
 7617. Findings; order
(a) If the court finds that the proposed patient was not a person in need of treatment at the time of admission or application or is not a patient in need of further treatment at the time of the hearing, the court shall enter a finding to that effect and shall dismiss the application. (b) If the proposed patient is found to have been a person in need of treatment at the time of admission or application and a patient in need of further treatment at the time of the hearing, the court may order the person: (1) hospitalized in a designated hospital;(2) hospitalized in any other public or private hospital if he or she and the hospital agree; or (3) to undergo a program of treatment other than hospitalization.(c) Prior to ordering any course of treatment, the court shall determine whether there exists an available program of treatment for the person which is an appropriate alternative to hospitalization. The court shall not order hospitalization without a thorough consideration of available alternatives. (d) Before making its decision, the court shall order testimony by an appropriate representative of a hospital, a community mental health agency, public or private entity or agency, or a suitable person, who shall assess the availability and appropriateness for the individual of treatment programs other than hospitalization. (e) Prior to ordering the hospitalization of a person, the court shall inquire into the adequacy of treatment to be provided to the person by the hospital. Hospitalization shall not be ordered unless the hospital in which the person is to be hospitalized can provide him or her with treatment which is adequate and appropriate to his or her condition. (f) Preference between available hospitals shall be given to the hospital which is located nearest to the persons residence, except when the person requests otherwise or there are other compelling reasons for not following the preference. (Added 1977, No. 252 (Adj. Sess.),  24.) 
 7617a. Reporting; National Instant Criminal Background Check System
(a) If the court issues a hospitalization order pursuant to subdivision 7617(b)(1) or (2) of this title or a nonhospitalization order pursuant to subdivision 7617(b)(3), the Court Administrator shall within 48 hours report the name of the person subject to the order to the National Instant Criminal Background Check System, established by Section 103 of the Brady Handgun Violence Prevention Act of 1993. The report shall include only information sufficient to identify the person, the reason for the report, and a statement that the report is made in accordance with 18 U.S.C.  922(g)(4). (b) A report required by this section shall be submitted notwithstanding section 7103 of this title or any other provision of law. (c) A report required by this section is confidential and exempt from public inspection and copying under the Public Records Act except as provided in subsection (d) of this section. The report shall not be used for any purpose other than for submission to the National Instant Criminal Background Check System pursuant to this section, where it may be used for any purpose permitted by federal law, including in connection with the issuance of a firearm-related permit or license. (d) A copy of the report required by this section shall be provided to the person who is the subject of the report. The report shall include written notice to the person who is the subject of the report that the person is not permitted to possess a firearm. (Added 2015, No. 14,  6, eff. Oct. 1, 2015.) 
 7618. Order; nonhospitalization
(a) If the court finds that a treatment program other than hospitalization is adequate to meet the persons treatment needs, the court shall order the person to receive whatever treatment other than hospitalization is appropriate for a period of 90 days. (b) If at any time during the specified period it comes to the attention of the court either that the patient is not complying with the order or that the alternative treatment has not been adequate to meet the patients treatment needs, the court may, after proper hearing: (1) Consider other alternatives, modify its original order, and direct the patient to undergo another program of alternative treatment for the remainder of the 90-day period; or (2) Enter a new order directing that the patient be hospitalized for the remainder of the 90-day period. (Added 1977, No. 252 (Adj. Sess.),  25.) 
 7619. Order; hospitalization
An initial order of hospitalization shall be for a period of 90 days from the date of the hearing. (Added 1977, No. 252 (Adj. Sess.),  26.) 
 7620. Application for continued treatment
(a) If, prior to the expiration of any order issued in accordance with section 7623 of this title, the Commissioner believes that the condition of the patient is such that the patient continues to require treatment, the Commissioner shall apply to the court for a determination that the patient is a patient in need of further treatment and for an order of continued treatment. (b) An application for an order authorizing continuing treatment shall contain a statement setting forth the reasons for the Commissioners determination that the patient is a patient in need of further treatment, a statement describing the treatment program provided to the patient, and the results of that course of treatment. (c) Any order of treatment issued in accordance with section 7623 of this title shall remain in force pending the courts decision on the application. (d) If the Commissioner seeks to have the patient receive the further treatment in a secure residential recovery facility, the application for an order authorizing continuing treatment shall expressly state that such treatment is being sought. The application shall contain, in addition to the statements required by subsection (b) of this section, a statement setting forth the reasons for the Commissioners determination that clinically appropriate treatment for the patients condition can be provided safely only in a secure residential recovery facility. (e) As used in this chapter:(1) Secure, when describing a residential facility, means that the residents can be physically prevented from leaving the facility by means of locking devices or other mechanical or physical mechanisms. (2) Secure residential recovery facility means a residential facility, licensed as a therapeutic community residence as defined in 33 V.S.A.  7102(11), for an individual who no longer requires acute inpatient care but who does remain in need of treatment within a secure setting for an extended period of time. A secure residential recovery facility shall not be used for any purpose other than the purposes permitted by this section. (Added 1977, No. 252 (Adj. Sess.),  27; amended 1997, No. 114 (Adj. Sess.),  2; 2011, No. 160 (Adj. Sess.),  3, eff. May 17, 2012.) 
 7621. Hearing on application for continued treatment; orders
(a) The hearing on the application for continued treatment shall be held in accordance with the procedures set forth in sections 7613, 7614, 7615, and 7616 of this title. (b) If the court finds that the patient is a patient in need of further treatment and requires hospitalization, it shall order hospitalization for up to one year. (c) If the court finds that the patient is a patient in need of further treatment but does not require hospitalization, it shall order nonhospitalization for up to one year. If the treatment plan proposed by the Commissioner for a patient in need of further treatment includes admission to a secure residential recovery facility, the court may at any time, on its own motion or on motion of an interested party, review the need for treatment at the secure residential recovery facility. (d) If at any time during the period of nonhospitalization ordered under subsection (c) of this section, it comes to the attention of the court that the person is not complying with the order or that the alternative treatment has not been adequate to meet the patients treatment needs, the court may, after proper hearing: (1) Consider other treatments not involving hospitalization, modify its original order, and direct the patient to undergo another program of alternative treatment for an indeterminate period, up to the expiration date of the original order; or (2) Order that the patient be hospitalized, up to the expiration date of the original order. (e) If the court finds that the patient is not a patient in need of further treatment, it shall order the patient discharged. (f) This section shall not be construed to prohibit the court from issuing subsequent orders after a new application is filed pursuant to section 7620 of this title. (Added 1977, No. 252 (Adj. Sess.),  28; amended 1997, No. 114 (Adj. Sess.),  3; 2011, No. 160 (Adj. Sess.),  4, eff. May 17, 2012.) 
 7622. Expert testimony
(a) A mental health professional testifying at hearings conducted under this part may, if appropriately qualified, give opinion testimony and, notwithstanding 12 V.S.A.  1612, describe any information which he or she acquired in attending the patient. (b) The facts or data in the particular case, upon which an expert bases an opinion or inference, may be those perceived by or made known to him or her at or before the hearing. If of a type reasonably relied upon by experts in the particular field in forming opinions or inferences upon the subject, the facts or data need not be admissible in evidence. (Added 1977, No. 252 (Adj. Sess.),  29.) 
 7623. Orders; custody
All court orders of hospitalization, nonhospitalization, and continued treatment shall be directed to the Commissioner and shall admit the patient to his or her care and custody for the period specified. (Added 1977, No. 252 (Adj. Sess.),  30.) 
 7624. Application for involuntary medication
(a) The Commissioner may commence an action for the involuntary medication of a person who is refusing to accept psychiatric medication and meets any one of the following six conditions: (1) has been placed in the Commissioners care and custody pursuant to section 7619 of this title or subsection 7621(b) of this title; (2) has previously received treatment under an order of hospitalization and is currently under an order of nonhospitalization, including a person on an order of nonhospitalization who resides in a secure residential recovery facility; (3) has been committed to the custody of the Commissioner of Corrections as a convicted felon and is being held in a correctional facility which is a designated facility pursuant to section 7628 of this title and for whom the Departments of Corrections and of Mental Health have determined jointly that involuntary medication would be appropriate pursuant to 28 V.S.A.  907(4)(H); (4) has an application for involuntary treatment pending for which the court has granted a motion to expedite pursuant to subdivision 7615(a)(2)(A)(i) of this title; (5)(A) has an application for involuntary treatment pending;(B) waives the right to a hearing on the application for involuntary treatment until a later date; and (C) agrees to proceed with an involuntary medication hearing without a ruling on whether he or she is a person in need of treatment; or (6) has had an application for involuntary treatment pending pursuant to subdivision 7615(a)(1) of this title for more than 26 days without a hearing having occurred and the treating psychiatrist certifies, based on specific behaviors and facts set forth in the certification, that in his or her professional judgment there is good cause to believe that: (A) additional time will not result in the person establishing a therapeutic relationship with providers or regaining competence; and (B) serious deterioration of the persons mental condition is occurring.(b)(1) Except as provided in subdivisions (2), (3), and (4) of this subsection, an application for involuntary medication shall be filed in the Family Division of the Superior Court in the county in which the person is receiving treatment. (2) If the application for involuntary medication is filed pursuant to subdivision (a)(4) of this section: (A) the application shall be filed in the county in which the application for involuntary treatment is pending; and (B) the court shall consolidate the application for involuntary treatment with the application for involuntary medication and rule on the application for involuntary treatment before ruling on the application for involuntary medication. (3) If the application for involuntary medication is filed pursuant to subdivision (a)(5) or (a)(6) of this section, the application shall be filed in the county in which the application for involuntary treatment is pending. (4) Within 72 hours of the filing of an application for involuntary medication pursuant to subdivision (a)(6) of this section, the court shall determine, based solely upon a review of the psychiatrists certification and any other filings, whether the requirements of that subdivision have been established. If the court determines that the requirements of subdivision (a)(6) of this section have been established, the court shall consolidate the application for involuntary treatment with the application for involuntary medication and hear both applications within ten days of the date that the application for involuntary medication is filed. The court shall rule on the application for involuntary treatment before ruling on the application for involuntary medication. Subsection 7615(b) of this title shall apply to applications consolidated pursuant to this subdivision. (c) The application shall include a certification from the treating physician, executed under penalty of perjury, that includes the following information: (1) the nature of the persons mental illness;(2) that the person is refusing medication proposed by the physician;(3) that the person lacks the competence to decide to accept or refuse medication and appreciate the consequences of that decision; (4) the necessity for involuntary medication;(5) any proposed medication, including the method, dosage range, and length of administration for each specific medication; (6) a statement of the risks and benefits of the proposed medications, including the likelihood and severity of adverse side effects and its effect on: (A) the persons prognosis with and without the proposed medications; and(B) the persons health and safety, including any pregnancy;(7) the current relevant facts and circumstances, including any history of psychiatric treatment and medication, upon which the physicians opinion is based; (8) what alternate treatments have been proposed by the doctor, the patient, or others, and the reasons for ruling out those alternatives, including information on the availability of any appropriate alternatives; and (9) whether the person has executed an advance directive in accordance with the provisions of chapter 231 of this title and the identity of the agent or agents designated by the advance directive. (d) A copy of the advance directive, if available, shall be attached to the application. (Added 1997, No. 114 (Adj. Sess.),  4; amended 2005, No. 174 (Adj. Sess.),  40; 2007, No. 15,  22; 2009, No. 154 (Adj. Sess.),  238; 2011, No. 160 (Adj. Sess.),  5, eff. May 17, 2012; 2013, No. 192 (Adj. Sess.),  12, 25.)
 7625. Hearing on application for involuntary medication; burden of proof
(a) Unless consolidated with an application for involuntary treatment pursuant to subdivision 7624(b)(2) or (b)(4) of this title, a hearing on an application for involuntary medication shall be held within seven days of filing and shall be conducted in accordance with sections 7613, 7614, and 7616 and subsections 7615(b)-(e) of this title. (b) In a hearing conducted pursuant to this section, section 7626, or section 7627 of this title, the Commissioner has the burden of proof by clear and convincing evidence. (c) In determining whether or not the person is competent to make a decision regarding the proposed treatment, the court shall consider whether the person is able to make a decision and appreciate the consequences of that decision. (Added 1997, No. 114 (Adj. Sess.),  4; amended 2013, No. 192 (Adj. Sess.),  13, 25.) 
 7626. Advance directive
(a) If a person who is the subject of an application filed under section 7624 of this title has executed an advance directive in accordance with the provisions of chapter 231 of this title, the court shall suspend the hearing and enter an order pursuant to subsection (b) of this section, if the court determines that: (1) the person is refusing to accept psychiatric medication;(2) the person is not competent to make a decision regarding the proposed treatment; and(3) the decision regarding the proposed treatment is within the scope of the valid, duly executed advance directive. (b) An order entered under subsection (a) of this section shall authorize the Commissioner to administer treatment to the person, including involuntary medication in accordance with the direction set forth in the advance directive or provided by the agent or agents acting within the scope of authority granted by the advance directive. If hospitalization is necessary to effectuate the proposed treatment, the court may order the person to be hospitalized. (c) [Repealed.](d)(1) The Commissioner of Mental Health shall develop a protocol for use by designated hospitals for the purpose of educating hospital staff on the use and applicability of advance directives pursuant to chapter 231 of this title and other written or oral expressions of treatment preferences pursuant to subsection 7627(b) of this title. (2) Prior to a patients discharge or release, a hospital shall provide information to a patient in the custody or temporary custody of the Commissioner regarding advance directives, including relevant information developed by the Vermont Ethics Network and Office of the Mental Health Care Ombudsman. (Added 1997, No. 114 (Adj. Sess.),  4; amended 2013, No. 192 (Adj. Sess.),  14, 25.) 
 7627. Court findings; orders
(a) The court shall issue an order regarding all possible findings pursuant to this section, and for persons subject to an application pursuant to subdivision 7624(a)(3) of this title, the court shall first find that the person is a person in need of treatment as defined by subdivision 7101(17) of this title. (b) If a person who is the subject of an application filed under section 7625 of this title has not executed an advance directive, the court shall follow the persons competently expressed written or oral preferences regarding medication, if any, unless the Commissioner demonstrates that the persons medication preferences have not led to a significant clinical improvement in the persons mental state in the past within an appropriate period of time. (c) If the court finds that there are no medication preferences or that the persons medication preferences have not led to a significant clinical improvement in the persons mental state in the past within an appropriate period of time, the court shall consider at a minimum, in addition to the persons expressed preferences, the following factors: (1) the persons religious convictions and whether they contribute to the persons refusal to accept medication; (2) the impact of receiving medication or not receiving medication on the persons relationship with his or her family or household members whose opinion the court finds relevant and credible based on the nature of the relationship; (3) the likelihood and severity of possible adverse side effects from the proposed medication;(4) the risks and benefits of the proposed medication and its effect on:(A) the persons prognosis; and(B) the persons health and safety, including any pregnancy; and(5) the various treatment alternatives available, which may or may not include medication.(d) As a threshold matter, the court shall consider the persons competency. If the court finds that the person is competent to make a decision regarding the proposed treatment or that involuntary medication is not supported by the factors in subsection (c) of this section, the court shall enter a finding to that effect and deny the application. (e) As a threshold matter, the court shall consider the persons competency. If the court finds that the person is incompetent to make a decision regarding the proposed treatment and that involuntary medication is supported by the factors in subsection (c) of this section, the court shall make specific findings stating the reasons for the involuntary medication by referencing those supporting factors. (f)(1) If the court grants the application, in whole or in part, the court shall enter an order authorizing the Commissioner to administer involuntary medication to the person. The order shall specify the types of medication, the permitted dosage range, length of administration, and method of administration for each. The order for involuntary medication shall not include electroconvulsive therapy, surgery, or experimental medications. A long-acting injection shall not be ordered without clear and convincing evidence, particular to the patient, that this treatment is the most appropriate under the circumstances. (2) The order shall require the persons treatment provider to conduct weekly reviews of the medication to assess the continued need for involuntary medication, the effectiveness of the medication, the existence of any side effects, and whether the patient has become competent pursuant to subsection 7625(c) of this title and shall also require the persons treatment provider to document this review in detail in the patients chart. The persons treatment provider shall notify the Department when he or she determines that the patient has regained competence. Within two days of receipt, the Department shall provide a copy of the notice to the patients attorney. (g) For a person receiving treatment pursuant to an order of hospitalization, the Commissioner may administer involuntary medication as authorized by this section to the person for up to 90 days, unless the court finds that an order is necessary for a longer period of time. Such an order shall not be longer than the duration of the current order of hospitalization. If at any time the treating psychiatrist finds that a person subject to an order for involuntary medication has become competent pursuant to subsection 7625(c) of this title, the order shall no longer be in effect. (h) For a person who had received treatment under an order of hospitalization and is currently receiving treatment pursuant to an order of nonhospitalization, if the court finds that without an order for involuntary medication there is a substantial probability that the person would continue to refuse medication and as a result would pose a danger of harm to self or others, the court may order hospitalization of the person for up to 72 hours to administer involuntary medication as ordered under this section. (i) The court may authorize future 72-hour hospitalizations of a person subject to an order under subsection (h) of this section to administer involuntary medication for 90 days following the initial hospitalization, unless the court finds that an involuntary medication order is necessary for a longer period of time. Such an order shall not be longer than the duration of the current order of nonhospitalization. (j) A future administration of involuntary medication authorized by the court under subsection (i) of this section shall occur as follows: (1) The treating physician shall execute and file with the Commissioner a certification executed under penalty of perjury that states all the following: (A) the person has refused medication;(B) the person is not competent to make a decision regarding medication and to appreciate the consequences; (C) the proposed medications, the dosage range, length of administration, and method of administration; and (D) the substantial probability that in the near future the person will pose a danger of harm to self or others if not hospitalized and involuntarily medicated. (2) Depending on the type of medication ordered, the Commissioner shall provide two to 14 days notice, as set forth in the initial court order, to the court, the person, and the persons attorney. The notice shall be given within 24 hours of receipt by the Commissioner of the physicians certification and shall state that the person may request an immediate hearing to contest the order. The person may be hospitalized in a designated hospital on the date specified in the notice for up to 72 hours in order to administer involuntary medication. (k) An order for involuntary medication issued under this section shall be effective concurrently with the current order of commitment issued pursuant to section 7623 of this title. (l) The treating physician shall provide written notice to the court to terminate the order when involuntary medication is no longer necessary. (m) At any time, the person may petition the court for review of the order.(n) As used in this section, household members means persons living together or sharing occupancy. (Added 1997, No. 114 (Adj. Sess.),  4; amended 2013, No. 192 (Adj. Sess.),  15, 25.) 
 7628. Protocol
The Department of Mental Health shall develop and adopt by rule a strict protocol to ensure the health, safety, dignity and respect of patients subject to administration of involuntary psychiatric medications in any designated hospital. This protocol shall be followed by all designated hospitals administering involuntary psychiatric medications. (Added 1997, No. 114 (Adj. Sess.),  4.) 
 7629. Legislative intent
(a) It is the intention of the General Assembly to recognize the right of a legally competent person to determine whether or not to accept medical treatment absent an emergency or a determination that the person is incompetent and lacks the ability to make a decision and appreciate the consequences. (b) The General Assembly adopts the goal of high-quality, patient-centered health care, which the Institute of Medicine defines as providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. A substitute decision-maker is sometimes necessary to make a decision about care when a person is incompetent and lacks the ability to make a decision and appreciate the consequences. Even when a person lacks competence, health care that a person is opposing should be avoided whenever possible because the distress and insult to human dignity that result from compelling a person to participate in medical treatment against his or her will are real, regardless of how poorly the person may understand the decision. (c) It is the policy of the General Assembly to work toward a mental health system that does not require coercion or the use of involuntary medication. (d) This chapter protects the rights and values described in this section through a judicial process to determine competence prior to an order for nonemergency involuntary medication and by limiting the duration of an order for involuntary treatment to no more than one year. The least restrictive order consistent with the persons right to adequate treatment shall be provided in all cases. (Added 1997, No. 114 (Adj. Sess.),  1; amended 2013, No. 192 (Adj. Sess.),  16.) 
 7701. Notice of rights
The head of a hospital shall provide reasonable means and arrangements, including the posting of excerpts from relevant statutes, for informing patients of their right to discharge and other rights and for assisting them in making and presenting requests for discharge or for application to have the patients status changed from involuntary to voluntary. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 2021, No. 30,  2.) 
 7703. Treatment
(a) Outpatient treatment or partial hospitalization shall be preferred to inpatient treatment. Emergency involuntary treatment shall be undertaken only when clearly necessary. Involuntary treatment shall be utilized only if voluntary treatment is not possible. (b) The Department shall establish minimum standards for adequate treatment as provided in this section, including requirements that, when possible, psychiatric unit staff be used as the primary source to implement emergency involuntary procedures such as seclusion and restraint. The Department shall oversee and collect information and report on data regarding the use of emergency involuntary procedures for patients admitted to a psychiatric unit regardless of whether the patient is under the care and custody of the Commissioner. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  9; 2011, No. 79 (Adj. Sess.),  25, eff. April 4, 2012; 2021, No. 30,  3.) 
 7704. Mechanical restraints
Mechanical restraints shall not be applied to a patient unless it is determined by the head of the hospital or his or her designee to be required by the medical needs of the patient or the hospital. Every use of a mechanical restraint and the reasons therefor shall be made a part of the clinical record of the patient under the signature of the head of the hospital or his or her designee. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7705. Communication and visitation
(a) Subject to the general rules and regulations of the hospital and except to the extent that the head of the hospital determines that it is necessary for the medical welfare or needs of the patient or the hospital to impose restrictions, every patient is entitled: (1) to communicate by sealed mail or otherwise with persons, including official agencies, inside or outside the hospital; (2) to receive visitors and to make and receive telephone calls; and(3) to exercise all civil rights, including the right to dispose of property, execute instruments, make purchases, enter contractual relationships, and vote on his or her own initiative, unless he or she has been adjudicated incompetent and has not been restored to legal capacity. (b) Notwithstanding any limitations or restrictions authorized by this section on the right of communication, every patient is entitled to communicate by sealed mail with the Board, the Commissioner, his or her attorney, his or her clergyman, and the District judge, if any, who ordered his or her hospitalization. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7706. Legal competence
No determination that a person requires treatment and no order of the court authorizing hospitalization or alternative treatment shall lead to a presumption of legal incompetence for matters other than treatment. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  10.) 
 7707. Record of restrictions
Any limitation imposed by the head of a hospital on the exercise of civil rights by a patient and the reasons for the limitation shall be made a part of the clinical record of the patient. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7708. Surgical operations
If the superintendent finds that a patient supported by the State requires a surgical operation or that a surgical operation would promote the possibility of his or her discharge from the hospital, the superintendent, with the consent of the patient, his or her attorney, his or her legally appointed guardian, if any, or next of kin, if any be known, may make the necessary arrangements with some surgeon and hospital for the operation. The expense of the operation shall be borne by the State in the same proportion as the patient is supported by the State. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7709. Change from involuntary to voluntary
At any time, a patient may, with the permission of the head of the hospital, have his or her status changed from involuntary to voluntary upon making application as provided in section 7503 of this title. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  11.) 
 7710. Visits by clergy or attorney
A patients clergy or an attorney at law retained by or on behalf of any patient or appointed for him or her by any court shall be admitted to visit at all reasonable times. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 7801. Application for discharge
(a) A patient who has been ordered hospitalized may apply for discharge to the Criminal Division of the Superior Court within which the hospital is located. A patient who has been ordered to receive treatment other than hospitalization may apply for discharge to the Criminal Division of the Superior Court which originally entered the order; the court in its discretion may transfer the matter, for the convenience of witnesses or for other reasons, to the Criminal Division of the Superior Court within which the treatment is centered or in which the patient resides. Applications may be made no sooner than 90 days after the issuance of an order of continued treatment or no sooner than six months after the filing of a previous application under this section. (b) The hearing on the application for discharge shall be held in accordance with the procedures set forth in sections 7613, 7614, 7615, and 7616 of this title. (c) If the court finds that the applicant is not a patient in need of further treatment, it shall order the patient discharged. (d) If the court finds that the applicant is a patient in need of further treatment, it shall deny the application and order continued treatment for an indeterminate period in accordance with subsections 7621(b), (c), and (d) of this title. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  12; 2009, No. 154 (Adj. Sess.),  238.) 
 7802. Administrative review
The head of the hospital and the Board shall cause the condition of every patient to be reviewed as regularly as practicable, but not less often than every six months, and whenever the head of a hospital or the Board certifies that the patient is not a patient in need of further treatment, the patient shall be discharged. If requested by the patient, all hearings by the Board on the issue of granting a discharge shall be on reasonable notice to the patients attorney, who shall be afforded an opportunity to attend. In the absence of any attorney, the Board shall notify the Criminal Division of the Superior Court and an attorney shall be appointed as provided in section 7111 of this title. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  13; 2009, No. 154 (Adj. Sess.),  238.) 
 7901. Intrastate transfers
The Commissioner may authorize the transfer of patients between the Vermont State Hospital or its successor in interest and designated hospitals if the Commissioner determines that it would be consistent with the medical needs of the patient to do so. Whenever a patient is transferred, written notice shall be given to the patients legal guardian or agent, if any, and any other person with the consent of the patient. In all such transfers, due consideration shall be given to the relationship of the patient to his or her family, legal guardian, or friends, so as to maintain relationships and encourage visits beneficial to the patient. Due consideration shall also be given to the separation of functions and to the divergent purposes of the Vermont State Hospital or its successor in interest and designated hospitals. No patient may be transferred to a correctional institution without the order of a court of competent jurisdiction. No patient may be transferred to a designated hospital outside the no refusal system unless the head of the hospital or his or her designee first accepts the patient. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 145 (Adj. Sess.),  2; 2005, No. 174 (Adj. Sess.),  41; 2011, No. 79 (Adj. Sess.),  26, eff. April 4, 2012.) 
 7902. Interstate transfers
(a) The transfer of nonresident patients to out-of-state facilities shall be governed by the Interstate Compact on Mental Health. (b) The transfer of nonresident patients from an out-of-state institution or hospital to a hospital in Vermont for the purpose of being near relatives or friends shall be in the discretion of the Commissioner, who shall take into consideration the relationship of the patient to his or her family, legal guardian, or friends, in order to maintain those relationships and encourage visits beneficial to the patient. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 2005, No. 174 (Adj. Sess.),  41.) 
 7903. Transfers to federal facilities
Upon receipt of a certificate from an agency of the United States that accommodations are available for the care of any individual hospitalized under this part of this title, and that the individual is eligible for care or treatment in a hospital or institution of that agency, the Commissioner may cause his or her transfer to that agency for hospitalization. The judge who ordered the individual to be hospitalized, and the attorney, guardian, if any, spouse, and parent or parents, or if none be known, an interested party, in that order, shall be notified immediately of the transfer by the Commissioner. No person may be transferred to an agency of the United States if he or she is confined pursuant to conviction of any felony or misdemeanor, or if he or she has been acquitted of a criminal charge solely on the ground of mental illness, unless prior to transfer the judge who originally ordered hospitalization of such person enters an order for the transfer after appropriate motion and hearing. Any person so transferred shall be deemed to be hospitalized by that agency pursuant to the original order of hospitalization. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 2009, No. 154 (Adj. Sess.),  150b.) 
 8003. Personal needs of patient
The Commissioner shall make any necessary arrangements to ensure:(1) that no patient is discharged or granted a conditional release from a hospital without suitable clothing; and (2) that any indigent patient discharged or granted a conditional release is furnished suitable transportation for his or her return home and an amount of money as may be prescribed by the head of the hospital to enable the patient to meet his or her immediate needs. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 252 (Adj. Sess.),  14.) 
 8005. Habeas corpus
Any individual hospitalized under this title or his or her attorney or an interested party may apply for a writ of habeas corpus from any court generally empowered to issue the writ in the jurisdiction in which he or she is detained. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8006. Visits
(a) The head of a hospital may grant a visit permit of not more than 30 days to any patient under his or her charge. (b) The granting and revocation of visits shall be made in accordance with rules and procedures adopted by the head of the hospital. (Added 1977, No. 252 (Adj. Sess.),  31.) 
 8007. Conditional discharges
(a) The Board or the head of a hospital may conditionally discharge from a hospital any patient who may be safely and properly cared for in a place other than the hospital. (b) A conditional discharge may extend for a term of six months, but shall not exceed 60 days unless the head of the hospital determines that a longer period will materially improve the availability of a program of treatment which is an alternative to hospitalization. (c) Unless sooner revoked or renewed, a conditional discharge shall become absolute at the end of its term. (d) A conditional discharge may be granted subject to the patients agreement to participate in outpatient, after-care, or follow-up treatment programs, and shall be subject to such other conditions and terms as are established by the granting authority. (e) Each patient granted a conditional discharge shall be provided, so far as practicable and appropriate, with continuing treatment on an outpatient or partial hospitalization basis. (f) Each patient granted a conditional discharge shall be given a written statement of the conditions of his or her release, the violation of which can cause revocation. (g) A conditional discharge may be renewed by the granting authority at any time before it becomes absolute if the head of a hospital first determines that such renewal will substantially reduce the risk that the patient will become a person in need of treatment in the near future. (Added 1977, No. 252 (Adj. Sess.),  32.) 
 8008. Revocation of conditional discharge
(a) The Board or the head of the hospital may revoke a conditional discharge at any time before that discharge becomes absolute if the patient fails to comply with the conditions of the discharge. (b) A revocation by the Board or the head of the hospital shall authorize the return of the patient to the hospital and shall be sufficient warrant for a law enforcement officer or mental health professional to take the patient into custody and return him or her to the hospital from which he or she was conditionally discharged. (c) Immediately upon his or her return to the hospital, the patient shall be examined by a physician who shall orally explain to the patient the purpose of the examination and the reasons why the patient was returned to the hospital. (d) If the examining physician certifies in writing to the head of the hospital that, in his or her opinion, the patient is a person in need of treatment, setting forth the recent and relevant facts supporting this opinion, the revocation shall become effective and the patient shall be readmitted to the hospital. If the examining physician does not so certify, the revocation shall be cancelled and the patient shall be returned to the place from which he or she was taken. (e) If the patient is readmitted to the hospital, he or she may apply immediately for a judicial review of his or her admission, and he or she shall be given a written notice of this right and of his or her right to legal counsel. (Added 1977, No. 252 (Adj. Sess.),  33.) 
 8009. Administrative discharge
(a) The head of the hospital may at any time discharge a voluntary or judicially hospitalized patient whom he or she deems clinically suitable for discharge. (b) The head of the hospital shall discharge a judicially hospitalized patient when the patient is no longer a patient in need of further treatment. When a judicially hospitalized patient is discharged, the head of the hospital shall notify the applicant, the certifying physician, the Family Division of the Superior Court, and anyone who was notified at the time the patient was hospitalized. (c) A person responsible for providing treatment other than hospitalization to an individual ordered to undergo a program of alternative treatment, under section 7618 or 7621 of this title, may terminate the alternative treatment to the individual if the provider of this alternative treatment considers the individual clinically suitable for termination of treatment. Upon termination of alternative treatment, the Family Division of the Superior Court shall be so notified by the provider of the alternative treatment. (Added 1977, No. 252 (Adj. Sess.),  34; amended 2009, No. 154 (Adj. Sess.),  150c.) 
 8101. Liability
(a) It shall be the duty of a patient, his or her legal representative, spouse, and, in the case of a patient who is a minor, his or her parents, in that order, to pay or contribute to the payment of the charge for the care and treatment of that patient when hospitalized under this part of this title in such manner and proportion as the Commissioner shall determine to be within their ability to pay. (b) The Commissioner shall adopt, pursuant to 3 V.S.A. chapter 25, rules that set forth in detail the levels of income, resources, expenses, and family size at which persons are deemed able to pay given amounts for the care and treatment of a patient, and the circumstances, if any, under which the rates of payment so established may be waived or modified. A copy of the payment schedule so adopted shall be made available in the admissions office at the Vermont State Hospital or its successor in interest. (c) The Commissioner shall, at the time of the hospitalization of a patient, investigate the ability to pay of persons liable under subsection (a) of this section, and may require from the liable persons sworn statements of income, resources, expenses, and family size. The Commissioner shall notify, within 30 days of the date of admission, in writing, each liable person of the amount of his or her liability and the fact that liability commences on the date of admission. The notice shall include a statement of the right of the liable person to an appeal under section 8111 of this title. (d) If any of the persons liable for support know of such liability and willfully conceal their ability to pay, they shall be ordered to pay, to the extent of their ability, charges which accrue during the period of concealment. (e) In his or her investigation, keeping of accounts, and collection of charges, the Commissioner shall have the support and cooperation of the Department for Children and Families insofar as the records of that Department relate to the ability to pay. (f) Any self pay and third party payments received from or on behalf of any patients or any residents at the Vermont Psychiatric Care Hospital, the Middlesex Therapeutic Community Residence, or their successors in interest, shall be paid to the Department of Mental Health for deposit in a special fund to offset the associated expenditures. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1973, No. 244 (Adj. Sess.),  2; 1999, No. 147 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  42; 2011, No. 79 (Adj. Sess.),  27, eff. April 4, 2012; 2015, No. 4,  88, eff. March 12, 2015; 2015, No. 23,  116.) 
 8102. Charges for care or treatment
As used in section 8101 of this title, charge for the care or treatment of a patient means an amount not exceeding the actual cost of the care and treatment. Actual cost shall mean either the rate provided for by a contract lawfully entered into under this part of this title, or, in the absence of a contract, a per diem rate as determined under section 8105 of this title. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1973, No. 244 (Adj. Sess.),  3.) 
 8103. Voluntary payments
The Commissioner may accept from any interested party any payment for the care and treatment of any patient, even if such payment is not required by an order of the Commissioner under section 8101 of this title, so long as the total payments received under section 8101 and this section do not exceed the actual cost of care and treatment. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8105. Computation of charge for care and treatment
The charge for the care and treatment of a patient at the Vermont State Hospital or its successor in interest shall be established at least annually by the Commissioner. The charge shall reflect the current cost of the care and treatment, including depreciation and overhead, for the Vermont State Hospital or its successor in interest. Depreciation shall include but not be limited to costs for the use of the plant and permanent improvements, and overhead shall include but not be limited to costs incurred by other departments and agencies for the operation of the hospital. Accounting principles and practices generally accepted for hospitals shall be followed by the Commissioner in establishing the charges. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1971, No. 154 (Adj. Sess.); 1973, No. 244 (Adj. Sess.),  4; 2011, No. 79 (Adj. Sess.),  28, eff. April 4, 2012.) 
 8106. Persons in arrears
At least every six months, the Commissioner shall ascertain those liable persons whose payments to the State are in arrears, the amount of the arrearage, and the amount of income or resources, excluding an estate of less than $1,500.00, from which any amount owed the State for care and treatment, as determined under section 8101 of this title, can be collected. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1973, No. 244 (Adj. Sess.),  5.) 
 8108. Claim allowed against estate
Claim for the care and treatment of a mentally ill person against his or her estate shall be presented and prosecuted by the Commissioner and shall be allowed by the Commissioner upon the estate, and paid by his or her administrator or executor. Such claims shall not exceed the amount which the Commissioner has found to be within the ability and legal obligation of the person to pay and full credit shall be allowed for any amounts paid prior to the death of the person. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1973, No. 244 (Adj. Sess.),  6.) 
 8110. Prosecution of claims
Claims due and unpaid under this part of this title shall be prosecuted and collected in the name of the State. A States Attorney or the Attorney General, when requested by the Commissioner, shall appear for and in behalf of the State in the prosecution of the claims. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8111. Appeals
A person aggrieved by an act or decision of the Commissioner relating to the charge for the care and treatment of a patient or to rates of payment established in accordance with section 8101 of this title shall have an immediate right of appeal under the provisions for contested cases in 3 V.S.A. chapter 25. (Added 1973, No. 244 (Adj. Sess.),  7.) 
 8201. Commissioner may license private hospital
After due investigation, the Commissioner may license for not less than two nor more than six years, any suitable person to keep a private hospital for the mentally ill, which shall be subject to visitations from the Commissioner. A license granted hereunder shall exempt the licensee from the licensing requirements of section 1901 et seq. of this title. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8202. Revocation of license
The Commissioner may revoke any license when it appears that the holder thereof does not exercise sufficient skill and is not possessed of adequate means and methods for the proper care and treatment of the patients therein. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8203. Notice of revocation
When a license is revoked, the Commissioner shall notify the holder thereof in writing and shall file a copy of the notice in the office of the clerk of the county in which the hospital is located, within five days after the date thereof. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8204. What deemed private hospital
A person who keeps or domiciles upon premises owned or occupied by him or her two or more mentally ill persons for care and treatment shall be deemed the keeper of a private hospital for the mentally ill. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8205. Penalty
A person who keeps a private hospital for the mentally ill, except as provided in this chapter, shall be fined not more than $500.00. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8350. Consent by minors for mental health treatment
A minor may give consent to receive any legally authorized outpatient treatment from a mental health professional, as defined in section 7101 of this title. Consent under this section shall not be subject to disaffirmance due to minority of the person consenting. The consent of a parent or legal guardian shall not be necessary to authorize outpatient treatment. As used in this section, outpatient treatment means psychotherapy and other counseling services that are supportive, but not prescription drugs. (Added 2017, No. 35,  1, eff. Jan. 1, 2018.) 
 8351. Definitions
As used in this chapter:(1) Conversion therapy means any practice by a mental health care provider that seeks to change an individuals sexual orientation or gender identity, including efforts to change behaviors or gender expressions or to change sexual or romantic attractions or feelings toward individuals of the same sex or gender. Conversion therapy does not include psychotherapies that: (A) provide support to an individual undergoing gender transition; or(B) provide acceptance, support, and understanding of clients or the facilitation of clients coping, social support, and identity exploration and development, including sexual-orientation-neutral or gender-identity-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices without seeking to change an individuals sexual orientation or gender identity. (2) Mental health care provider means a person licensed to practice medicine pursuant to 26 V.S.A. chapter 23, 33, or 81 who specializes in the practice of psychiatry; a psychologist, a psychologist-doctorate, or a psychologist-master as defined in 26 V.S.A.  3001; a clinical social worker as defined in 26 V.S.A.  3201; a clinical mental health counselor as defined in 26 V.S.A.  3261; a licensed marriage and family therapist as defined in 26 V.S.A.  4031; a psychoanalyst as defined in 26 V.S.A.  4051; any other allied mental health professional; or a student, intern, or trainee of any such profession. (Added 2015, No. 138 (Adj. Sess.),  2.) 
 8352. Treatment of minors
A mental health care provider shall not use conversion therapy with a client younger than 18 years of age. (Added 2015, No. 138 (Adj. Sess.),  2.) 
 8353. Unprofessional conduct
Any conversion therapy used on a client younger than 18 years of age by a mental health care provider shall constitute unprofessional conduct as provided in the relevant provisions of Title 26 and shall subject the mental health care provider to discipline pursuant to the applicable provisions of that title and of 3 V.S.A. chapter 5. (Added 2015, No. 138 (Adj. Sess.),  2.) 
 8401. Definitions
As used in this chapter, drug addict means a person who shows signs of mental illness because of his or her use of drugs, hallucinogens, stimulants, or sedatives or who has an uncontrollable desire for their use or consumption. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 208 (Adj. Sess.),  4.) 
 8402. Hospitalization
Except as otherwise provided in this chapter a drug addict may be admitted to a designated hospital and provided with care and treatment in the same manner and under the same conditions as a mentally ill person. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 208 (Adj. Sess.),  5.) 
 8403. Length of treatment
No drug addict may be admitted to a hospital for voluntary treatment for a period in excess of six months. If he or she is admitted by order of the Criminal Division of the Superior Court, the order shall specifically provide for a maximum of six months in the hospital. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1973, No. 52,  1; 1977, No. 145 (Adj. Sess.),  3; 1977, No. 208 (Adj. Sess.),  6; 2009, No. 154 (Adj. Sess.),  238.) 
 8404. Conditional discharge
The Board of Mental Health, in its discretion, may grant a conditional discharge to a patient admitted under this chapter after the expiration of one month from the date of admission and may revoke any conditional discharge so granted. A revocation of a conditional discharge by the Board of Mental Health at any time prior to the expiration of the original term of hospitalization shall be sufficient warrant for the return of the patient to the hospital from which he or she was discharged, there to remain until a subsequent conditional discharge or the expiration of the full term from the date of the original admission. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 8405. Outside visits
In the discretion of the head of a hospital, a patient admitted under this chapter may be permitted to visit a specifically designated place for a period not to exceed five days and return to the same hospital. The visit may be allowed to see a dying relative, to attend the funeral of a relative, to obtain special medical services, to contact prospective employers, or for any compelling reason consistent with the welfare or rehabilitation of the patient. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 991. Establishment of Birth Information Network
(a) The Commissioner of Health shall establish a statewide birth information network designed to identify newborns who have specified health conditions which may respond to early intervention and treatment by the health care system. (b) The Department of Health is authorized to collect information for the Birth Information Network for the purpose of preventing and controlling disease, injury, and disability. The Commissioner, in collaboration with appropriate partners, shall coordinate existing data systems and records to enhance the Networks comprehensiveness and effectiveness, including: (1) vital records (birth, death, and fetal death certificates);(2) the children with special health needs database;(3) newborn metabolic screening;(4) a voluntary developmental screening test;(5) universal newborn hearing screening;(6) the Hearing Outreach Program;(7) the cancer registry;(8) the lead screening registry;(9) the immunization registry;(10) the special supplemental nutrition program for women, infants, and children;(11) the Medicaid claims database;(12) the hospital discharge data system;(13) health records, including discharge summaries, disease indexes, nursery logs, pediatric logs, and neonatal intensive care unit logs, from hospitals, outpatient specialty clinics, genetics clinics, and cytogenetics laboratories; and (14) the Vermont Health Care Claims Uniform Reporting and Evaluation System.(c) [Repealed.](d) The Network shall provide information on public health activities, such as surveillance, assessment, and planning for interventions to improve the health and quality of life for Vermonts infants and children and their families. This information shall be used for improving health care delivery systems and outreach and referral services for families with children with special health needs and for determining measures that can be taken to prevent further medical conditions. (e) The Network shall be designed to follow infants and children up to one year of age with the 40 medical conditions listed in the matrix developed by the Birth Information Council which have been selected as identifiable via existing Vermont data systems and are considered to be representative of the most significant health conditions of newborns in Vermont, including conditions relating to upper and lower limbs. The Department of Health is authorized to amend the list of medical conditions through rulemaking pursuant to 3 V.S.A. chapter 25 to meet the objectives of this section. (f) The Networks data system shall be designed to coordinate with the data systems of other states so that data on out-of-state births to Vermont residents will be captured for vital records, case ascertainment, and follow-up services. The Commissioner of Health is authorized to enter into interstate agreements containing the necessary conditions for information transmission. (g) The Commissioner of Health shall compile information every two years to document possible links between environmental and chemical exposure with the special health conditions of Vermonts infants and children. (h) The Department of Health shall develop a form that contains a description of the Birth Information Network and the purpose of the Network. The form shall include a statement that the parent or guardian of a child may contact the Department of Health and have his or her childs personally identifying information removed from the Network, using a process developed by the Advisory Committee. (Added 2003, No. 32,  2; amended 2011, No. 35,  3, eff. May 18, 2011; 2013, No. 131 (Adj. Sess.),  119; 2015, No. 23,  152; 2015, No. 152 (Adj. Sess.),  13; 2017, No. 46,  37, eff. July 1, 2019.) 
 992. Birth Information Network; confidentiality
(a) The Birth Information Network shall be designed to protect the confidentiality of the individuals and families involved. Information from the Network shall be used only in ways that reflect responsible public health protocols and practice. (b) The Commissioner shall take measures necessary to comply with the federal Standards for Privacy of Individually Identifiable Health Information contained in Parts 160 and 164 of Title 45 of the Code of Federal Regulations, 45 CFR  160.101 et seq. and 45 CFR  164.102 et seq., and any subsequent amendments, including the following: (1) security procedures limiting access to Network data;(2) a confidentiality statement to be signed by staff members;(3) encryption of identifying information; and(4) use of information for research and assessment purposes. (Added 2003, No. 32,  3; amended 2017, No. 46,  37, eff. July 1, 2019.)
 993. Advisory Committee
The Commissioner of Health shall appoint an advisory committee to comment on the effectiveness of the Birth Information Network and to gather information about funding opportunities. The Advisory Committee shall be composed of representatives from the primary organizations involved in Network data collection and use. (Added 2003, No. 32,  4; amended 2017, No. 46,  37, eff. July 1, 2019.) 
 8705. Sterilization; policy
(a) It is the policy of the State of Vermont to allow voluntary and involuntary sterilizations of adults with an intellectual disability under circumstances that will ensure that the best interests and rights of such persons are fully protected. In accordance with this policy, a person with an intellectual disability, as defined in 1 V.S.A.  146, may not be sterilized without his or her consent unless there is a prior hearing in the Superior Court as provided in this chapter. A person with an intellectual disability under 18 years of age shall not be sterilized. (b) Sterilization is defined to mean a surgical procedure, the purpose of which is to render an individual incapable of procreating. (Added 1981, No. 142 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  111; 2017, No. 113 (Adj. Sess.),  102.) 
 8706. Voluntary sterilization
Any person with an intellectual disability over the age of 18, who does not have a guardian with the power to consent to nonemergency surgery, may obtain a voluntary sterilization subject to all of the following preconditions: (1) the person with an intellectual disability has freely, voluntarily, and without coercion personally requested a physician to perform a sterilization; (2) the person with an intellectual disability has given informed consent to the sterilization in that: (A) the physician has provided a complete explanation concerning:(i) the nature and irreversible consequences of a sterilization procedure; and(ii) the availability of alternative contraceptive measures;(B) the physician is satisfied that the consent is based upon an understanding of that information and that before the operation is undertaken the physician personally obtains evidence of the persons retention of that understanding, not less than 10 days following the original explanation; (C) the consent is in writing and signed by the person with an intellectual disability;(3) the person with an intellectual disability has been informed and is aware that his or her consent may be withdrawn at any time prior to the operation; and (4) the physician has reviewed medical records and psychological assessments of the person with an intellectual disability. (Added 1981, No. 142 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  111.) 
 8707. Competency to consent; procedure
(a)(1) If the physician from whom the sterilization has been sought refuses to perform the sterilization because he or she is not satisfied that the person with an intellectual disability has the ability to give the informed consent required by section 8706 of this title, the person with an intellectual disability may file a petition in Superior Court for a determination of the persons competency to consent to the sterilization. (2) The petition shall set forth the information required by subdivisions 8709(b)(1)-(5) of this title. (3) Upon filing of the petition, the court shall appoint a qualified developmental disabilities professional as defined in subdivision 8821(8) of this title to examine the person with an intellectual disability and present evidence to the court as to that persons ability to give informed consent. (4) The hearing shall be limited to a determination of the person with an intellectual disabilitys competency to consent to a sterilization, and shall be conducted in accordance with sections 8709(c), 8710, and 8711(a) and (b) of this title. (b)(1) If, after the hearing, the court determines on the basis of clear and convincing proof that the person with an intellectual disability is competent to consent and has given the required consent, it shall order that a voluntary sterilization may be performed. (2) If the court determines that the person with an intellectual disability is not competent to give consent it shall inform the person that he or she has the right to petition the court for an involuntary sterilization pursuant to the requirements of section 8708 of this title. (Added 1981, No. 142 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  111.) 
 8708. Involuntary sterilization
(a) Any sterilization sought on behalf of a person with an intellectual disability or requested by any person denied a voluntary sterilization by section 8707 of this title shall be considered an involuntary sterilization. (b) Involuntary sterilizations may be performed only after a hearing in the Superior Court pursuant to sections 8709-8712 of this title. For the purposes of involuntary sterilization proceedings under this chapter, the person with an intellectual disability subject to a petition for sterilization shall be defined as the respondent. (Added 1981, No. 142 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  111.) 
 8709. Petition and notice of hearing
(a) Any adult with an intellectual disability, his or her parent, private guardian, near relative, as defined in section 8821 of this title, or physician, may file a petition in the Superior Court alleging that the person has an intellectual disability and is in need of sterilization. (b) The petition shall set forth:(1) the name, age, and residence of the person to be sterilized;(2) the names and addresses of the petitioner and parents, guardians, spouse, and nearest relative of said person; (3) the mental condition of said person;(4) a statement of said persons ability to give informed consent to the sterilization;(5) said persons ability to pay for legal counsel;(6) the relation of said person to the petitioner;(7) the reasons and supporting facts why sterilization is in the best interest of said person. (c) Upon filing of the petition, the court shall fix a time and place for the hearing not more than 45 days from the receipt of the petition. Not less than 20 days prior to the date set for the hearing, the court shall cause the petitioner to serve the respondent with the petition and notice of hearing. The court shall also mail a copy of the petition and notice of the hearing to the respondents counsel, his or her legal guardian, and nearest relative. (Added 1981, No. 142 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  111; 2013, No. 192 (Adj. Sess.),  25.) 
 8710. Appointment of counsel
The respondent shall be represented by counsel throughout the proceeding. Upon filing of the petition the court shall notify the respondent that he or she shall be afforded the right to counsel. If the petition states that the respondent is unable to pay for counsel, the court shall appoint counsel to be paid by the State or set a hearing for a determination of the respondents ability to pay for counsel. The court may also require appointment of a guardian ad litem to represent the interest of the respondent. Counsel shall receive copies of the comprehensive evaluations required by section 8711(d) of this title and such other documents as may be received and issued by the court. (Added 1981, No. 142 (Adj. Sess.),  1.) 
 8711. Conduct of hearing
(a) The respondent, the petitioner, and all other persons to whom notice has been sent may attend the hearing, testify, present evidence, and subpoena, present, and cross-examine witnesses, including those who prepared the comprehensive evaluation. The court may exclude any person not necessary for the conduct of the hearing. (b) The hearing shall be conducted according to the rules of evidence applicable in civil actions in the Superior Courts of the State and to an extent not inconsistent with this chapter, the Rules of Civil Procedure of the State shall be applicable. (c) The court shall determine the following:(1) whether the respondent has an intellectual disability;(2) whether the respondent is competent to give informed consent as defined in section 8706 of this title; and (3) if the court determines that the respondent is not competent to give informed consent, whether a sterilization is in the best interests of the respondent by considering the following factors: (A) that the respondent is physically capable of conceiving a child;(B) that the respondent is likely to engage in sexual activity at present or in the near future under circumstances which may result in pregnancy; (C) that the nature of the respondents disability renders the respondent incapable now or in the future of caring for a child; (D) that the respondents disability is not likely to improve, nor does medical knowledge exist to establish that an advance in treatment of the disability is likely; and (E) that no effective, less drastic alternative to sterilization is medically indicated which will meet the needs of the respondent. (d) The court shall order the Commissioner of Disabilities, Aging, and Independent Living to arrange for the preparation of a comprehensive medical, psychological, and social evaluation of the person through developmental disability agencies affiliated with the Department. The comprehensive evaluation shall be completed within 30 days of the receipt of the petition. The medical report shall be prepared by a physician and shall describe the physical condition of the respondent and the availability of effective, alternative contraceptive measures to meet the needs of the person. The psychological report shall include a diagnosis of the persons intellectual ability and social functioning. The social report shall be prepared by a qualified developmental disabilities professional, and shall describe the respondents developmental and social functioning. (e) The petitioner shall have the burden of proving the elements of the petition by clear and convincing evidence. (f) The evaluation shall be received into evidence, if the persons who prepared the evaluation are available for the hearing or subject to service of subpoena. However, the court shall not be bound by the evidence contained in the evaluation, but shall make its determination upon the entire record. (Added 1981, No. 142 (Adj. Sess.),  1; amended 1989, No. 187 (Adj. Sess.),  5; 1995, No. 174 (Adj. Sess.),  3; 2005, No. 174 (Adj. Sess.),  43; 2013, No. 96 (Adj. Sess.),  111.) 
 8712. Findings; order
(a) The court shall prepare written findings of fact and state separately its conclusions of law in all cases. (b) If upon completion of the hearing and consideration of the record, the court finds that the person with an intellectual disability is competent to give informed consent and no such consent has been given, no sterilization may be ordered. (c) If upon completion of the hearing and consideration of the record, the court finds that the person is incompetent to consent and that the sterilization is in the best interests of the person, it shall order that an involuntary sterilization may be performed. (Added 1981, No. 142 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  111.) 
 8713. Confidentiality of proceedings
All proceedings under this chapter shall be closed to the public, and the records shall be sealed unless requested to be opened by the respondent. (Added 1981, No. 142 (Adj. Sess.),  1.) 
 8714. Appeal; automatic stay
(a) Any party to the proceeding shall have the right to appeal from a judgment issued pursuant to this chapter within 30 days of the judgment pursuant to the Vermont rules of appellate procedure. (b) If the court has issued a judgment allowing sterilization, the judgment shall not become final for 30 days. An appeal of such a judgment shall operate as a stay of the order during the pendency of the appeal or during the pendency of any further appeal to the U.S. Supreme Court. (Added 1981, No. 142 (Adj. Sess.),  1.) 
 8715. Liability; costs
(a) Sterilizations performed pursuant to this chapter shall be legal and no person shall be civilly or criminally liable for performing a sterilization pursuant to such order of the court; provided, however, that the provisions of this chapter shall not affect any liability which may be incurred as a consequence of the manner in which such sterilization operation is performed. (b) The cost of evaluations required by sections 8707 and 8709 of this title shall be paid for out of appropriations of the Department of Disabilities, Aging, and Independent Living. (Added 1981, No. 142 (Adj. Sess.),  1; amended 1989, No. 187 (Adj. Sess.),  5; 1995, No. 174 (Adj. Sess.),  3; 2005, No. 174 (Adj. Sess.),  44.) 
 8716. Jurisdiction
The Superior Court shall have exclusive original jurisdiction over all proceedings brought under this chapter. Proceedings under this chapter shall be commenced in the Superior Court of the county in which the person with an intellectual disability resides. (Added 1981, No. 142 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  111.) 
 8721. Purpose
It is the policy of the State of Vermont that each citizen with a developmental disability shall have the following opportunities: (1) To live in a safe environment with respect and dignity.(2) To live with family or in a home of his or her choice.(3) To make choices which affect his or her life.(4) To attend neighborhood schools, be employed, and participate in activities, to the extent that this purpose is not construed to alter or extend rights or responsibilities of federal laws relating to special education. (5) To have access to the community support and services that are available to other citizens. (Added 1995, No. 174 (Adj. Sess.),  1.)
 8722. Definitions
As used in this chapter:(1) Department means the Department of Disabilities, Aging, and Independent Living.(2) Developmental disability means a severe, chronic disability of a person that is manifested before the person reaches 18 years of age and results in: (A) intellectual disability, autism, or pervasive developmental disorder; and(B) deficits in adaptive behavior at least two standard deviations below the mean for a normative comparison group. (3) Family means a group of individuals that includes a person with a developmental disability and that: (A) is related by blood, marriage, or adoption; or(B) considers themselves a family based upon bonds of affection, which, for the purposes of this subdivision, means enduring ties that do not depend upon the existence of an economic relationship. (4) Person with a developmental disability means a person who is a resident of Vermont and who has a developmental disability. (5) Recipient means a person with a developmental disability or a family that has been approved to receive services or funding under criteria specified in the system of care plan. (6) Service means support or service provided, funded, or coordinated by the Department.(7) System of care plan means the plan adopted pursuant to section 8725 of this title and that describes funding and services to be provided to people with developmental disabilities and their families. (Added 1995, No. 174 (Adj. Sess.),  1; amended 2005, No. 174 (Adj. Sess.),  45; 2013, No. 96 (Adj. Sess.),  112; 2013, No. 140 (Adj. Sess.),  1.) 
 8723. Department of Disabilities, Aging, and Independent Living; duties
The Department shall plan, coordinate, administer, monitor, and evaluate State and federally funded services for people with developmental disabilities and their families within Vermont. The Department shall be responsible for coordinating the efforts of all agencies and services, government and private, on a statewide basis in order to promote and improve the lives of individuals with developmental disabilities. Within the limits of available resources, the Department shall: (1) promote the principles stated in section 8724 of this title and shall carry out all functions, powers, and duties required by this chapter by collaborating and consulting with people with developmental disabilities, their families, guardians, community resources, organizations, and people who provide services throughout the State; (2) develop, maintain, and monitor an equitably and efficiently allocated statewide system of community-based services that reflect the choices and needs of people with developmental disabilities and their families; (3) acquire, administer, and exercise fiscal oversight over funding for community-based services, including the management of State contracts; (4) identify resources and legislation needed to maintain a statewide system of community-based services; (5) establish a statewide procedure for applying for services;(6) facilitate or provide pre-service or in-service training and technical assistance to service providers consistent with the system of care plan; (7) maintain a statewide system of quality assessment and assurance for services provided to people with developmental disabilities and provide quality improvement support to ensure that the principles of service in section 8724 of this title are achieved; (8) encourage the establishment and development of locally administered and locally controlled nonprofit services for people with developmental disabilities, based on the specific needs of individuals and their families; (9) promote and facilitate participation by people with developmental disabilities and their families in activities and choices that affect their lives and in designing services that reflect their unique needs, strengths, and cultural values; (10) promote positive images and public awareness of people with developmental disabilities and their families; (11) certify services that are paid for by the Department; and(12) establish a procedure for investigation and resolution of complaints regarding the availability, quality, and responsiveness of services provided throughout the State. (Added 1995, No. 174 (Adj. Sess.),  1; amended 2005, No. 174 (Adj. Sess.),  46; 2013, No. 140 (Adj. Sess.),  1.) 
 8724. Principles of service
Services provided to people with developmental disabilities and their families shall foster and adhere to the following principles: (1) Childrens services. Children, regardless of the severity of their disability, need families and enduring relationships with adults in a nurturing home environment. The quality of life of children with developmental disabilities, their families, and communities is enhanced by caring for children within their own homes. Children with disabilities benefit by growing up in their own families; families benefit by staying together; and communities benefit from the diversity that is provided when people with varying abilities are included. (2) Adult services. Adults, regardless of the severity of their disability, can make decisions for themselves, can live in typical homes, and can contribute as citizens to the communities where they live. (3) Full information. In order to make good decisions, people with developmental disabilities and their families need complete information about the availability, choices, and costs of services, how the decision-making process works, and how to participate in that process. (4) Individualized support. People with developmental disabilities have differing abilities, needs, and goals. To be effective and efficient, services must be individualized to the capacities, needs, and values of each individual. (5) Family support. Effective family support services shall be designed and provided with respect and responsiveness to the unique needs, strengths, and cultural values of each family and the familys expertise regarding its own needs. (6) Meaningful choices. People with developmental disabilities and their families cannot make good decisions without meaningful choices about how they live and the kinds of services they receive. Effective services shall be flexible so they can be individualized to support and accommodate personalized choices, values, and needs and assure that each recipient is directly involved in decisions that affect that persons life. (7) Community participation. When people with disabilities are segregated from community life, all Vermonters are diminished. Community participation is increased when people with disabilities meet their everyday needs through resources available to all members of the community. (8) Employment. The goal of job support is to obtain and maintain paid employment in regular employment settings. (9) Accessibility. Services must be geographically available so that people with developmental disabilities and their families are not required to move to gain access to needed services, thereby forfeiting natural community support systems. (10) Health and safety. The safety and health of people with developmental disabilities is of paramount concern.(11) Trained staff. In order to assure that the goals of this chapter are attained, all individuals who provide services to people with developmental disabilities and their families must receive training as required by section 8731 of this title. (12) Fiscal integrity. The fiscal stability of the service system is dependent upon skillful and frugal management and sufficient resources to meet the needs of Vermonters with developmental disabilities. (Added 1995, No. 174 (Adj. Sess.),  1.) 
 8725. System of care plan
(a) Every three years, the Department shall adopt a plan for the nature, extent, allocation, and timing of services consistent with the principles of service set forth in section 8724 of this title that will be provided to people with developmental disabilities and their families. (b)(1) The Commissioner shall determine plan priorities based upon:(A) information obtained from people with developmental disabilities, their families, guardians, and people who provide the services; (B) a comprehensive needs assessment that includes:(i) demographic information about people with developmental disabilities;(ii) information about existing services used by individuals and their families;(iii) characteristics of unserved and underserved individuals and populations; and(iv) the reasons for these gaps in service and the varying community needs and resources.(2) Once the plan priorities are determined, the Commissioner shall consider funds available to the Department in allocating resources. (c) Not later than 60 days before adopting the proposed plan, the Commissioner shall submit it to the Advisory Board established in section 8733 of this title for advice and recommendations. The Advisory Board shall provide the Commissioner with written comments on the proposed plan. (d) The Commissioner may make annual revisions to the plan as deemed necessary in accordance with the process set forth in this section. The Commissioner shall submit any proposed revisions to the Advisory Board established in section 8733 of this title for comment within the time frame established by subsection (c) of this section. (e) Notwithstanding 2 V.S.A.  20(d), on or before January 15 of each year, the Department shall report to the Governor and the committees of jurisdiction regarding implementation of the plan, the extent to which the principles of service set forth in section 8724 of this title are achieved, and whether people with a developmental disability have any unmet service needs, including the number of people on waiting lists for developmental services. (f) If the Department requires an extension to complete the system of care plan, it shall submit a written request indicating the anticipated completion date to the House Committee on Human Services and to the Senate Committee on Health and Welfare at least two months prior to the expiration of the existing system of care plan. The request for an extension may be granted upon the approval of both the Chairs of the House Committee on Human Services and the Senate Committee on Health and Welfare. (Added 1995, No. 174 (Adj. Sess.),  1; amended 2013, No. 140 (Adj. Sess.),  1; 2021, No. 186 (Adj. Sess.),  2, eff. June 9, 2022.) 
 8726. Application for services; rules
(a) No later than January 1, 1997, the department shall adopt rules that include the following:(1) Criteria for determining whether an applicant is a person with a developmental disability.(2) A format and procedures, for processing applications for services, including time frames, emergency procedures, and notice of determination. (3) Procedures and time frames for periodic reviews of a persons eligibility and continuing need for services. (4) Standards and procedures for billing.(5) Complaints and appeals, including notice as required in section 8727 of this title.(b) No later than July 1, 1997, the department shall adopt rules that include the following:(1) Certification standards and procedures for programs for people with developmental disabilities. (2) Training standards for staff.(3) Standards for training and supervision of personnel who perform special care procedures.(c) Any person with a developmental disability or a family of a person with a disability shall be provided with: (1) Timely information and referral to community and governmental resources.(2) An opportunity to request services.(3) Upon request, an assessment of the most appropriate supports and resources for their needs and choices. (4) Services and funding within the departments available resources in accordance with both the system of care plan and the persons or familys written plan of service. (d) Any person with a developmental disability or a family who is receiving services on July 1, 1996, shall continue to receive services consistent with their needs and the system of care plan. (Added 1995, No. 174 (Adj. Sess.),  1.) 
 8727. Complaints; appeals
(a) Notice. The Department or agency or program funded by the Department shall provide notice:(1) To an applicant or the applicants guardian, as applicable, of the rights provided under this chapter, State and federal law, and any other available rights of appeal for violations of any of those rights. (2) To a person with a developmental disability or the persons guardian, as applicable, of any decision to deny, suspend, reduce, or terminate services, prior to any action by the Department or agency or program funded by the Department and the procedure for appealing the decision. (b) Appeals. A person with a developmental disability or the persons guardian may appeal a decision of the Department or an agency or program funded by the Department to deny or terminate eligibility for services; to deny, terminate, suspend, or reduce services; or when a request is not acted upon promptly to the Human Services Board. The fair hearing before the Human Services Board shall be conducted pursuant to 3 V.S.A.  3091(b), (c), (e), (f), (g), and (h)(3) and the following: (1) The Board shall not reverse or modify a decision of the Department that is consistent with the system of care plan and the rules of the Department, provided that the Board may reverse or modify a decision of the Department that the Board determines is in conflict with State or federal law. The Board shall not reverse or modify a decision of the Department that is determined to be in compliance with applicable law, even though the board may disagree with the results effected by that decision. (2)(A) The Secretary of Human Services shall review all decisions and orders of the Board issued under this subsection and shall adopt a decision or order of the Board, except that the Secretary may reverse or modify any decision or order of the Board if: (i) the Boards findings of fact lack support in the record; or(ii) the decision or order implicates the validity or applicability of any rule or policy of the agency. (B) The Secretary shall issue a written decision stating the legal, factual or policy basis for reversing or modifying a decision or order of the Board. The Secretary shall approve, modify or reverse a decision or order of the Board within 15 days of the date of the decision or order. If the Secretary fails to issue a written decision within 15 days, the decision and order of the Board shall be deemed to be approved by the Secretary. A decision and order of the Board under this subsection shall become the final and binding decision of the Department upon approval by the Secretary. (3) The fair hearing officer:(A) shall assure that a person with a developmental disability shall have access to legal representation; and (B) may order an independent evaluation at no cost to the person when the fair hearing officer finds that it would aid in the resolution of the issue on appeal. (c) Internal complaints and resolution procedures. The Commissioner shall:(1) establish procedures for the investigation and resolution of complaints by recipients or by service providers regarding the availability, quality, and responsiveness of services provided. (2) establish a procedure for the prompt and impartial resolution of disputes that are not subject to review before the Human Services Board as provided by subsection (b) of this section, such as disputes by recipients regarding the manner, quality, or accessibility of services provided by programs or agencies funded by the Department. (3) offer conflict resolution services conducted by trained mediators to assist in resolving disputes between recipients and programs and agencies funded by the Department. (4) offer arbitration to be conducted by a trained independent arbitrator for resolution of disputes that are not resolved by the procedures provided in subdivision (2) or (3) of this subsection, pursuant to which the decision of the arbitrator shall be final and binding, except to the extent that either party has other legal remedies. (d) Procedure by next friend. The appeal and complaint procedures provided by this section may be initiated by a next friend when a person with a developmental disability is unable to initiate the procedure due to cognitive limitations and the person does not have a guardian, or there is a conflict of interest between the person with a developmental disability and the persons guardian that has resulted in failure to initiate either the appeal or complaint procedure. (Added 1995, No. 174 (Adj. Sess.),  1.) 
 8728. Rights of recipients
(a) Every person with a developmental disability who receives services has the right to:(1) Be free from aversive procedures, devices, and treatments.(2) Privacy, dignity, confidentiality, and humane care.(3) Associate with individuals of both genders.(4) Communicate in private by mail and telephone.(5) Communicate in his or her primary language and primary mode of communication.(6) Be free from retaliation for making a complaint, voicing a grievance, recommending changes in policies, or exercising a legal right. (7) Maintain contact with family, unless contact has been restricted by court order.(8) Refuse or terminate services, except where services are required by court order.(9) Have access to, read, and challenge any information contained in any records about the person that are maintained by the Department or any agency or program funded by the Department and to file a written statement in the record regarding any portion of the record with which the person disagrees. (b) Every family that receives services has the right to:(1) Receive services without relinquishing custody of a child or children, except when custody is terminated in accordance with Vermont law. (2) Privacy and confidentiality.(3) Communicate in the familys primary language and primary mode of communication.(4) Be free from retaliation for making a complaint, voicing a grievance, recommending a change in policy, or exercising a legal right. (c) People committed to the care of the Commissioner pursuant to chapter 206, subchapter 3 of this title, relating to judicial proceedings, shall have all the rights provided by this section except when the Commissioner restricts those rights for reasons of safety, security, or treatment. (Added 1995, No. 174 (Adj. Sess.),  1.) 
 8729. Family support payments: tax exemption
Any payment to an eligible family for the support of a person with a developmental disability constitutes a State benefit and shall not be deemed to be income for the purposes of State taxation or of determining eligibility for any income-related State benefits, but may be included in household income for purposes of 32 V.S.A. chapter 154 as provided in section 6061 of that chapter. (Added 1995, No. 174 (Adj. Sess.),  1; amended 2005, No. 185 (Adj. Sess.),  13a.) 
 8730. Service providers; certification
The Department shall adopt rules that provide for certification standards and procedures for programs for people with developmental disabilities funded by the Department. The Department shall not certify a program unless it adheres to the principles in section 8724 of this title and provides recipients with the rights in section 8728 of this title. (Added 1995, No. 174 (Adj. Sess.),  1.) 
 8731. Training
(a) For the purposes of this section, staff means any person who receives compensation to provide services to one or more recipients and includes the persons supervisor. Staff does not include a family-directed respite worker. (b) The Department shall assure that all staff receive pre-service and in-service training consistent with the system of care plan. Family-directed respite staff shall receive pre-service and in-service training at the request of the family at no cost to the family. People with developmental disabilities and their families may participate in the training, including planning and delivery of that training. (c) The Department shall adopt rules for training standards that ensure that individual support staff understand the philosophy and values that underlie the services and that they acquire the skills necessary to implement the purposes and principles of this subchapter and to address the individual needs of the person or family for whom they provide services. (d) All staff and all family-directed respite workers shall be trained in the requirements of 33 V.S.A. chapter 69, relating to reports of abuse, neglect, and exploitation of elders or of adults who have a disability, and the requirements of 33 V.S.A. chapter 49, subchapter 2, relating to reports of suspected abuse or neglect of children. (Added 1995, No. 174 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  113.) 
 8732. Special care needs
(a) For the purposes of this section, special care procedure means a procedure that is necessitated by a specific medical need that a person with a developmental disability would perform but for the persons disability, provided that, in the determination of the supervising registered nurse, the procedure may be performed safely by a trained special care provider. (b) The Department shall, with the approval of the Board of Nursing, adopt rules that establish standards for training and supervision of personnel who perform special care procedures for people with developmental disabilities. The rules shall include training requirements, competency testing, and requirements for nursing supervision. (Added 1995, No. 174 (Adj. Sess.),  1.) 
 8733. Advisory Board
(a) The Advisory Board is created to advise the Department on the status and needs of people with developmental disabilities and their families. The Board shall also advise the Commissioner regarding the development of the system of care plan described in section 8725 of this title and recommend legislation, rules, policies, and standards to implement the system of care plan. (b) The Board shall consist of 15 members appointed by the Governor: five persons shall be recipients, five members shall be advocates that represent people with developmental disabilities, and five members shall be professionals with expertise in the area of developmental disabilities. (c) Members of the Board shall be appointed for staggered terms of three years, beginning April 1, and shall serve until a successor is appointed. (d) The Board shall elect a Chair from among its members. The Board shall meet at least annually at the time and place determined by the Chair, and at such other times and places as the Chair may determine to be necessary. (e) Members shall be entitled to reimbursement for necessary and actual expenses incurred in performance of their duties under this chapter. (Added 1995, No. 174 (Adj. Sess.),  1.) 
 8820. Purpose
The purpose of this chapter is to establish procedures for determining appropriate care for persons with an intellectual disability in Vermont. (Added 1979, No. 167 (Adj. Sess.),  1; amended 2013, No. 96 (Adj. Sess.),  114.) 
 8839. Definitions
As used in this subchapter:(1) Danger of harm to others means the person has inflicted or attempted to inflict serious bodily injury to another or has committed an act that would constitute a sexual assault or lewd or lascivious conduct with a child. (2) Designated program means a program designated by the Commissioner as adequate to provide in an individual manner appropriate custody, care, and habilitation to persons with intellectual disabilities receiving services under this subchapter. (3) Person in need of custody, care, and habilitation means:(A) a person with an intellectual disability, which means significantly subaverage intellectual functioning existing concurrently with deficits in adaptive behavior that were manifest before 18 years of age; (B) who presents a danger of harm to others; and(C) for whom appropriate custody, care, and habilitation can be provided by the Commissioner in a designated program. (Added 1987, No. 248 (Adj. Sess.),  9; amended 2013, No. 96 (Adj. Sess.),  114; 2013, No. 158 (Adj. Sess.),  11, eff. July 1, 2017; 2015, No. 23,  66; 2015, No. 97 (Adj. Sess.),  51; 2017, No. 113 (Adj. Sess.),  103.) 
 8840. Jurisdiction and venue
Proceedings brought under this subchapter for commitment to the Commissioner for custody, care, and habilitation shall be commenced by petition in the Family Division of the Superior Court for the unit in which the respondent resides. (Added 1987, No. 248 (Adj. Sess.),  9; amended 2009, No. 154 (Adj. Sess.),  238; 2019, No. 77,  21, eff. June 19, 2019.) 
 8841. Petition; procedures
The filing of the petition and procedures for initiating a hearing shall be as provided in sections 8822-8826 of this title. (Added 1987, No. 248 (Adj. Sess.),  9.) 
 8842. Hearing
Hearings under this subchapter for commitment shall be conducted in accordance with section 8827 of this title. (Added 1987, No. 248 (Adj. Sess.),  9.) 
 8843. Findings and order
(a) In all cases, the court shall make specific findings of fact and state its conclusions of law. (b) If the court finds that the respondent is not a person in need of custody, care, and habilitation, it shall dismiss the petition. (c) If the court finds that the respondent is a person in need of custody, care, and habilitation, it shall order the respondent committed to the custody of the Commissioner for placement in a designated program in the least restrictive environment consistent with the respondents need for custody, care, and habilitation for an indefinite or a limited period. (Added 1987, No. 248 (Adj. Sess.),  9.) 
 8844. Legal competence
No determination that a person is in need of custody, care, and habilitation and no order authorizing commitment shall lead to a presumption of legal incompetence. (Added 1987, No. 248 (Adj. Sess.),  9.) 
 8845. Judicial review
(a) A person committed under this subchapter may be discharged from custody by a Superior judge after judicial review as provided herein or by administrative order of the Commissioner. (b) Procedures for judicial review of persons committed under this subchapter shall be as provided in section 8834 of this title, except that proceedings shall be brought in the Criminal Division of the Superior Court in the unit in which the person resides or, if the person resides out of state, in the unit which issued the original commitment order. (c) A person committed under this subchapter shall be entitled to a judicial review annually. If no such review is requested by the person, it shall be initiated by the Commissioner. However, such person may initiate a judicial review under this subsection after 90 days of initial commitment but before the end of the first year of the commitment. (d) If at the completion of the hearing and consideration of the record, the court finds at the time of the hearing that the person is still in need of custody, care, and habilitation, commitment shall continue for an indefinite or limited period. If the court finds at the time of the hearing that the person is no longer in need of custody, care, and habilitation, it shall discharge the person from the custody of the Commissioner. An order of discharge may be conditional or absolute and may have immediate or delayed effect. (Added 1987, No. 248 (Adj. Sess.),  9; amended 2009, No. 154 (Adj. Sess.),  152.) 
 8846. Right to counsel
Persons subject to commitment or judicial review under this subchapter shall have a right to counsel as provided in section 7111 of this title. (Added 1987, No. 248 (Adj. Sess.),  9.) 
 8901. Purpose
The purpose of this chapter is to expand community mental health and developmental disability services; to encourage participation in such a program by persons in local communities; to obtain better understanding of the need for community mental health and developmental services; to authorize funding for the program by State aid, local financial support, and direct payment by people who receive services who have the ability to pay; and to provide services to persons with a mental condition or psychiatric disability, persons with a developmental disability, and children or adolescents with a severe emotional disturbance. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1979, No. 108 (Adj. Sess.),  1; 1987, No. 264 (Adj. Sess.),  10; 2005, No. 174 (Adj. Sess.),  47; 2013, No. 96 (Adj. Sess.),  115.) 
 8907. Designation of agencies to provide mental health and developmental disability services
(a) Except as otherwise provided in this chapter, the Commissioners of Mental Health and of Disabilities, Aging, and Independent Living shall, within the limits of funds designated by the Legislature for this purpose, ensure that community services to persons with a mental condition or psychiatric disability and persons with a developmental disability throughout the State are provided through designated community mental health agencies. The Commissioners shall designate public or private nonprofit agencies to provide or arrange for the provision of these services. (b) Within the limits of available resources, each designated community mental health or developmental disability agency shall plan, develop, and provide or otherwise arrange for those community mental health or developmental disability services that are not assigned by law to the exclusive jurisdiction of another agency and which are needed by and not otherwise available to persons with a mental condition or psychiatric disability or a developmental disability or children and adolescents with a severe emotional disturbance in accordance with the provisions of 33 V.S.A. chapter 43 who reside within the geographic area served by the agency. (Added 1979, No. 108 (Adj. Sess.),  2; amended 1987, No. 264 (Adj. Sess.),  11; 2005, No. 174 (Adj. Sess.),  47; 2007, No. 15,  15; 2013, No. 96 (Adj. Sess.),  115.) 
 8908. Local community services plan
Each designated community mental health and developmental disability agency shall determine the need for community mental health and developmental disability services within the area served by the agency and shall thereafter prepare a local community services plan which describes the methods by which the agency will provide those services. The plan shall include a schedule for the anticipated provision of new or additional services and shall specify the resources which are needed by and available to the agency to implement the plan. The community services plan shall be reviewed annually. (Added 1979, No. 108 (Adj. Sess.),  3; amended 2005, No. 174 (Adj. Sess.),  47.) 
 8909. Boards of directors of nonprofit corporations designated as community mental health and developmental disability agencies
(a) The board of a nonprofit corporation that is designated by the Commissioner of Mental Health or of Disabilities, Aging, and Independent Living to be a community mental health and developmental disability agency shall be representative of the demographic makeup of the area served by the agency. A majority of the members of the board shall be composed of both individuals who are or were eligible to receive services from an agency because of their disability, and family members of an individual who is or was eligible to receive services because of his or her disability. The board president shall survey board members on an annual basis and shall certify to the Commissioner that the composition of the board is comprised of a majority as required by this section. This composition of the board shall be confirmed by the organizations annual independent audit. Annually, the board shall determine whether or not this disclosure shall be made available to the public on request. The board shall have overall responsibility and control of the planning and operation of the community mental health agency. (b) The board shall direct the development of the local community services plan and shall consult with the Commissioners, with consumers, with other organizations representing persons receiving services, persons with developmental disabilities, and children and adolescents with a severe emotional disturbance, and with other governmental or private agencies that provide community services to the people served by the agency to determine the needs of the community for mental health and developmental disability services, and the priority need for service. The plan shall encourage utilization of existing agencies, professional personnel, and public funds at both State and local levels in order to improve the effectiveness of mental health and developmental disability services and to prevent unnecessary duplication of expenditures. (c) For the purpose of this section:(1) Disability means, with respect to an individual,(A) a physical or mental impairment, including alcoholism and substance abuse as defined by the Americans with Disabilities Act, that substantially limits one or more of the major life activities of the individual; (B) a record of such an impairment; or(C) being regarded as having such an impairment.(2) Family member means an individual who is related to the individual with a disability by blood, marriage, or adoption, or considers himself or herself to be family based upon bonds of affection, and who currently shares a household with the individual with a disability or has, in the past, shared a household with that individual. For the purposes of this section, bonds of affection means enduring ties that do not depend on the existence of an economic relationship. (3) Commissioner means either the Commissioner of Mental Health or the Commissioner of Disabilities, Aging, and Independent Living, or both, depending on the circumstances and subject matter of the issue or issues being addressed. (Added 1979, No. 108 (Adj. Sess.),  4; amended 1987, No. 264 (Adj. Sess.),  12; 1989, No. 187 (Adj. Sess.),  5; 1995, No. 174 (Adj. Sess.),  3; 1997, No. 113 (Adj. Sess.),  1; 2005, No. 174 (Adj. Sess.),  47; 2007, No. 15,  16, 22; 2013, No. 96 (Adj. Sess.),  115.) 
 8910. State aid; fees
(a) Upon application to the Commissioner by a designated community mental health and developmental disability agency, the Commissioner of the appropriate Department may grant to the agency funds to be used for carrying out its mental health and developmental disability services. Such grant of funds shall be based on a program plan and program budget developed by the agency and submitted to and approved by the Commissioner or Commissioners. The budget plan must indicate cost per unit of service and anticipated fees for services and must represent a balanced plan of anticipated receipts and expenditures. (b) No State funds shall be distributed to a community mental health agency unless the Commissioner determines that the agency has a reasonable cost per service unit and has established a uniform and reasonable schedule of fees for services provided to those persons who can afford to pay. A policy statement regarding fees, instructions for payment of fees, and fee collection procedures to be used by the agency shall be prepared and updated annually. (c) Nothing in this section should be interpreted to preclude anyone from receiving the services of the agencies due to inability to pay nor to preclude an agency from bringing an action as provided by law to recover fees due. (Added 1979, No. 108 (Adj. Sess.),  5; amended 2005, No. 174 (Adj. Sess.),  47.) 
 8911. Powers of the Commissioners
(a) If the Commissioners after discussion with the board of a community mental health and developmental disability agency determine that the local community services plan required by section 8908 of this chapter is inadequate to meet the needs of persons with a mental condition or psychiatric disability or with developmental disabilities or children and adolescents with a severe emotional disturbance in accordance with the provisions of 33 V.S.A. chapter 43 in the area served by a mental health and developmental disability agency or that an agency has, for reasons other than lack of resources, failed or refused to implement an otherwise adequate plan, the Commissioners shall take one or more of the following steps: (1) Offer technical assistance to the agency.(2) Actively seek out and designate another agency to provide the needed services.(3) Directly provide or arrange the needed services if it appears that the services will not otherwise be available within a reasonable period of time. The remedies specified in this subsection shall be in addition to any other rights and remedies which are available to the Commissioner under State or federal law. (b) Until May 1, 1998, no agency which has been designated as a community mental health agency may lose its designation without first being provided with notice and an opportunity for hearing in accordance with the provisions of 3 V.S.A.  809-813. After May 1, 1998, no agency may lose its designation except in accordance with new rules adopted for that purpose under the provisions of this subsection. Notwithstanding any other provisions to the contrary in 3 V.S.A. chapter 25, the Commissioner shall, in consultation with the designated provider system and consumer groups, develop proposed rules setting forth the standards and procedures for designation, redesignation, and loss of designation, and provide for six months notice of intent to revoke an agencys designation. The proposed rules shall also provide standards with measurable performance-based criteria and a streamlined appeals process. On or before December 31, 1997, the Commissioner shall file and hold public hearings on the proposed rules as provided in 3 V.S.A.  838, 839, and 840 in accordance with 3 V.S.A. chapter 25. The Commissioner shall file the final proposed rules with the General Assembly on or before January 15, 1998. Unless disapproved by act of the General Assembly on or before April 1, 1998, the Commissioner may adopt the rules by filing with the Secretary of State, which rules shall take effect on May 1, 1998. (c) The board of directors of a community mental health and developmental disability agency will be given a six-month notice of any intent on the part of the Commissioners to terminate its designated status. The Commissioners shall provide a written notice which outlines the performance based rationale associated with such intent. The board of directors shall have six months to review the Commissioners stated concerns and implement a corrective action plan. The board of directors shall also be informed, in writing, of current standards and procedures regarding appeal processes. (Added 1979, No. 108 (Adj. Sess.),  6; amended 1987, No. 264 (Adj. Sess.),  13; 1997, No. 61,  140a; 2005, No. 174 (Adj. Sess.),  47; 2013, No. 96 (Adj. Sess.),  115.) 
 8912. Contracts with nondesignated agencies
The Commissioners may enter into agreements with local community mental health and developmental disability agencies or with any public or private agency for the purpose of establishing specialized services which are needed by persons with a mental condition or psychiatric disability or with developmental disabilities or children and adolescents with a severe emotional disturbance and are not available from designated community mental health agencies. (Added 1979, No. 108 (Adj. Sess.),  7; amended 1987, No. 264 (Adj. Sess.),  14; 2005, No. 174 (Adj. Sess.),  47; 2013, No. 96 (Adj. Sess.),  115.) 
 8913. Minimum program standards and other regulations
(a) The Commissioners shall establish minimum program standards for services provided by community mental health and developmental disability agencies. Minimum program standards shall specify the basic activities and resources which are necessary for the implementation of such programs. (b) The procedure for establishing such standards shall be in accordance with 3 V.S.A. chapter 25. (Added 1979, No. 108 (Adj. Sess.),  8; amended 2005, No. 174 (Adj. Sess.),  47.) 
 8914. Rates of payments to designated and specialized service agencies
(a) The Secretary of Human Services shall have sole responsibility for establishing the Departments of Healths, of Mental Healths, and of Disabilities, Aging, and Independent Livings rates of payments for designated and specialized service agencies that are reasonable and adequate to achieve the required outcomes for designated populations. When establishing rates of payment for designated and specialized service agencies, the Secretary shall adjust rates to take into account factors that include: (1) the reasonable cost of any governmental mandate that has been enacted, adopted, or imposed by any State or federal authority; and (2) a cost adjustment factor to reflect changes in reasonable costs of goods and services of designated and specialized service agencies, including those attributed to inflation and labor market dynamics. (b) When establishing rates of payment for designated and specialized service agencies, the Secretary may consider geographic differences in wages, benefits, housing, and real estate costs in each region of the State. (Added 2017, No. 82,  11, eff. June 15, 2017.) 
 9001. PurposeArticle I
The party states find that the proper and expeditious treatment of the mentally ill and developmentally disabled can be facilitated by cooperative action, to the benefit of the patients, their families, and society as a whole. Further, the party states find that the necessity of and desirability for furnishing such care and treatment bears no primary relation to the residence or citizenship of the patient but that, on the contrary, the controlling factors of community safety and humanitarianism require that facilities and services be made available for all who are in need of them. Consequently, it is the purpose of this compact and of the party states to provide the necessary legal basis for the institutionalization or other appropriate care and treatment of the mentally ill and developmentally disabled under a system that recognizes the paramount importance of patient welfare and to establish the responsibilities of the party states in terms of such welfare. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  48.) 
 9002. DefinitionsArticle II
As used in this compact:(a) Sending state shall mean a party state from which a patient is transported pursuant to the provisions of the compact or from which it is contemplated that a patient may be so sent. (b) Receiving state shall mean a party state to which a patient is transported pursuant to the provisions of the compact or to which it is contemplated that a patient may be so sent. (c) Institution shall mean any hospital or other facility maintained by a party state or political subdivision thereof for the care and treatment of mental illness or developmental disability. (d) Patient shall mean any person subject to or eligible as determined by the laws of the sending state, for institutionalization or other care, treatment, or supervision pursuant to the provisions of this compact. (e) Aftercare shall mean care, treatment and services provided a patient, as defined herein, on convalescent status or conditional release. (f) Mental illness shall mean mental disease to such extent that a person so afflicted requires care and treatment for his or her own welfare, or the welfare of others, or of the community. (g) State shall mean any state, territory or possession of the United States, the District of Columbia, and the commonwealth of Puerto Rico. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  48.) 
 9003. Institutionalization of patientsArticle III
(a) Whenever a person physically present in any party state shall be in need of institutionalization by reason of mental illness or developmental disability, he or she shall be eligible for care and treatment in an institution in that state irrespective of his or her residence, settlement, or citizenship qualifications. (b) The provisions of paragraph (a) of this article to the contrary notwithstanding, any patient may be transferred to an institution in another state whenever there are factors based upon clinical determinations indicating that the care and treatment of said patient would be facilitated or improved thereby. Any such institutionalization may be for the entire period of care and treatment or for any portion or portions thereof. The factors referred to in this paragraph shall include the patients family, character of the illness and probable duration thereof, and such other factors as shall be considered appropriate. (c) No state shall be obliged to receive any patient pursuant to the provisions of paragraph (b) of this article unless the sending state has given advance notice of its intention to send the patient; furnished all available medical and other pertinent records concerning the patient; given the qualified medical or other appropriate clinical authorities of the receiving state an opportunity to examine the patient if said authorities so wish; and unless the receiving state shall agree to accept the patient. (d) In the event that the laws of the receiving state establish a system of priorities for the admission of patients, an interstate patient under this compact shall receive the same priority as a local patient and shall be taken in the same order and at the same time that he or she would be taken if he or she were a local patient. (e) Pursuant to this compact, the determination as to the suitable place of institutionalization for a patient may be reviewed at any time and such further transfer of the patient may be made as seems likely to be in the best interest of the patient. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  48.) 
 9004. Aftercare and supervisionArticle IV
(a) Whenever pursuant to the laws of the state in which a patient is physically present, it shall be determined that the patient should receive aftercare or supervision, such care or supervision may be provided in a receiving state. If the medical or other appropriate clinical authorities having responsibility for the care and treatment of the patient in the sending state shall have reason to believe that aftercare in another state would be in the best interest of the patient and would not jeopardize the public safety, they shall request the appropriate authorities in the receiving state to investigate the desirability of affording the patient such aftercare in said receiving state and such investigation shall be made with all reasonable speed. The request for investigation shall be accompanied by complete information concerning the patients intended place of residence and the identity of the person in whose charge it is proposed to place the patient, the complete medical history of the patient and such other documents as may be pertinent. (b) If the medical or other appropriate clinical authorities having responsibility for the care and treatment of the patient in the sending state and the appropriate authorities in the receiving state find that the best interest of the patient would be served thereby, and if the public safety would not be jeopardized thereby, the patient may receive aftercare or supervision in the receiving state. (c) In supervising, treating, or caring for a patient on aftercare pursuant to the terms of this article, a receiving state shall employ the same standards of visitation, examination, care and treatment that it employs for similar local patients. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9005. Escape of patientsArticle V
Whenever a dangerous or potentially dangerous patient escapes from an institution in any party state, that state shall promptly notify all appropriate authorities within and without the jurisdiction of the escape in a manner reasonably calculated to facilitate the speedy apprehension of the escapee. Immediately upon the apprehension and identification of any such dangerous or potentially dangerous patient, he or she shall be detained in the state where found pending disposition in accordance with law. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9006. TransportationArticle VI
The duly accredited officers of any state party to this compact, upon the establishment of their authority and the identity of the patient, shall be permitted to transport any patient being moved pursuant to this compact through any and all states party to this compact, without interference. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9007. Costs Article VII
(a) No person shall be deemed a patient of more than one institution at any given time. Completion of transfer of any patient to an institution in a receiving state shall have the effect of making the person a patient of the institution in the receiving state. (b) The sending state shall pay all costs of and incidental to the transportation of any patient pursuant to this compact, but any two or more party states may, by making a specific agreement for that purpose, arrange for a different allocation of costs as among themselves. (c) No provision of this compact shall be construed to alter or affect any internal relationships among the departments, agencies, and officers of and in the government of a party state or between a party state and its subdivisions, as to the payment of costs, or responsibilities therefor. (d) Nothing in this compact shall be construed to prevent any party state or subdivision thereof from asserting any right against any person, agency or other entity in regard to costs for which such party state or subdivision thereof may be responsible pursuant to any provision of this compact. (e) Nothing in this compact shall be construed to invalidate any reciprocal agreement between a party state and a nonparty state relating to institutionalization, care or treatment of the mentally ill or developmentally disabled, or any statutory authority pursuant to which such agreements may be made. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  48.) 
 9008. GuardiansArticle VIII
(a) Nothing in this compact shall be construed to abridge, diminish, or in any way impair the rights, duties, and responsibilities of any patients guardian on his or her own behalf or in respect of any patient for whom he or she may serve, except that where the transfer of any patient to another jurisdiction makes advisable the appointment of a supplemental or substitute guardian, any court of competent jurisdiction in the receiving state may make such supplemental or substitute appointment and the court which appointed the previous guardian shall, upon being duly advised of the new appointment and upon the satisfactory completion of such accounting and other acts as such court may by law require, relieve the previous guardian of power and responsibility to whatever extent shall be appropriate in the circumstances; provided, however, that in the case of any patient having settlement in the sending state, the court of competent jurisdiction in the sending state shall have the sole discretion to relieve a guardian appointed by it or continue his or her power and responsibility, whichever it shall deem advisable. The court in the receiving state may, in its discretion, confirm or reappoint the person or persons previously serving as guardian in the sending state in lieu of making a supplemental or substitute appointment. (b) The term guardian as used in paragraph (a) of this article shall include any guardian, trustee, legal committee, conservator, or other person or agency, however denominated, who is charged by law with power to act for or responsibility for the person or property of a patient. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9009. Criminal patientsArticle IX
(a) No provision of this compact except Article V shall apply to any person institutionalized while under sentence in a penal or correctional institution or while subject to trial on a criminal charge, or whose institutionalization is due to the commission of an offense for which, in the absence of mental illness or developmental disability, the person would be subject to incarceration in a penal or correctional institution. (b) To every extent possible, it shall be the policy of states party to this compact that no patient shall be placed or detained in any prison, jail, or lockup, but the patient shall, with all expedition, be taken to a suitable institutional facility for mental illness or developmental disability. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  48.) 
 9010. Compact administratorArticle X
(a) Each party state shall appoint a compact administrator who, on behalf of his or her state, shall act as general coordinator of activities under the compact in his or her state and who shall receive copies of all reports, correspondence and other documents relating to any patient processed under the compact by his or her state either in the capacity of sending or receiving state. The compact administrator or his or her duly designated representative shall be the official with whom other party states shall deal in any matter relating to the compact or any patient processed thereunder. (b) The compact administrators of the respective party states shall have power to promulgate reasonable rules and regulations to carry out more effectively the terms and provisions of this compact. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9011. Supplementary agreementsArticle XI
The duly constituted administrative authorities of any two or more party states may enter into supplementary agreements for the provision of any service or facility or for the maintenance of any institution on a joint or cooperative basis whenever the states concerned shall find that such agreements will improve services, facilities, or institutional care and treatment in the fields of mental illness or developmental disability. No such supplementary agreement shall be construed so as to relieve any party state of any obligation which it otherwise would have under other provisions of this compact. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 257 (Adj. Sess.),  4; 2005, No. 174 (Adj. Sess.),  48.) 
 9012. Adoption; effectArticle XII
This compact shall enter into full force and effect as to any state when enacted by it into law and such state shall thereafter be a party thereto with any and all states legally joining therein. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9013. WithdrawalArticle XIII
(a) A state party to this compact may withdraw therefrom by enacting a statute repealing the same. Such withdrawal shall take effect one year after notice thereof has been communicated officially and in writing to the governors and compact administrators of all other party states. However, the withdrawal of any state shall not change the status of any patient who has been sent to said state or sent out of said state pursuant to the provisions of the compact. (b) Withdrawal from any agreement permitted by article VII(b) as to costs or from any supplementary agreement made pursuant to article XI shall be in accordance with the terms of such agreement. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9014. Construction; separability of provisionsArticle XIV
This compact shall be liberally construed so as to effectuate the purposes thereof. The provisions of this compact shall be severable and if any phrase, clause, sentence, or provision of this compact is declared to be contrary to the constitution of any party state or of the United States or the applicability thereof to any government, agency, person or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any government, agency, person, or circumstance shall not be affected thereby. If this compact shall be held contrary to the constitution of any state party thereto, the compact shall remain in full force and effect as to the remaining states and in full force and effect as to the state affected as to all severable matters. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9051. Administrator
The Commissioner of Mental Health is hereby designated the Compact Administrator. The Commissioner shall administer the compact set out as subchapter 1 of this chapter with the power and duties therein specified and shall have authority to incur, on behalf of the State, financial obligations necessary for the proper performance of his or her duties under the compact. If any supplementary agreement made under the compact requires or contemplates the use of any institution or facility of the State or other service of the State, the agreement shall not take effect until its relevant provisions are approved by the General Assembly. The Compact Administrator shall cooperate with other officers, departments, and agencies of the State which are affected by the Compact Administrators actions in the performance of his or her duties. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1989, No. 187 (Adj. Sess.),  5; 1995, No. 174 (Adj. Sess.),  3; 2005, No. 174 (Adj. Sess.),  48; 2007, No. 15,  17.) 
 9052. Transfer of patients
The Compact Administrator shall consult with the immediate family of any person whom he or she proposes to transfer from a State institution to an institution in another state which is a party to this compact and shall take final action as to the transfer of such person only with the approval of the Superior Court of the unit of original commitment. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968; amended 1977, No. 145 (Adj. Sess.),  5; 2009, No. 154 (Adj. Sess.),  153.) 
 1001. Reports to Commissioner of Health
(a) When a physician, health care provider, nurse practitioner, nurse, physician assistant, or school health official has reason to believe that a person is sick or has died of a diagnosed or suspected disease, identified by the Department of Health as a reportable disease and dangerous to the public health, or if a laboratory director has evidence of such sickness or disease, he or she shall transmit within 24 hours a report thereof and identify the name and address of the patient and the name of the patients physician to the Commissioner of Health or designee. In the case of the human immunodeficiency virus (HIV), reason to believe shall mean personal knowledge of a positive HIV test result. The Commissioner, with the approval of the Secretary of Human Services, shall by rule establish a list of those diseases dangerous to the public health that shall be reportable. Nonmedical community-based organizations shall be exempt from this reporting requirement. All information collected pursuant to this section and in support of investigations and studies undertaken by the Commissioner for the purpose of determining the nature or cause of any disease outbreak shall be privileged and confidential. The Department of Health shall, by rule, require that any person required to report under this section has in place a procedure that ensures confidentiality. (b) Public health records developed or acquired by State or local public health agencies that relate to HIV or AIDS and that contain either personally identifying information or information that may indirectly identify a person shall be confidential and only disclosed following notice to and written authorization from the individual subject of the public health record or the individuals legal representative. Notice otherwise required pursuant to this section shall not be required for disclosures to the federal government; other departments, agencies, or programs of the State; or other states infectious disease surveillance programs if the disclosure is for the purpose of comparing the details of potentially duplicative case reports, provided the information shall be shared using the least identifying information first so that the individuals name shall be used only as a last resort. (c) [Repealed.](d) A confidential public health record, including any information obtained pursuant to this section, shall not be: (1) disclosed or discoverable in any civil, criminal, administrative, or other proceeding;(2) used to determine issues relating to employment or insurance for any individual;(3) used for any purpose other than public health surveillance, and epidemiological follow-up.(e) Any person who:(1) Willfully or maliciously discloses the content of any confidential public health record without written authorization or other than as authorized by law or in violation of subsection (b), (c), or (d) of this section shall be subject to a civil penalty of not less than $10,000.00 and not more than $25,000.00, costs and attorneys fees as determined by the court, compensatory and punitive damages, or equitable relief, including restraint of prohibited acts, costs, reasonable attorneys fees, and other appropriate relief. (2) Negligently discloses the content of any confidential public health record without written authorization or other than as authorized by law or in violation of subsection (b), (c), or (d) of this section shall be subject to a civil penalty in an amount not to exceed $2,500.00 plus court costs, as determined by the court, which penalty and costs shall be paid to the subject of the confidential information. (3) Willfully, maliciously, or negligently discloses the results of an HIV test to a third party in a manner that identifies or provides identifying characteristics of the person to whom the test results apply without written authorization or other than as authorized by law or in violation of subsection (b), (c), or (d) of this section and that results in economic, bodily, or psychological harm to the subject of the test is guilty of a misdemeanor, punishable by imprisonment for a period not to exceed one year or a fine not to exceed $25,000.00, or both. (4) Commits any act described in subdivision (1), (2), or (3) of this subsection shall be liable to the subject for all actual damages, including damages for any economic, bodily, or psychological harm that is a proximate result of the act. Each disclosure made in violation of this chapter is a separate and actionable offense. Nothing in this section shall limit or expand the right of an injured subject to recover damages under any other applicable law. (f) [Repealed.](g) Health care providers must, prior to performing an HIV test, inform the individual to be tested that a positive result will require reporting of the result and the individuals name to the Department, and that there are testing sites that provide anonymous testing that are not required to report positive results. The Department shall develop and make widely available a model notification form. (h) Nothing in this section shall affect the ongoing availability of anonymous testing for HIV. Anonymous HIV testing results shall not be required to be reported under this section. (i) The Department shall annually evaluate the systems and confidentiality procedures developed to implement networked and non-networked electronic reporting, including system breaches and penalties for disclosure to State personnel. The Department shall provide the results of this evaluation to and solicit input from the Vermont HIV/AIDS Community Advisory Group. (j) The Department shall collaborate with community-based organizations to educate the public and health care providers about the benefits of HIV testing and the use of current testing technologies. (k) The Commissioner shall maintain a separate database of reports received pursuant to subsection 1141(i) of this title for the purpose of tracking the number of tests performed pursuant to chapter 21, subchapter 5 of this title and other information as the Department of Health finds necessary and appropriate. The database shall not include any information that personally identifies a patient. (Amended 1979, No. 60,  1; 1997, No. 7,  1, eff. April 29, 1997; 1999, No. 17,  2; 2007, No. 73,  2; eff. April 1, 2008; 2007, No. 194 (Adj. Sess.),  2; 2009, No. 81 (Adj. Sess.),  1, eff. April 20, 2010; 2013, No. 34,  30a; 2015, No. 37,  2.) 
 1004. Report by physician; quarantine
A physician who knows or suspects that a person whom he or she has been called to attend is sick or has died of a communicable disease dangerous to the public health shall immediately quarantine and report to the health officer the place where such case exists, but if the attending physician, at the time of his or her first visit, is unable to make a specific diagnosis, he or she may quarantine the premises temporarily and until a specific diagnosis is made, and post thereon a card upon which the word quarantine should be plainly written or printed. Such quarantine shall continue in force until the health officer examines and quarantines as is provided in this title. 
 1004a. Quarantine
The Commissioner of Health shall have the power to quarantine a person diagnosed with or suspected of having a disease dangerous to the public health. (Added 1979, No. 60,  2.) 
 1007. Quarantined patient leaving hospital, report
When a patient who has a communicable disease subject to quarantine leaves a hospital or institution, without the consent of the authorities of such hospital or institution the physician or other person in charge of such a hospital or institution shall notify forthwith the Commissioner that such person has left the hospital or institution and is the bearer of such communicable disease. (Amended 1979, No. 60,  3.) 
 1008. Vaccines, antibiotics, antiserums, and other agents; purchase and distribution; penalties
(a) The Department is authorized to procure vaccines, antibiotics, antiserums, and such other agents as may be necessary for the prevention and diagnosis of infectious and communicable diseases or diseases of public health significance in which there is an unmet need and to distribute same free of charge upon application thereof by licensed physicians, and under such rules as the Department and Secretary of Human Services may prescribe; and the expense thereof shall be paid by the State. (b) A person selling or disposing of any vaccine, antibiotic, antiserum, or other agent procured or distributed under the provisions of this section for personal gain shall be fined not more than $50.00 or less than $10.00 for each such offense. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1961, No. 51, 1, 2; 1979, No. 60,  4; 2017, No. 113 (Adj. Sess.),  57.) 
 1010. Ophthalmia neonatorum
The Department and the Secretary of Human Services may make such rules as they deem necessary for the prevention of blindness caused by the disease known as ophthalmia neonatorum, and they may furnish, at the expense of the State, such prophylactic outfits as are necessary for the use of physicians. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1979, No. 60,  5; 2017, No. 113 (Adj. Sess.),  58.) 
 1041. Reports by physicians and certain others
A physician who is consulted by a person infected with tuberculosis in any form shall submit the name and address of such person to the Commissioner upon such forms as he or she may furnish, with such other facts as may be required, within one week after such consultation. (Amended 1969, No. 101,  1, eff. April 19, 1969.) 
 1042. Record of cases; instructions
The Commissioner shall keep an accurate record of cases reported as provided in sections 1007 and 1041 of this title, and the same shall not be published, but shall be kept by the Board for such purposes as are necessary in the discharge of its duties. Upon being notified of a case mentioned in sections 1007 and 1041 of this title, the Board shall take such action as it deems necessary for the protection of the public and the individuals health. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1043. Investigation; educational campaign, report
The Board shall investigate the prevalence and extent of tuberculosis and other chronic respiratory diseases in the State, shall adopt and make use of means for educating the people of the State in respect to the causes and nature of these diseases, means for their prevention and treatment, and in respect to the best method of preventing and limiting the prevalence of these diseases. Such educational campaign shall be carried on in such manner as the Board deems proper to disseminate the facts in regard to these diseases. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1969, No. 101,  2, eff. April 19, 1969.) 
 1047. Indigent persons with respiratory diseases
Persons who have tuberculosis and other chronic respiratory diseases, who are without the means to obtain adequate care and treatment for such diseases, shall be deemed indigent persons for the purposes of this subchapter. (Amended 1965, No. 5,  1; 1969, No. 101,  3, eff. April 19, 1969; 2013, No. 96 (Adj. Sess.),  92.) 
 1048. Examination; report; treatment
A physician, licensed to practice medicine and surgery in the State, shall immediately after examination of an indigent person wishing treatment for tuberculosis or other chronic respiratory disease make a report of his or her findings to the Commissioner of Health. Upon receipt of such report, the Commissioner may authorize treatment of the person who has tuberculosis or other chronic respiratory disease. Such persons physician shall thereupon prescribe the time of treatment and designate the facility at which treatment shall be given; provided, however, that in a case of tuberculosis suspected of being infectious, the Commissioner may apply all the laws and regulations of communicable disease control. (Amended 1969, No. 101,  4, eff. April 19, 1969; 2013, No. 96 (Adj. Sess.),  92.) 
 1051. Tuberculosis treatment facilities
The Commissioner shall approve facilities in the State where indigent persons may be treated for tuberculosis under this subchapter. The Commissioner and the Board of Health shall determine to their satisfaction that all such facilities furnish adequate and proper tuberculosis treatment. Treatment for other chronic respiratory diseases under this subchapter may be given at any accredited hospital. (Amended 1959, No. 190,  2; 1966, No. 22 (Sp. Sess.),  1; 1969, No. 101,  6, eff. April 19, 1969.) 
 1053. Treatment and care of patients
The Secretary of Human Services may provide for treatment and care of tuberculosis and chronic respiratory disease patients at facilities designated by him or her. (Amended 1965, No. 5,  2; 1966, No. 22 (Sp. Sess.),  2; 1969, No. 101,  7, eff. April 19, 1969; 1973, No. 89,  2.) 
 1054. Tuberculosis clinic and treatment program
(a) The Department shall visit all newly reported cases or suspect cases of tuberculosis with periodic follow-up visits as deemed necessary. (b) The Department shall provide for:(1) prompt examination of all suspects and contacts;(2) chemotherapeutic treatment of all active cases attending this clinic; and hospitalization in accordance with sections 1047-1051 of this title; (3) chemotherapy for converters and inactive cases;(4) the reevaluation and reexamination of inactive cases as medically indicated. (Added 1961, No. 270,  1-3, eff. Aug. 1, 1961; amended 1973, No. 89,  3; 1997, No. 147 (Adj. Sess.),  272.)
 1055. Tuberculosis; compulsory examinations
When the Commissioner of Health has reasonable cause to believe that any person has tuberculosis in an active stage or in a communicable form, the Commissioner may request the person to undergo an examination at a clinic or hospital approved by the Secretary of Human Services for that purpose at the expense of the State by a physician qualified in chest diseases. If the person refuses the examination, the Commissioner may petition the Superior Court for the unit where the person resides for an order requiring the person to submit to examination. When the court finds that there is reasonable cause to believe that the person has tuberculosis in an active stage or in a communicable form, it may order the person to be examined. (Added 1967, No. 49,  1; amended 1973, No. 89,  4; 2009, No. 154 (Adj. Sess.),  144.) 
 1056. Nature of examination; findings
The examination shall be in the manner and form prescribed by the Commissioner of Health. It may include taking of an x-ray of the chest and enough microscopical examinations and cultures to permit completion of diagnosis. The findings of the examination shall be reported in full to the Commissioner of Health who shall furnish copies thereof to the person examined. (Added 1967, No. 49,  2.) 
 1057. Medical management
(a) When the Commissioner of Health determines, as a result of an examination as provided by sections 1055 and 1056 of this title, that any person has tuberculosis in an active stage and in communicable form to an extent that the person may expose other persons or the public generally to danger of infection, he or she shall investigate the circumstances thereof and if he or she finds that the person does constitute a health hazard to the public, he or she may request the court to order the person to a hospital or other suitable place and require appropriate medical management of the person therein until he or she determines that the management is no longer necessary. Such medical care and treatment as the Commissioner of Health considers necessary and proper may be furnished to the sick person at the expense of the State. Treatment shall not be imposed on any person against his or her will unless the Commissioner determines that the person constitutes a public health hazard without such treatment. (b) Nothing in sections 1055 to 1061 of this title shall be construed to compel any person who is being treated by prayer or spiritual means alone in accordance with the tenets and practice of a well-recognized church or religious denomination by a duly accredited practitioner to be medically managed in a place to which he or she objects as long as suitable healing methods or isolation can be maintained in a place of his or her own choosing, provided that he or she does not constitute a public health hazard as determined by the Commissioner, and that all sanitation rules are complied with. (Added 1967, No. 49,  3; amended 1973, No. 89,  5; 2013, No. 96 (Adj. Sess.),  92; 2017, No. 113 (Adj. Sess.),  59.) 
 1058. Compulsory medical management
If any person fails or refuses to comply with an order of the court issued under section 1057 of this title, the Commissioner of Health, in accordance with the order, may request any police officer or sheriff in writing to take the person into custody and deliver him or her forthwith to a place or facility for such services as designated by the Secretary of Human Services as provided in sections 1053 and 1055 of this title. The officer shall tender the person named in the order a copy of the order of the court and of the request to him or her to apprehend and deliver the person to the place of tuberculosis management, and shall make return of his or her doings to the court. (Added 1967, No. 49,  4; amended 1973, No. 89,  6.) 
 1059. Leaving compulsory medical management
A person who is managed by order of the court shall not leave the place of compulsory medical management without the permission in writing of the court or the Commissioner of Health. That permission may constitute a final discharge or be for a specified period of time. In either case the Commissioner of Health may impose such conditions as he or she considers reasonable, including requirements for periodic examinations. Any person so managed who leaves the place of management without permission, or who fails to return thereto within the time prescribed, may be returned to the place of management without further court order and the Commissioner of Health may direct any officer specified in section 1058 of this title, in writing, to apprehend the person and to return him or her forthwith to the place of management. (Added 1967, No. 49,  5; amended 1973, No. 89,  7.) 
 1060. Rights of a person in compulsory medical management
Any person in compulsory medical management by order of the court who believes his or her physical condition is such as to warrant his or her discharge, if the discharge is refused by the Commissioner of Health, is entitled to a physical examination by a qualified physician of his or her own choice. If as a result of examination the physician feels that the continued compulsory medical management is no longer justified and the Commissioner of Health does not concur in that opinion, the person may appeal by petition to the court issuing the original order for his or her compulsory medical management. Proceedings before the court shall be de novo, and the court may require such further examination as it considers necessary and may, in its discretion, at the expense of the State appoint no less than three independent physicians, at least one of whom shall have had special experience in respiratory diseases, to examine the person. At the conclusion of the proceedings, the court shall make findings of fact and issue such order as it considers proper. The order of the court may be appealed to the Supreme Court in the manner provided by law for appeals from a Criminal Division of the Superior Court generally. A person may not petition for release from medical management within six months from the date a court order is made, whether an appeal is taken or not. (Added 1967, No. 49,  6; amended 1973, No. 89,  8; 2009, No. 154,  238.) 
 1061. Construction with other laws
Sections 1055-1060 of this title are in addition to any other statutes relating to communicable diseases generally or to tuberculosis specifically and shall not abrogate or repeal those other statutes unless in direct conflict therewith, in which case the provisions of such sections shall control. (Added 1967, No. 49,  7.) 
 1091. Venereal diseases; definitions
In this subchapter, unless the context requires otherwise:(1) Authoritative source means a physician licensed in the State, superintendent of a State institution or private hospital, medical officers of the armed forces of the State or United States, State and territorial health officers, and personnel of the Department of Health designated by the Board of Health. (2) Venereal disease means syphilis, gonorrhea, and any other sexually transmitted disease which the Department finds to be of significance and amenable to control. (Amended 1967, No. 7,  1; 1979, No. 60,  6.) 
 1091a. Venereal diseases, control
Venereal diseases are contagious, infectious, communicable, and dangerous to public health. Protection of the public requires the identification and treatment of persons infected by those diseases. (Added 1967, No. 7,  2.) 
 1092. Treatments, refusal, penalty
A physician or other person, except persons who merely practice the religious tenets of their church without pretending a knowledge of medicine or surgery, provided, however, that sanitary laws, rules, and regulations are complied with, who knows or has reason to believe that a person whom he or she treats or prescribes for, or to whom he or she sells patent or proprietary medicine purporting to cure or alleviate the symptoms of gonorrhea or syphilis, has one of these diseases, shall immediately report the name, nationality, race, marital state, address, age, and sex of such person, and, if obtainable, the date and source of contracting the same, to the Commissioner on forms furnished for that purpose. Such persons so reported shall submit to regular treatment prescribed by a physician until discharged by the physician. A person who willfully refuses to regularly submit to prescribed treatment shall be reported at once to the States Attorney for immediate prosecution. Such willful refusal shall be punishable by a fine of not more than $100.00 or three months imprisonment, or both. 
 1093. Examination and report
Whenever the Board shall receive information from an authoritative source to the effect that a person is suspected of being infected with an infectious venereal disease and is likely to infect or to be the source of infection of another person, such Board shall cause a medical examination to be made of such person, for the purpose of ascertaining whether or not such person is in fact infected with such disease in a communicable stage, and such person shall submit to such examination and permit specimens of blood or bodily discharges to be taken for laboratory examinations as may be necessary to establish the presence or absence of such disease or infection, and such person may be detained until the results of such examinations are known. The required examination shall be made by a physician licensed to practice in this State, or a licensed physician designated by the person to be examined. Such licensed physician making such examination shall report thereon to the Board and to the person examined. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1973, No. 89,  9.) 
 1094. Restraining order
Such suspected person may by petition directed to a Justice of the Supreme Court or a Superior judge pray for an order restraining the making of such examination and no examination shall then be made except upon order of such Justice or judge, and such petition and order shall not be a matter of public record. Before such examination, each suspected person shall be informed of this right and be given an opportunity to avail himself or herself thereof. 
 1095. Treatment of partner of patient diagnosed with a sexually transmitted disease
(a) As used in this section:(1) Expedited partner treatment means the practice of treating the sexual partner or partners of a patient diagnosed with a sexually transmitted disease for the sexually transmitted disease by providing a prescription or medication to the patient for the sexual partner or partners without the prescribing or dispensing health care professional examining the sexual partner or partners. (2) Health care professional means a physician licensed pursuant to 26 V.S.A. chapter 23 or 33, a physician assistant certified to prescribe and dispense prescription drugs pursuant to 26 V.S.A. chapter 31, or a nurse authorized to prescribe and dispense prescription drugs pursuant to 26 V.S.A. chapter 28. (b) A health care professional may provide expedited partner treatment to a patients sexual partner or partners for the treatment of a sexually transmitted disease designated by the Commissioner by rule. (c) A health care professional who prescribes or dispenses prescription drugs for a patients sexual partner or partners without an examination pursuant to subsection (b) of this section shall do so in accordance with guidance published by the Commissioner and shall include with each prescription and medication dispensed a letter that: (1) cautions the sexual partner not to take the medication if he or she is allergic to the medication prescribed or dispensed; and (2) recommends that the sexual partner visit a health care professional for evaluation.(d) The Commissioner shall establish by rule additional treatment standards for expedited partner treatment and authorize expedited partner treatment for any sexually transmitted diseases, provided that expedited partner treatment for those diseases conforms to the best practice recommendations of the Centers for Disease Control and Prevention. (Added 2013, No. 42,  1; amended 2013, No. 42,  2, eff. March 1, 2014.) 
 1096. Penalty
A person who violates a provision of sections 1092-1095 of this title, for which no other penalty is provided, shall be fined not more than $500.00 or imprisoned for not more than six months, or both. 
 1097. Educational campaign
The Board shall conduct an educational campaign of methods for the prevention and treatment and care of persons who have venereal diseases. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2013, No. 96 (Adj. Sess.),  92.) 
 1098. Examination and treatment by Board
The Board shall provide at the expense of the State facilities for the free laboratory examination of material from suspected cases of venereal disease, and shall furnish hospitalization and other accredited specific treatment at cost or free to such clinical patients as the Board shall deem entitled to such aid. Payment for diagnosis and treatment shall not be furnished until the report required by section 1093 of this title has been made. The Board shall include, in bulletins or circulars distributed by it, information concerning such diseases. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1973, No. 89,  10.) 
 1099. Reports and records confidential
All information and reports in connection with persons who have venereal diseases shall be regarded as absolutely confidential and for the sole use of the Board in the performance of its duties hereunder, and such records shall not be accessible to the public nor shall such records be deemed public records; and the Board shall not disclose the names or addresses of persons so reported or treated except to a prosecuting officer or in court in connection with a prosecution under section 1105 or 1106 of this title. The foregoing shall not constitute a restriction on the Board in the performance of its duties in controlling these communicable diseases. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2013, No. 96 (Adj. Sess.),  92.) 
 1100. Rules
The Board shall make and enforce such rules for the quarantining and treatment of cases of venereal disease reported to it as may be deemed necessary for the protection of the public. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 113 (Adj. Sess.),  60.) 
 1101. Reports by public institutions
The superintendent or other officer in charge of public institutions such as hospitals, dispensaries, clinics, homes, psychiatric hospitals, and charitable and correctional institutions shall report promptly to the Board the name, sex, age, nationality, race, marital state, and address of every patient under observation who has venereal diseases in any form, stating the name, character, stage, and duration of the infection, and, if obtainable, the date and source of contracting the same. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2013, No. 96 (Adj. Sess.),  92.) 
 1102. Taking blood samples
A practitioner of medicine and surgery or osteopathy attending a pregnant woman shall take samples of blood of such woman, if possible prior to the third month of gestation, and submit same to a laboratory approved by the Board for a standard serological test for syphilis. Every other person permitted by law to take blood tests shall similarly cause a sample of blood of a pregnant woman attended by him or her to be taken by a duly licensed practitioner of medicine and surgery or osteopathy and submit it to a laboratory approved by the Board for a standard serological test for syphilis. (Amended 1959, No. 19, eff. March 5, 1959; 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1103. Birth certificate; serological test
A person required by section 5071 of this title to file a report of birth shall state on the report whether a blood test for syphilis has been made upon a sample of blood taken from the woman who bore the child named in the report and if so shall state the date on which the test was made. In case no such blood test has been made, such fact shall be stated in the report with the reason why such test has not been made. In no event shall the birth certificate state the result of the serological test for syphilis made pursuant to the provisions of this section and section 1102 of this title. (Amended 2017, No. 46,  8, eff. July 1, 2019; 2017, No. 113 (Adj. Sess.),  61.) 
 1104. Serological test, definition
A standard serological test shall be a test for syphilis approved by the Board and shall be performed on request by the State laboratory or at a laboratory approved for this purpose by the Board. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1105. Marrying when infected with venereal disease
A person, having been told by a physician that he or she was infected with gonorrhea or syphilis in a stage which is or may become communicable to a marital partner, or knowing that he or she is so infected, who marries, without assurance and certification from a legally qualified practitioner of medicine and surgery or osteopathy that he or she is free from such disease in a stage which is or may become communicable to the marital partner shall be imprisoned not less than two years or fined not less than $500.00, or both. 
 1106. Sexual intercourse when infected with venereal disease
A person who has sexual intercourse while knowingly infected with gonorrhea or syphilis in a communicable stage shall be imprisoned not more than two years or fined not more than $500.00, or both. (Amended 1973, No. 89,  11; 1981, No. 223 (Adj. Sess.),  23.) 
 1120. Definitions
As used in this subchapter:(1) Child care facility means a child care facility or family day care home licensed or registered under 33 V.S.A. chapter 35, unless exempted by rule adopted under section 1123 of this title. (2) School means a public or independent prekindergarten, kindergarten, elementary, or secondary school, or any postsecondary school as defined in 16 V.S.A.  176(b), unless exempted by rule adopted pursuant to section 1123 of this title. (Added 1979, No. 40; amended 1981, No. 18,  1; 1993, No. 75,  1; 2007, No. 204 (Adj. Sess.),  5.) 
 1121. Immunizations required prior to attending school and child care facilities
(a) No person may enroll as a student in a Vermont school, regardless of whether the student has been enrolled in the school during a previous school year, unless the appropriate school official has received a record or certificate of immunization issued by a licensed health care practitioner or a health clinic that the person has received required immunizations appropriate to age as specified by the Vermont Department of Health. (b) No person may enroll or retain a child in a child care facility, regardless of whether the child has been enrolled in the facility during a previous year, unless the facility has received a record or certificate of immunization issued by a licensed health care practitioner or a health clinic that the child has received required immunizations in the prior 12-month period appropriate to age as specified by the Vermont Department of Health. (c)(1) To the extent permitted under 20 U.S.C.  1232g (family educational and privacy rights), and any regulations adopted thereunder, all schools and child care facilities shall make publicly available the aggregated immunization rates of the student body for each required immunization using a standardized form that shall be created by the Department. Each school and child care facility shall provide the information on the school and child care facilitys aggregated immunization rate for each required immunization to students, or in the case of a minor to parents and guardians, at the start of each academic year and to any student, or in the case of a minor to the parent or guardian of any student, who transfers to the school or child care facility after the start of the academic year. A student attending a postsecondary school shall directly receive information on the schools aggregated immunization rate at the start of the academic year or upon transfer to the school, regardless of whether the student is a minor. (2) Each school and child care facility shall annually, on or before January 1, submit its standardized form containing the student bodys aggregated immunization rates to the Department. (3) Notwithstanding section 1120 of this title, as used in this subsection only, the term child care facility shall exclude a family day care home licensed or registered under 33 V.S.A. chapter 35. (Added 1979, No. 40; amended 1981, No. 18,  2; 2007, No. 204 (Adj. Sess.),  6; 2011, No. 157 (Adj. Sess.),  1; 2013, No. 34,  12; 2015, No. 37,  3.) 
 1122. Exemptions
(a) Notwithstanding subsections 1121(a) and (b) of this title, a person may remain in school or in a child care facility without a required immunization: (1) If the person or, in the case of a minor, the persons parent or guardian presents a form created by the Department and signed by a licensed health care practitioner authorized to prescribe vaccines or a health clinic stating that the person is in the process of being immunized. The person may continue to attend school or a child care facility for up to six months while the immunization process is being accomplished. (2) If a licensed health care practitioner who is authorized to prescribe vaccines certifies in writing that a specific immunization is or may be detrimental to the persons health. A certifying health care practitioner shall specify the required immunization in question as well as the probable duration of the condition or circumstance that is or may be detrimental to the persons health. Any exemption certified under this subdivision shall terminate when the condition or circumstance cited no longer applies. (3) If the person or, in the case of a minor, the persons parent or guardian annually provides a signed statement to the school or child care facility on a form created by the Department that the person, parent, or guardian: (A) holds religious beliefs opposed to immunization; and(B) has reviewed evidence-based educational material provided by the Department regarding immunizations, including: (i) information about the risks of adverse reactions to immunization;(ii) information that failure to complete the required vaccination schedule increases risk to the person and others of contracting or carrying a vaccine-preventable infectious disease; and (iii) information that there are persons with special health needs attending schools and child care facilities who are unable to be vaccinated or who are at heightened risk of contracting a vaccine-preventable communicable disease and for whom such a disease could be life-threatening. (b) The Department of Health may provide by rule for further exemptions to immunization based upon sound medical practice. (c) A form signed pursuant to subdivision (a)(3) of this section and the fact that such a form was signed shall not be: (1) construed to create or deny civil liability for any person; or(2) admissible as evidence in any civil proceeding.(d) As used in this section, health care practitioner means a person licensed by law to provide professional health care services to an individual during the course of that individuals medical care or treatment. (Added 1979, No. 40; amended 1981, No. 18,  3; 2007, No. 204 (Adj. Sess.),  7; 2011, No. 157 (Adj. Sess.),  2; 2015, No. 37,  4, eff. July 1, 2016.) 
 1123. Immunization rules
The Department shall adopt rules for administering this subchapter. Such rules shall be developed in consultation with the Agency of Education with respect to immunization requirements for Vermont schools, and in consultation with the Department for Children and Families with respect to immunization requirements for child care facilities. Such rules shall list which immunizations shall be required and the manner and frequency of their administration, and may provide for exemptions as authorized by this subchapter. (Added 1979, No. 40; amended 2007, No. 204 (Adj. Sess.),  8; 2013, No. 92 (Adj. Sess.),  256, eff. Feb. 14, 2014; 2015, No. 37,  5; 2017, No. 74,  26.) 
 1124. Access to and reporting of immunization records
(a) In addition to any data collected in accordance with the requirements of the Centers for Disease Control and Prevention, the Department shall annually collect from schools the immunization rates for at least those students in the first and eighth grades for each required vaccine. The data collected by the Department shall include the number of medical and religious exemptions filed for each required vaccine and the number of students with a provisional admittance. (b) Appropriate health personnel, including school nurses, shall have access to immunization records of anyone enrolled in Vermont schools or child care facilities, when access is required in the performance of official duties related to the immunizations required by this subchapter. Access to student immunization records shall only be provided with the prior written consent of parents and students as required by the Family Educational Rights and Privacy Act, 20 U.S.C.  1232g, and any regulations adopted thereunder. (Added 1979, No. 40; amended 1981, No. 18,  4; 2007, No. 204 (Adj. Sess.),  9; 2011, No. 157 (Adj. Sess.),  3; 2015, No. 37,  6, eff. July 1, 2016.) 
 1125. Quality improvement measures
The Department may implement quality improvement initiatives in any school that has a provisional admittance rate or an exemption rate above the State average. (Added 2015, No. 37,  7.) 
 1126. Noncompliance
The school board of each district, or the board of trustees of each independent school, or the chief executive officer of each postsecondary school, or the director of each child care facility shall exclude from school or a child care facility any person not otherwise exempted under this subchapter who fails to comply with its provisions. No person shall be excluded for failure to comply with the provisions of this subchapter unless there has been a notification by the appropriate school or child care facility authority to the person, or in the case of a minor to the persons parent or guardian of the noncompliance with this subsection, and of their rights under section 1122 of this title. In the event of exclusion, school officials or the director of the child care facility shall notify the Department of Health and contact the parents or guardians in an effort to secure compliance with the requirements of this subchapter so that the person may attend school or the child care facility. (Added 1979, No. 40; amended 1981, No. 18,  5; 1993, No. 75,  2; 2007, No. 204 (Adj. Sess.),  10.) 
 1127. Discrimination and testing prohibited
(a) No school district or educational institution shall request or require any applicant, or prospective or current student to have an HIV-related blood test nor shall any school district or educational institution discriminate against an applicant, or prospective or current student on the basis of a persons having a positive test result from an HIV-related blood test. (b) A person aggrieved by a violation of this section or the Attorney General on behalf of such a person may bring an action for injunctive relief and damages in the Superior Court of the county in which the violation is alleged to have occurred. The court may award costs and reasonable attorneys fees to an aggrieved person who prevails in an action brought under this subsection. (Added 1987, No. 176 (Adj. Sess.),  4.) 
 1128. Access to health services and testing
(a) No health care provider or facility shall request or require any applicant for care or services or any client or patient to have an HIV-related blood test as a condition for receiving unrelated treatment or service nor shall any such provider or facility discriminate against any applicant, client, or patient on the basis of a persons having a positive test result from an HIV-related blood test. Nothing in this section shall preclude health care providers or facilities from recommending testing for medically appropriate diagnostic purposes or from administering to clients or patients who consent to have an HIV-related blood test. (b) Failure of a health care provider to comply with any provision of this section shall constitute grounds for disciplinary action or any other regulatory action authorized by law. Failure of a health care facility to comply with any provision of this section shall constitute grounds for modification, suspension, or revocation of the facilitys license, authority to operate, or any other regulatory action authorized by law. Any such regulatory action shall be taken in accordance with the disciplinary, licensing, or other procedures established by law for the board or agency having jurisdiction over the health care provider or facility. (c) A person aggrieved by a violation of this section or the Attorney General on behalf of such a person may bring an action for injunctive relief and damages in the Superior Court of the county in which the violation is alleged to have occurred. The court may award costs and reasonable attorneys fees to an aggrieved person who prevails in an action brought under this subsection. (Added 1987, No. 176 (Adj. Sess.),  5.) 
 1129. Immunization registry
(a) A health care provider shall report to the Department all data regarding immunizations of adults and of children under 18 years of age within seven days of the immunization, provided that required reporting of immunizations of adults shall commence within one month after the health care provider has established an electronic health records system and data interface pursuant to the e-health standards developed by the Vermont Information Technology Leaders. A health insurer shall report to the Department all data regarding immunizations of adults and of children under 18 years of age at least quarterly. All data required pursuant to this subsection shall be reported in a format required by the Department. (b) The Department may use the data to create a registry of immunizations. Registry information shall remain confidential and privileged, except as provided in subsections (c) and (d) of this section. Registry information regarding a particular adult shall be provided, upon request, to the adult, the adults health care provider, and the adults health insurer. Registry information regarding a particular minor child may be provided, upon request, to school nurses, or in the absence of a nurse on staff, administrators, and upon request and with written parental consent, to licensed day care providers, to document compliance with Vermont immunization laws. Registry information regarding a particular child shall be provided, upon request to the minor childs parent or guardian, health insurer, and health care provider, or to the child after the child reaches the age of majority. (c) The Department may exchange confidential registry information with the immunization registries of other states in order to obtain comprehensive immunization records. (d) The Department may provide confidential registry information to health care provider networks serving Vermont patients; to the Vermont Health Information Exchange; and, with the approval of the Commissioner, to researchers who present evidence of approval from an institutional review board in accordance with 45 C.F.R.  164.512. (e) Prior to releasing confidential information pursuant to subsections (c) and (d) of this section, the Commissioner shall obtain from State registries, health care provider networks, the Vermont Health Information Exchange, and researchers a written agreement to keep any identifying information confidential and privileged. (f) The Department may share registry information for public health purposes in summary, statistical, or other form in which particular individuals are not identified, except as provided in subsections (c) and (d) of this section. (g) As used in this section, administrator means an individual licensed under 16 V.S.A. chapter 5, the majority of whose employed time in a public school, school district, or supervisory union is assigned to developing and managing school curriculum, evaluating and disciplining personnel, or supervising and managing a school system or school program. Administrator also means an individual employed by an approved or recognized independent school, the majority of whose assigned time is devoted to those duties. (Added 1997, No. 91 (Adj. Sess.),  1; amended 2007, No. 204 (Adj. Sess.),  11; 2015, No. 37,  8; 2021, No. 9,  14a, eff. April 17, 2021.) 
 1130. Immunization funding
(a) As used in this section:(1) Health care facility shall have the same meaning as in section 9402 of this title.(2) Health care professional means an individual, partnership, corporation, facility, or institution licensed or certified or authorized by law to provide professional health care services. (3) Health insurer shall have the same meaning as in section 9402 of this title, but does not apply to insurers providing coverage only for a specified disease or other limited benefit coverage. (4) Immunizations means vaccines and the application of the vaccines as recommended by the practice guidelines for children and adults established by the Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC). (5) State health care programs means any health care program providing immunizations with funds available through State and federal sources. (6) Covered lives means the number of Vermont residents covered under a health insurance plan provided or administered by a health insurer. (b)(1) The Department of Health shall administer an immunization program with the goals of ensuring universal access to vaccines for all Vermonters at no charge to the individual and reducing the cost at which the State may purchase vaccines. The Department shall purchase, provide for the distribution of, and monitor the use of vaccines as provided for in this subsection and subsection (c) of this section. The cost of the vaccines and an administrative surcharge shall be reimbursed by health insurers as provided for in subsections (e) and (f) of this section. (2) The Department shall solicit, facilitate, and supervise the participation of health care professionals, health care facilities, and health insurers in the immunization program in order to accomplish the States goal of universal access to immunizations at the lowest practicable cost to individuals, insurers, and State health care programs. (3) The Department shall gather and analyze data regarding the immunization program for the purpose of ensuring its quality and maximizing protection of Vermonters against diseases preventable by vaccination. (c) The immunization program shall purchase vaccines from the federal Centers for Disease Control and Prevention at the lowest available cost. The Department shall determine annually which vaccines for adults shall be purchased under the program. (d) The immunization program shall provide for distribution of the vaccines to health care professionals and health care facilities for administration to patients. (e) Health insurers shall remit to the Department the cost of vaccines, as established by the Commissioner of Health based on the recommendation of the Immunization Funding Advisory Committee established in subsection (g) of this section. (f) The Department shall charge each health insurer a surcharge for the costs and administration of the immunization program. The surcharge shall be deposited into an existing special fund and used solely for the purpose of administering the program. (g)(1) The Immunization Funding Advisory Committee is established to provide the Commissioner of Health with an annual per-member per-month cost for vaccines for the pediatric population, an annual per-member per-month cost for vaccines for the adult population, and a recommendation for the amount of the yearly vaccine assessment. The Committee shall comprise the following nine members: (A) the Executive Officer of the Board of Pharmacy;(B) the Executive Director of the Green Mountain Care Board;(C) a representative of the Vermont Blueprint for Health, nominated by the Director of the Blueprint and appointed by the Commissioner of Health; (D) three representatives of health insurers, one from each of the States largest private health insurers, as determined by the number of covered lives, appointed by the Commissioner of Health; (E) a representative of the American Academy of Pediatrics, Vermont chapter, appointed by the Commissioner of Health; (F) a representative of the American Academy of Family Medicine, Vermont chapter, appointed by the Commissioner of Health; and (G) a representative of employers that self-insure for health coverage, appointed by the Commissioner of Health. (2) The Committee shall select a chair from among its members at the first meeting of each calendar year. The Committee shall receive administrative support from the Department of Health. (3) By January 1 of each year, the Committee shall provide to the Commissioner the annual fiscal assessment and the per-member per-month cost for pediatric vaccines based on the total number of pediatric covered lives reported by health insurers and the per-member per-month cost for adult vaccines based on the total number of adult covered lives reported by health insurers. (h) If federal purchase requirements do not further the goal of ensuring universal access to vaccines for all, the Commissioner may, following consultation with the Immunization Funding Advisory Committee, discontinue the program with six months advance notice to all health care professionals and to all health insurers with Vermont covered lives. (i) The Department may adopt rules under 3 V.S.A. chapter 25 to implement this section. (Added 2005, No. 191 (Adj. Sess.),  23; amended 2007, No. 70,  29; 2009, No. 61,  42; 2009, No. 156 (Adj. Sess.),  I.20; 2011, No. 157 (Adj. Sess.),  4; 2011, No. 162 (Adj. Sess.),  C.200, eff. May 17, 2012; 2013, No. 79,  17, eff. Jan. 1, 2014; 2013, No. 179 (Adj. Sess.),  E.312.1.)
 1131. Vermont Immunization Advisory Council
(a) Creation. There is created the Vermont Immunization Advisory Council for the purpose of providing education policy, medical, and epidemiological expertise and advice to the Department with regard to the safety of immunizations and immunization schedules. (b) Membership. The Council shall be composed of the following members:(1) a representative of the Vermont Board of Medical Practice, appointed by the Governor;(2) the Secretaries of Human Services and of Education or their designees;(3) the State epidemiologist;(4) a practicing pediatrician, appointed by the Governor;(5) a representative of both public and independent schools, appointed by the Governor; and (6) any other persons deemed necessary by the Commissioner.(c) Powers and duties. The Council shall:(1) review and make recommendations regarding the States immunization schedule for attendance in schools and child care facilities; and (2) provide any other advice and expertise requested by the Commissioner.(d) Assistance. The Council shall have the administrative, technical, and legal assistance of the Department. (e) Meetings. (1) The Council shall convene at the call of the Commissioner, but no less than once each year. (2) The Council shall select a chair from among its members at the first meeting.(3) A majority of the membership shall constitute a quorum. (Added 2015, No. 37,  9.)
 1132. Vaccine Adverse Event Reporting System
A health care practitioner administering vaccinations shall report to the Vaccine Adverse Event Reporting System, in consultation with the patient, or if a minor, the patients parent or guardian, all significant adverse events that occur after vaccination of adults and children, even if the practitioner is unsure whether a vaccine caused the adverse event. (Added 2015, No. 37,  10.) 
 1140. Definitions
As used in this subchapter:(1) Bloodborne pathogen means a pathogenic microorganism that is present in human blood and can cause disease in humans. Such pathogens include hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). (2) Emergency personnel shall have the same meaning as in 20 V.S.A.  3171, but shall also include members of a ski patrol trained through the National Ski Patrol or substantially similar program. (3) Employer means the organization on whose behalf a worker is employed or volunteering when rendering health services to a source patient pursuant to this subchapter. (4) Health care provider shall have the same meaning as in subdivision 9432(9) of this title. (5) Health care worker means any individual or employee of a health care provider who provides medical or other health services in the course of the workers employment. (6) Health services means activities and functions that are directly related to care, treatment, or diagnosis of a patient, including emergency medical treatment. (7) Manner sufficient to transmit means consistent with current guidelines of the Centers for Disease Control and Prevention, as determined by a physician licensed to practice medicine in Vermont. (8) Public safety personnel means an individual employed or volunteering for a fire department, police department, or ambulance service. (9) Source patient means an individual who, in the course of receiving health services, may have exposed a health care worker, public safety personnel, or emergency personnel to blood or bodily fluids in a manner sufficient to transmit a bloodborne disease. (10) Worker means emergency personnel, health care worker, or public safety personnel. (Added 2007, No. 194 (Adj. Sess.),  1.)
 1141. Communicable disease testing
(a) A health care provider may order a test for bloodborne pathogens if a health care worker, public safety personnel, or emergency personnel has been exposed to the blood or bodily fluids of the source patient in a manner sufficient to transmit a bloodborne pathogen-related illness to the affected worker while engaged in rendering health services to the source patient, and provided that: (1) the source patient:(A) has provided informed consent, as defined in subdivision 9701(17) of this title; or(B) is deceased;(2) the worker has provided a blood sample and consented to testing for bloodborne pathogens and a physician has documented that bloodborne pathogen test results are needed for beginning, continuing, modifying, or discontinuing medical treatment for the worker; (3) a physician with specialty training in infectious diseases has confirmed that the worker has been exposed to the blood or bodily fluids of the source patient in a manner sufficient to transmit a bloodborne pathogen-related illness; (4) a health care provider has informed the worker of the confidentiality requirements in subsection (c) of this section and the penalties for unauthorized disclosure of source patient information under subsection (e) of this section; and (5) a health care provider has informed the source patient of the purpose and confidentiality provisions in subsections (b) and (c) of this section, respectively, if applicable. (b) Bloodborne pathogen test results of a source patient obtained under subsection (a) of this section are for diagnostic purposes and to determine the need for treatment or medical care specific to a bloodborne pathogen-related illness of a worker. Test results may not be used as evidence in any criminal or civil proceedings. (c) The result of a test ordered pursuant to subsection (a) of this section is protected health information subject to the Standards for Privacy of Individually Identifiable Health Information established under the Health Insurance Portability and Accountability Act of 1996 and contained in 45 C.F.R., Parts 160 and 164, and any subsequent amendments. Test results shall be confidential except that the worker who sustained the exposure, the health care provider who ordered the test, and the source patient, upon his or her request, shall be informed of the test results. Test results reported to the worker and documented in his or her medical record shall not include any personally identifying information relative to the source patient. Test results shall be transmitted to the Commissioner of Health pursuant to subsection (i) of this section. (d) Prior to laboratory testing of a source patients blood sample for bloodborne pathogens, personal identifiers shall be removed from the sample. (e) Unauthorized disclosures of test results obtained under this section shall be subject to the penalties provided under the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. subsections 1320d-5 and 1320d-6, and may be considered unprofessional conduct under applicable licensing, certification, and registration laws. (f) The results of rapid testing technologies shall be considered preliminary and may be released in accordance with the manufacturers instructions as approved by the federal Food and Drug Administration. Corroborating or confirmatory testing must be conducted as follow-up to a positive preliminary test. (g) The health care provider who requested the test shall provide the source patient and the worker an opportunity to receive follow-up testing and shall provide information on options for counseling, as appropriate. (h) Records pertaining to testing performed pursuant to this section shall not be recorded in the source patients medical record unless authorized by the source patient and shall not be maintained in the location where the test is ordered or performed for more than 60 days. (i) A laboratory having personal knowledge of a test result under this section shall transmit within 24 hours a report thereof to the Department of Health pursuant to subsection 1001(k) of this title. (j) The employer of any worker exposed to blood or bodily fluids while rendering health services to a source patient during the performance of normal job duties shall maintain an incident report with information regarding the exposure that is relevant to a workers compensation claim. The employer shall not be provided or have access to information personally identifying the source patient. (k) The costs of all diagnostic tests authorized by these provisions shall be borne by the employer of the worker. (l) Notwithstanding any other law to the contrary, a health care provider who orders a test in accordance with this section shall not be subject to civil or criminal liability for ordering the test. Nothing in this subsection shall be construed to establish immunity for the failure to exercise due care in the performance or analysis of the test. (m) A health care providers duties under this section are not continuing but limited to testing and services performed under this section. (Added 2007, No. 194 (Adj. Sess.),  1.) 
 9101. Definitions
The words flight and fled as used in this chapter shall be construed to mean any voluntary or involuntary departure from the jurisdiction of the court where the proceedings hereinafter mentioned may have been instituted and are still pending, with the effect of avoiding, impeding, or delaying the action of the court in which such proceedings may have been instituted or be pending, or any such departure from the state where the person demanded then was, if he or she then were under detention by law as a person of unsound mind and subject to detention. The word state wherever used in this chapter, shall include states, territories, districts, and insular and other possessions of the United States. As applied to a request to return any person within the purview of this chapter to or from the District of Columbia, the words executive authority, governor, and chief magistrate respectively shall include a judge of the United States district court for the District of Columbia and other authority. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9102. Who may be extradited
A person alleged to be of unsound mind found in this State, who has fled from another state, shall, on demand of the executive authority of the state from which he or she fled, be delivered up to be removed thereto, if at the time of his or her flight: (1) He or she was under detention by law in a hospital, asylum, or other institution for the insane as a person of unsound mind; or (2) He or she had been theretofore determined by legal proceedings to be of unsound mind, the finding being unreversed and in full force and effect, and the control of his or her person having been acquired by a court of competent jurisdiction of the state from which he or she fled; or (3) He or she was subject to detention in such state, being then his or her legal domicile (personal service of process having been made) based on legal proceedings there pending to have him or her declared of unsound mind. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9103. Duty of Governor
When the executive authority of any state demands of the Governor any fugitive within the purview of section 9102 of this title and produces a copy of the commitment, decree, or other judicial process and proceedings, certified as authentic by the Governor or chief magistrate of the state whence the person so charged has filed, with an affidavit made before a proper officer showing the person to be such a fugitive, the Governor shall cause him or her to be apprehended and secured, if found in this State, and to cause immediate notice of his or her apprehension to be given to the executive authority making such demand, or to the agent of such authority appointed to receive the fugitive, and to cause the fugitive to be delivered to such agent when he or she shall appear. If such agent does not appear within 30 days from the time of the apprehension, the fugitive may be discharged. All costs and expenses incurred in apprehending, security, maintaining, and transmitting such fugitive to the state making such demand, shall be paid by such state. An agent so appointed who receives the fugitive into his or her custody shall be empowered to transport him or her to the state from which he or she has fled. The Governor is hereby vested with the power, on the application of any person interested, to demand the return to this State of any fugitive within the purview of this chapter. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9104. Limitation on proceedings
Any proceedings under this chapter shall be begun within one year after the flight therein referred to. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9105. Uniformity of interpretation
This chapter shall be so interpreted and construed as to effectuate its general purpose to make uniform the law of those states which enact it. (Added 1967, No. 305 (Adj. Sess.),  1, eff. Oct. 1, 1968.) 
 9301. Policy
It is the policy of the State of Vermont to assure that citizens with developmental disabilities receive such protection and assistance as is necessary to allow them to live safely within the communities of this State. In furtherance of this policy, this chapter is enacted to permit the supervision of those individuals who are unable to provide for their own needs on account of developmental disabilities and to protect such persons from violations of their human and civil rights. It is the purpose of this chapter to limit the States guardianship of people with developmental disabilities who are living in the community to the extent necessary to ensure their safety and well-being. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1.) 
 9302. Definitions
As used in this chapter:(1) Person with developmental disabilities means:(A) a person with a severe, chronic disability that must arise before the person reaches the age of 18, and results in: (i) intellectual disability, autism, or pervasive developmental disorder; and(ii) deficits in adaptive behavior at least two standard deviations below the mean for a normative comparative comparison group; or (B) a person with a developmental disability who was receiving services on July 1, 1996.(2) Commissioner means the Commissioner of Disabilities, Aging, and Independent Living.(3) Near relative means a spouse, parent, step parent, brother, sister, or grandparent.(4) Interested person means a responsible adult who has a direct interest in a person with developmental disabilities and includes the person with developmental disabilities, a near relative, guardian, public official, social worker, or clergy. (5) Person in need of guardianship means a person who:(A) has developmental disabilities within the meaning of this chapter;(B) is unable to personally exercise some or all of the powers and responsibilities described in section 9310 of this title; and (C) is not receiving the active assistance of a responsible adult to carry out the powers and responsibilities described in section 9310 of this title. (6) Guardianship means the legal status of a person with developmental disabilities who is subject to the Commissioners exercise of some or all of the powers listed in section 9310 of this title. (7) [Repealed.](8) Qualified developmental disabilities professional means a psychologist, physician, registered nurse, educator, or social worker with specialized training or at least one year of experience in working with people with developmental disabilities. (9) Respondent means a person who is the subject of a petition filed pursuant to section 9305 of this title. (10) Department means the Department of Disabilities, Aging, and Independent Living. (Added 1977, No. 192 (Adj. Sess.),  1; amended 1989, No. 187 (Adj. Sess.),  5; 1995, No. 174 (Adj. Sess.),  3; 2001, No. 43,  1; 2005, No. 174 (Adj. Sess.),  49; 2013, No. 96 (Adj. Sess.),  116.)
 9303. Jurisdiction and venue
(a) The Family Division of the Superior Court shall have exclusive jurisdiction over all proceedings brought under the authority of this chapter. Proceedings under this chapter shall be commenced in the Family Division of the Superior Court for the unit in which the person with developmental disabilities is residing. (b)(1) The Probate Division of the Superior Court shall have concurrent jurisdiction to appoint the Commissioner to serve as a temporary guardian for a person in need of guardianship when: (A) a petition has been filed pursuant to 14 V.S.A.  3063;(B) the Probate Division of the Superior Court finds that the respondent is a person in need of guardianship as defined in subdivision 9302(5) of this title; and (C) no suitable private guardian can be located.(2) Within 60 days after appointment as a temporary guardian, the Commissioner shall file an application in the Family Division of the Superior Court for appointment under this chapter and for modification or termination of the Probate Division order. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1; 2009, No. 154 (Adj. Sess.),  154; 2009, No. 154 (Adj. Sess.),  154a, eff. Feb. 1, 2011.) 
 9304. Eligibility for guardianship of the person
Guardianship may be provided to any person with developmental disabilities who:(1) is at least 18 years of age; and(2) is in need of supervision and protection for the persons own welfare or the public welfare. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1.) 
 9305. Petition for guardianship
Any interested person with knowledge of the facts alleged may request the States Attorney having jurisdiction to file a petition with the Family Division of the Superior Court alleging that person is developmentally disabled and in need of guardianship. The States Attorney shall file the petition unless it clearly appears that the petition will be insufficient to support an action under this chapter. The petition shall set forth: (1) The name, address, and telephone number of the interested person who requested the filing of the petition, and the nature of his or her interest in the person alleged to have developmental disabilities; (2) The name, address, telephone number, and age of the respondent and the name, address, and telephone number of any near relative of the respondent and the name of any guardian or person holding a power of attorney of the person; (3) The reasons and the supporting facts why guardianship is needed;(4) The petition shall be limited to information that is relevant to the respondents need for guardianship. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1; 2009, No. 154 (Adj. Sess.),  238.) 
 9306. Comprehensive evaluation
(a) The Family Division of the Superior Court shall mail a copy of any petition filed pursuant to section 9305 of this title to the Commissioner, who shall promptly arrange for the preparation of a comprehensive evaluation of the respondent. The evaluation shall include information regarding the respondents developmental and social functioning which is relevant to the persons need for guardianship. The evaluation shall contain recommendations and supporting data regarding the ability of the respondent to function in society without guardianship and shall specify those activities for which the respondent needs supervision and protection, and shall include information regarding the availability of one or more responsible adults to assist the individual in decision-making. (b) The evaluation shall be prepared by a qualified developmental disabilities professional. The evaluation shall be completed within 40 days of the courts service of the petition upon the Commissioner unless the time period is extended by the court for cause. The Commissioner shall send the request for evaluation to the evaluator at least 30 days before it is due. The Commissioner shall provide for reimbursement of the costs of the evaluation. (c) The Department shall send a copy of the evaluation to the court, the States Attorney, the director of guardianship services, and to counsel for the respondent. The evaluation is a confidential document, and shall not be further disclosed by the court and the parties without the consent of the respondent or a person authorized to act on behalf of the respondent, except that the Department shall release the evaluation to a developmental services agency, if necessary, for the purpose of obtaining or improving services to the person. (d) The evaluation shall not be used as evidence in any other judicial proceeding without the consent of the respondent or the respondents guardian or upon order of the court. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1; 2009, No. 154 (Adj. Sess.),  238.) 
 9307. Notice of petition and hearing
Within five days of filing the petition, the court shall fix a time and place for hearing and shall mail a copy of the petition and notice of hearing to the respondent, the respondents counsel, the guardian for the respondent, if any, the interested person who requested the filing of the petition, the Commissioner, the States Attorney, and such other persons as the court determines. The notice of hearing shall be mailed to the respondents near relatives. The hearing shall be held not fewer than 20 nor more than 30 days after the filing of the evaluation with the court. The hearing may be continued for good cause shown for not more than 15 additional days. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1.) 
 9308. Appointment of counsel
Upon the filing of the petition, the court shall appoint counsel for the respondent, and shall notify the respondent of the name, address, and telephone number of the appointed counsel. Compensation shall be paid by the Department to counsel assigned by the court, any rule or law to the contrary notwithstanding. Counsel shall receive a copy of the petition and comprehensive evaluation and such other documents as may be received or issued by the court. Counsel shall consult with the respondent prior to the hearing and, to the maximum extent possible, explain to the respondent the meaning of the proceedings and of all relevant documents. (Added 1977, No. 192 (Adj. Sess.),  1; amended 1979, No. 167 (Adj. Sess.),  2; 1989, No. 187 (Adj. Sess.),  5; 1995, No. 174 (Adj. Sess.),  3; 2001, No. 43,  1.) 
 9309. Hearing and appeal
(a) The respondent, the States Attorney, and all other persons to whom notice has been given pursuant to section 9307 of this title may attend the hearing and testify. The court may in its discretion receive the testimony of any other person. The respondent and States Attorney may subpoena, present, and cross-examine witnesses, including those who prepared the comprehensive evaluation. The court may exclude any person not necessary for the conduct of the hearing. The States Attorney shall consult with the interested person who requested the filing of the petition regarding the facts of the case. (b) The hearing shall be conducted in a manner consistent with orderly procedure and in a physical setting not likely to have a harmful effect on the mental or physical health of the respondent. In all proceedings, the court shall have taken and preserved an accurate record of the proceedings. The court shall not be bound by the evidence contained in the comprehensive evaluation, but shall make its determination upon the entire record. In all cases, the court shall make specific findings of fact, state separately its conclusions of law, and direct the entry of an appropriate judgment. The general public shall be excluded from hearings under this chapter, and only the parties, their counsel, the interested person who requested the filing of the petition, witnesses, and other persons accompanying a party for his or her assistance, and such other persons as the court finds to have a proper interest in the case or in the work of the court may be admitted by the court. The proceedings of the hearing shall be confidential, and a record of the proceedings may not be released without the consent of the respondent or the respondents guardian. (c) The States Attorney shall appear and present evidence in support of the petition. The person who requested the filing of the petition may be represented by private counsel in any proceedings brought under this chapter. (d) If, upon completion of the hearing and consideration of the record, the court finds that the respondent is not a person in need of guardianship, as defined in subdivision 9302(5) of this title, it shall dismiss the petition and seal the records of the proceedings. (e) The court shall enter judgment specifying the powers of the Commissioner pursuant to section 9310 of this title if, upon completion of the hearing and consideration of the record, the court finds that the petitioner has proved by clear and convincing evidence that the respondent is: (1) a person with developmental disabilities;(2) at least 18 years of age; and(3) [Deleted.](4) in need of guardianship for his or her own welfare or the public welfare.(f) The court may grant or restrict the powers of guardianship to the Commissioner. An appointment of the Commissioner to provide guardianship shall not constitute a judicial finding that the person is legally incompetent for all purposes, but shall only restrict the persons rights with respect to those powers expressly granted to the Commissioner. (g) Any party to the proceeding before the Family Division of the Superior Court may appeal the courts decision. The appeal shall be taken in such manner as the Supreme Court may by rule provide for appeals from the Family Division of the Superior Court. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1; 2009, No. 154 (Adj. Sess.),  238.) 
 9310. Powers of Commissioner as guardian
(a) The court may appoint the Commissioner guardian of the respondent if it determines that a guardian is needed to supervise and protect the respondent through the exercise of any or all of the following powers: (1) The power to exercise general supervision over the respondent. This includes choosing or changing the residence, care, habilitation, education, and employment of the respondent and the power to approve or withhold approval of the sale or encumbrance of real property of the respondent; (2) The power to approve or withhold approval of any contract, by or in the name of the respondent; (3) The power to obtain legal advice and to commence or defend against judicial actions in the name of the respondent; (4) The power to seek, obtain, and give consent to initiation and continuation of medical and dental treatment that best promotes the health, comfort, and well-being of the respondent, or to withhold consent for initiation or continuation of treatment which does not promote the health or well-being of the respondent. In exercising this power, the Commissioner shall be guided by the wishes and preferences of the individual. Any decision to withhold or abate medical treatment for an irreversible or terminal condition shall be reviewed by the Departments ethics committee. Nothing in this chapter shall be interpreted as giving the Commissioner authority to consent to sterilization, lobotomy, involuntary administration of psychotropic medications, surgery of the brain for the purpose of modifying behavior, or electroconvulsive therapy for the respondent. (b) Nothing in this chapter shall give the Commissioner authority to place a person with developmental disabilities in a State hospital except pursuant to chapter 181 of this title. (c) The Commissioner shall exercise his or her supervisory authority over the respondent in a manner which is least restrictive of the persons personal freedom consistent with the respondents need for supervision and protection. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1.) 
 9313. Duties of Commissioner when providing guardianship services
(a) When providing guardianship services to a person with developmental disabilities, the Commissioner shall maintain close contact with the person with developmental disabilities, no matter where the person is living in this State, and shall permit and encourage maximum self-reliance on the part of the person with developmental disabilities under his or her protection. The Commissioner shall permit and encourage involvement by the person with developmental disabilities, and family members, and other individuals of the persons choice in planning and decision-making. (b) In addition to the supervisory powers vested in the Commissioner by the court pursuant to section 9310 of this title, the Commissioner shall assist any person who is under guardianship to obtain those services to which the person is lawfully entitled and which the person needs in order to maximize opportunities for social and financial independence. Those services include, but are not limited to: (1) Education services for a person with developmental disabilities who is of school age;(2) Residential services for any person with developmental disabilities who lacks adequate or appropriate housing or residential supervision; (3) Medical and dental services as needed;(4) Therapeutic and habilitative services, adult education, vocational rehabilitation, or other appropriate programs or services for any person with developmental disabilities who is in need of such training or services; (5) Counseling and social services;(6) Counseling and assistance in the use of and handling of money. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1.)
 9314. Annual review
(a) The Commissioner shall prepare an annual review of the social adjustment and progress of every person who is receiving guardianship services under this chapter. A copy of the review shall be kept on file by the Commissioner and shall be made available upon the request of the person with developmental disabilities and such other people as receive the written permission of the person or the Commissioner. (b) The Commissioner shall annually review the legal status of each person receiving services under this chapter. If the Commissioner determines that the annual review of social adjustment and progress warrants a modification or termination of guardianship services for the person, the Commissioner shall petition the Family Division of the Superior Court pursuant to section 9316 of this title for the appropriate relief. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1; 2009, No. 154 (Adj. Sess.),  238.) 
 9315. Review of Commissioners decision
A person who is receiving services under this chapter may appeal a decision of the Commissioner in accordance with 3 V.S.A.  3091 or by petition to the Family Division of the Superior Court. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1; 2009, No. 154 (Adj. Sess.),  238.) 
 9316. Modification or termination of guardianship services
(a) The Commissioner shall provide guardianship services in accordance with the order of the Probate Division or Family Division of the Superior Court until termination or modification thereof by the court. (b) The Commissioner, the person with developmental disabilities, or any interested person may petition the appointing court, if it exists, or the Superior Court for the unit where the person resides to modify or terminate the judgment pursuant to which the Commissioner is providing guardianship. The petitioner, or the Commissioner as petitioner, and the respondent shall be the parties to an application to modify or terminate guardianship. (c) Notice and hearing on the petition shall proceed in the manner set forth in sections 9307-9309 of this title. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1; 2009, No. 154 (Adj. Sess.),  155; 2009, No. 154 (Adj. Sess.),  155a, eff. Feb. 1, 2011.) 
 9317. General provision
The Commissioner may delegate his or her powers and duties under this chapter to staff within the Department, and may adopt, pursuant to 3 V.S.A. chapter 25, rules necessary for the proper and efficient administration of this chapter. (Added 1977, No. 192 (Adj. Sess.),  1; amended 2001, No. 43,  1; 2017, No. 113 (Adj. Sess.),  104.) 
 9331. Definitions
For purposes of this chapter:(1) Commissioner means the Commissioner of Financial Regulation.(2) DNA means deoxyribonucleic acid and RNA means ribonucleic acid.(3) Employee has the same meaning as in 21 V.S.A.  495d.(4) Employer has the same meaning as in 21 V.S.A.  495d.(5) Employment agency has the same meaning as in 21 V.S.A.  495d.(6) Genetic information means the results of genetic testing contained in any report, interpretation, evaluation, or other record thereof. (7)(A) Genetic testing means a test, examination, or analysis that is diagnostic or predictive of a particular heritable disease or disorder and is of: (i) a human chromosome or gene;(ii) human DNA or RNA; or(iii) a human genetically encoded protein.(B) The test for human genetically encoded protein referred to in subdivision (A)(iii) of this subdivision (7) shall be generally accepted in the scientific and medical communities as being specifically determinative for the presence or absence of a mutation, alteration, or deletion of a gene or chromosome. (C) For the purposes of sections 9332 and 9333 of this title, as they apply to insurers, section 9334 of this title, and 8 V.S.A.  4727, and notwithstanding any language in this section to the contrary, genetic testing does not include: (i) a test, examination, or analysis which reports on an individuals current condition unless such a test, examination, or analysis is designed or intended to be specifically determinative for the presence or absence of a mutation, alteration, or deletion of a gene or chromosome; or (ii) a test, examination, or analysis of a human chromosome or gene, of human DNA or RNA, or of a human genetically encoded protein that is diagnostic or predictive of a particular heritable disease or disorder, if, in accordance with generally accepted standards in the medical community, the potential presence or absence of a mutation, alteration, or deletion of a gene or chromosome has already manifested itself by causing a disease, disorder, or medical condition or by symptoms highly predictive of the disease, disorder, or medical condition. (8) Insurance means a policy of insurance regulated under Title 8, offered or issued in this State, including health, life, disability, and long-term care insurance policies, hospital and medical service corporation service contracts, and health maintenance organization benefit plans. (9) Labor organization has the same meaning as in 21 V.S.A.  495d.(10) Licensing agency means a unit of State government authorized to grant, deny, renew, revoke, suspend, annul, withdraw, or amend a professional license, certification, or registration. (Added 1997, No. 160 (Adj. Sess.),  5, eff. Jan. 1, 1999.) 
 9332. Genetic testing; limitations
(a) No person shall be required to undergo genetic testing, except as provided in this chapter. (b) A person may be required to undergo genetic testing in connection with insurance subject to the limitations imposed under section 9334 of this title or if otherwise required by law for the following reasons: (1) to establish parentage;(2) to determine the presence of metabolic disorders in a newborn by testing conducted pursuant to newborn screening and protocols; (3) in connection with a criminal investigation or prosecution;(4) for remains identification by the chief medical examiner or designee;(5) for purposes of the State DNA Data Bank, the State DNA Database, and CODIS pursuant to 20 V.S.A. chapter 113, subchapter 4. (c) Samples collected pursuant to subdivision (b)(1), (2), (3), or (4) of this section or collected voluntarily pursuant to an agreement shall not be utilized for any purpose in connection with the State DNA Data Bank, the State DNA Database, and CODIS unless specifically authorized by 20 V.S.A. chapter 113, subchapter 4. (d) Except for the provisions of subsection (b) of this section, no genetic testing shall be performed on any individual or body parts of any individual nor shall any bodily materials be released for purposes of genetic testing without the prior written authorization and informed consent of the individual to be tested except for medical research where the identity of the subject is unknown or, if the research shall be conducted with anonymized medical information where individual identifiers are encrypted or encoded and the identity of the individual is not disclosed, or if the identity of the individual is known, where standards of protection are equal to those contained in regulations promulgated by the federal Office for Protection from Research Risk (OPRR). (e) Except for the provisions of subsection (b) of this section, any results of genetic testing or the fact that an individual has requested genetic services or undergone genetic testing shall be disclosed only pursuant to a written authorization executed by the individual tested or by a person authorized by law to act for the individual. (f) Except for the provisions of subsection (b) of this section, at the time of suggesting or requesting that an individual consent to genetic testing, the person making the suggestion or request shall advise the individual subject of the test that the results of the test: (1) may become part of the individuals permanent medical record; and(2) may be material to the ability of the individual to obtain certain insurance benefits. (Added 1997, No. 160 (Adj. Sess.),  5, eff. Jan. 1, 1999.)
 9333. Genetic testing; employment; membership in a labor organization; professional licensure
(a) No person shall, directly or indirectly, do any of the following as a condition of, or to affect the terms, conditions, or privileges of employment, of membership in a labor organization, or of professional licensure, certification, or registration: (1) use the fact that genetic counseling or testing services have been requested or that genetic testing has been performed; (2) use genetic testing results or genetic information from a person or a member of a persons family; (3) use the diagnosis of a genetic disease derived from a clinical interview and examination, but not derived from the results of a genetic test; or (4) require genetic testing.(b) As used in this section, employment includes application for employment, provided that subject to the underwriting limitations of section 9334 of this title, this subsection shall not prohibit use of genetic testing results or genetic information in connection with life, disability income, or long-term care insurance provided under an employee benefit plan. (c) No person shall disclose to an employer, labor organization, employment agency, or licensing agency any genetic testing results or genetic information, that genetic services have been requested, or that genetic testing has been performed, with respect to an individual who is an employee, labor organization member, professional licensee, certificate holder, or registrant. (Added 1997, No. 160 (Adj. Sess.),  5, eff. Jan. 1, 1999.) 
 9334. Genetic testing as a condition of insurance coverage
(a) No policy of insurance offered for delivery or issued in this State shall be underwritten or conditioned on the basis of: (1) any requirement or agreement of the individual to undergo genetic testing; or(2) the results of genetic testing of a member of the individuals family.(b) A violation of this section shall be considered an unfair method of competition or unfair or deceptive act or practice in the business of insurance in violation of 8 V.S.A.  4724. (c) In addition to other remedies available under the law, a person who violates this section shall be subject to the enforcement provisions available under Title 8. (Added 1997, No. 160 (Adj. Sess.),  5, eff. Jan. 1, 1999.) 
 9335. Remedies
(a) Any person who intentionally violates section 9333 or subsection 9334(a) of this chapter shall be imprisoned not more than one year or fined not more than $10,000.00, or both. (b) Any person aggrieved by a violation of this chapter may bring an action for civil damages, including punitive damages, equitable relief, including restraint of prohibited acts, restitution of wages or other benefits, and reinstatement, costs, and reasonable attorneys fees, and other appropriate relief. (Added 1997, No. 160 (Adj. Sess.),  5, eff. Jan. 1, 1999.) 
 9351. Health Information Technology Plan
(a)(1) The Department of Vermont Health Access, in consultation with the Departments Health Information Exchange Steering Committee, shall be responsible for the overall coordination of Vermonts statewide Health Information Technology Plan. The Plan shall be revised annually and updated comprehensively every five years to provide a strategic vision for clinical health information technology. (2) The Department shall submit the proposed Plan to the Green Mountain Care Board annually on or before November 1. The Green Mountain Care Board shall approve, reject, or request modifications to the Plan within 45 days following its submission; if the Board has taken no action after 45 days, the Plan shall be deemed to have been approved. (3)(A) The Department, in consultation with the Steering Committee, shall administer the Plan. (B) The Plan shall include the implementation of an integrated electronic health information infrastructure for the sharing of electronic health information among health care facilities, health care professionals, public and private payers, and patients. The Plan shall provide for each patients electronic health information that is contained in the Vermont Health Information Exchange to be accessible to health care facilities, health care professionals, and public and private payers to the extent permitted under federal law unless the patient has affirmatively elected not to have the patients electronic health information shared in that manner. (C) The Plan shall include standards and protocols designed to promote patient education, patient privacy, physician best practices, electronic connectivity to health care data, access to advance care planning documents, and, overall, a more efficient and less costly means of delivering quality health care in Vermont. (b) The Health Information Technology Plan shall:(1) support the effective, efficient, statewide use of electronic health information in patient care, health care policymaking, clinical research, health care financing, and continuous quality improvements; (2) educate the general public and health care professionals about the value of an electronic health infrastructure for improving patient care; (3) ensure the use of national standards for the development of an interoperable system, which shall include provisions relating to security, privacy, data content, structures and format, vocabulary, and transmission protocols; (4) propose strategic investments in equipment and other infrastructure elements that will facilitate the ongoing development of a statewide infrastructure; (5) recommend funding mechanisms for the ongoing development and maintenance costs of a statewide health information system, including funding options and an implementation strategy for a loan and grant program; (6) incorporate the existing health care information technology initiatives to the extent feasible in order to avoid incompatible systems and duplicative efforts; (7) integrate the information technology components of the Blueprint for Health established in chapter 13 of this title, the Agency of Human Services Enterprise Master Patient Index and all other Medicaid management information systems being developed by the Department of Vermont Health Access, information technology components of the quality assurance system, the program to capitalize with loans and grants electronic medical record systems in primary care practices, and any other information technology initiatives coordinated pursuant to 3 V.S.A.  3027; and (8) address issues related to data ownership, governance, and confidentiality and security of patient information. (c) The Department of Vermont Health Access, in consultation with the Steering Committee and subject to Green Mountain Care Board approval, may propose updates to the Plan in addition to the annual updates as needed to reflect emerging technologies, the States changing needs, and such other areas as the Department deems appropriate. The Department shall solicit recommendations from interested stakeholders in order to propose updates to the Health Information Technology Plan pursuant to subsection (a) of this section and to this subsection, including applicable standards, protocols, and pilot programs, and following approval of the proposed updates by the Green Mountain Care Board, may enter into a contract or grant agreement with appropriate entities to update some or all of the Plan. Upon approval of the updated Plan by the Green Mountain Care Board, the Department of Vermont Health Access shall distribute the updated Plan to the Secretary of Administration; the Secretary of Digital Services; the Commissioner of Financial Regulation; the Secretary of Human Services; the Commissioner of Health; the Commissioner of Mental Health; the Commissioner of Disabilities, Aging, and Independent Living; the Senate Committee on Health and Welfare; the House Committee on Health Care; affected parties; and interested stakeholders. Unless major modifications are required, the Department may present updated information about the Plan to the legislative committees of jurisdiction in lieu of creating a written report. (d) The Health Information Technology Plan shall serve as the framework within which the Green Mountain Care Board reviews certificate of need applications for information technology under section 9440b of this title. In addition, the Commissioner of Information and Innovation shall use the Health Information Technology Plan as the basis for independent review of State information technology procurements. (e) The privacy standards and protocols developed in the Statewide Health Information Technology Plan shall be no less stringent than applicable federal and State guidelines, including the Standards for Privacy of Individually Identifiable Health Information established under the Health Insurance Portability and Accountability Act of 1996 and contained in 45 C.F.R., Parts 160 and 164, and any subsequent amendments, and the privacy provisions established under Subtitle D of Title XIII of Division A of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5,  13400 et seq. The standards and protocols shall require that access to individually identifiable health information is secure and traceable by an electronic audit trail. (f) [Repealed.] (Added 2009, No. 61,  1; amended 2009, No. 156 (Adj. Sess.),  I.25; 2011, No. 63,  G.103; 2013, No. 79,  49b; 2015, No. 172 (Adj. Sess.),  E.306; 2017, No. 85,  F.9, eff. June 28, 2017; 2017, No. 187 (Adj. Sess.),  2, eff. May 28, 2018; 2019, No. 53,  4, eff. March 1, 2020.)
 9352. Vermont Information Technology leaders
(a) Governance. The Vermont Information Technology Leaders, Inc. (VITL) Board of Directors shall consist of no fewer than nine nor more than 14 members. The term of each member shall be two years, except that of the members first appointed, approximately one-half shall serve a term of one year and approximately one-half shall serve a term of two years, and members shall continue to hold office until their successors have been duly appointed. The Board of Directors shall comprise representatives of the business community, of health care consumers, of Vermont hospitals, of Vermont-licensed clinicians, and of health insurers licensed to offer plans in Vermont, as well as individuals familiar with health information technology, including, to the extent practicable, one or more individuals who are or have served as the chief technology officer for a health care facility. (b) Conflict of interest. In carrying out their responsibilities under this section, Directors of VITL shall be subject to conflict of interest policies established by the Secretary of Administration to ensure that deliberations and decisions are fair and equitable. (c)(1) Health information exchange operation. VITL shall be designated in the Health Information Technology Plan approved by the Green Mountain Care Board pursuant to section 9351 of this title to operate the exclusive statewide health information exchange network for this State. The Plan shall determine the manner in which Vermonts health information exchange network shall be managed. The Green Mountain Care Board shall have the authority to approve VITLs budget pursuant to chapter 220 of this title. Nothing in this chapter shall impede local community providers from the exchange of electronic medical data. (2) Notwithstanding any provision of 3 V.S.A.  2222 or 2283b to the contrary, upon request of the Secretary of Administration, the Agency of Digital Services shall review VITLs technology for security, privacy, and interoperability with State government information technology, consistent with the States health information technology plan required by section 9351 of this title. (d) Privacy. The standards and protocols implemented by VITL shall be consistent with those adopted by the statewide Health Information Technology Plan pursuant to subsection 9351(e) of this title. (e) Report. On or before January 15 of each year, VITL shall file a report with the Green Mountain Care Board; the Secretary of Administration; the Secretary of Digital Services; the Commissioner of Financial Regulation; the Commissioner of Vermont Health Access; the Secretary of Human Services; the Commissioner of Health; the Commissioner of Mental Health; the Commissioner of Disabilities, Aging, and Independent Living; the Senate Committee on Health and Welfare; and the House Committee on Health Care. The report shall include an assessment of progress in implementing health information technology in Vermont and recommendations for additional funding and legislation required. In addition, VITL shall publish minutes of VITL meetings and any other relevant information on a public website. The provisions of 2 V.S.A.  20(d) (expiration of required reports) shall not apply to the report to be made under this subsection. (f) Funding authorization. VITL is authorized to seek matching funds to assist with carrying out the purposes of this section. In addition, it may accept any and all donations, gifts, and grants of money, equipment, supplies, materials, and services from the federal or any local government, or any agency thereof, and from any person, firm, foundation, or corporation for any of its purposes and functions under this section and may receive and use the same, subject to the terms, conditions, and regulations governing such donations, gifts, and grants. VITL shall not use any State funds for health care consumer advertising, marketing, or similar services unless necessary to comply with the terms of a contract or grant that requires a contribution of State funds. (g) Waivers. The Secretary of Human Services or designee, in consultation with VITL, may seek any waivers of federal law, of rule, or of regulation that might assist with implementation of this section. (h) [Repealed.](i) Certification of meaningful use and connectivity. (1) To the extent necessary to support Vermonts health care reform goals or as required by federal law, VITL shall be authorized to certify the meaningful use of health information technology and electronic health records by health care providers licensed in Vermont. (2) VITL, in consultation with health care providers and health care facilities, shall establish criteria for creating or maintaining connectivity to the States health information exchange network. VITL shall provide the criteria annually on or before March 1 to the Green Mountain Care Board established pursuant to chapter 220 of this title. (j) Scope of activities. VITL and any person who serves as a member, director, officer, or employee of VITL with or without compensation shall not be considered a health care provider as defined in subdivision 9432 of this title for purposes of any action taken in good faith pursuant to or in reliance upon provisions of this section relating to VITLs: (1) governance;(2) electronic exchange of health information and operation of the statewide Health Information Exchange Network as long as nothing in such exchange or operation constitutes the practice of medicine pursuant to 26 V.S.A. chapter 23 or 33; (3) implementation of privacy provisions;(4) funding authority;(5) application for waivers of federal law;(6) establishment and operation of a financing program providing electronic health records systems to providers; or (7) certification of health care providers meaningful use of health information technology. (Added 2009, No. 61,  1; amended 2009, No. 67 (Adj. Sess.),  108; 2009, No. 156 (Adj. Sess.),  I.26; 2011, No. 63,  G.104; 2013, No. 79,  34a, eff. June 7, 2013; 2013, No. 142 (Adj. Sess.),  34; 2015, No. 54,  9, eff. June 5, 2015; 2015, No. 172 (Adj. Sess.),  E.306.1; 2017, No. 187 (Adj. Sess.),  3, eff. May 28, 2018.)
 9361. Health care providers delivering health care services through telemedicine or by store-and-forward means
(a) As used in this section, distant site, health care provider, originating site, store and forward, and telemedicine shall have the same meanings as in 8 V.S.A.  4100k. (b) Subject to the limitations of the license under which the individual is practicing, a health care provider licensed in this State may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient in person, through telemedicine, or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings. (c)(1) A health care provider delivering health care services or dental services through telemedicine shall obtain and document a patients oral or written informed consent for the use of telemedicine technology prior to delivering services to the patient. (A) The informed consent for telemedicine services shall be provided in accordance with Vermont and national policies and guidelines on the appropriate use of telemedicine within the providers profession and shall include, in language that patients can easily understand: (i) an explanation of the opportunities and limitations of delivering health care services or dental services through telemedicine; (ii) informing the patient of the presence of any other individual who will be participating in or observing the patients consultation with the provider at the distant site and obtaining the patients permission for the participation or observation; and (iii) assurance that all services the health care provider delivers to the patient through telemedicine will be delivered over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191. (B) For services delivered through telemedicine on an ongoing basis, the health care provider shall be required to obtain consent only at the first episode of care. (2) The provider shall include the patients written consent in the patients medical record or document the patients oral consent in the patients medical record. (3) A health care provider delivering telemedicine services through a contract with a third-party vendor shall comply with the provisions of this subsection (c) to the extent permissible under the terms of the contract. If the contract requires the health care provider to use the vendors own informed consent provisions instead of those set forth in this subsection, the health care provider shall be deemed to be in compliance with the requirements of this subsection if he or she adheres to the terms of the vendors informed consent policies. (4) Notwithstanding any provision of this subsection to the contrary, a health care provider shall not be required to obtain a patients informed consent for the use of telemedicine in the following circumstances: (A) in the case of a medical emergency;(B) for the second certification of an emergency examination determining whether an individual is a person in need of treatment pursuant to section 7508 of this title; or (C) for a psychiatrists examination to determine whether an individual is in need of inpatient hospitalization pursuant to 13 V.S.A.  4815(g)(3). (d) Neither a health care provider nor a patient shall create or cause to be created a recording of a providers telemedicine consultation with a patient. (e)(1) A patient receiving health care services or dental services by store-and-forward means shall be informed of the patients right to refuse to receive services in this manner and to request services in an alternative format, such as through real-time telemedicine services or an in-person visit. (2) Receipt of services by store-and-forward means shall not preclude a patient from receiving real-time telemedicine services or an in-person visit with the distant site health care provider at a future date. (3) Originating site health care providers involved in the store-and-forward process shall obtain informed consent from the patient as described in subsection (c) of this section. (Added 2011, No. 107 (Adj. Sess.),  4, eff. May 8, 2012; amended 2017, No. 64,  2, eff. Oct. 1, 2017; 2019, No. 91 (Adj. Sess.),  25, eff. March 30, 2020.) 
 9362. Health care providers delivering health care services by audio-only telephone
(a) As used in this section, health insurance plan and health care provider have the same meaning as in 8 V.S.A.  4100l and telemedicine has the same meaning as in 8 V.S.A.  4100k. (b)(1) Subject to the limitations of the license under which the individual is practicing and, for Medicaid patients, to the extent permitted by the Centers for Medicare and Medicaid Services, a health care provider may deliver health care services to a patient using audio-only telephone if the patient elects to receive the services in this manner and it is clinically appropriate to do so. A health care provider shall comply with any training requirements imposed by the providers licensing board on the appropriate use of audio-only telephone in health care delivery. (2) A health care provider delivering health care services using audio-only telephone shall include or document in the patients medical record: (A) the patients informed consent for receiving services using audio-only telephone in accordance with subsection (c) of this section; and (B) the reason or reasons that the provider determined that it was clinically appropriate to deliver health care services to the patient by audio-only telephone. (3)(A) A health care provider shall not require a patient to receive health care services by audio-only telephone if the patient does not wish to receive services in this manner. (B) A health care provider shall deliver care that is timely and complies with contractual requirements and shall not delay care unnecessarily if a patient elects to receive services through an in-person visit or telemedicine instead of by audio-only telephone. (c) A health care provider delivering health care services by audio-only telephone shall obtain and document a patients oral or written informed consent for the use of audio-only telephone prior to the appointment or at the start of the appointment but prior to delivering any billable service. (1) The informed consent for audio-only telephone services shall be provided in accordance with Vermont and national policies and guidelines on the appropriate use of telephone services within the providers profession and shall include, in language that patients can easily understand: (A) that the patient is entitled to choose to receive services by audio-only telephone, in person, or through telemedicine, to the extent clinically appropriate; (B) that receiving services by audio-only telephone does not preclude the patient from receiving services in person or through telemedicine at a later date; (C) an explanation of the opportunities and limitations of delivering and receiving health care services using audio-only telephone; (D) informing the patient of the presence of any other individual who will be participating in or listening to the patients consultation with the provider and obtaining the patients permission for the participation or observation; (E) whether the services will be billed to the patients health insurance plan if delivered by audio-only telephone and what this may mean for the patients financial responsibility for co-payments, coinsurance, and deductibles; and (F) informing the patient that not all audio-only health care services are covered by all health plans. (2) For services delivered by audio-only telephone on an ongoing basis, the health care provider shall be required to obtain consent only at the first episode of care. (3) If the patient provides oral informed consent, the provider shall offer to provide the patient with a written copy of the informed consent. (4) Notwithstanding any provision of this subsection to the contrary, a health care provider shall not be required to obtain a patients informed consent for the use of audio-only telephone services in the case of a medical emergency. (5) A health care provider may use a single informed consent form to address all telehealth modalities, including telemedicine, store and forward, and audio-only telephone, as long as the form complies with the provisions of section 9361 of this chapter and this section. (d) Neither a health care provider nor a patient shall create or cause to be created a recording of a providers telephone consultation with a patient. (e) Audio-only telephone services shall not be used in the following circumstances:(1) for the second certification of an emergency examination determining whether an individual is a person in need of treatment pursuant to section 7508 of this title; or (2) for a psychiatrists examination to determine whether an individual is in need of inpatient hospitalization pursuant to 13 V.S.A.  4815(g)(3). (Added 2021, No. 6,  5, eff. March 29, 2021.) 
 9371. Principles for health care reform
The General Assembly adopts the following principles as a framework for reforming health care in Vermont: (1) The State of Vermont must ensure universal access to and coverage for high-quality, medically necessary health services for all Vermonters. Systemic barriers, such as cost, must not prevent people from accessing necessary health care. All Vermonters must receive affordable and appropriate health care at the appropriate time in the appropriate setting. (2) Overall health care costs must be contained, and growth in health care spending in Vermont must balance the health care needs of the population with the ability to pay for such care. (3) The health care system must be transparent in design, efficient in operation, and accountable to the people it serves. The State must ensure public participation in the design, implementation, evaluation, and accountability mechanisms of the health care system. (4) Primary care must be preserved and enhanced so that Vermonters have care available to them, preferably within their own communities. The health care system must ensure that Vermonters have access to appropriate mental health care that meets standards of quality, access, and affordability equivalent to other components of health care as part of an integrated, holistic system of care. Other aspects of Vermonts health care infrastructure, including the educational and research missions of the States academic medical center and other postsecondary educational institutions, the nonprofit missions of the community hospitals, and the critical access designation of rural hospitals, must be supported in such a way that all Vermonters, including those in rural areas, have access to necessary health services and that these health services are sustainable. (5) Every Vermonter should be able to choose his or her health care providers.(6) Vermonters should be aware of the costs of the health services they receive. Costs should be transparent and easy to understand. (7) Individuals have a personal responsibility to maintain their own health and to use health resources wisely, and all individuals should have a financial stake in the health services they receive. (8) The health care system must recognize the primacy of the relationship between patients and their health care practitioners, respecting the professional judgment of health care practitioners and the informed decisions of patients. (9) Vermonts health delivery system must seek continuous improvement of health care quality and safety and of the health of the population and promote healthy lifestyles. The system therefore must be evaluated regularly for improvements in access, quality, and cost containment. (10) Vermonts health care system must include mechanisms for containing all system costs and eliminating unnecessary expenditures, including by reducing administrative costs and by reducing costs that do not contribute to efficient, high-quality health services or improve health outcomes. Efforts to reduce overall health care costs should identify sources of excess cost growth. (11) The financing of health care in Vermont must be sufficient, fair, predictable, transparent, sustainable, and shared equitably. (12) The system must consider the effects of payment reform on individuals and on health care professionals and suppliers. It must enable health care professionals to provide, on a solvent basis, effective and efficient health services that are in the public interest. (13) Vermonts health care system must operate as a partnership between consumers, employers, health care professionals, hospitals, and the State and federal government. (14) State government must ensure that the health care system satisfies the principles expressed in this section. (Added 2011, No. 48,  3, eff. May 26, 2011; amended 2017, No. 200 (Adj. Sess.),  14; 2019, No. 14,  53, eff. April 30, 2019.) 
 9372. Purpose
It is the intent of the General Assembly to create an independent board to promote the general good of the State by: (1) improving the health of the population;(2) reducing the per-capita rate of growth in expenditures for health services in Vermont across all payers while ensuring that access to care and quality of care are not compromised; (3) enhancing the patient and health care professional experience of care;(4) recruiting and retaining high-quality health care professionals; and(5) achieving administrative simplification in health care financing and delivery. (Added 2011, No. 48,  3, eff. May 26, 2011.)
 9373. Definitions
As used in this chapter:(1) Board means the Green Mountain Care Board established in this chapter.(2) Chronic care means health services provided by a health care professional for an established clinical condition that is expected to last a year or more and that requires ongoing clinical management attempting to restore the individual to highest function, minimize the negative effects of the condition, prevent complications related to chronic conditions, engage in advanced care planning, and promote appropriate access to palliative care. (3) Chronic care management means a system of coordinated health care interventions and communications for individuals with chronic conditions, including significant patient self-care efforts, systemic supports for licensed health care practitioners and their patients, and a plan of care emphasizing prevention of complications, utilizing evidence-based practice guidelines, patient empowerment strategies, and evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health. (4) Global payment means a payment from a health insurer, Medicaid, Medicare, or other payer for the health services of a defined population of patients for a defined period of time. Such payments may be adjusted to account for the populations underlying risk factors, including severity of illness and socioeconomic factors that may influence the cost of health care for the population. (5) Green Mountain Care means the public-private universal health care program designed to provide health benefits through a simplified, uniform, single administrative system pursuant to 33 V.S.A. chapter 18, subchapter 2. (6) Health care professional means an individual, partnership, corporation, facility, or institution licensed or certified or otherwise authorized by Vermont law to provide professional health services. (7) Health care system means the local, State, regional, or national system of delivering health services, including administrative costs, capital expenditures, preventive care, and wellness services. (8) Health insurer means any health insurance company, nonprofit hospital and medical service corporation, managed care organization, and, to the extent permitted under federal law, any administrator of a health benefit plan offered by a public or a private entity. The term does not include Medicaid or any other State health care assistance program financed in whole or in part through a federal program. (9) Health service means any treatment or procedure delivered by a health care professional to maintain an individuals physical or mental health or to diagnose or treat an individuals physical or mental condition, including services ordered by a health care professional, chronic care management, preventive care, wellness services, and medically necessary services to assist in activities of daily living. (10) Integrated delivery system means a group of health care professionals, associated either through employment by a single entity or through a contractual arrangement, that provides health services for a defined population of patients and is compensated through a global payment. (11) Manufacturers of prescribed products shall have the same meaning as manufacturers in section 4631a of this title. (12) Payment reform means modifying the method of payment from a fee-for-service basis to one or more alternative methods for compensating health care professionals, health care provider bargaining groups created pursuant to section 9409 of this title, integrated delivery systems, and other health care professional arrangements, manufacturers of prescribed products, medical supply companies, and other companies providing health services or health supplies for the provision of high-quality and efficient health services, products, and supplies while measuring quality and efficiency. The term may include shared savings agreements, bundled payments, episode-based payments, and global payments. (13) Preventive care means health services provided by health care professionals to identify and treat asymptomatic individuals who have risk factors or preclinical disease, but in whom the disease is not clinically apparent, including immunizations and screening, counseling, treatment, and medication determined by scientific evidence to be effective in preventing or detecting a condition. (14) [Repealed.](15) Wellness services means health services, programs, or activities that focus on the promotion or maintenance of good health. (16) Accountable care organization and ACO means an organization of health care providers that has a formal legal structure, is identified by a federal taxpayer identification number, and agrees to be accountable for the quality, cost, and overall care of the patients assigned to it. (17) Health care spending estimate means the estimate established in accordance with section 9383 of this title. (18) Net patient revenues has the same meaning as in 33 V.S.A.  1951. (Added 2011, No. 48,  3, eff. May 26, 2011; amended 2011, No. 171 (Adj. Sess.),  6, eff. May 16, 2012; 2013, No. 79,  20, eff. Jan. 1, 2014; 2013, No. 96 (Adj. Sess.),  117; 2015, No. 113 (Adj. Sess.),  3, eff. Jan. 1, 2018; 2017, No. 167 (Adj. Sess.),  7, eff. May 22, 2018; 2019, No. 55,  3a, eff. June 10, 2019.)
 9374. Board membership; authority
(a)(1) On July 1, 2011, the Green Mountain Care Board is created and shall consist of a chair and four members. The Chair and all of the members shall be State employees and shall be exempt from the State classified system. The Chair shall receive compensation equal to that of a Superior judge, and the compensation for the remaining members shall be two-thirds of the amount received by the Chair. (2) The Chair and the members of the Board shall be nominated by the Green Mountain Care Board Nominating Committee established in subchapter 2 of this chapter using the qualifications described in section 9392 of this chapter and shall be otherwise appointed and confirmed in the manner of a Superior judge. The Governor shall not appoint a nominee who was denied confirmation by the Senate within the past six years. (b)(1) The initial term of the Chair shall be seven years, and the term of the Chair shall be six years thereafter. (2) The term of each member other than the Chair shall be six years, except that of the members first appointed, one each shall serve a term of three years, four years, five years, and six years. (3) Subject to the nomination and appointment process, a member may serve more than one term. (4) Members of the Board may be removed only for cause. The Board shall adopt rules pursuant to 3 V.S.A. chapter 25 to define the basis and process for removal. (c)(1) No Board member shall, during his or her term or terms on the Board, be an officer of, director of, organizer of, employee of, consultant to, or attorney for any person subject to supervision or regulation by the Board, provided that for a health care practitioner, the employment restriction in this subdivision shall apply only to administrative or managerial employment or affiliation with a hospital or other health care facility, as defined in section 9432 of this title, and shall not be construed to limit generally the ability of the health care practitioner to practice his or her profession. (2) No Board member shall participate in creating or applying any law, rule, or policy or in making any other determination if the Board member, individually or as a fiduciary, or the Board members spouse, parent, or child wherever residing or any other member of the Board members family residing in his or her household has an economic interest in the matter before the Board or has any more than a de minimis interest that could be substantially affected by the proceeding. (3) The prohibitions contained in subdivisions (1) and (2) of this subsection shall not be construed to prohibit a Board member from, or require a Board member to recuse himself or herself from Board activities as a result of, any of the following: (A) being an insurance policyholder or from receiving health services on the same terms as are available to the public generally; (B) owning a stock, bond, or other security in an entity subject to supervision or regulation by the Board that is purchased by or through a mutual fund, blind trust, or other mechanism where a person other than the Board member chooses the stock, bond, or security; or (C) receiving retirement benefits through a defined benefit plan from an entity subject to supervision or regulation by the Board. (4) No Board member shall, during his or her term or terms on the Board, solicit, engage in negotiations for, or otherwise discuss future employment or a future business relationship of any kind with any person subject to supervision or regulation by the Board. (5) No Board member may appear before the Board or any other State agency on behalf of a person subject to supervision or regulation by the Board for a period of one year following his or her last day as a member of the Green Mountain Care Board. (d)(1) The Chair shall have general charge of the offices and employees of the Board but may hire a director to oversee the administration and operation. (2)(A) Except for final decisions in regulatory matters over which the Board has jurisdiction, a member of the Board, Board officer, or Board employee may perform any service that is within the Boards jurisdiction and that the Board delegates to the member, officer, or employee. (B) The Board shall establish procedures to ensure that Board employees have appropriate supervision in their performance of delegated activities and that the Board remains informed regarding these activities. (e)(1) The Board shall establish a consumer, patient, business, and health care professional advisory group to provide input and recommendations to the Board. Members of such advisory group who are not State employees or whose participation is not supported through their employment or association shall receive per diem compensation and reimbursement of expenses pursuant to 32 V.S.A.  1010, provided that the total amount expended for such compensation shall not exceed $5,000.00 per year. (2) The Board may establish additional advisory groups and subcommittees as needed to carry out its duties. The Board shall appoint diverse health care professionals to the additional advisory groups and subcommittees as appropriate. (3) To the extent funds are available, the Board may examine, on its own or through collaboration or contracts with third parties, the effectiveness of existing requirements for health care professionals, such as quality measures and prior authorization, and evaluate alternatives that improve quality, reduce costs, and reduce administrative burden. (f) In carrying out its duties pursuant to this chapter, the Board shall seek advice from the Office of the Health Care Advocate. The Office shall advise the Board regarding the policies, procedures, and rules established pursuant to this chapter. The Office shall represent the interests of Vermont patients and Vermont consumers of health insurance and may suggest policies, procedures, or rules to the Board in order to protect patients and consumers interests. (g) The Chair of the Board or designee may apply for grant funding, if available, to advance or support any responsibility within the Boards jurisdiction. (h)(1) The Board may assess and collect from each regulated entity the actual costs incurred by the Board, including staff time and contracts for professional services, in carrying out its regulatory duties for health insurance rate review under 8 V.S.A.  4062; hospital budget review under chapter 221, subchapter 7 of this title; and accountable care organization certification and budget review under section 9382 of this title. The Board may also assess and collect from general hospitals licensed under chapter 43 of this title expenses incurred by the Commissioner of Health in administering hospital community reports under section 9405b of this title. (2)(A) In addition to the assessment and collection of actual costs pursuant to subdivision (1) of this subsection and except as otherwise provided in subdivisions (2)(C) and (3) of this subsection, all other expenses of the Board shall be borne as follows: (i) 40 percent by the State from State monies;(ii) 30 percent by the hospitals;(iii) 24 percent by nonprofit hospital and medical service corporations licensed under 8 V.S.A. chapter 123 or 125, health insurance companies licensed under 8 V.S.A. chapter 101, and health maintenance organizations licensed under 8 V.S.A. chapter 139; and (iv) six percent by accountable care organizations certified under section 9382 of this title. (B) Expenses under subdivision (A)(iii) of this subdivision (2) shall be allocated to persons licensed under Title 8 based on premiums paid for health care coverage, which for the purposes of this subdivision (2) shall include major medical, comprehensive medical, hospital or surgical coverage, and comprehensive health care services plans, but shall not include long-term care, limited benefits, disability, credit or stop loss, or excess loss insurance coverage. (C) Expenses incurred by the Board for regulatory duties associated with certificates of need shall be assessed pursuant to the provisions of section 9441 of this title and not in accordance with the formula set forth in subdivision (A) of this subdivision (2). (3) The Board may determine the scope of the incurred expenses to be allocated pursuant to the formula set forth in subdivision (2) of this subsection if, in the Boards discretion, the expenses to be allocated are in the best interests of the regulated entities and of the State. (4) If the amount of the proportional assessment to any entity calculated in accordance with the formula set forth in subdivision (2)(A) of this subsection would be less than $150.00, the Board shall assess the entity a minimum fee of $150.00. The Board shall apply the amounts collected based on the difference between each applicable entitys proportional assessment amount and $150.00 to reduce the total amount assessed to the regulated entities pursuant to subdivisions (2)(A)(ii)-(iv) of this subsection. (5)(A) Annually on or before September 15, the Board shall report to the House and Senate Committees on Appropriations the total amount of all expenses eligible for allocation pursuant to this subsection (h) during the preceding State fiscal year and the total amount actually billed back to the regulated entities during the same period. The provisions of 2 V.S.A.  20(d) (expiration of required reports) shall not apply to the report to be made under this subdivision. (B) The Board and the Department shall also present the information required by this subsection (h) to the Joint Fiscal Committee annually at its September meeting. (i) In addition to any other penalties and in order to enforce the provisions of this chapter and empower the Board to perform its duties, the Chair of the Board may issue subpoenas, examine persons, administer oaths, and require production of papers and records. Any subpoena or notice to produce may be served by registered or certified mail or in person by an agent of the Chair. Service by registered or certified mail shall be effective three business days after mailing. Any subpoena or notice to produce shall provide at least six business days time from service within which to comply, except that the Chair may shorten the time for compliance for good cause shown. Any subpoena or notice to produce sent by registered or certified mail, postage prepaid, shall constitute service on the person to whom it is addressed. Each witness who appears before the Chair under subpoena shall receive a fee and mileage as provided for witnesses in civil cases in Superior Courts; provided, however, any person subject to the Boards authority shall not be eligible to receive fees or mileage under this section. (j) A person who fails or refuses to appear, to testify, or to produce papers or records for examination before the Chair upon properly being ordered to do so may be assessed an administrative penalty by the Chair of not more than $2,000.00 for each day of noncompliance and proceeded against as provided in the Administrative Procedure Act, and the Chair may recommend to the appropriate licensing entity that the persons authority to do business be suspended for up to six months. (Added 2011, No. 48,  3, eff. May 26, 2011; amended 2011, No. 171 (Adj. Sess.),  5, eff. May 16, 2012; 2013, No. 79,  35b, eff. Jan. 1, 2014; 2013, No. 79,  37a; 2015, No. 113 (Adj. Sess.),  9, eff. May 17, 2016; 2017, No. 154 (Adj. Sess.),  23, eff. May 21, 2018; 2017, No. 167 (Adj. Sess.),  13, eff. May 22, 2018; 2017, No. 167 (Adj. Sess.),  17; 2019, No. 88 (Adj. Sess.),  67, eff. March 4, 2020; 2021, No. 137 (Adj. Sess.),  5, eff. July 1, 2022.) 
 9375. Duties
(a) The Board shall execute its duties consistent with the principles expressed in section 9371 of this title. (b) The Board shall have the following duties:(1) Oversee the development and implementation, and evaluate the effectiveness, of health care payment and delivery system reforms designed to control the rate of growth in health care costs; promote seamless care, administration, and service delivery; and maintain health care quality in Vermont, including ensuring that the payment reform pilot projects set forth in this chapter are consistent with such reforms. (A) Implement by rule, pursuant to 3 V.S.A. chapter 25, methodologies for achieving payment reform and containing costs that may include the participation of Medicare and Medicaid, which may include the creation of health care professional cost-containment targets, global payments, bundled payments, global budgets, risk-adjusted capitated payments, or other uniform payment methods and amounts for integrated delivery systems, health care professionals, or other provider arrangements. (i) The Board shall work in collaboration with providers to develop payment models that preserve access to care and quality in each community. (ii) The rule shall take into consideration current Medicare designations and payment methodologies, including critical access hospitals, prospective payment system hospitals, graduate medical education payments, Medicare dependent hospitals, and federally qualified health centers. (iii) The payment reform methodologies developed by the Board shall encourage coordination and planning on a regional basis, taking into account existing local relationships between providers and human services organizations. (B) Prior to the initial adoption of the rules described in subdivision (A) of this subdivision (1), report the Boards proposed methodologies to the House Committee on Health Care and the Senate Committee on Health and Welfare. (C) In developing methodologies pursuant to subdivision (A) of this subdivision (1), engage Vermonters in seeking ways to equitably distribute health services while acknowledging the connection between fair and sustainable payment and access to health care. (D) Nothing in this subdivision (1) shall be construed to limit the authority of other agencies or departments of State government to engage in additional cost-containment activities to the extent permitted by State and federal law. (2)(A) Review and approve Vermonts statewide Health Information Technology Plan pursuant to section 9351 of this title to ensure that the necessary infrastructure is in place to enable the State to achieve the principles expressed in section 9371 of this title. (B) Review and approve the criteria required for health care providers and health care facilities to create or maintain connectivity to the States health information exchange as set forth in section 9352 of this title. Within 90 days following this approval, the Board shall issue an order explaining its decision. (C) Annually review and approve the budget, consistent with available funds, of the Vermont Information Technology Leaders, Inc. (VITL). This review shall take into account VITLs responsibilities pursuant to section 9352 of this title and the availability of funds needed to support those responsibilities. (3) Review and approve the Health Care Workforce Development Strategic Plan created in chapter 222 of this title. (4) Publish on its website the Health Resource Allocation Plan identifying Vermonts critical health needs, goods, services, and resources in accordance with section 9405 of this title. (5) Set rates for health care professionals pursuant to section 9376 of this title, to be implemented over time, and make adjustments to the rules on reimbursement methodologies as needed. (6) Approve, modify, or disapprove requests for health insurance rates pursuant to 8 V.S.A.  4062, taking into consideration the requirements in the underlying statutes, changes in health care delivery, changes in payment methods and amounts, protecting insurer solvency, and other issues at the discretion of the Board. (7) Review and establish hospital budgets pursuant to chapter 221, subchapter 7 of this title. (8) Review and approve, approve with conditions, or deny applications for certificates of need pursuant to chapter 221, subchapter 5 of this title. (9) Review and approve, with recommendations from the Commissioner of Vermont Health Access, the benefit package or packages for qualified health benefit plans and reflective health benefit plans pursuant to 33 V.S.A. chapter 18, subchapter 1. The Board shall report to the House Committee on Health Care and the Senate Committee on Health and Welfare within 15 days following its approval of any substantive changes to the benefit packages. (10) Develop and maintain a method for evaluating systemwide performance and quality, including identification of the appropriate process and outcome measures: (A) for determining public and health care professional satisfaction with the health system;(B) for utilization of health services;(C) in consultation with the Department of Health and the Director of the Blueprint for Health, for quality of health services and the effectiveness of prevention and health promotion programs; (D) for cost-containment and limiting the growth in health care expenditures;(E) for determining the adequacy of the supply and distribution of health care resources in this State; (F) to address access to and quality of mental health and substance abuse services; and(G) for other measures as determined by the Board.(11) Develop the health care spending estimate pursuant to section 9383 of this title.(12) Review data regarding mental health and substance abuse treatment reported to the Department of Financial Regulation pursuant to 8 V.S.A.  4089b(g)(1)(G) and discuss such information, as appropriate, with the Mental Health Technical Advisory Group established pursuant to subdivision 9374(e)(2) of this title. (13) Adopt by rule pursuant to 3 V.S.A. chapter 25 such standards as the Board deems necessary and appropriate to the operation and evaluation of accountable care organizations pursuant to this chapter, including reporting requirements, patient protections, and solvency and ability to assume financial risk.  [Subsection (b)(14) repealed effective January 16, 2026.] (14)(A) Collect and review annualized data from ambulatory surgical centers licensed pursuant to chapter 49 of this title, which shall include net patient revenues and which may include data on an ambulatory surgical centers scope of services, volume, payer mix, and coordination with other aspects of the health care system. The Boards processes shall be appropriate to ambulatory surgical centers scale, their role in Vermonts health care system, and their administrative capacity, and the Board shall seek to minimize the administrative burden of data collection on ambulatory surgical centers. The Board shall also consider ways in which ambulatory surgical centers can be integrated into systemwide payment and delivery system reform. (B) In its annual report pursuant to subsection (d) of this section, the Board shall describe its oversight of ambulatory surgical centers pursuant to subdivision (A) of this subdivision (14) for the most recently concluded 12-month period of the Boards review, including the amount of each ambulatory surgical centers net patient revenues and, using claims data from the Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES), information regarding high-volume outpatient surgeries and procedures performed in ambulatory surgical center and hospital settings in Vermont, any changes in utilization over time, and a comparison of the commercial insurance rates paid for the same surgeries and procedures performed in ambulatory surgical centers and in hospitals in Vermont. (15) Collect and review data from each community mental health and developmental disability agency designated by the Commissioner of Mental Health or of Disabilities, Aging, and Independent Living pursuant to chapter 207 of this title, which may include data regarding a designated or specialized service agencys scope of services, volume, utilization, payer mix, quality, coordination with other aspects of the health care system, and financial condition, including solvency. The Boards processes shall be appropriate to the designated and specialized service agencies scale and their role in Vermonts health care system, and the Board shall consider ways in which the designated and specialized service agencies can be integrated fully into systemwide payment and delivery system reform. (c) The Board shall have the following duties related to Green Mountain Care:(1) Prior to implementing Green Mountain Care, consider recommendations from the Agency of Human Services, and define the Green Mountain Care benefit package within the parameters established in 33 V.S.A. chapter 18, subchapter 2, to be adopted by the Agency by rule. (2) When providing its recommendations for the benefit package pursuant to subdivision (1) of this subsection, the Agency of Human Services shall present a report on the benefit package proposal to the House Committee on Health Care and the Senate Committee on Health and Welfare. The report shall describe the covered services to be included in the Green Mountain Care benefit package and any cost-sharing requirements. If the General Assembly is not in session at the time that the Agency makes its recommendations, the Agency shall send its report electronically or by first-class mail to each member of the House Committee on Health Care and the Senate Committee on Health and Welfare. (3) Prior to implementing Green Mountain Care and annually after implementation, recommend to the Governor a three-year Green Mountain Care budget pursuant to 32 V.S.A. chapter 5, to be adjusted annually in response to realized revenues and expenditures, that reflects any modifications to the benefit package and includes recommended appropriations, revenue estimates, and necessary modifications to tax rates and other assessments. (d) Annually on or before January 15, the Board shall submit a report of its activities for the preceding calendar year to the House Committee on Health Care and the Senate Committee on Health and Welfare. (1) The report shall include:(A) any changes to the payment rates for health care professionals pursuant to section 9376 of this title; (B) any new developments with respect to health information technology;(C) the evaluation criteria adopted pursuant to subdivision (b)(8) of this section and any related modifications; (D) the results of the systemwide performance and quality evaluations required by subdivision (b)(8) of this section and any resulting recommendations; (E) the process and outcome measures used in the evaluation;(F) the impact of the Medicaid and Medicare cost shifts and uncompensated care on health insurance premium rates and any recommendations on mechanisms to ensure that appropriations intended to address the Medicaid cost shift will have the intended result of reducing the premiums imposed on commercial insurance premium payers below the amount they otherwise would have been charged; (G) any recommendations for modifications to Vermont statutes; and(H) any actual or anticipated impacts on the work of the Board as a result of modifications to federal laws, regulations, or programs. (2) The report shall identify how the work of the Board comports with the principles expressed in section 9371 of this title. (e)(1) The Board shall summarize and synthesize the key findings and recommendations from reports prepared by and for the Board, including its expenditure analyses and focused studies. The Board shall develop, in consultation with the Office of the Health Care Advocate, a standard for creating plain language summaries that the public can easily use and understand. (2) All reports and summaries prepared by the Board shall be available to the public and shall be posted on the Boards website. (Added 2011, No. 48,  3, eff. May 26, 2011; amended 2011, No. 171 (Adj. Sess.),  12, eff. May 16, 2012; 2013, No. 79,  5 l, eff. Jan. 1, 2014; 2013, No. 79,  41; 2015, No. 54,  7, eff. June 5, 2015; 2015, No. 113 (Adj. Sess.),  4, eff. Jan. 1, 2018; 2017, No. 88 (Adj. Sess.),  1, eff. Feb. 20, 2018; 2017, No. 113 (Adj. Sess.),  105; 2017, No. 154 (Adj. Sess.),  3, eff. May 21, 2018; 2017, No. 167 (Adj. Sess.),  1, 8, eff. May 22, 2018; 2017, No. 187 (Adj. Sess.),  4, eff. May 28, 2018; 2019, No. 19,  3, eff. Jan. 1, 2020; 2019, No. 53,  2; 2019, No. 55,  4, eff. June 10, 2019; 2019, No. 63,  10 eff. June 17, 2019; 2019, No. 140 (Adj. Sess.),  1, eff. July 6, 2020; 2021, No. 167 (Adj. Sess.),  9, eff. June 1, 2022.) 
 9376. Payment amounts; methods
(a) It is the intent of the General Assembly to ensure payments to health care professionals that are consistent with efficiency, economy, and quality of care and will permit them to provide, on a solvent basis, effective and efficient health services that are in the public interest. It is also the intent of the General Assembly to eliminate the shift of costs between the payers of health services to ensure that the amount paid to health care professionals is sufficient to enlist enough providers to ensure that health services are available to all Vermonters and are distributed equitably. (b)(1) The Board shall set reasonable rates for health care professionals, health care provider bargaining groups created pursuant to section 9409 of this title, manufacturers of prescribed products, medical supply companies, and other companies providing health services or health supplies based on methodologies pursuant to section 9375 of this title, in order to have a consistent reimbursement amount accepted by these persons. In its discretion, the Board may implement rate-setting for different groups of health care professionals over time and need not set rates for all types of health care professionals. In establishing rates, the Board may consider legitimate differences in costs among health care professionals, such as the cost of providing a specific necessary service or services that may not be available elsewhere in the State, and the need for health care professionals in particular areas of the State, particularly in underserved geographic or practice shortage areas. (2) Nothing in this subsection shall be construed to:(A) limit the ability of a health care professional to accept less than the rate established in subdivision (1) of this subsection (b) from a patient without health insurance or other coverage for the service or services received; or (B) reduce or limit the covered services offered by Medicare or Medicaid.(c) The Board shall approve payment methodologies that encourage cost-containment; provision of high-quality, evidence-based health services in an integrated setting; patient self-management; access to primary care health services for underserved individuals, populations, and areas; and healthy lifestyles. Such methodologies shall be consistent with payment reform and with evidence-based practices, and may include fee-for-service payments if the Board determines such payments to be appropriate. (d) To the extent required to avoid federal antitrust violations and in furtherance of the policy identified in subsection (a) of this section, the Board shall facilitate and supervise the participation of health care professionals and health care provider bargaining groups in the process described in subsection (b) of this section. (Added 2011, No. 48,  3, eff. May 26, 2011; amended 2015, No. 54,  8, eff. June 5, 2015.) 
 9377. Payment reform; pilots
(a) It is the intent of the General Assembly to achieve the principles stated in section 9371 of this title. In order to achieve this goal and to ensure the success of health care reform, it is the intent of the General Assembly that payment reform be implemented and that payment reform be carried out as described in this section. It is also the intent of the General Assembly to ensure sufficient State involvement and action in the design and implementation of the payment reform pilot projects described in this section to comply with federal and State antitrust provisions by replacing competition between payers and others with State-supervised cooperation and regulation. (b)(1) The Board shall be responsible for payment and delivery system reform, including the pilot projects established in this section. (2) Payment reform pilot projects shall be developed and implemented to manage the costs of the health care delivery system, improve health outcomes for Vermonters, provide a positive health care experience for patients and health care professionals, and further the following objectives: (A) payment reform pilot projects should align with the Blueprint for Health strategic plan and the Statewide Health Information Technology Plan; (B) health care professionals should coordinate patient care through a local entity or organization facilitating this coordination or another structure which results in the coordination of patient care and a sustained focus on disease prevention and promotion of wellness that includes individuals, employers, and communities; (C) health insurers, Medicaid, Medicare, and all other payers should reimburse health care professionals for coordinating patient care through consistent payment methodologies, which may include a global budget; a system of cost containment limits, health outcome measures, and patient consumer satisfaction targets, which may include risk-sharing or other incentives designed to reduce costs while maintaining or improving health outcomes and patient consumer satisfaction; or another payment method providing an incentive to coordinate care and control cost growth; (D) the scope of services in any capitated payment should be broad and comprehensive, including prescription drugs, diagnostic services, acute and sub-acute home health services, services received in a hospital, mental health and substance abuse services, and services from a licensed health care practitioner; and (E) health insurers, Medicaid, Medicare, and all other payers should reimburse health care professionals for providing the full spectrum of evidence-based health services. (3) In addition to the objectives identified in subdivision (a)(2) of this section, the design and implementation of payment reform pilot projects may consider: (A) alignment with the requirements of federal law to ensure the full participation of Medicare in multipayer payment reform; and (B) with input from long-term care providers, the inclusion of home health services and long-term care services as part of capitated payments. (c) To the extent required to avoid federal antitrust violations, the Board shall facilitate and supervise the participation of health care professionals, health care facilities, and insurers in the planning and implementation of the payment reform pilot projects, including by creating a shared incentive pool if appropriate. The Board shall ensure that the process and implementation include sufficient State supervision over these entities to comply with federal antitrust provisions and shall refer to the Attorney General for appropriate action the activities of any individual or entity that the Board determines, after notice and an opportunity to be heard, violate State or federal antitrust laws without a countervailing benefit of improving patient care, improving access to health care, increasing efficiency, or reducing costs by modifying payment methods. (d) The Board or designee shall apply for grant funding, if available, for the evaluation of the pilot projects described in this section. (e) The Board or designee shall convene a broad-based group of stakeholders, including health care professionals who provide health services, health insurers, professional organizations, community and nonprofit groups, consumers, businesses, school districts, the Office of the Health Care Advocate, and State and local governments, to advise the Board in developing and implementing the pilot projects and to advise the Green Mountain Care Board in setting overall policy goals. (f) The first pilot project shall become operational no later than July 1, 2012, and two or more additional pilot projects shall become operational no later than October 1, 2012. (g)(1) Health insurers shall participate in the development of the payment reform strategic plan for the pilot projects and in the implementation of the pilot projects, including providing incentives, fees, or payment methods, as required in this section. This requirement may be enforced by the Department of Financial Regulation to the same extent as the requirement to participate in the Blueprint for Health pursuant to 8 V.S.A.  4088h. (2) The Board may establish procedures to exempt or limit the participation of health insurers offering a stand-alone dental plan or specific disease or other limited-benefit coverage or participation by insurers with a minimal number of covered lives as defined by the Board, in consultation with the Commissioner of Financial Regulation. Health insurers shall be exempt from participation if the insurer offers only benefit plans which are paid directly to the individual insured or the insureds assigned beneficiaries and for which the amount of the benefit is not based upon potential medical costs or actual costs incurred. (3) In the event that the Secretary of Human Services is denied permission from the Centers for Medicare and Medicaid Services to include financial participation by Medicare in the pilot projects, health insurers shall not be required to cover the costs associated with individuals covered by Medicare. (4) After implementation of the pilot projects described in this subchapter, health insurers shall have appeal rights pursuant to section 9381 of this title. (Added 2011, No. 48,  3, eff. May 26, 2011; amended 2011, No. 171 (Adj. Sess.),  27, eff. May 16, 2012; 2013, No. 79,  35c, eff. Jan. 1, 2014.) 
 9377a. Prior authorization pilot program
(a) The Green Mountain Care Board shall develop and implement a pilot program or programs for the purpose of measuring the change in system costs within primary care associated with eliminating prior authorization requirements for imaging, medical procedures, prescription drugs, and home care. The program shall be designed to measure the effects of eliminating prior authorizations on provider satisfaction and on the number of requests for and expenditures on imaging, medical procedures, prescription drugs, and home care. In developing the pilot program proposal, the Board shall collaborate with health care professionals and health insurers throughout the State or regionally. (b) The Board shall submit an update regarding implementation of prior authorization pilot programs as part of its annual report under subsection 9375(d) of this title. (Added 2013, No. 79,  40a.) 
 9378. Public process
The Green Mountain Care board shall provide a process for soliciting public input. The process may include receiving written comments on proposed new or amended rules or holding public hearings, or both. (Added 2011, No. 48,  3, eff. May 26, 2011.) 
 9379. Agency cooperation
The Secretary of Administration shall ensure that, in accordance with State and federal privacy laws, the Green Mountain Care Board has access to data and analysis held by any Executive Branch agency which is necessary to carry out the Boards duties as described in this chapter. (Added 2011, No. 48,  3, eff. May 26, 2011.) 
 9380. Rules
The Board may adopt rules pursuant to 3 V.S.A. chapter 25 as needed to carry out the provisions of this chapter. (Added 2011, No. 48,  3, eff. May 26, 2011.) 
 9381. Appeals
(a) The Green Mountain Care Board shall adopt procedures for administrative appeals of its actions, orders, or other determinations. Such procedures shall provide for the issuance of a final order and the creation of a record sufficient to serve as the basis for judicial review pursuant to subsection (b) of this section. (b) Any person aggrieved by a final action, order, or other determination of the Green Mountain Care Board may, upon exhaustion of all administrative appeals available pursuant to subsection (a) of this section, appeal to the Supreme Court pursuant to the Vermont Rules of Appellate Procedure. (c) If an appeal or other petition for judicial review of a final order is not filed in connection with an order of the Green Mountain Care Board pursuant to subsection (b) of this section, the Chair may file a certified copy of the final order with the clerk of a court of competent jurisdiction. The order so filed has the same effect as a judgment of the court and may be recorded, enforced, or satisfied in the same manner as a judgment of the court. (d) A decision of the Boards approving, modifying, or disapproving a health insurers proposed rate pursuant to 8 V.S.A.  4062 shall be considered a final action of the Board and may be appealed to the Supreme Court pursuant to subsection (b) of this section. (Added 2011, No. 48,  3, eff. May 26, 2011; amended 2011, No. 171 (Adj. Sess.), eff. May 16, 2012; 2013, No. 79,  5m, eff. Jan. 1, 2014.) 
 9382. Oversight of accountable care organizations
(a) In order to be eligible to receive payments from Medicaid or commercial insurance through any payment reform program or initiative, including an all-payer model, each accountable care organization shall obtain and maintain certification from the Green Mountain Care Board. The Board shall adopt rules pursuant to 3 V.S.A. chapter 25 to establish standards and processes for certifying accountable care organizations. To the extent permitted under federal law, the Board shall ensure these rules anticipate and accommodate a range of ACO models and sizes, balancing oversight with support for innovation. In order to certify an ACO to operate in this State, the Board shall ensure that the following criteria are met: (1) The ACOs governance, leadership, and management structure is transparent, reasonably and equitably represents the ACOs participating providers and its patients, and includes a consumer advisory board and other processes for inviting and considering consumer input. (2) The ACO has established appropriate mechanisms and care models to provide, manage, and coordinate high-quality health care services for its patients, including incorporating the Blueprint for Health, coordinating services for complex high-need patients, and providing access to health care providers who are not participants in the ACO. The ACO ensures equal access to appropriate mental health care that meets standards of quality, access, and affordability equivalent to other components of health care as part of an integrated, holistic system of care. (3) The ACO has established appropriate mechanisms to receive and distribute payments to its participating health care providers in a fair and equitable manner. To the extent that the ACO has the authority and ability to establish provider reimbursement rates, the ACO shall minimize differentials in payment methodology and amounts among comparable participating providers across all practice settings, as long as doing so is not inconsistent with the ACOs overall payment reform objectives. (4) The ACO has established appropriate mechanisms and criteria for accepting health care providers to participate in the ACO that prevent unreasonable discrimination and are related to the needs of the ACO and the patient population served. (5) The ACO has established mechanisms and care models to promote evidence-based health care, patient engagement, coordination of care, use of electronic health records, and other enabling technologies to promote integrated, efficient, seamless, and effective health care services across the continuum of care, where feasible. (6) The ACOs participating providers have the capacity for meaningful participation in health information exchanges. (7) The ACO has performance standards and measures to evaluate the quality and utilization of care delivered by its participating health care providers. (8) The ACO does not place any restrictions on the information its participating health care providers may provide to patients about their health or decisions regarding their health. (9) The ACOs participating health care providers engage their patients in shared decision making to inform them of their treatment options and the related risks and benefits of each. (10) The ACO offers assistance to health care consumers, including:(A) maintaining a consumer telephone line for complaints and grievances from attributed patients; (B) responding and making best efforts to resolve complaints and grievances from attributed patients, including providing assistance in identifying appropriate rights under a patients health plan; (C) providing an accessible mechanism for explaining how ACOs work;(D) providing contact information for the Office of the Health Care Advocate; and(E) sharing deidentified complaint and grievance information with the Office of the Health Care Advocate at least twice annually. (11) The ACO collaborates with providers not included in its financial model, including home- and community-based providers and dental health providers. (12) The ACO does not interfere with patients choice of their own health care providers under their health plan, regardless of whether a provider is participating in the ACO; does not reduce covered services; and does not increase patient cost sharing. (13) The meetings of the ACOs governing body comply with the provisions of section 9572 of this title. (14) The impact of the ACOs establishment and operation does not diminish access to any health care or community-based service or increase delays in access to care for the population and area it serves. (15) The ACO has in place appropriate mechanisms to conduct ongoing assessments of its legal and financial vulnerabilities. (16) The ACO has in place a financial guarantee sufficient to cover its potential losses.(17) The ACO provides connections and incentives to existing community services for preventing and addressing the impact of childhood adversity. The ACO collaborates on the development of quality-outcome measurements for use by primary care providers who work with children and families and fosters collaboration among care coordinators, community service providers, and families. (b)(1) The Green Mountain Care Board shall adopt rules pursuant to 3 V.S.A. chapter 25 to establish standards and processes for reviewing, modifying, and approving the budgets of ACOs with 10,000 or more attributed lives in Vermont. To the extent permitted under federal law, the Board shall ensure the rules anticipate and accommodate a range of ACO models and sizes, balancing oversight with support for innovation. In its review, the Board shall review and consider: (A) information regarding utilization of the health care services delivered by health care providers participating in the ACO and the effects of care models on appropriate utilization, including the provision of innovative services; (B) the Health Resource Allocation Plan identifying Vermonts critical health needs, goods, services, and resources as identified pursuant to section 9405 of this title; (C) the expenditure analysis for the previous year and the proposed expenditure analysis for the year under review by payer; (D) the character, competence, fiscal responsibility, and soundness of the ACO and its principals; (E) any reports from professional review organizations;(F) the ACOs efforts to prevent duplication of high-quality services being provided efficiently and effectively by existing community-based providers in the same geographic area, as well as its integration of efforts with the Blueprint for Health and its regional care collaboratives; (G) the extent to which the ACO provides incentives for systemic health care investments to strengthen primary care, including strategies for recruiting additional primary care providers, providing resources to expand capacity in existing primary care practices, and reducing the administrative burden of reporting requirements for providers while balancing the need to have sufficient measures to evaluate adequately the quality of and access to care; (H) the extent to which the ACO provides incentives for systemic integration of community-based providers in its care model or investments to expand capacity in existing community-based providers, in order to promote seamless coordination of care across the care continuum; (I) the extent to which the ACO provides incentives for systemic health care investments in social determinants of health, such as developing support capacities that prevent hospital admissions and readmissions, reduce length of hospital stays, improve population health outcomes, reward healthy lifestyle choices, and improve the solvency of and address the financial risk to community-based providers that are participating providers of an accountable care organization; (J) the extent to which the ACO provides incentives for preventing and addressing the impacts of adverse childhood experiences (ACEs) and other traumas, such as developing quality outcome measures for use by primary care providers working with children and families, developing partnerships between nurses and families, providing opportunities for home visits, and including parent-child centers and designated agencies as participating providers in the ACO; (K) public comment on all aspects of the ACOs costs and use and on the ACOs proposed budget; (L) information gathered from meetings with the ACO to review and discuss its proposed budget for the forthcoming fiscal year; (M) information on the ACOs administrative costs, as defined by the Board;(N) the effect, if any, of Medicaid reimbursement rates on the rates for other payers;(O) the extent to which the ACO makes its costs transparent and easy to understand so that patients are aware of the costs of the health care services they receive; and (P) the extent to which the ACO provides resources to primary care practices to ensure that care coordination and community services, such as mental health and substance use disorder counseling that are provided by community health teams, are available to patients without imposing unreasonable burdens on primary care providers or on ACO member organizations. (2) The Green Mountain Care Board shall adopt rules pursuant to 3 V.S.A. chapter 25 to establish standards and processes for reviewing, modifying, and approving the budgets of ACOs with fewer than 10,000 attributed lives in Vermont. In its review, the Board may consider as many of the factors described in subdivision (1) of this subsection as the Board deems appropriate to a specific ACOs size and scope. (3)(A) The Office of the Health Care Advocate shall have the right to receive copies of all materials related to any ACO budget review and may: (i) ask questions of employees of the Green Mountain Care Board related to the Boards ACO budget review; (ii) submit written questions to the Board that the Board will ask of the ACO in advance of any hearing held in conjunction with the Boards ACO review; (iii) submit written comments for the Boards consideration; and(iv) ask questions and provide testimony in any hearing held in conjunction with the Boards ACO budget review. (B) The Office of the Health Care Advocate shall not disclose further any confidential or proprietary information provided to the Office pursuant to this subdivision (3). (c) The Boards rules shall include requirements for submission of information and data by ACOs and their participating providers as needed to evaluate an ACOs success. They may also establish standards as appropriate to promote an ACOs ability to participate in applicable federal programs for ACOs. (d) All information required to be filed by an ACO pursuant to this section or to rules adopted pursuant to this section shall be made available to the public upon request, provided that individual patients or health care providers shall not be directly or indirectly identifiable. (e) To the extent required to avoid federal antitrust violations, the Board shall supervise the participation of health care professionals, health care facilities, and other persons operating or participating in an accountable care organization. The Board shall ensure that its certification and oversight processes constitute sufficient State supervision over these entities to comply with federal antitrust provisions and shall refer to the Attorney General for appropriate action the activities of any individual or entity that the Board determines, after notice and an opportunity to be heard, may be in violation of State or federal antitrust laws without a countervailing benefit of improving patient care, improving access to health care, increasing efficiency, or reducing costs by modifying payment methods. (Added 2015, No. 113 (Adj. Sess.),  5, eff. Jan. 1, 2018; amended 2017, No. 59,  1; 2017, No. 167 (Adj. Sess.),  2, 13a, eff. May 22, 2018; 2017, No. 200 (Adj. Sess.),  15; 2017, No. 204 (Adj. Sess.),  7; 2019, No. 14,  54, eff. April 30, 2019; 2019, No. 52,  2a.) 
 9383. Expenditure analysis; health care spending estimate
(a) The Board shall develop annually an expenditure analysis and an estimate of future health care spending covering a period of at least two years. These analyses shall contain data and information as set forth in this section that the Board shall consider and incorporate into its work in furtherance of its statutory duties, including using them as tools in the Boards review of health insurance rates and the budgets of hospitals and accountable care organizations. The analyses shall: (1) inform the Boards regulatory processes in order to promote improved health outcomes, health care cost containment, quality of care, access to care, and appropriate resource allocation; and (2) quantify the total amount of money that has been and is estimated to be expended for all health care services provided by health care facilities and providers in Vermont and for health care services provided to residents of this State regardless of the site of service, to the extent data are available. (b) The expenditure analysis and the estimate of future health care spending shall include breakdowns for broad sectors such as hospital, physician, mental health, home health, and pharmacy and may include estimates for disease prevention and health promotion activities and other social determinants of health. The analyses shall include: (1) expenditures by commercial health plans, hospital and medical service corporations, and health maintenance organizations regulated by this State; and (2) expenditures for Medicare, Medicaid, self-insured employers, and other forms of health coverage, to the extent data are available. (c) Annually on or before January 15, the Board shall submit the expenditure analysis and the estimate of future health care spending to the House Committees on Appropriations, on Health Care, and on Human Services and the Senate Committees on Appropriations, on Health and Welfare, and on Finance. (Added 2017, No. 167 (Adj. Sess.),  9, eff. May 22, 2018.) 
 9390. Green Mountain Care Board Nominating Committee created; composition
(a) The Green Mountain Care Board Nominating Committee is created for the nomination of the Chair and members of the Green Mountain Care Board. (b)(1) The Committee shall consist of nine members who shall be selected as follows:(A) Two members appointed by the Governor.(B) Two members of the Senate, who shall not be members of the same party, to be appointed by the Committee on Committees. (C) Two members of the House of Representatives, who shall not be members of the same party, to be appointed by the Speaker of the House of Representatives. (D) One member each to be appointed by the Governor, the President Pro Tempore of the Senate, and the Speaker of the House, with knowledge of or expertise in health care policy, health care delivery, or health care financing, to complement that of the remaining members of the Committee. (2) The members of the Committee shall serve for terms of two years and may serve for no more than three consecutive terms. All appointments shall be made between January 1 and February 1 of each odd-numbered year, except to fill a vacancy. Members shall serve until their successors are appointed. (3) The members shall elect their own chair who shall serve for a term of two years.(c) For Committee meetings held when the General Assembly is not in session, the legislative members of the Green Mountain Care Board Nominating Committee shall be entitled to per diem compensation and reimbursement of expenses in accordance with the provisions of 2 V.S.A.  406. Committee members who are not legislators shall be entitled to per diem compensation and reimbursement of expenses on the same basis as that applicable to the legislative members, and their compensation and reimbursements shall be paid out of the budget of the Green Mountain Care Board. (d) The Green Mountain Care Board Nominating Committee shall use the qualifications described in section 9392 of this title for the nomination of candidates for the Chair and members of the Green Mountain Care Board. The Nominating Committee shall adopt procedures for a nomination process based on the rules adopted by the Judicial Nominating Board, and shall make such procedures available to the public. (e) A quorum of the Committee shall consist of five members.(f) The Board is authorized to use the staff and services of appropriate State agencies and departments as necessary to conduct investigations of applicants. (Added 2011, No. 48,  3, eff. May 26, 2011.) 
 9391. Nomination and appointment process
(a) Whenever a vacancy occurs on the Green Mountain Care Board, or when an incumbent does not declare that he or she will be a candidate to succeed himself or herself, the Green Mountain Care Board Nominating Committee shall select for consideration by the Committee, by majority vote, provided that a quorum is present, from the applications for membership on the Green Mountain Care Board as many candidates as it deems qualified for the position or positions to be filled. The Committee shall base its determinations on the qualifications set forth in section 9392 of this section. (b) The Committee shall submit to the Governor the names of the persons it deems qualified to be appointed to fill the position or positions and the name of any incumbent who declares that he or she wishes to be a candidate to succeed himself or herself. (c) The Governor shall make an appointment to the Green Mountain Care Board from the list of qualified candidates submitted pursuant to subsection (b) of this section. The appointment shall be subject to the consent of the Senate. The names of candidates submitted and not selected shall remain confidential. (d) All proceedings of the Committee, including the names of candidates considered by the Committee and information about any candidate submitted by any source, shall be confidential. (Added 2011, No. 48,  3, eff. May 26, 2011; amended 2011, No. 171 (Adj. Sess.),  38, eff. May 16, 2012.) 
 9392. Qualifications for nominees
The Green Mountain Care Board Nominating Committee shall assess candidates using the following criteria: (1) commitment to the principles expressed in section 9371 of this title;(2) knowledge of or expertise in health care policy, health care delivery, or health care financing, and openness to alternative approaches to health care; (3) possession of desirable personal characteristics, including integrity, impartiality, health, empathy, experience, diligence, neutrality, administrative and communication skills, social consciousness, public service, and regard for the public good; (4) knowledge, expertise, and characteristics that complement those of the remaining members of the Board; (5) impartiality and the ability to remain free from undue influence by a personal, business, or professional relationship with any person subject to supervision or regulation by the Board. (Added 2011, No. 48,  3, eff. May 26, 2011.) 
 9401. Policy
(a) It is the policy of the State of Vermont that health care is a public good for all Vermonters and to ensure that all residents have access to quality health services at costs that are affordable. To achieve this policy, it is necessary that the State ensure the quality of health care services provided in Vermont and, until health care systems are successful in controlling their costs and resources, to oversee cost containment. (b) It is further the policy of the State of Vermont that the health care system should:(1) maintain and improve the quality of health care services offered to Vermonters;(2) utilize planning, market, and other mechanisms that contain or reduce increases in the cost of delivering services so that health care costs do not consume a disproportionate share of Vermonters incomes or the monies available for other services required to insure the health, safety, and welfare of Vermonters; (3) encourage regional and local participation in decisions about health care delivery, financing, and provider supply; (4) utilize planning, market, and other mechanisms that will achieve rational allocation of health care resources in the State; (5) facilitate universal access to preventive and medically necessary health care;(6) support efforts to integrate mental health and substance abuse services with overall medical care. (Added 1991, No. 160 (Adj. Sess.),  1, eff. May 11, 1992; amended 1995, No. 180 (Adj. Sess.),  7; 2009, No. 49,  8; 2009, No. 128 (Adj. Sess.),  8, eff. May 27, 2010.) 
 9402. Definitions
As used in this chapter, unless otherwise indicated:(1) Commissioner means the Commissioner of Financial Regulation or the Commissioners designee. (2) Community report means the hospital report prepared under section 9405a of this title. (3) Department means the Department of Financial Regulation.(4) [Repealed.](5) Expenditure analysis means the expenditure analysis developed pursuant to section 9383 of this title. (6) Health care facility means all institutions, whether public or private, proprietary or nonprofit, which offer diagnosis, treatment, inpatient, or ambulatory care to two or more unrelated persons, and the buildings in which those services are offered. The term shall not apply to any facility operated by religious groups relying solely on spiritual means through prayer or healing, but includes all institutions included in subdivision 9432(8) of this title, except health maintenance organizations. (7) Health care provider means a person, partnership, or corporation, other than a facility or institution, licensed or certified or authorized by law to provide professional health care service in this State to an individual during that individuals medical care, treatment, or confinement. (8) Health insurer means any health insurance company, nonprofit hospital and medical service corporation, managed care organizations, and, to the extent permitted under federal law, any administrator of an insured, self-insured, or publicly funded health care benefit plan offered by public and private entities. (9) Health maintenance organization means any person certified to operate a health maintenance organization by the Commissioner pursuant to 8 V.S.A. chapter 139. (10) Health Resource Allocation Plan means the plan published by the Green Mountain Care Board in accordance with subsection 9405(b) of this title. (11) Home health agency means a for-profit or nonprofit health care facility providing part-time or intermittent skilled nursing services and at least one of the following other therapeutic services made available on a visiting basis, in a place of residence used as a patients home: physical, speech, or occupational therapy; medical social services; home health aide services; or other non-nursing therapeutic services, including the services of nutritionists, dieticians, psychologists, and licensed mental health counselors. (12) Home health services means activities and functions of a home health agency, including nurses, home health aides, physical therapists, occupational therapists, speech therapists, medical social workers, or other non-nursing therapeutic services directly related to care, treatment, or diagnosis of patients in the home. (13) Hospital means an acute care hospital licensed under chapter 43 of this title.(14) Managed care organization means any financing mechanism or system that manages health care delivery for its members or subscribers, including health maintenance organizations and any other similar health care delivery system or organization. (15) Health care spending estimate means the spending estimate established in accordance with section 9383 of this title. (16) State Health Improvement Plan means the plan developed under section 9405 of this title. (17) Green Mountain Care Board or Board means the Green Mountain Care Board established in chapter 220 of this title. (Added 1991, No. 160 (Adj. Sess.),  1, eff. May 11, 1992; amended 1995, No. 180 (Adj. Sess.),  8; 2003, No. 53,  2, 26; 2005, No. 57,  3, eff. June 13, 2005; 2007, No. 27,  11; 2009, No. 49,  9; 2011, No. 48,  19; 2011, No. 171 (Adj. Sess.),  13, eff. May, 16, 2012; 2015, No. 54,  33; 2017, No. 167 (Adj. Sess.),  3, 10, eff. May 22, 2018.) 
 9404. Administration
(a) The Commissioner and the Green Mountain Care Board shall supervise and direct the execution of all laws vested in the Department and the Board, respectively, by this chapter, and shall formulate and carry out all policies relating to this chapter. (b) The Commissioner and the Board may:(1) apply for and accept gifts, grants, or contributions from any person for purposes consistent with this chapter; (2) adopt rules necessary to implement the provisions of this chapter; and(3) enter into contracts and perform such acts as are necessary to accomplish the purposes of this chapter. (c) [Repealed.](d) There is hereby created a special fund to be known as the Green Mountain Care Board Regulatory and Administrative Fund pursuant to 32 V.S.A. chapter 7, subchapter 5, for the purpose of providing the financial means for the Green Mountain Care Board to administer its obligations, responsibilities, and duties as required by law, including pursuant to 8 V.S.A.  4062, chapters 220 and 221 of this title, and 33 V.S.A. chapter 18. All fees, fines, penalties, and similar assessments received by the Board in the administration of its obligations, responsibilities, and duties shall be credited to the Fund. The Fund may also be used by the Department of Health to administer its obligations, responsibilities, and duties as required by chapter 221 of this title. (Added 1991, No. 160 (Adj. Sess.),  1, eff. May 11, 1992; amended 1995, No. 180 (Adj. Sess.),  10, 38(a); 1999, No. 49,  222; 2013, No. 79,  36; 2015, No. 54,  34; 2015, No. 68 (Adj. Sess.),  67.) 
 9405. State Health Improvement Plan; Health Resource Allocation Plan
(a) The Secretary of Human Services or designee, in consultation with the Chair of the Green Mountain Care Board and health care professionals and after receipt of public comment, shall adopt a State Health Improvement Plan that sets forth the health goals and values for the State. The Secretary may amend the Plan as the Secretary deems necessary and appropriate. The Plan shall include health promotion, health protection, nutrition, and disease prevention priorities for the State; identify available human resources as well as human resources needed for achieving the States health goals and the planning required to meet those needs; identify gaps in ensuring equal access to appropriate mental health care that meets standards of quality, access, and affordability equivalent to other components of health care as part of an integrated, holistic system of care; and identify geographic parts of the State needing investments of additional resources in order to improve the health of the population. Copies of the Plan shall be submitted to members of the Senate Committee on Health and Welfare and the House Committee on Health Care. (b) The Green Mountain Care Board, in consultation with the Secretary of Human Services or designee, shall publish on its website the Health Resource Allocation Plan identifying Vermonts critical health needs, goods, services, and resources, which shall be used to inform the Boards regulatory processes, cost containment and statewide quality of care efforts, health care payment and delivery system reform initiatives, and any allocation of health resources within the State. The Plan shall identify Vermont residents needs for health care services, programs, and facilities; the resources available and the additional resources that would be required to realistically meet those needs and to make access to those services, programs, and facilities affordable for consumers; and the priorities for addressing those needs on a statewide basis. The Board may expand the Plan to include resources, needs, and priorities related to the social determinants of health. The Plan shall be revised periodically, but not less frequently than once every four years. (1) In developing the Plan, the Board shall:(A) consider the principles in section 9371 of this title, as well as the purposes enumerated in sections 9401 and 9431 of this title; (B) identify priorities using information from:(i) the State Health Improvement Plan;(ii) emergency medical services resources and needs identified by the EMS Advisory Committee in accordance with subsection 909(f) of this title; (iii) the community health needs assessments required by section 9405a of this title;(iv) available health care workforce information;(v) materials provided to the Board through its other regulatory processes, including hospital budget review, oversight of accountable care organizations, issuance and denial of certificates of need, and health insurance rate review; and (vi) the public input process set forth in this section;(C) use existing data sources to identify and analyze the gaps between the supply of health resources and the health needs of Vermont residents and to identify utilization trends to determine areas of underutilization and overutilization; and (D) consider the cost impacts of fulfilling any gaps between the supply of health resources and the health needs of Vermont residents. (2) The Green Mountain Care Board shall convene the Green Mountain Care Board General Advisory Committee established pursuant to subdivision 9374(e)(1) of this title to provide recommendations to the Board during the Boards development of the Plan. (3) The Board shall receive and consider public input on the Plan at a minimum of one Board meeting and one meeting of the Advisory Committee and shall give interested persons an opportunity to submit their views orally and in writing. (4) As used in this section:(A) Health resources means investments into the States health care system, including investments in personnel, equipment, and infrastructure necessary to deliver: (i) hospital, nursing home, and other inpatient services;(ii) ambulatory care, including primary care services, mental health services, health screening and early intervention services, and services for the prevention and treatment of substance use disorders; (iii) home health services; and(iv) emergency care, including ambulance services.(B) Health resources may also include investments in personnel, equipment, and infrastructure necessary to address the social determinants of health. (Added 1991, No. 160 (Adj. Sess.),  1, eff. May 11, 1992; amended 1995, No. 180 (Adj. Sess.),  11; 2003, No. 53,  3; 2007, No. 27,  6; 2011, No. 48,  20; 2011, No. 139 (Adj. Sess.),  16, eff. May 14, 2012; 2011, No. 171 (Adj. Sess.),  9, eff. May 16, 2012; 2013, No. 79,  37; 2017, No. 167 (Adj. Sess.),  4, eff. May 22, 2018; 2017, No. 200 (Adj. Sess.),  16; 2019, No. 14,  55, eff. April 20, 2019; 2019, No. 166 (Adj. Sess.),  28, eff. Oct. 1, 2020.) 
 9405a. Public participation and strategic planning
(a) Each hospital shall have a protocol for meaningful public participation in its strategic planning process for identifying and addressing health care needs that the hospital provides or could provide in its service area. Needs identified through the process shall be integrated with the hospitals long-term planning. Each hospital shall post on its website a description of its identified needs, strategic initiatives developed to address the identified needs, annual progress on implementation of the proposed initiatives, opportunities for public participation, and the ways in which the hospital ensures access to appropriate mental health care that meets standards of quality, access, and affordability equivalent to other components of health care as part of an integrated, holistic system of care. Hospitals may meet the community health needs assessment and implementation plan requirement through compliance with the relevant Internal Revenue Service community health needs assessment requirements for nonprofit hospitals. (b) When a hospital is working on a new community health needs assessment, the hospital shall post on its website information about the process for developing the community needs assessment and opportunities for public participation in the process. (Added 2003, No. 53,  4; amended 2005, No. 71,  77a; 2007, No. 27,  4; 2011, No. 48,  21; 2015, No. 152 (Adj. Sess.),  1, eff. May 31, 2016; 2017, No. 200 (Adj. Sess.),  17; 2019, No. 14,  56, eff. April 20, 2019.) 
 9405b. Hospital community reports and ambulatory surgical center quality reports
(a) The Commissioner of Health, in consultation with representatives from hospitals, other groups of health care professionals, and members of the public representing patient interests, shall adopt rules establishing a statewide comparative hospital quality report. Hospitals located outside this State which serve a significant number of Vermont residents, as determined by the Commissioner of Health, shall be invited to participate in the community report process established by this section. The report shall include: (1) Measures of quality, including process and performance measures, that are valid, reliable, and useful, including comparisons to appropriate national benchmarks for high quality and successful results. (2) Measures of patient safety that are valid, reliable, and useful, including comparisons to appropriate industry benchmarks for safety. (3) Measures of hospital-acquired infections that are valid, reliable, and useful, including comparisons to appropriate industry benchmarks. (4) Valid, reliable, and useful information on nurse staffing, including comparisons to appropriate industry benchmarks for safety. This information may include system-centered measures such as skill mix, nursing care hours per patient day, and other system-centered measures for which reliable industry benchmarks become available. (5) Measures of the hospitals financial health, including comparisons to appropriate national benchmarks for efficient operation and fiscal health. (6) A summary of the hospitals budget, including revenue by source, the one-year and four-year capital expenditure plans, the depreciation schedule for existing facilities, and quantification of cost shifting to private payers. (7) Data that provides valid, reliable, useful, and efficient information for payers and the public for the comparison of charges for higher volume health care services. (b) Each hospital shall publish on its website:(1) the hospitals process for achieving openness, inclusiveness, and meaningful public participation in its strategic planning and decision making; (2) the hospitals consumer complaint resolution process, including identification of the hospital officer or employee responsible for its implementation; (3) information on membership and governing body qualifications; a listing of the current governing body members, including each members name, town of residence, occupation, employer, and job title, and the amount of compensation, if any, for serving on the governing body; and means of obtaining a schedule of meetings of the hospitals governing body, including times scheduled for public participation; and (4) a link to the comparative statewide hospital quality report.(c) The Commissioner of Health shall publish the statewide comparative hospital quality report on a public website and shall update the report at least annually beginning on June 1, 2017. (d) The Commissioner of Health shall publish or otherwise make publicly available on its website each ambulatory surgical centers performance results from quality reporting programs offered by the Centers for Medicare and Medicaid Services and shall update the information at least annually. (Added 2003, No. 53,  5; amended 2005, No. 71,  77b; 2005, No. 153 (Adj. Sess.),  1; 2005, No. 215 (Adj. Sess.),  327; 2007, No. 27,  5; 2011, No. 48,  22; 2013, No. 79,  38; 2015, No. 11,  22; 2015, No. 152 (Adj. Sess.),  2, eff. May 31, 2016; 2019, No. 55,  5, eff. Jan. 1, 2020.) 
 9405c. Notice of acquisition
(a) As used in this section:(1) Acquire means a purchase or transfer through which a hospital will own or control the business of a medical practice. (2) Hospital means a general hospital or hospital facility licensed under chapter 43 of this title. (3) Medical practice means a business through which one or more physicians practice medicine. (b) Each hospital shall provide notice to the Office of the Attorney General at least 90 days or as soon as practicable prior to the effective date of a transaction through which the hospital will acquire a medical practice. The notice shall include at least the following information: (1) the name and address of the hospital acquiring the medical practice and contact information for a representative of the hospital; and (2) the name and address of the medical practice being acquired and contact information for a representative of the medical practice. (c) Information provided to the Office of the Attorney General pursuant to this section is exempt from public inspection and copying under the Public Records Act and shall be kept confidential except to the extent necessary to allow the Office to perform an inquiry into potentially anticompetitive practices. (Added 2015, No. 143 (Adj. Sess.),  2.) 
 9408. Common claims forms and procedures
No later than January 15, 1993, the Commissioner shall adopt by rule uniform health insurance claims forms and uniform standards and procedures for the processing of claims, including electronic claims forms submission. (Added 1991, No. 160 (Adj. Sess.),  1, eff. May 11, 1992; amended 1995, No. 180 (Adj. Sess.),  14.) 
 9408a. Uniform provider credentialing
(a) Definitions. As used in this section:(1) Credentialing means a process through which an insurer or hospital makes a determination, based on criteria established by the insurer or hospital, concerning whether a provider is eligible to: (A) provide health care services to an insured or hospital patients; and(B) receive reimbursement for the health care services.(2) Health care services means health-care-related services or products rendered or sold by a provider within the scope of the providers license or legal authorization, including hospital, medical, surgical, dental, vision, and pharmaceutical services or products. (3) Insured means an individual entitled to reimbursement for expenses of health care services under a policy issued or administered by an insurer. (4) Insurer has the same meaning as in subdivision 9402(8) of this title.(5) Provider has the same meaning as in subdivision 9402(7) of this title.(b) The Department shall prescribe the credentialing application form used by the Council for Affordable Quality Healthcare (CAQH), or a similar, nationally recognized form prescribed by the Commissioner, in electronic or paper format, which must be used beginning January 1, 2007 by an insurer or a hospital that performs credentialing. The Commissioner may grant a hospital an extension to the implementation date for up to one year. (c) An insurer or a hospital shall notify a provider concerning a deficiency on a completed credentialing application form submitted by the provider not later than 30 business days after the insurer or hospital receives the completed credentialing application form. (d) A hospital shall notify a provider concerning the status of the providers completed credentialing application not later than: (1) 60 days after the hospital receives the completed credentialing application form; and (2) every 30 days after the notice is provided under subdivision (1) of this subsection, until the hospital makes a final credentialing determination concerning the provider. (e) [Repealed.](f) An insurer shall act upon and finish the credentialing process of a completed application submitted by a provider within 60 calendar days of receipt of the application. An application shall be considered complete once the insurer has received all information and documentation necessary to make its credentialing determination as provided in subsections (b) and (c) of this section. (Added 2005, No. 191 (Adj. Sess.),  56; amended 2007, No. 70,  30; 2007, No. 203 (Adj. Sess.),  30, eff. June 10, 2008; 2015, No. 152 (Adj. Sess.),  3.) 
 9409. Health care provider bargaining groups
(a) The Green Mountain Care Board may approve the creation of one or more health care provider bargaining groups, consisting of health care providers who choose to participate. A bargaining group is authorized to negotiate on behalf of all participating providers with the Secretary of Administration, the Secretary of Human Services, the Green Mountain Care Board, or the Commissioner of Labor with respect to any matter in this chapter; chapter 13, 219, 220, or 222 of this title; 21 V.S.A. chapter 9; and 33 V.S.A. chapters 18 and 19 with respect to provider regulation, provider reimbursement, administrative simplification, information technology, workforce planning, or quality of health care. (b) The Green Mountain Care Board shall adopt by rule criteria for forming and approving bargaining groups, and criteria and procedures for negotiations authorized by this section. (c) The rules relating to negotiations shall include a nonbinding arbitration process to assist in the resolution of disputes. Nothing in this section shall be construed to limit the authority of the Secretary of Administration, the Secretary of Human Services, the Green Mountain Care Board, or the Commissioner of Labor to reject the recommendation or decision of the arbiter. (Added 1991, No. 160 (Adj. Sess.),  1, eff. May 11, 1992; amended 1995, No. 180 (Adj. Sess.),  15, 38(a); 2005, No. 103 (Adj. Sess.),  3, eff. April 5, 2006; 2011, No. 171 (Adj. Sess.),  24, eff. May 16, 2012; 2015, No. 152 (Adj. Sess.),  5.) 
 9410. Health care database
(a)(1) The Board shall establish and maintain a unified health care database to enable the Board to carry out its duties under this chapter, chapter 220 of this title, and Title 8, including: (A) determining the capacity and distribution of existing resources;(B) identifying health care needs and informing health care policy;(C) evaluating the effectiveness of intervention programs on improving patient outcomes;(D) comparing costs between various treatment settings and approaches;(E) providing information to consumers and purchasers of health care; and(F) improving the quality and affordability of patient health care and health care coverage.(2) [Repealed.](b) The database shall contain unique patient and provider identifiers and a uniform coding system and shall reflect all health care utilization, costs, and resources in this State and health care utilization and costs for services provided to Vermont residents in another state. (c) Health insurers, health care providers, health care facilities, and governmental agencies shall file reports, data, schedules, statistics, or other information determined by the Board to be necessary to carry out the purposes of this section. Such information may include: (1) health insurance claims and enrollment information used by health insurers;(2) information relating to hospitals filed under subchapter 7 of this chapter (hospital budget reviews); and (3) any other information relating to health care costs, prices, quality, utilization, or resources required by the Board to be filed. (d) The Board may by rule establish the types of information to be filed under this section, and the time and place and the manner in which such information shall be filed. (e) [Repealed.](f) The Board shall adopt a confidentiality code to ensure that information obtained under this section is handled in an ethical manner. (g) Any person who knowingly fails to comply with the requirements of this section or rules adopted pursuant to this section shall be subject to an administrative penalty of not more than $1,000.00 per violation. The Board may impose an administrative penalty of not more than $10,000.00 each for those violations the Board finds were willful. In addition, any person who knowingly fails to comply with the confidentiality requirements of this section or confidentiality rules adopted pursuant to this section and uses, sells, or transfers the data or information for commercial advantage, pecuniary gain, personal gain, or malicious harm shall be subject to an administrative penalty of not more than $50,000.00 per violation. The powers vested in the Board by this subsection shall be in addition to any other powers to enforce any penalties, fines, or forfeitures authorized by law. (h)(1) All health insurers shall electronically provide to the Board in accordance with standards and procedures adopted by the Board by rule: (A) their health insurance claims data, provided that the Board may exempt from all or a portion of the filing requirements of this subsection data reflecting utilization and costs for services provided in this State to residents of other states; (B) cross-matched claims data on requested members, subscribers, or policyholders; and(C) member, subscriber, or policyholder information necessary to determine third-party liability for benefits provided. (2) The collection, storage, and release of health care data and statistical information that are subject to the federal requirements of the Health Insurance Portability and Accountability Act (HIPAA) shall be governed exclusively by the regulations adopted thereunder in 45 C.F.R. Parts 160 and 164. (A) All health insurers that collect the Health Employer Data and Information Set (HEDIS) shall annually submit the HEDIS information to the Board in a form and in a manner prescribed by the Board. (B) All health insurers shall accept electronic claims submitted in Centers for Medicare and Medicaid Services format for UB-92 or HCFA-1500 records, or as amended by the Centers for Medicare and Medicaid Services. (3)(A) The Board shall collaborate with the Agency of Human Services and participants in the Agencys initiatives in the development of a comprehensive health care information system. The collaboration is intended to address the formulation of a description of the data sets that will be included in the comprehensive health care information system, the criteria and procedures for the development of limited-use data sets, the criteria and procedures to ensure that HIPAA compliant limited-use data sets are accessible, and a proposed time frame for the creation of a comprehensive health care information system. (B) To the extent allowed by HIPAA, the data shall be available as a resource for insurers, employers, providers, purchasers of health care, and State agencies to continuously review health care utilization, expenditures, and performance in Vermont. In presenting data for public access, comparative considerations shall be made regarding geography, demographics, general economic factors, and institutional size. (C) Consistent with the dictates of HIPAA, and subject to such terms and conditions as the Board may prescribe by rule, the Vermont Program for Quality in Health Care shall have access to the unified health care database for use in improving the quality of health care services in Vermont. In using the database, the Vermont Program for Quality in Health Care shall agree to abide by the rules and procedures established by the Board for access to the data. The Boards rules may limit access to the database to limited-use sets of data as necessary to carry out the purposes of this section. (D) Notwithstanding HIPAA or any other provision of law, the comprehensive health care information system shall not publicly disclose any data that contain direct personal identifiers. For the purposes of this section, direct personal identifiers include information relating to an individual that contains primary or obvious identifiers, such as the individuals name, street address, e-mail address, telephone number, and Social Security number. (i) On or before January 15, 2018 and every three years thereafter, the Commissioner of Health shall submit a recommendation to the General Assembly for conducting a survey of the health insurance status of Vermont residents. The provisions of 2 V.S.A.  20(d)(expiration of required reports) shall not apply to the report to be made under this subsection. (j)(1) As used in this section, and without limiting the meaning of subdivision 9402(8) of this title, the term health insurer includes: (A) any entity defined in subdivision 9402(8) of this title;(B) any third party administrator, any pharmacy benefit manager, any entity conducting administrative services for business, and any other similar entity with claims data, eligibility data, provider files, and other information relating to health care provided to a Vermont resident, and health care provided by Vermont health care providers and facilities required to be filed by a health insurer under this section; (C) any health benefit plan offered or administered by or on behalf of the State of Vermont or an agency or instrumentality of the State; and (D) any health benefit plan offered or administered by or on behalf of the federal government with the agreement of the federal government. (2) The Board may adopt rules to carry out the provisions of this subsection, including criteria for the required filing of such claims data, eligibility data, provider files, and other information as the Board determines to be necessary to carry out the purposes of this section and this chapter. (Added 1991, No. 160 (Adj. Sess.),  1, eff. May 11, 1992; amended 1995, No. 180 (Adj. Sess.),  16, 38(a); 2005, No. 71,  312; 2005, No. 122 (Adj. Sess.),  14; 2005, No. 191 (Adj. Sess.),  57; 2007, No. 15,  22; 2007, No. 70,  25; 2007, No. 80,  19; 2009, No. 42,  33; 2009, No. 61,  3; 2009, No. 156 (Adj. Sess.),  I.27; 2011, No. 48,  27, eff. Oct. 1, 2011; 2013, No. 79,  40, eff. June 7, 2013; 2013, No. 142 (Adj. Sess.),  35; 2015, No. 54,  35; 2021, No. 167 (Adj. Sess.),  5, eff. June 1, 2022.) 
 9411. Interactive price transparency dashboard
(a) The Green Mountain Care Board shall develop and maintain a public, interactive, Internet-based price transparency dashboard that allows consumers to compare health care prices for certain health care services across the State. Using data from the Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES) established pursuant to section 9410 of this title, the dashboard shall provide the range of actual allowed amounts for selected health care services, showing both the amount paid by the health insurer or other payer and the amount of the members responsibility, and shall allow the consumer to sort the information by geographic location, by health care provider, by payer type, and by the specific health care procedure or health care service. The Board shall provide a link on the dashboard to the statewide comparative hospital quality report published by the Commissioner of Health pursuant to section 9405b of this title. (b) The Board shall update the information in the interactive price transparency dashboard at least annually. 
 9412. Enforcement
(a) In order to carry out the duties under this chapter, in addition to the powers provided in this chapter, in chapter 220 of this title, and in Title 8, the Commissioner and the Board may examine the books, accounts, and papers of health insurers, health care providers, health care facilities, health plans, contracting entities, covered entities, and payers, as defined in section 9418 of this title, and may administer oaths and may issue subpoenas to a person to appear and testify or to produce documents or things. (b) In addition to any other power or duty authorized by law, the Commissioner of Financial Regulation shall in the case of health insurers, enforce a violation of a provision of this subchapter, or a rule adopted pursuant to a provision of this subchapter, as a violation of a requirement of Title 8 relating to health insurers. (Added 1991, No. 160 (Adj. Sess.),  1, eff. May 11, 1992; amended 1995, No. 180 (Adj. Sess.),  18, 38; 2009, No. 61,  28; 2011, No. 171 (Adj. Sess.),  14, eff. May 16, 2012.) 
 9413. Health care quality and price comparison
Each health insurer with more than 200 covered lives in this State shall establish an Internet-based tool to enable its members to compare the price of health care in Vermont by service or procedure, including office visits, emergency care, radiologic services, and preventive care such as mammography and colonoscopy. The tool shall include provider quality information as available and to the extent consistent with other applicable laws and regulations. The tool shall allow members to compare price by selecting a specific service or procedure and a geographic region of the State. Based on the criteria specified, the tool shall provide the member with an estimate for each provider of the amount the member would pay for the service or procedure, an estimate of the amount the insurance plan would pay, and an estimate of the combined payments. The price information shall reflect the cost-sharing applicable to a members specific plan, as well as any remaining balance on the members deductible for the plan year. (Added 2015, No. 54,  20, eff. July 1, 2016.) 
 9414. Quality assurance for managed care
(a) The Commissioner shall have the power and responsibility to ensure that each managed care organization provides quality health care to its members, in accordance with the provisions of this section. (1) In determining whether a managed care organization meets the requirements of this section, the Commissioner may review and examine, in accordance with subsection (e) of this section, the organizations administrative policies and procedures, quality management and improvement procedures, utilization management, credentialing practices, members rights and responsibilities, preventive health services, medical records practices, grievance and appeal procedures, member services, financial incentives or disincentives, disenrollment, provider contracting, and systems and data reporting capacities. The Commissioner shall establish, by rule, specific criteria to be considered under this section. (2) A managed care organization shall, in plain language, disclose to its members:(A) any provision of its enrollment plan or provider contracts that may restrict referral or treatment options or that may require prior authorization or utilization review or that may limit in any manner the services covered under the members enrollment plan; (B) the criteria used for credentialing or selecting health care providers with whom the organization contracts; (C) the financial inducements offered to any health care provider or health care facility for the reduction or limitation of health care services; (D) the utilization review procedures of the organization, including the credentials and training of utilization review personnel; (E) whether the organizations health care providers are contractually prohibited from participating in other managed care organizations or from performing services for persons who are not members of the managed care organization; (F) upon request, health care providers available to members under the enrollment plan.(3) A managed care organization shall not include any provision in a contract with a health care provider that prohibits the health care provider from disclosing to members information about the contract or the members enrollment plan that may affect their health or any decision regarding health care treatment. (4) The Commissioner or designee may resolve any consumer or provider complaint arising out of this subsection as though the managed care organization were an insurer licensed pursuant to Title 8. As used in this section, complaint means a report of a violation or suspected violation of the standards set forth in this section or adopted by rule pursuant to this section and made by or on behalf of a consumer or provider. (5) The Commissioner shall prepare an annual report on or before July 1 of each year providing the number of complaints received during the previous calendar year regarding violations or suspected violations of the standards set forth in this section or adopted by rule pursuant to this section. The report shall specify the aggregate number of complaints related to each standard and shall be posted on the Departments website. (b)(1) A managed care organization shall assure that the health care services provided to members are consistent with prevailing professionally recognized standards of medical practice. (2) A managed care organization shall participate in the Blueprint for Health established in chapter 13 of this title. If needed to implement the Blueprint, a managed care organization shall establish a chronic care program, which shall include: (A) appropriate benefit plan design;(B) informational materials, training, and follow-up necessary to support members and providers; and (C) payment reform methodologies.(3) Each managed care organization shall have procedures to assure availability, accessibility, and continuity of care, and ongoing procedures for the identification, evaluation, resolution, and follow-up of potential and actual problems in its health care administration and delivery. (4) Each managed care organization shall be accredited by a national independent accreditation organization approved by the Commissioner. (c) Consistent with participation in the Blueprint for Health pursuant to subdivision (b)(2) of this section and the accreditation required by subdivision (b)(4) of this section, the managed care organization shall have an internal quality assurance program to monitor and evaluate its health care services, including primary and specialist physician services, and ancillary and preventive health care services, across all institutional and noninstitutional settings. The internal quality assurance program shall be fully described in written form, provided to all managers, providers, and staff and made available to members of the organization. The components of the internal quality assurance program shall include the following: (1) a peer review committee or comparable designated committee responsible for quality assurance activities; (2) accountability of the committee to the board of directors or other governing authority of the organization; (3) participation by an appropriate base of providers and support staff;(4) supervision by the medical director of the organization;(5) regularly scheduled meetings; and(6) minutes or records of the meetings which describe in detail the actions of the committee, including problems discussed, charts reviewed, recommendations made, and any other pertinent information. (d), (e) [Repealed.](f)(1) For the purpose of evaluating a managed care organizations performance under the provisions of this section, the Commissioner may examine and review information protected by the provisions of the patients privilege under 12 V.S.A.  1612(a), or otherwise required by law to be held confidential. (2) [Repealed.](3) Any information made available under this section shall be furnished in a manner that does not disclose the identity of the protected person. The Commissioner shall adopt a confidentiality code to ensure that information obtained under this section is handled in an ethical manner. Information disclosed to the Commissioner under this section shall be confidential and privileged and shall not be subject to subpoena or available for public disclosure, except that the Commissioner is authorized to use such information during the course of any legal or regulatory action under this title against a managed care organization. (g)(1) In addition to any other remedy or sanction provided by law, after notice and an opportunity to be heard, if the Commissioner determines that a managed care organization has violated or failed to comply with any of the provisions of this section or any rule adopted pursuant to this section, the Commissioner may: (A) sanction the violation or failure to comply as provided in Title 8, including sanctions provided by or incorporated in 8 V.S.A.  4726, 5108, and 5109, and may use any information obtained during the course of any legal or regulatory action against a managed care organization; (B) order the managed care organization to cease and desist in further violations; and(C) order the managed care organization to remediate the violation, including issuing an order to the managed care organization to terminate its contract with any person or entity which administers claims or the coverage of benefits on behalf of the managed care organization. (2) A managed care organization that contracts with a person or entity to administer claims or provide coverage of health benefits is fully responsible for the acts and omissions of such person or entity. Such person or entity shall comply with all obligations, under this title and Title 8, of the health insurance plan and the health insurer on behalf of which such person or entity is providing or administering coverage. (3) A violation of any provision of this section or a rule adopted pursuant to this section shall constitute an unfair act or practice in the business of insurance in violation of 8 V.S.A.  4723. (h) Each managed care organization subject to examination, investigation, or review by the Commissioner under this section shall pay the Commissioner the reasonable costs of such examination, investigation, or review conducted or caused to be conducted by the Commissioner, at a rate to be determined by the Commissioner. All examinations conducted under this section shall be pursuant to and in conformity with 8 V.S.A.  3573, 3574, 3575, and 3576, except that the Commissioner may modify or adapt those examination guidelines, principles, and procedures to be more appropriate or useful to the examination of managed care organizations. (i) [Repealed.] (Added 1993, No. 30,  19; amended 1995, No. 180 (Adj. Sess.),  21, 38(a), (b); 1999, No. 38,  22, eff. May 20, 1999; 2007, No. 142 (Adj. Sess.),  2, 3, eff. May 14, 2008; 2007, No. 204 (Adj. Sess.),  1; 2015, No. 54,  36; 2015, No. 152 (Adj. Sess.),  7.)
 9414a. Annual reporting by health insurers
(a) As used in this section:(1) Adverse benefit determination means a denial, reduction, modification, or termination of, or a failure to provide or make payment in whole or in part for, a benefit, including: (A) a denial, reduction, modification, termination, or failure to provide or make payment that is based on a determination of the members eligibility to participate in a health benefit plan; (B) a denial, reduction, modification, or termination of, or failure to make payment in whole or in part for, a benefit resulting from the application of any utilization review; and (C) a failure to provide coverage for an item or service for which benefits are otherwise provided because the item or service is determined to be experimental, investigational, or not medically necessary or appropriate. (2) Claim means a preservice review or a request for payment for a covered service that a member or the members health care provider submits to the insurer at or after the time that health care services have been provided. (3) Concurrent review means utilization review conducted during a members stay in a hospital or other facility, or during another ongoing course of treatment. (4) Grievance means a complaint submitted by or on behalf of a member regarding:(A) an adverse benefit determination;(B) the availability, delivery, or quality of health care services;(C) claims payment, handling, or reimbursement for health care services; or(D) matters relating to the contractual relationship between a member and the managed care organization or health insurer offering the health benefit plan. (5) Independent external review means a review of a health care decision by an independent review organization pursuant to 8 V.S.A.  4089f. (6) Postservice review means the review of any claim for a benefit that is not a preservice or concurrent review. (7) Preservice review means the review of any claim for a benefit with respect to which the terms of coverage condition receipt of the benefit in whole or in part on approval of the benefit in advance of obtaining health care. (8) Utilization review means a set of formal techniques designed to monitor the use, or evaluate the clinical necessity, appropriateness, efficacy, or efficiency, of health care services, procedures, or settings, including prescription drugs. (b) Health insurers with a minimum of 2,000 Vermont lives covered at the end of the preceding year or who offer insurance through the Vermont Health Benefit Exchange pursuant to 33 V.S.A. chapter 18, subchapter 1 shall annually report the following information to the Commissioner of Financial Regulation, in plain language, as an addendum to the health insurers annual statement: (1) the health insurers state of domicile and the total number of states in which the insurer operates; (2) the total number of Vermont lives covered by the health insurer;(3) the total number of claims submitted to the health insurer;(4) the total number of claims denied by the health insurer, including the total number of denied claims for mental health services, treatment for substance use disorder, and prescription drugs; (5) data regarding the number and percentage of denials of service by the health insurer based on utilization review, including utilization review at the preservice review, concurrent review, and postservice review levels and including denials of mental health services, services for substance use disorder, and prescription drugs broken out separately, including: (A) denials of service by the health insurer;(B) denials of service appealed to the health insurer at the first-level grievance and, of those, the total number overturned; (C) denials of service appealed to the health insurer at any second-level grievance and, of those, the total number overturned; (D) denials of service at the preservice level for which external review was sought and, of those, the total number overturned; (6) the total number of adverse benefit determinations made by the health insurer, including:(A) the total number of adverse benefit determinations appealed to the health insurer at the first-level grievance and, of those, the total number overturned; (B) the total number of adverse benefit determinations appealed to the health insurer at any second-level grievance and, of those, the total number overturned; (C) the total number of adverse benefit determinations for which external review was sought and, of those, the total number overturned; (7) [Repealed.](8) the total number of claims denied by the health insurer as duplicate claims, as coding errors, or for services or providers not covered; (9) the percentage of claims processed in a timely manner;(10) the percentage of claims processed accurately, both financially and administratively;(11) the number and percentage of utilization review decisions meeting the timelines described in subdivisions (A)-(D) of this subdivision (11), including timeliness data for all utilization review decisions and timeliness data for physical health, mental health, substance use disorder, and prescription drug utilization review decisions broken out separately: (A) concurrent reviews within 24 hours;(B) urgent preservice reviews within 48 hours of receipt of the request;(C) non-urgent preservice reviews within two business days of receipt of request; and(D) postservice reviews within 30 days of receipt of request;(12) data regarding the number of grievances related to availability, delivery, or quality of health care services or matters relating to the contractual relationship between a member and the health insurer, including: (A) health care provider performance and office management issues;(B) plan administration;(C) access to health care providers and services;(D) access to mental health providers and services; and(E) access to substance use disorder providers and services;(13) the total number of claims, including separate numbers for claims related to mental health services, services for substance use disorder, and prescription drugs, denied by the health insurer on the grounds that the service was experimental, investigational, or an off-label use of a drug; was not medically necessary; or involved access to a provider that is inconsistent with the limitations imposed by the plan; (14) results of surveys evaluating health care provider satisfaction with the health insurer;(15) the health insurers actions taken in response to the prior years health care provider survey results; (16)(A) the titles and salaries of all corporate officers and board members during the preceding year; and (B) the bonuses and compensatory benefits of all corporate officers and board members during the preceding year; (17) the health insurers marketing and advertising expenses during the preceding year;(18) the health insurers federal and Vermont-specific lobbying expenses during the preceding year; (19) the amount and recipient of each political contribution made by the health insurer during the preceding year; (20) the amount and recipient of dues paid during the preceding year by the health insurer to trade groups that engage in lobbying efforts or that make political contributions; (21) the health insurers legal expenses related to claims or service denials during the preceding year; and (22) the amount and recipient of charitable contributions made by the health insurer during the preceding year. (c) Health insurers may indicate the extent of overlap or duplication in reporting the information described in subsection (b) of this section. (d) The Department of Financial Regulation shall create a standardized form using terms with uniform, industry-standard meanings for the purpose of collecting the information described in subsection (b) of this section, and each health insurer shall use the standardized form for reporting the required information as an addendum to its annual statement. To the extent possible, health insurers shall report information specific to Vermont on the standardized form and shall indicate on the form where the reported information is not specific to Vermont. (e)(1) The Department of Financial Regulation and the Office of the Health Care Advocate shall post on their websites links to the standardized form completed by each health insurer pursuant to this section. Each health insurer shall post its form on its own website. (2) The Department of Vermont Health Access shall post on the Vermont Health Benefit Exchange established pursuant to 33 V.S.A. chapter 18, subchapter 1 an electronic link to the standardized forms posted by the Department of Financial Regulation pursuant to subdivision (1) of this subsection. (f) The Commissioner of Financial Regulation may adopt rules pursuant to 3 V.S.A. chapter 25 to carry out the purposes of this section. (Added 2011, No. 150 (Adj. Sess.),  1; amended 2013, No. 79,  40b; 2015, No. 152 (Adj. Sess.),  8.) 
 9416. Vermont Program for Quality in Health Care
(a) The Commissioner of Health shall contract with the Vermont Program for Quality in Health Care, Inc. to implement and maintain a statewide quality assurance system to evaluate and improve the quality of health care services rendered by health care providers of health care facilities, including managed care organizations, to determine that health care services rendered were professionally indicated or were performed in compliance with the applicable standard of care, and that the cost of health care rendered was considered reasonable by the providers of professional health services in that area. The Commissioner of Health shall ensure that the information technology components of the quality assurance system comply with, and the Commissioner of Vermont Health Access shall ensure such components are incorporated into, the Statewide Health Information Technology Plan developed under section 9351 of this title and any other information technology initiatives coordinated pursuant to 3 V.S.A.  3027. (b) The Vermont Program for Quality in Health Care, Inc. shall file an annual report with the Commissioner of Health. The report shall include an assessment of progress in the areas designated by the Commissioner of Health, including comparative studies on the provision and outcomes of health care and professional accountability. (c) Expenses incurred under this section by the Vermont Program for Quality in Health Care, Inc. shall be borne as follows: 35 percent by the hospitals, 15 percent by nonprofit hospital and medical service corporations licensed under 8 V.S.A. chapter 123 or 125, and 50 percent by health insurance companies licensed under 8 V.S.A. chapter 101, and health maintenance organizations licensed under 8 V.S.A. chapter 139. Expenses allocated under this section to persons licensed under 8 V.S.A. chapters 101 and 139 shall be billed based on premiums paid for health insurance coverage as defined in subsection 9415(b) of this title. Expenses allocated under this section shall not exceed 75 percent of the operating budget of the Vermont Program for Quality in Health Care, Inc. (Added 1995, No. 180 (Adj. Sess.),  21a; amended 2005, No. 215 (Adj. Sess.),  329; 2007, No. 70,  33; 2009, No. 61,  4; 2011, No. 171 (Adj. Sess.),  30, eff. July 1, 2013; 2017, No. 85,  F.10, eff. June 28, 2017.) 
 9417. Tax-advantaged accounts for health-related expenses; administration; rulemaking
(a) As used in this section:(1) Flexible spending account or FSA has the same meaning as in 26 U.S.C.  106(c)(2).(2) Health reimbursement arrangement or HRA means any account-based reimbursement arrangement funded solely by employer contributions that reimburses an employee, spouse, or dependents, or a combination thereof, for medical care expenses incurred by the employee, spouse, dependents, or a combination thereof, up to a maximum coverage amount set by the employer for a given coverage period, and that is established pursuant to 26 U.S.C.  105-106 and applicable guidance from the Internal Revenue Service. (3) Health savings account or HSA has the same meaning as in 26 U.S.C.  223(d)(1).(b) Any entity administering one or more HRAs, HSAs, FSAs, or similar tax-advantaged accounts for health-related expenses, or a combination of these, in this State is subject to the jurisdiction of the Commissioner of Financial Regulation pursuant to 8 V.S.A.  10 and all other applicable provisions. (c) The Commissioner of Financial Regulation shall adopt rules pursuant to 3 V.S.A. chapter 25 to license and regulate, to the extent permitted under federal law, entities administering or proposing to administer one or more HRAs, HSAs, FSAs, or similar tax-advantaged accounts for health-related expenses, or a combination of these, in this State. The rules shall include: (1) licensure or registration filing requirements; and(2) such requirements and qualifications for such entities as the Commissioner determines necessary to protect Vermont consumers and employers and to help ensure that funds are disbursed appropriately. (d) Following the adoption of rules pursuant to subsection (c) of this section, an entity making an initial application for a license or registration to administer HRAs, HSAs, FSAs, or similar tax-advantaged accounts for health-related expenses, or a combination of these, in this State shall pay to the Commissioner a nonrefundable fee of $600.00 for examining, investigating, and processing the application. Each such entity shall also pay a renewal fee of $600.00 on or before December 31 every three years following initial licensure. (e) This section shall not apply to an employer that self-administers one or more tax-advantaged accounts on behalf of its own employees. (Added 2019, No. 54,  1; amended 2021, No. 137 (Adj. Sess.),  6, eff. July 1, 2022.) 
 9418. Payment for health care services
(a) Except as otherwise specified, as used in this subchapter:(1) Claim means any claim, bill, or request for payment for all or any portion of provided health care services that is submitted by: (A) a health care provider or a health care facility pursuant to a contract or agreement with the health plan; or (B) a health care provider, a health care facility, or a patient covered by the health plan. (2) Contested claim means a claim submitted to a payer, health plan, or contracting entity that does not include: (A) sufficient information needed to determine payer liability; or(B) reasonable access to information needed to determine the liability or basis for payment of the claim. (3) Contracting entity means any entity that contracts directly or indirectly with a health care provider for either the delivery of health care services or the selling, leasing, renting, assigning, or granting of access to a contract or terms of a contract. For purposes of this subchapter, the Department of Vermont Health Access, health care providers, physician hospital organizations, health care facilities, and stand-alone dental plans are not contracting entities. (4) Covered entity means an organization that enters into a contract with a contracting entity to gain access to a provider network contract. For purposes of this subchapter, the Department of Vermont Health Access is not a covered entity. (5) Denied or denial means the circumstance in which the plan asserts that it has no liability to pay a claim, based on eligibility status of the patient, coverage of a service under the health plan, medical necessity of a service, liability of another payer, or other grounds. (6) Edit or editing means a practice or procedure pursuant to which one or more adjustments are made to Current Procedural Terminology (CPT) codes, American Society of Anesthesiologists (ASA) current procedural terminology, the American Dental Associations (ADA) current dental terminology, or Healthcare Common Procedure Coding System (HCPCS) Level II codes included in a claim that result in: (A) payment being made based on some, but not all, of the codes originally billed by a participating health care provider; (B) payment being made based on different codes from those originally billed by a participating health care provider; (C) payment for one or more of the codes included in the claim originally billed by a participating health care provider being reduced by application of payers editing software, such as multiple procedure logic software; (D) payment for one or more of the codes being denied;(E) a reduced payment as a result of services provided to an insured that are claimed under more than one procedure code on the same service date; or (F) any combination of the subdivisions in this subdivision (6).(7) Health care contract or contract means a contract entered into, amended, or renewed between a contracting entity or health plan and a health care provider specifying the rights and responsibilities of the contracting entity and provider for the delivery of health care services to insureds, including primary care health services, preventive health services, chronic care services, and specialty health care services. (8) Health plan means a health insurer, disability insurer, health maintenance organization, medical or hospital service corporation, and, to the extent permitted under federal law, any administrator of an insured or self-insured plan. Health plan also includes a health plan that requires its medical groups, independent practice associations, or other independent contractors to pay claims for the provision of health care services. (9) Health care provider or provider means a person, partnership, or corporation licensed, certified, or otherwise authorized by law to provide professional health care services in this State and shall include a health care provider group, network, independent practice association, or physician hospital organization that is acting exclusively as an administrator on behalf of a health care provider to facilitate the providers participation in health care contracts. The term includes a hospital but does not include a pharmacist, pharmacy, nursing home, or a health care provider organization or physician hospital organization that leases its network to a covered entity or contracts directly with employers or self-insured plans. (10) Insured means any person eligible for health care benefits under a health benefit plan, and includes all of the following terms: enrollee, subscriber, member, insured, dependent, covered individual, and beneficiary. (11) Most favored nation clause means a provision in a health care contract that:(A) prohibits, or grants a contracting entity an option to prohibit, a participating provider who contracts with another contracting entity from accepting lower payment for the provision of health care services than the payment specified in the first contracting entitys contract; (B) requires, or grants a contracting entity an option to require, the participating provider to accept a lower payment in the event the participating provider agrees to provide health care services for any other contracting entity at a lower price; (C) requires, or grants a contracting entity an option to require, termination or renegotiation of the existing health care contract in the event the participating provider agrees to provide health care services for any other contracting entity at a lower price; (D) requires the participating provider to disclose the participating providers contractual reimbursement rates with other contracting entities. (12) National Correct Coding Initiative, or NCCI means the Centers for Medicare and Medicaid Services (CMS) published list of edits and adjustments that are made to health care providers claims submitted for services or supplies provided to patients insured under the federal Medicare program and other federal insurance programs. (13) Participating provider means a health care provider that has a health care contract with a contracting entity and is entitled to reimbursement for health care services rendered to an insured under the health care contract. The term includes a hospital, but does not include a pharmacist, pharmacy, or nursing home, or a health care practitioner organization or physician-hospital organization that leases the health care practitioner organizations or physician-hospital organizations network to a covered entity or contracts directly with employers or self-insured plans. (14) Payer means any person or entity that assumes the financial risk for the payment of claims under a health care contract or the reimbursement for health care services rendered to an insured by a participating provider under the health care contract. The term payer does not include: (A) the Department of Vermont Health Access; or(B) reinsurers that neither pay claims directly nor act as contracting entities.(15) 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. (16) Procedure codes means a set of descriptive codes indicating the procedure performed by a health care provider and includes the American Medical Associations Current Procedural Terminology codes (CPT), the Healthcare Common Procedure Coding System Level II Codes (HCPCS), the American Society of Anesthesiologists (ASA) current procedural terminology, and the American Dental Associations current dental terminology. (17) Product means, to the extent permitted by State and federal law, one of the following types of categories of coverage for which a participating provider may be obligated to provide health care services pursuant to a health care contract: (A) health maintenance organization;(B) preferred provider organization;(C) fee-for-service or indemnity plan;(D) Medicare Advantage HMO plan;(E) Medicare Advantage private fee-for-service plan;(F) Medicare Advantage special needs plan;(G) Medicare Advantage PPO;(H) Medicare supplement plan;(I) workers compensation plan; or(J) any other commercial health coverage plan or product.(b) No later than 30 days following receipt of a claim, a health plan, contracting entity, or payer shall do one of the following: (1) Pay or reimburse the claim.(2) Notify the claimant in writing that the claim is contested or denied. The notice shall include specific reasons supporting the contest or denial and a description of any additional information required for the health plan, contracting entity, or payer to determine liability for the claim. (3) Pend a claim for services rendered to an enrollee during the second and third months of the consecutive three-month grace period required for recipients of advance payments of premium tax credits pursuant to 26 U.S.C.  36B. In the event the enrollee pays all outstanding premiums prior to the exhaustion of the grace period, the health plan, contracting entity, or payer shall have 30 days following receipt of the outstanding premiums to proceed as provided in subdivision (1) or (2) of this subsection, as applicable. (c) If a claim is contested because the health plan, contracting entity, or payer was not provided with sufficient information to determine payer liability and for which written notice has been provided as required by subdivision (b)(2) of this section, then the health plan, contracting entity, or payer shall have 30 days after receipt of the additional information to complete consideration of the claim. (d) A health plan, contracting entity, or payer shall acknowledge receipt of an electronic claim to the submitting party within 24 hours after the beginning of the next business day following receipt of the claim. For purposes of this subsection, the term submitting party means: (1) a health care provider submitting a claim to a contracting entity, health plan, or payer; or (2) a clearinghouse submitting a claim on behalf of a health care provider to a contracting entity, health plan, or payer. (e) Interest shall accrue on a claim at the rate of 12 percent per annum calculated as follows: (1) for a claim that is uncontested, from the first calendar day following the 30-day period following the date the claim is received by the health plan, contracting entity, or payer; (2) for a nonelectronic contested claim for which notice was provided as required by subdivision (b)(2) of this section, or for an electronic contested claim for which notice and acknowledgment were provided as required in subdivision (b)(2) and subsection (c) of this section, from the first calendar day after the 30-day period following the date that sufficient additional information is received; (3) for a nonelectronic contested claim for which notice was not provided as required by subdivision (b)(2) of this section or for which notice was provided later than the 30 days required by subdivision (b)(2) of this section, from the first calendar day after the 30-day period following the date the original claim was received by the health plan, contracting entity, or payer; (4) for a contested electronic claim, for which notice and acknowledgment were not provided as required by subdivision (b)(2) and subsection (c) of this section, or for which notice or acknowledgment were provided later than the time required by subdivision (b)(2) and subsection (c) of this section, from the first calendar day after the 30-day period following the date the original claim was received by the health plan, contracting entity, or payer; (5) for a claim that was denied or for which notice of denial was provided as required by subdivision (b)(2) of this section, from the first calendar day after the 30-day period following the date of a final arbitration award, judgment, or administrative order that found a plan, contracting entity, or payer to be liable for payment of the claim; and (6) for a claim that was denied, for which notice of denial was not provided as required by subdivision (b)(2) of this section, or for which notice was provided later than the 30 days required by subdivision (b)(2) of this section, from the first calendar day after the 30-day period following the date the original claim was received by the health plan, contracting entity, or payer. (f) The Commissioner may suspend the accrual of interest under subsection (e) of this section if the Commissioner determines that the health plans failure to pay a claim within the applicable time limit is the result of a major disaster, act-of-God, or unanticipated major computer system failure or that the action is necessary to protect the solvency of the health plan. (g) All payments shall be made within the time periods provided by this section unless otherwise specified in the contract between the health plan and the health care provider or the health care facility. The health plan shall provide notice as required by subsection (b) of this section and pay interest on uncontested and contested claims as required in subsection (e) of this section from the day following the contract payment period, unless otherwise specified in the contract. (h) A health plan in this State shall not impose on any provider any retrospective denial of a previously paid claim or any part of that previously paid claim, unless: (1) The health plan has provided at least 30 days notice of any retrospective denial or overpayment recovery or both in writing to the provider. The notice must include: (A) the patients name;(B) the service date;(C) the payment amount;(D) the proposed adjustment; and(E) a reasonably specific explanation of the proposed adjustment.(2) The time that has elapsed since the date of payment of the previously paid claim does not exceed 12 months. (i) The retrospective denial of a previously paid claim shall be permitted beyond 12 months from the date of payment for any of the following reasons: (1) the plan has a reasonable belief that fraud or other intentional misconduct has occurred;(2) the claim payment was incorrect because the health care provider was already paid for the health services identified in the claim; (3) the health care services identified in the claim were not delivered by the provider;(4) the claim payment is the subject of adjustment with another health plan; or(5) the claim is the subject of legal action.(j)(1) For purposes of subsections (h) and (i) of this section, for routine recoveries as described in subdivisions (A) through (J) of this subdivision (1), retrospective denial or overpayment recovery of any or all of a previously paid claim shall not require 30 days notice before recovery may be made. A recovery shall be considered routine only if one of the following situations applies: (A) duplicate payment to a health care provider for the same professional service;(B) payment with respect to an individual who was not a plan member as of the date the service was provided; (C) payment for a noncovered service, not to include services denied as not medically necessary, experimental, or investigational in nature, or services denied through a utilization review mechanism; (D) erroneous payment for services due to plan administrative error;(E) erroneous payment for services where the claim was processed in a manner inconsistent with the data submitted by the provider; (F) payment where the health care provider provides the plan with new or additional information demonstrating an overpayment; (G) payment to a health care provider at an incorrect rate or using an incorrect fee schedule;(H) payment of claims for the same plan member that are received by the health plan out of the chronological order in which the services were performed; (I) payment where the health care provider has received payment for the same services from another payer whose obligation is primary; or (J) payments made in coordination with a payment by a government payer that require adjustment based on an adjustment in the government-paid portion of the claim. (2) Notwithstanding the provisions of subdivision (1) of this subsection, recoveries which, in the reasonable business judgment of the payer, would be likely to affect a significant volume of claims or accumulate to a significant dollar amount shall not be deemed routine, regardless of whether one or more of the situations in subdivisions (1)(A) through (1)(J) of this subsection apply. (3) Nothing in this subsection shall be construed to affect the time frames established in subdivision (h)(2) or subsection (i) of this section. (k) Notwithstanding this section, a health plan may not retroactively deny or recoup a pharmacy point-of-sale payment except in the circumstances of fraud, intentional misconduct, a member not receiving the prescription, or error in the processing of the claim. (l) Nothing in this section shall be construed to prohibit a health plan from applying payment policies that are consistent with applicable federal or State laws and regulations, or to relieve a health plan from complying with payment standards established by federal or State laws and regulations. (m) The provisions of this section shall not apply to stand-alone dental plans licensed to do business in Vermont. (Added 1997, No. 159 (Adj. Sess.),  14a; amended 2005, No. 103 (Adj. Sess.),  3, eff. April 5, 2006; 2007, No. 203 (Adj. Sess.),  27, eff. June 10, 2008; 2009, No. 61,  29; 2009, No. 156 (Adj. Sess.),  I.28; 2011, No. 171 (Adj. Sess.),  11g; 2013, No. 79,  5, eff. Jan. 1, 2014; 2015, No. 54,  37.) 
 9418a. Processing claims, downcoding, and adherence to coding rules
(a) Health plans, contracting entities, covered entities, and payers shall accept and initiate the processing of all health care claims submitted by a health care provider pursuant to and consistent with the current version of the American Medical Associations Current Procedural Terminology (CPT) codes, reporting guidelines, and conventions; the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System (HCPCS); American Society of Anesthesiologists; the National Correct Coding Initiative (NCCI); the National Council for Prescription Drug Programs coding; or other appropriate nationally recognized standards, guidelines, or conventions approved by the Commissioner. (b) When editing claims, health plans, contracting entities, covered entities, and payers shall adhere to edit standards except as provided in subsection (c) of this section: (1) the CPT, HCPCS, and NCCI;(2) national specialty society edit standards; or(3) other appropriate nationally recognized edit standards, guidelines, or conventions approved by the Commissioner. (c) Adherence to the edit standards in subdivision (b)(1) or (2) of this section is not required: (1) When necessary to comply with State or federal laws, rules, regulations, or coverage mandates; or (2) For edits that the payer determines are more favorable to providers than the edit standards in subdivisions (b)(1) through (3) of this section or to address new codes not yet incorporated by a payers edit management software, provided the edit standards are developed with input from the relevant Vermont provider community and national provider organizations and provided the edits are available to providers on the plans websites and in their newsletters. (d) Nothing in this section shall preclude a health plan, contracting entity, covered entity, or payer from determining that any such claim is not eligible for payment in full or in part, based on a determination that: (1) the claim is contested as defined in subdivision 9418(a)(2) of this title;(2) the service provided is not a covered benefit under the contract, including a determination that such service is not medically necessary or is experimental or investigational; (3) the insured did not obtain a referral, prior authorization, or precertification, or satisfy any other condition precedent to receiving covered benefits from the health care provider; (4) the covered benefit exceeds the benefit limits of the contract;(5) the person is not eligible for coverage or is otherwise not compliant with the terms and conditions of his or her coverage agreement; (6) the health plan has a reasonable belief that fraud or other intentional misconduct has occurred; or (7) the health plan, contracting entity, covered entity, or payer determines through coordination of benefits that another entity is liable for the claim. (e) Nothing in this section shall be deemed to require a health plan, contracting entity, covered entity, or payer to pay or reimburse a claim, in full or in part, or to dictate the amount of a claim to be paid by a health plan, contracting entity, covered entity, or payer to a health care provider. (f) No health plan, contracting entity, covered entity, or payer shall automatically reassign or reduce the code level of evaluation and management codes billed for covered services (downcoding), except that a health plan, contracting entity, covered entity, or payer may reassign a new patient visit code to an established patient visit code based solely on CPT codes, CPT guidelines, and CPT conventions. (g) Notwithstanding the provisions of subsection (d) of this section, and other than the edits contained in the conventions in subsections (a) and (b) of this section, health plans, contracting entities, covered entities, and payers shall continue to have the right to deny, pend, or adjust claims for services on other bases and shall have the right to reassign or reduce the code level for selected claims for services based on a review of the clinical information provided at the time the service was rendered for the particular claim or a review of the information derived from a health plans fraud or abuse billing detection programs that create a reasonable belief of fraudulent or abusive billing practices, provided that the decision to reassign or reduce is based primarily on a review of clinical information. (h) Every health plan, contracting entity, covered entity, and payer shall publish on its provider website and in its provider newsletter if applicable: (1) the name of any commercially available claims editing software product that the health plan, contracting entity, covered entity, or payer utilizes; (2) the standard or standards, pursuant to subsection (b) of this section, that the entity uses for claim edits; (3) the payment percentages for modifiers; and(4) any significant edits, as determined by the health plan, contracting entity, covered entity, or payer, added to the claims software product after the effective date of this section, which are made at the request of the health plan, contracting entity, covered entity, or payer. (i) Upon written request, the health plan, contracting entity, covered entity, or payer shall also directly provide the information in subsection (h) of this section to a health care provider who is a participating member in the health plans, contracting entitys, covered entitys, or payers provider network. (j) For purposes of this section, health plan includes a workers compensation policy of a casualty insurer licensed to do business in Vermont. (k) BlueCross BlueShield of Vermont and the Vermont Medical Society are requested to continue convening a work group consisting of health plans, health care providers, State agencies, and other interested parties to study the edit standards in subsection (b) of this section, the edit standards in national class action settlements, and edit standards and edit transparency standards established by other states to determine the most appropriate way to ensure that health care providers can access information about the edit standards applicable to the health care services they provide. The work group is requested to provide an annual progress report to the House Committee on Health Care and the Senate Committees on Health and Welfare and on Finance. (l) With respect to the work group established under subsection (k) of this section and to the extent required to avoid violations of federal antitrust laws, the Department shall facilitate and supervise the participation of members of the work group. (Added 2007, No. 203 (Adj. Sess.),  28, eff. June 10, 2008; amended 2009, No. 61,  30; 2011, No. 21,  18; 2011, No. 171 (Adj. Sess.),  11a, eff. May 16, 2012.) 
 9418b. Prior authorization
(a) Health plans shall pay claims for health care services for which prior authorization was required by and received from the health plan, unless: (1) the insured was not a covered individual at the time the service was rendered;(2) the insureds benefit limitations were exhausted;(3) the prior authorization was based on materially inaccurate information from the health care provider; (4) the health plan has a reasonable belief that fraud or other intentional misconduct has occurred; or (5) the health plan determines through coordination of benefits that another health insurer is liable for the claim. (b) Notwithstanding the provisions of subsection (a) of this section, nothing in this section shall be construed to prohibit a health plan from denying continued or extended coverage as part of concurrent review, denying a claim if the health plan is not primarily obligated to pay the claim, or applying payment policies that are consistent with an applicable law, rule, or regulation. (c) A health plan shall furnish, upon request from a health care provider, a current list of services and supplies requiring prior authorization. (d) A health plan shall post a current list of services and supplies requiring prior authorization to the insurers website. (e) In addition to any other remedy provided by law, if the Commissioner finds that a health plan has engaged in a pattern and practice of violating this section, the Commissioner may impose an administrative penalty against the health plan of no more than $500.00 for each violation, and may order the health plan to cease and desist from further violations and order the health plan to remediate the violation. In determining the amount of penalty to be assessed, the Commissioner shall consider the following factors: (1) the appropriateness of the penalty with respect to the financial resources and good faith of the health plan; (2) the gravity of the violation or practice;(3) the history of previous violations or practices of a similar nature;(4) the economic benefit derived by the health plan and the economic impact on the health care facility or health care provider resulting from the violation; and (5) any other relevant factors.(f) Nothing in this section shall be construed to prohibit a health plan from applying payment policies that are consistent with applicable federal or State laws and regulations, or to relieve a health plan from complying with payment standards established by federal or State laws and regulations. (g)(1)(A) Notwithstanding any provision of law to the contrary, on and after March 1, 2014, when requiring prior authorization for prescription drugs, medical procedures, and medical tests, a health plan shall accept for each prior authorization request either: (i) the national standard transaction information, such as HIPAA 278 standards, for sending or receiving authorizations electronically; or (ii) a uniform prior authorization form developed pursuant to subdivisions (2) and (3) of this subsection (g). (B) A health plan shall have the capability to accept both the national standard transaction information and the uniform prior authorization forms developed pursuant to subdivisions (2) and (3) of this subsection (g). (2)(A) No later than September 1, 2013, the Department of Financial Regulation shall develop a clear, uniform, and readily accessible prior authorization form for prior authorization requests for medical procedures and medical tests. (B) No later than September 1, 2013, the Department of Financial Regulation shall develop clear, uniform, and readily accessible forms for prior authorization requests for prescription drugs after determining the appropriate number of forms. (3) Each uniform prior authorization form developed pursuant to subdivision (2) of this subsection shall meet the following criteria, where applicable: (A) The form shall include the core set of common data requirements for nonclinical information for prior authorization included in the HIPAA 278 standard transaction, national standards for prior authorization and electronic prescriptions, or both. The Department shall revise the form as needed to ensure that national standards are adopted and incorporated as soon as such standards are available and final. (B) The form shall be made available electronically by the Department and by the health plan. (C) The completed form or its data elements may be submitted electronically from the prescribing health care provider to the health plan. (D) The Department shall develop the form in consultation with the Department of Vermont Health Access and with input from interested parties from at least one public meeting. (E) The Department shall consider input on the proposed form from the national ASC X-12 workgroup, if available. (F) In developing the uniform prior authorization forms, the Department shall take into consideration the following: (i) existing prior authorization forms established by the federal Centers for Medicare and Medicaid Services, by the Department of Vermont Health Access, and by insurance and Medicaid departments and agencies in other states; and (ii) national standards related to electronic prior authorization.(4) A health plan shall respond to a completed prior authorization request from a prescribing health care provider within 48 hours for urgent requests and within two business days of receipt for non-urgent requests. The health plan shall notify a health care provider of or make available to a health care provider a receipt of the request for prior authorization and any needed missing information within 24 hours of receipt. If a health plan does not, within the time limits set forth in this section, respond to a completed prior authorization request, acknowledge receipt of the request for prior authorization, or request missing information, the prior authorization request shall be deemed to have been granted. (h)(1) A health plan shall review the list of medical procedures and medical tests for which it requires prior authorization at least annually and shall eliminate the prior authorization requirements for those procedures and tests for which such a requirement is no longer justified or for which requests are routinely approved with such frequency as to demonstrate that the prior authorization requirement does not promote health care quality or reduce health care spending to a degree sufficient to justify the administrative costs to the plan. (2) A health plan shall attest to the Department of Financial Regulation and the Green Mountain Care Board annually on or before September 15 that it has completed the review and appropriate elimination of prior authorization requirements as required by subdivision (1) of this subsection. (Added 2007, No. 203 (Adj. Sess.),  29, eff. June 10, 2008; amended 2009, No. 61,  31; 2011, No. 171 (Adj. Sess.),  11h; 2013, No. 79,  5a, eff. June 7, 2013; 2015, No. 54,  38; 2019, No. 140 (Adj. Sess.),  8, eff. July 6, 2020.) 
 9418c. Fair contract standards
(a) Required information.(1) Each contracting entity shall provide and each health care contract shall obligate the contracting entity to provide participating health care providers information sufficient for the participating provider to determine the compensation or payment terms for health care services, including all of the following: (A) The manner of payment, such as fee-for-service, capitation, case rate, or risk.(B) On request, the fee-for-service dollar amount allowable for each CPT code for those CPT codes that a provider in the same specialty typically uses or that the requesting provider actually bills. Fee schedule information may be provided by CD-ROM or electronically, at the election of the contracting entity, but a provider may elect to receive a hard copy of the fee schedule information instead of the CD-ROM or electronic version. (C) A clearly understandable, readily available mechanism, such as a specific website address, that includes the following information: (i) the name of the commercially available claims editing software product that the health plan, contracting entity, covered entity, or payer uses; (ii) the standard or standards from subsection 9418a(c) of this title that the entity uses for claim edits; (iii) payment percentages for modifiers; and(iv) any significant edits, as determined by the health plan, contracting entity, covered entity, or payer, added to the claims software product, which are made at the request of the health plan, contracting entity, covered entity, or payer, and which have been approved by the Commissioner pursuant to subsection 9418a(b) or (c) of this title. (2) Contracting entities shall provide the information described in subdivisions (1)(A) and (B) of this subsection to health care providers who are actively engaged in the process of determining whether to become a participating provider in the contracting entitys network. (3) Contracting entities may require health care providers to execute written confidentiality agreements with respect to fee schedule and claim edit information received from contracting entities. (4) Each health care contract shall include the following information:(A) Any product, company, or network for which the participating provider has agreed to provide services. (B) For each product or network, reimbursement terms and methodologies, unless the terms are identical for multiple products or networks. (C) The term of the health care contract.(D) Termination notice period and reasons for termination.(E) Language that identifies the entity responsible for the processing of the participating providers compensation or payment, including contact information, including telephone, fax, and e-mail. This requirement may be satisfied by providing a specific web address that contains the necessary information. (F) Any internal mechanism provided by the contracting entity to resolve disputes concerning the interpretation or application of the terms and conditions of the contract. A contracting entity may satisfy this requirement by providing a clearly understandable, readily available mechanism, such as a specific website address or an appendix, that allows a participating provider to determine the procedures for the internal mechanism to resolve those disputes. (G) A list of addenda, if any, to the contract.(b) Summary disclosure form.(1) Each contracting entity shall include a summary disclosure form with a health care contract that includes all of the information specified in subsection (a) of this section. The information in the summary disclosure form shall refer to the location in the health care contract, whether a page number, section of the contract, appendix, or other identifier, that specifies the provisions in the contract to which the information in the form refers. (2) The summary disclosure form shall include all of the following information:(A) That the form is merely a guide to the health care contract and that the terms and conditions of the health care contract constitute the actual contract rights of the parties. (B) That reading the form is not a substitute for reading the entire health care contract.(C) That by signing the health care contract, the participating provider will be bound by the contracts terms and conditions. (D) That the terms and conditions of the health care contract may be amended pursuant to section 9418d of this title, and the participating provider is encouraged to carefully read any proposed amendments sent after execution of the contract. (E) That nothing in the summary disclosure form creates any additional rights or causes of action in favor of either party. (3) No contracting entity that includes any information in the summary disclosure form with the reasonable belief that the information is truthful and accurate shall be subject to a civil action for damages or to binding arbitration based on information included in the summary disclosure form. Inclusion of intentional misstatements or intentional misrepresentations in the summary disclosure form shall be considered a violation of this chapter subject to enforcement under section 9418g of this title. This section does not impair or affect any power of the Department of Financial Regulation to enforce any applicable law. (4) The summary disclosure form described in subdivisions (1) and (2) of this subsection shall be in substantially the following form: SUMMARY DISCLOSURE FORM[ ] ............... (5) Upon request, contracting entities shall provide the summary disclosure form to a participating provider or a provider who is actively engaged in the process of determining whether to become a participating provider within 60 days of the request. (c) When a contracting entity presents a proposed health care contract for consideration by a provider, the contracting entity shall provide in writing or make reasonably available the information required in subdivisions (a)(1)(A) and (B) of this section. (d) Upon request, the contracting entity shall identify any utilization management, quality improvement, price or quality transparency program, or a similar program that the contracting entity uses to review, monitor, evaluate, or assess the services provided pursuant to a health care contract. The contracting entity shall disclose the policies, procedures, or guidelines of such a program upon request by the participating provider who is subject to or is participating in the program within 14 days after the date of the request. (e) The requirements of subdivision (b)(5) of this section do not prohibit a contracting entity from requiring a reasonable confidentiality agreement between the provider and the contracting entity regarding the terms of the proposed health care contract. (Added 2009, No. 61,  32.) 
 9418d. Contract amendments
(a) A health care contract may be amended by mutual agreement of the parties.(b) Absent mutual agreement of the parties, a health care contract may be amended only as follows: (1) The contracting entity shall provide to the participating provider notice of the amendment and the amendment in writing not later than 60 days prior to the effective date of the amendment. The notice shall be conspicuously entitled Notice of Amendment to Contract and shall include a summary of the amendment as described in subdivision (4) of this subsection. The notice period may be extended by mutual agreement of the parties. (2) The participating provider shall have 60 days after receiving the amendment, notice, and summary pursuant to subdivision (1) of this subsection to object, in writing, to the proposed amendment. If the participating provider objects to the amendment and there is no resolution of the objection within 60 days following the contracting entitys receipt of the written objection, either party may terminate the contract upon written notice of termination provided to the other party. Termination shall become effective in the time period specified in the health care contract. If no termination period is specified in the health care contract, the termination shall become effective 90 days after the notice of termination is provided. The terms of the underlying contract shall remain in effect through the termination period and shall be unaffected by the proposed amendment. (3) If the participating provider does not object to the amendment in the manner specified in subdivision (2) of this subsection, the amendment shall be effective as specified in the notice described in subdivision (1) of this subsection. (4) The notice of amendment shall include a summary cover sheet that shall include the following information: (A) a brief explanation of the amendment;(B) the date the amendment will become effective;(C) a notice of right to object in writing to the amendment;(D) the time frame for objection;(E) the address to send an objection;(F) contact information for the person to call to discuss the amendment for further information, or to resolve an objection; (G) the effect of an objection;(H) the right to terminate the contract if the objection is not resolved;(I) the time period for the effective date of any such termination; and(J) the address to send a notice of termination.(c) Subsection (b) of this section shall not apply in the following circumstances:(1) The delay caused by compliance with the 60-day notice period in subdivision (b)(1) of this section could result in imminent harm to an insured. (2) The amendment of a health care contract is required by a State or federal law, rule, or regulation that includes an effective date for the amendment. (3) The provider affirmatively accepts the amendment in writing and agrees to an earlier effective date than that specified in the notice required by subdivision (b)(1) of this section. (4) The participating providers payment or compensation is based on the current Medicaid or Medicare physician reimbursement schedule, and the amendment reflects a change in payment or compensation resulting solely from a change in that physician reimbursement schedule. (5) The amendment is a routine change or update of the health care contract made in response to any addition, deletion, or revision of any service code, procedure code, or reporting code, or a pricing change is made by a third party source. For purposes of this subdivision: (A) Service code, procedure code, or reporting code means the American Medical Associations Current Procedural Terminology, the American Dental Associations Current Dental Terminology, the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System, the World Health Organizations International Classification of Diseases, or the Drug Topics Red Book average wholesale price; and (B) Third party source means the American Medical Association; the American Society of Anesthesiologists; the American Dental Association; the Centers for Medicare and Medicaid Services; the National Center for Health Statistics; the U.S. Department of Health and Human Services Office of the Inspector General; the Vermont Department of Financial Regulation; or the Vermont Agency of Human Services. (d) Notwithstanding subsections (a), (b), and (c) of this section, a health care contract may be amended by operation of law as required by any applicable state or federal law, rule, or regulation. (e) Subsection (b) of this section shall not apply to amendments of health care contracts with hospitals. (Added 2009, No. 61,  33.) 
 9418e. Most favored nation clauses prohibited
No later than 180 days after the effective date of this section, no contracting entity shall do any of the following: (1) offer to a provider, hospital, pharmacist, or pharmacy a health care contract that includes a most favored nation clause; (2) enter into a health care contract with a provider, hospital, pharmacist, or pharmacy that includes a most favored nation clause; or (3) amend an existing health care contract previously entered into with a provider, hospital, pharmacist, or pharmacy to include a most favored nation clause. (Added 2009, No. 61,  34.) 
 9418f. Rental network contracts
(a) Definitions. As used in this section:(1) Health care services means services for the diagnosis, prevention, treatment, or cure of a health condition, illness, injury, or disease. (2)(A) Provider means a physician, a physician organization, or a physician hospital organization that is acting exclusively as an administrator on behalf of a provider to facilitate the providers participation in health care contracts. (B) Provider does not include a physician organization or physician hospital organization that leases or rents the physician organizations or physician hospital organizations network to a covered entity. (3) Provider network contract means a contract between a contracting entity and a provider specifying the rights and responsibilities of the contracting entity and provider for the delivery of and payment for health care services to covered individuals. (b) Scope. This section shall not apply to:(1) Provider network contracts for services provided to Medicaid, Medicare, or the State Childrens Health Insurance Program (SCHIP) beneficiaries. (2) Circumstances in which access to the provider network contract is granted to an entity operating under the same brand licensee program as the contracting entity. (c)(1) Registration. Any person not otherwise licensed or registered by the Commissioner that intends to conduct business as a contracting entity shall register with the Commissioner prior to commencing business. Each person not licensed or registered by the Commissioner as a contracting entity upon the effective date of this section shall have 30 days within which to register with the Commissioner. (2) Registration shall consist of the submission of the following information:(A) the official name of the contracting entity;(B) the mailing address and main telephone number for the contracting entitys main headquarters; and (C) the name and telephone number of the contracting entitys representative who shall serve as the primary contact with the Commissioner. (3) The information required by this subsection shall be submitted in written or electronic format, as prescribed by the Commissioner. (4) Annually on July 1, each person registered as a contracting entity under this section shall pay to the Commissioner a fee of $200.00. Fees collected under this subdivision shall be deposited into the Health Care Special Fund, number 21070, and shall be available to the Commissioner to offset the cost of administering the registration process. (d)(1) Contracting entity rights and responsibilities. A contracting entity may not grant access to a providers health care services and contractual discounts pursuant to a provider network contract unless: (A) the provider network contract specifically states that the contracting entity may enter into an agreement with a third party, allowing the third party to obtain the contracting entitys rights and responsibilities under the provider network contract as if the third party were the contracting entity; and (B) the third party accessing the provider network contract is contractually obligated to comply with all applicable terms, limitations, and conditions of the provider network contract. (2) A contracting entity that grants access to a providers health care services and contractual discounts pursuant to a provider network contract shall: (A) identify and provide to the provider, upon request at the time a provider network contract is entered into with a provider, a written or electronic list of all third parties known at the time of contracting, to which the contracting entity has or will grant access to the providers health care services and contractual discounts pursuant to a provider network contract; (B) maintain a website or other readily available mechanism, such as a toll-free telephone number, through which a provider may obtain a listing, updated at least every 90 days, of the third parties to which the contracting entity has executed contracts to grant access to such providers health care services and contractual discounts pursuant to a provider network contract; (C) provide the covered entity with sufficient information regarding the provider network contract to enable the covered entity to comply with all relevant terms, limitations, and conditions of the provider network contract; (D) require that the covered entity who contracts with the contracting entity to gain access to the provider network contract identify the source of the contractual discount taken by the covered entity on each remittance advice or explanation of payment form furnished to a health care provider when such discount is pursuant to the contracting entitys provider network contract; (E) notify the covered entity who contracts with the contracting entity to gain access to the provider network contract of the termination of the provider network contract no later than 30 days prior to the effective date of the final termination of the provider network contract; and (F) require those that are by contract eligible to claim the right to access a providers discounted rate to cease claiming entitlement to those rates or other contracted rights or obligations for services rendered after termination of the provider network contract. (3) The notice required under subdivision (2)(E) of this subsection can be provided through any reasonable means, including written notice, electronic communication, or an update to an electronic database or other provider listing. (4) Subject to any applicable continuity of care requirements, agreements, or contractual provisions: (A) a covered entitys right to access a providers health care services and contractual discounts pursuant to a provider network contract shall terminate on the date the provider network contract is terminated; (B) claims for health care services performed after the termination date of the provider network contract are not eligible for processing and payment in accordance with the provider network contract; and (C) claims for health care services performed before the termination date of the provider network contract, but processed after the termination date, are eligible for processing and payment in accordance with the provider network contract. (5)(A) All information made available to providers in accordance with the requirements of this section shall be confidential and shall not be disclosed to any person or entity not involved in the providers practice or the administration thereof without the prior written consent of the contracting entity. (B) Nothing in this section shall be construed to prohibit a contracting entity from requiring the provider to execute a reasonable confidentiality agreement to ensure that confidential or proprietary information disclosed by the contracting entity is not used for any purpose other than the providers direct practice management or billing activities. (e) Rental by third parties prohibited. A covered entity, having itself been granted access to a providers health care services and contractual discounts pursuant to a provider network contract, may not further lease, rent, or otherwise grant access to the contract to any other person. (f)(1) Unauthorized access to provider network contracts. It is a violation of this subchapter subject to enforcement under section 9418g of this title to access or utilize a providers contractual discount pursuant to a provider network contract without a contractual relationship with the provider, contracting entity, or covered entity, as specified in this section. (2) Contracting entities and third parties are obligated to comply with subdivision (d)(2)(B) of this section concerning the services referenced on a remittance advice or explanation of payment. A provider may refuse the discount taken on the remittance advice or explanation of payment if the discount is taken without a contractual basis or in violation of these sections. However, an error in the remittance advice or explanation of payment may be corrected within 30 days following notice by the provider. (3) A contracting entity may not lease, rent, or otherwise grant a covered entity access to a provider network contract unless the covered entity accessing the health care contract is: (A) a payer, a third party administrator, or another entity that administers or processes claims on behalf of the payer; (B) a preferred provider organization or preferred provider network, including a physician organization or physician hospital organization; or (C) an entity engaged in the electronic claims transport between the contracting entity and the payer that does not provide access to the providers services and a discount to any other covered entity. (Added 2009, No. 61,  35.) 
 9418g. Enforcement
In addition to any other remedy provided by law, the Commissioner may, in his or her sole discretion, enforce the provisions of this subchapter as specified in this section. In determining whether to undertake an enforcement action, the Commissioner may consider the relative resources of the complaining party and the alleged noncompliant party, the Commissioners other enforcement responsibilities, and such other factors as the Commissioner deems appropriate. (1) The Commissioner shall have the power to examine and investigate any health plan, contracting entity, covered entity, or payer to determine if the health plan, contracting entity, covered entity, or payer has violated the provisions of this subchapter, or any rules or order of the Commissioner adopted or issued thereunder. (2) If the Commissioner finds that a health plan, contracting entity, covered entity, or payer has violated this subchapter, or any rules or order of the Commissioner adopted or issued thereunder, the Commissioner may order the health plan, contracting entity, covered entity, or payer to cease and desist from further violations and may order the health plan, contracting entity, covered entity, or payer to remediate the violation. (3) If the Commissioner finds that a health plan, contracting entity, covered entity, or payer has violated this subchapter or any rules or order of the Commissioner adopted or issued thereunder, the Commissioner may impose an administrative penalty against the health plan, contracting entity, covered entity, or payer of no more than $1,000.00 for each violation and no more than $10,000.00 for each willful violation. In determining the amount of the penalty to be assessed, the Commissioner shall consider the following factors: (A) the appropriateness of the penalty with respect to the financial resources and good faith of the health plan, contracting entity, covered entity, or payer; (B) the gravity of the violation or practice;(C) the history of previous violations or practices of a similar nature;(D) the economic benefit derived by the health plan, contracting entity, covered entity, or payer and the economic impact on the health care facility or health care provider resulting from the violation; (E) any other relevant factors.(4) Any dispute arising out of or relating to the provisions of this subchapter shall, at the option of either party, be settled by arbitration in accordance with the commercial rules of the American Arbitration Association or the rules or procedures of another mutually agreed upon alternative dispute resolution forum, such as the American Health Lawyers Association. Judgment upon the arbitrators award may be entered in any court having jurisdiction, and the arbitrators award shall be binding on both parties. (5) Nothing in this subchapter shall be construed to prohibit a health plan, contracting entity, covered entity, or payer from applying payment policies that are consistent with applicable federal or State laws and regulations, or to relieve a health plan, contracting entity, covered entity, or payer from complying with payment standards established by federal or State laws and regulations, including rules adopted by the Commissioner. (Added 2009, No. 61,  36.) 
 9419. Charges for access to medical records
(a) A custodian may impose a charge that is no more than a flat $5.00 fee or no more than $0.50 per page, whichever is greater, for providing copies of an individuals health care record. A custodian shall provide an individual or the authorized recipient with an itemized bill for the charges assessed. A custodian shall not charge for providing copies of any health care record requested to support a claim or an appeal under any provision of the Social Security Act or for any other federal or State needs-based benefit or program. (b) A custodian may charge an individual a fee, reasonably related to the associated costs, for providing copies of X-rays, films, models, disks, tapes, or other health care record information maintained in other formats. (c) As used in this section:(1) Custodian means any person who maintains health care information for any lawful purpose, including a health care provider, a health care facility, or a health insurer. (2) Health care record means all written and recorded health care information about an individual maintained by a custodian. (3) Individual means a natural person, alive or dead, who is the subject of health care information and includes, when appropriate, the individuals attorney-in-fact; legal guardian; health care agent, as defined in chapter 231 of this title; executor; or administrator. (Added 1999, No. 129 (Adj. Sess.),  2; amended 2017, No. 113 (Adj. Sess.),  107.) 
 9420. Conversion of nonprofit hospitals
(a) Policy and purpose. The State has a responsibility to assure that the assets of nonprofit entities, which are impressed with a charitable trust, are managed prudently and are preserved for their proper charitable purposes. (b) Definitions. As used in this section:(1) Charitable assets means the fair market value of a nonprofit hospital. When a conversion affects only some of the assets of a nonprofit hospital, charitable assets means those assets of the hospital that will be so affected. (2) [Repealed.](3) Conversion means a transaction or series of transactions described in subdivision (4) of this subsection. (4) Convert means to sell, transfer, lease, exchange, option, commit, convey, or otherwise dispose of assets or operations of a nonprofit hospital. The term does not include transactions occurring in the normal and ordinary course of business for the nonprofit hospital, such as management contracts, vendor contracts, physician-hospital contracts, managed care contracts, financing agreements, or ventures such as letters of credit, or cooperative or networking agreements with for-profit providers. (5) Fair market value means the price that the assets being converted would bring in a competitive and open market under a fair sale with the buyer and seller acting prudently, knowledgeably, at arms length, and in their own best interests. (6) Hospital system means a network of hospitals affiliated with a nonprofit hospital.(7) Nonprofit hospital means a nonprofit entity, where no part of the net earnings may lawfully be applied to the benefit of any private shareholder or individual, and which is a hospital as defined in section 1902 of this title, or a hospital member of a hospital system; provided, that the term hospital does not include any hospital conducted, maintained, or operated by the U.S. government or the State of Vermont or the duly authorized agency of either. (8) Parties means the nonprofit hospital and any other person who is a party to a conversion described in the application filed pursuant to subsection (e) of this section, including, without limitation, any person that, pursuant to the plan of conversion, is to receive charitable assets or proceeds as a result of the conversion. When, in this section, reference is made to liabilities or obligations of the parties, such liabilities and obligations shall be joint and several. (9) Qualifying amount means an amount that is at least $1 million and represents at least 40 percent of the value of the assets of the nonprofit hospital, or that vests control of the nonprofit hospital in another person or entity. For purposes of determining whether the threshold requirements of this subdivision have been or will be met, related conversions shall be aggregated. (10) Green Mountain Care Board or Board means the Green Mountain Care Board established in chapter 220 of this title. (c) Approval required for conversion of qualifying amount of charitable assets. A nonprofit hospital may convert a qualifying amount of charitable assets only with the approval of the Green Mountain Care Board, and either the Attorney General or the Superior Court, pursuant to the procedures and standards set forth in this section. (d) Exception for conversions in which assets will be owned and controlled by a nonprofit corporation. (1) Other than subsection (q) of this section and subdivision (2) of this subsection, this section shall not apply to conversions in which the party receiving assets of a nonprofit hospital is a nonprofit corporation. (2) In any conversion that would have required an application under subsection (e) of this section but for the exception set forth in subdivision (1) of this subsection, notice to or written waiver by the Attorney General shall be given or obtained as if required under 11B V.S.A.  12.02(g). (e) Application. Prior to consummating any conversion of a qualifying amount of charitable assets, the parties shall submit an application to the Attorney General and the Green Mountain Care Board, together with any attachments complying with subsection (f) of this section. If any material change occurs in the proposal set forth in the filed application, an amendment setting forth such change, together with copies of all documents and other material relevant to such change, shall be filed with the Attorney General and the Board within two business days, or as soon thereafter as practicable, after any party to the conversion learns of such change. If the conversion involves a hospital system, and one or more of the hospitals in the system desire to convert charitable assets, the Attorney General, in consultation with the Board, shall determine whether an application shall be required from the hospital system. (f) Completion and contents of application. (1) Within 30 days of receipt of the application, or within 10 days of receipt of any amendment thereto, whichever is longer, the Attorney General, with the Green Mountain Care Boards agreement, shall determine whether the application is complete. The Attorney General shall promptly notify the parties of the date the application is deemed complete, or of the reasons for a determination that the application is incomplete. A complete application shall include the following: (A) A detailed summary of the purposes and material terms of the proposed conversion.(B) The names and addresses of the parties that have been or will be created as part of the conversion, including a list of all individuals who are or have been chosen as their directors, officers, or board members. (C) Copies of all organizational documents relating to the parties.(D) Copies of all contracts and other agreements related to the conversion.(E) Copies of the most recent audited financial reports of the entities involved.(F) A detailed description of all assets of the nonprofit hospital, including the value of the assets and the basis for that valuation. For assets included in or otherwise affected by the conversion, the following information is also to be included: (i) the nature of any restrictions on such assets owned or held by the nonprofit hospital and the purpose or purposes for which such assets were received; (ii) a statement as to whether the assets will be converted to cash in connection with or as a result of the conversion; and (iii) a detailed description of all proposed changes in control or ownership of the assets and an explanation regarding whether and if so, how the charitable assets of the nonprofit hospital will continue to be used in a manner consistent with their intended charitable purpose. (G) A description of the process by which the decision to undertake the conversion and to select the acquiring party and the type and amount of consideration to be given or received in the conversion, if applicable, was reached by the nonprofit hospital, and all documents relating to that process and decision, including minutes, committee or special study reports, correspondence, presentations, audits, and other internal or outside reviews or analyses. (H) The amount, source, and nature of any consideration to be paid to the nonprofit hospital, its directors, officers, board members, executives, or experts retained by the nonprofit hospital, including prospective employment or consultation. (I) A detailed description of the structure and functions of any charitable foundation that will receive proceeds of the conversion, including a description of its assets, its mission, the purposes of the foundation, the expected charitable uses of the assets, how it will be broadly based in, and represent, the community affected by the conversion, and how proceeds from the conversion will be controlled. (J) A certified board resolution or other appropriate document evidencing approval of the conversion by each party involved. (K) A certification signed by those members, identified by name and title, of the governing body or other person approving the conversion on behalf of the nonprofit hospital that the standards set forth in subsection (j) of this section have been considered in good faith and are met, together with such explanations and other documentation as may be necessary to demonstrate such compliance. (L) A separate certification from each member of the governing board, the chief executive officer, and other officers designated in the governing documents of the nonprofit hospital, executed under oath, stating whether that director or officer is then, or may become within three years of completion of the conversion a member or shareholder in, or officer, employee, agent, or consultant of, or may otherwise derive any compensation or benefits, directly or indirectly, from any party. (M) A statement from any party specifying the manner in which it proposes to continue to fulfill the charitable obligations of the nonprofit hospital, if applicable. (N) Any additional information the Attorney General or Green Mountain Care Board finds necessary or appropriate for the full consideration of the application. (2) The parties shall make the contents of the application reasonably available to the public prior to any hearing for public comment described in subsection (g) of this section to the extent that they are not otherwise exempt from disclosure under 1 V.S.A.  317(b). (g) Notice and hearing for public comment on application. (1) The Attorney General and the Green Mountain Care Board shall hold one or more public hearings on the transaction or transactions described in the application. A record shall be made of any hearing. The hearing shall commence within 30 days of the determination by the Attorney General that the application is complete. If a hearing is continued or multiple hearings are held, any hearing shall be completed within 60 days of the Attorney Generals determination that an application is complete. In determining the number, location, and time of hearings, the Attorney General, in consultation with the Board, shall consider the geographic areas and populations served by the nonprofit hospital and most affected by the conversion and the interest of the public in commenting on the application. (2) The Attorney General shall provide reasonable notice of any hearing to the parties, the Board, and the public, and may order that the parties bear the cost of notice to the public. Notice to the public shall be provided in newspapers having general circulation in the region affected and shall identify the applicants and the proposed conversion. A copy of the public notice shall be sent to the Office of the Health Care Advocate, to the State Long-Term Care Ombudsman, and to the Senators and members of the House of Representatives representing the county and district and to the clerk, chief municipal officer, and legislative body of the municipality in which the nonprofit hospital is principally located. Upon receipt, the clerk shall post notice in or near the clerks office and in at least two other public places in the municipality. Any person may testify at a hearing under this section and, within such reasonable time as the Attorney General may prescribe, file written comments with the Attorney General and Board concerning the proposed conversion. (h) Determination by the Green Mountain Care Board. (1) The Green Mountain Care Board shall consider the application, together with any report and recommendations from the Boards staff requested by the Board, and any other information submitted into the record, and approve or deny it within 50 days following the last public hearing held pursuant to subsection (g) of this section, unless the Board extends such time up to an additional 60 days with notice prior to its expiration to the Attorney General and the parties. (2) The Board shall approve the proposed transaction if the Board finds that the application and transaction will satisfy the criteria established in section 9437 of this title. For purposes of applying the criteria established in section 9437, the term project shall include a conversion or other transaction subject to the provisions of this subchapter. (3) A denial by the Board may be appealed to the Supreme Court pursuant to section 9381 of this title. If no appeal is taken or if the Boards order is affirmed by the Supreme Court, the application shall be terminated. A failure of the Board to approve of an application in a timely manner shall be considered a final order in favor of the applicant. (i) Determination by Attorney General. The Attorney General shall make a determination as to whether the conversion described in the application meets the standards provided in subsection (j) of this section. (1) If the Attorney General determines that the conversion described in the application meets the standards set forth in subsection (j) of this section, the Attorney General shall approve the conversion and so notify the parties in writing. (2) If the Attorney General determines that the conversion described in the application does not meet such standards, the Attorney General may not approve the conversion and shall so notify the parties of such disapproval and the basis for it in writing, including identification of the standards listed in subsection (j) of this section that the Attorney General finds not to have been met by the proposed conversion. Nothing in this subsection shall prevent the parties from amending the application to meet any objections of the Attorney General. (3) The notice of approval or disapproval by the Attorney General under this subsection shall be provided no later than either 60 days following the date of the last hearing held under subsection (g) of this section or ten days following approval of the conversion by the Board, whichever is later. The Attorney General, for good cause, may extend this period an additional 60 days. (j) Standards for Attorney Generals review. In determining whether to approve a conversion under subsection (i) of this section, the Attorney General shall consider whether: (1) the governing body of the nonprofit hospital exercised due diligence in deciding to engage in the conversion, selecting the acquiring party, and ensuring that the terms and conditions of the conversion are fair and reasonable to the nonprofit hospital; (2) the nonprofit hospital will receive fair market value for its charitable assets, and whether the market value of those assets has not been manipulated by the actions of the parties in a manner that causes the value of the assets to decrease; (3) the conversion will not result in a breach of fiduciary duty, including any undisclosed or material conflicts of interest related to payments or benefits to officers, directors, board members, executives, or experts employed or retained by the parties; (4) the conversion will not result in private inurement to any person;(5) the proceeds of the conversion will be used in a manner and place consistent with the public benefit purposes of the nonprofit hospital; (6) any foundation established to hold the proceeds of the conversion will be representative of and broadly based in the community served by the nonprofit hospital and will be subject to appropriate public accountability standards; (7) the application contains sufficient information and data to permit the Attorney General and the Green Mountain Care Board to evaluate the conversion and its effects on the publics interests in accordance with this section; and (8) the conversion plan has made reasonable provision for reports, upon request, to the Attorney General on the conduct and affairs of any person that, as a result of the conversion, is to receive charitable assets or proceeds from the conversion to carry on any part of the public purposes of the nonprofit hospital. (k) Investigation by Attorney General. The Attorney General may conduct an investigation relating to the conversion pursuant to the procedures set forth generally in 9 V.S.A.  2460. The Attorney General may contract with such experts or consultants the Attorney General deems appropriate to assist in an investigation of a conversion under this section. The Attorney General may order any party to reimburse the Attorney General for all reasonable and actual costs incurred by the Attorney General in retaining outside professionals to assist with the investigation or review of the conversion. (l) Superior Court action. If the Attorney General does not approve the conversion described in the application and any amendments, the parties may commence an action in the Superior Court of Washington County, or with the agreement of the Attorney General, of any other county, within 60 days of the Attorney Generals notice of disapproval provided to the parties under subdivision (i)(2) of this section. The parties shall notify the Green Mountain Care Board of the commencement of an action under this subsection. The Board shall be permitted to request that the court consider the Boards determination under subsection (h) of this section in its decision under this subsection. (m) Court determination and order. (1) Within 45 days of the commencement of an action under subsection (l) of this section, the court shall hold a hearing to determine whether the conversion described in the application and any amendments submitted prior to the Attorney Generals notice of disapproval satisfy the standards under subsection (j) of this section that the Attorney General identified in the notice of disapproval as not having been met by the transaction described in the application. The court shall determine the matter within 45 days of the conclusion of the hearing. The court, for good cause, may extend each of the time periods provided in this subsection for its hearing and determination for an additional 30 days, or for a longer period if agreed to by the parties and the Attorney General. The Attorney General shall represent the interests of the public at any hearing under this subsection. The parties shall have the burden to establish that the application, with any amendments that were submitted prior to the Attorney Generals notice of disapproval, meets each of the standards of subsection (j) of this section identified in the Attorney Generals notice of disapproval as not having been met by the application. (2) If the court finds that the parties have shown that the conversion described in the application meets the standards of subsection (j) of this section identified in the Attorney Generals notice of disapproval as not having been met by the application, the court shall set aside the determination of the Attorney General, and the parties may proceed under this section as if the Attorney General had approved the conversion described in the application. (3) If the Attorney General substantially prevails in the action, the court may order the parties to reimburse the State for the reasonable value of the Attorney Generals services and expenses in defending the action, separate and apart from any amounts the parties are required to pay pursuant to subsection (k) of this section. (4) Nothing herein shall prevent the Attorney General, while an action brought under subsection (l) of this section is pending, from approving the conversion described in the application, as modified by such terms as are agreed between the parties, the Attorney General, and the Green Mountain Care Board to bring the conversion into compliance with the standards set forth in subsection (j) of this section. (n) Use of converted assets or proceeds of a conversion approved pursuant to this section. If at any time following a conversion, the Attorney General has reason to believe that converted assets or the proceeds of a conversion are not being held or used in a manner consistent with information provided to the Attorney General, the Board, or a court in connection with any application or proceedings under this section, the Attorney General may investigate the matter pursuant to procedures set forth generally in 9 V.S.A.  2460 and may bring an action in Washington Superior Court or in the Superior Court of any county where one of the parties has a principal place of business. The court may order appropriate relief in such circumstances, including avoidance of the conversion or transfer of the converted assets or proceeds or the amount of any private inurement to a person or party for use consistent with the purposes for which the assets were held prior to the conversion, and the award of costs of investigation and prosecution under this subsection, including the reasonable value of legal services. (o) Remedies and penalties for violations. (1) The Attorney General may bring or maintain a civil action in the Washington Superior Court, or any other county in which one of the parties has its principal place of business, to enjoin, restrain, or prevent the consummation of any conversion which has not been approved in accordance with this section or where approval of the conversion was obtained on the basis of materially inaccurate information furnished by any party to the Attorney General or the Board. (2) A conversion entered into in violation of any provision of this section may be voided, upon petition of the Attorney General, by the Superior Court of Washington County or the county in which any party has its principal place of business. (3) If a person violates a provision of this section or any lawful order of a court acting pursuant to this section, the court, upon petition of the Attorney General, may order that person to pay to the State the value of services and expenses incurred by the Attorney General in the investigation and prosecution of the violation, and may: (A) order that person to cease such activity or other appropriate injunctive relief;(B) order the disgorgement of any private inurement; and(C) impose a penalty on that person of up to $1 million.(4) In determining whether to grant relief under this subsection, and the nature of such relief, the court shall consider whether: (A) the violation was willful;(B) any person has derived, or may derive, an economic benefit from the conversion;(C) the purposes for which the assets had been held by the nonprofit hospital have been frustrated by the violation; and (D) the interests of the public or the community served by the nonprofit hospital would be jeopardized by voiding the contract. (p) Conversion of less than a qualifying amount of assets. (1) The Attorney General may conduct an investigation relating to a conversion pursuant to the procedures set forth generally in 9 V.S.A.  2460 if the Attorney General has reason to believe that a nonprofit hospital has converted or is about to convert less than a qualifying amount of its assets in such a manner that would: (A) if it met the qualifying amount threshold, require an application under subsection (e) of this section; and (B) constitute a conversion that does not meet one or more of the standards set forth in subsection (j) of this section. (2) The Attorney General, in consultation with the Green Mountain Care Board, may bring an action with respect to any conversion of less than a qualifying amount of assets, according to the procedures set forth in subsection (n) of this section. The Attorney General shall notify the Board of any action commenced under this subsection. The Board shall be permitted to investigate and determine whether the transaction satisfies the criteria established in subdivision (g)(2) of this section, and to request that the court consider the Boards recommendation in its decision under this subsection. In such an action, the Superior Court may enjoin or void any transaction and may award any other relief as provided under subsection (n) of this section. (3) In any action brought by the Attorney General under this subdivision, the Attorney General shall have the burden to establish that the conversion: (A) violates one or more of the standards listed in subdivision (j)(1), (3), (4), or (6) of this section; or (B) substantially violates one or more of the standards set forth in subdivisions (j)(2) and (5) of this section. (q) Other preexisting authority. (1) Nothing in this section shall be construed to limit the authority of the Green Mountain Care Board, Attorney General, Department of Health, or a court of competent jurisdiction under existing law, or the interpretation or administration of a charitable gift under 14 V.S.A.  2328. (2) This section shall not be construed to limit the regulatory and enforcement authority of the Board, or exempt any applicant or other person from requirements for licensure or other approvals required by law. (Added 2005, No. 28,  1, eff. May 24, 2005; amended 2015, No. 54,  39; 2017, No. 113 (Adj. Sess.),  108.) 
 9421. Pharmacy benefit management; registration; insurer audit of pharmacy benefit manager activities
(a) A pharmacy benefit manager shall not do business in this State without first registering with the Commissioner on a form and in a manner prescribed by the Commissioner. (b) In accordance with rules adopted by the Commissioner, pharmacy benefit managers operating in the State of Vermont and proposing to contract for the provision of pharmacy benefit management shall notify health insurers when the pharmacy benefit manager provides a quotation that a quotation for an administrative-services-only contract with full pass through of negotiated prices, rebates, and other such financial benefits that would identify to the health insurer external sources of revenue and profit is generally available and whether the pharmacy benefit manager offers that type of arrangement. Quotations for an administrative-services-only contract shall include a reasonable fee payable by the health insurer that represents a competitive pharmacy benefit profit. This subsection shall not be interpreted to require a pharmacy benefit manager to offer an administrative-services-only contract. (c) In order to enable periodic verification of pricing arrangements in administrative-services-only contracts, pharmacy benefit managers shall allow access, in accordance with rules adopted by the Commissioner, by the health insurer who is a party to the administrative-services-only contract to financial and contractual information necessary to conduct a complete and independent audit designed to verify the following: (1) full pass through of negotiated drug prices and fees associated with all drugs dispensed to beneficiaries of the health plan in both retail and mail order settings or resulting from any of the pharmacy benefit management functions defined in the contract; (2) full pass through of all financial remuneration associated with all drugs dispensed to beneficiaries of the health plan in both retail and mail order settings or resulting from any of the pharmacy benefit management functions defined in the contract; and (3) any other verifications relating to the pricing arrangements and activities of the pharmacy benefit manager required by the contract if required by the Commissioner. (d) The reasonable expenses of the Department of Financial Regulation in administering the provisions of this section may be charged to pharmacy benefit managers in the manner provided for in 8 V.S.A.  18. These expenses shall be allocated in proportion to the lives of Vermonters covered by each pharmacy benefit manager as reported annually to the Commissioner in a manner and form prescribed by the Commissioner. The Department of Financial Regulation shall not charge its expenses to the pharmacy benefit manager contracting with the Department of Vermont Health Access if the Department of Vermont Health Access notifies the Department of Financial Regulation of the conditions contained in its contract with a pharmacy benefit manager. (e) The Commissioner may adopt such rules as are necessary or desirable in carrying out the purposes of this section. The rules also shall ensure that proprietary information is kept confidential and not disclosed by a health insurer.  [Subsection (f) redesignated as subsection (g) effective January 1, 2023; for subsection (f) effective January 1, 2023 see below.] (f) As used in this section:(1) Health insurer shall have the same meaning as in subdivision 9471(2) of this title.(2) Health plan shall have the same meaning as in subdivision 9471(3) of this title.(3) Pharmacy benefit management shall have the same meaning as in subdivision 9471(4) of this title. (4) Pharmacy benefit manager shall have the same meaning as in subdivision 9471(5) of this title.  [Subsection (f) effective January 1, 2023; for subsection (f) effective until January 1, 2023 see above.] (f) The Department of Financial Regulation shall monitor the cost impacts on Vermont consumers of pharmacy benefit manager regulation pursuant to this section, subchapter 9 of this chapter, and 8 V.S.A. chapter 107 and shall recommend appropriate modifications to the laws as needed to promote health care affordability in this State. (Added 2007, No. 80,  9; amended 2009, No. 156 (Adj. Sess.),  I.29; 2011, No. 150 (Adj. Sess.),  3; 2017, No. 113 (Adj. Sess.),  109; 2021, No. 131 (Adj. Sess.),  1a, eff. January 1, 2023.) 
 9422. Credit card payments optional for providers
(a) As used in this section:(1) Credit card payment means a type of electronic funds transfer in which a health insurer or its contracted vendor issues a single-use series of numbers associated with payment for health care services delivered by a health care provider and chargeable for a predetermined dollar amount and in which the health care provider is responsible for processing the payment using a credit card terminal or Internet portal. The term includes virtual or online credit card payments in which no physical credit card is presented to the health care provider and the single-use credit card number expires upon payment processing. (2) Health care provider has the same meaning as in section 9402 of this title.(3) Health insurer means an insurance company that provides health insurance as defined in 8 V.S.A.  3301(a)(2), a nonprofit hospital or medical service corporation, a managed care organization, a health maintenance organization, and, to the extent permitted under federal law, any administrator of an insured, self-insured, or publicly funded health care benefit plan offered by a public or private entity, as well as any entity offering a policy for specific disease, accident, injury, hospital indemnity, dental care, disability income, long-term care, or other limited benefit coverage. (b) A health insurer or its contracted vendor shall not require a health care provider, including a dentist or ambulance service provider, to accept reimbursement by credit card payment unless the health care provider has affirmatively elected to receive payments in this manner. If a health care provider, including a dentist or ambulance service provider, does not affirmatively elect to receive reimbursement by credit card payment, the health insurer or its contracted vendor shall make payments to the provider in another manner. (Added 2021, No. 25,  32, eff. Jan. 1, 2022.) 
 9431. Policy and purpose
(a) It is declared to be the public policy of this State that the general welfare and protection of the lives, health, and property of the people of this State require that all new health care projects be offered or developed in a manner that avoids unnecessary duplication and contains or reduces increases in the cost of delivering services, while at the same time maintaining and improving the quality of and access to health care services, and promoting rational allocation of health care resources in the State; and that the need, cost, type, level, quality, and feasibility of providing any new health care project be subject to review and assessment prior to any offering or development. (b) [Repealed.] (Added 1979, No. 65,  1; amended 1997, No. 159 (Adj. Sess.),  6, eff. April 29, 1998; 2003, No. 53,  8; 2011, No. 171 (Adj. Sess.),  14a, eff. Jan. 1, 2013; 2017, No. 167 (Adj. Sess.),  6.)
 9432. Definitions
As used in this subchapter:(1) Ambulatory surgical center means a facility or portion of a facility that provides surgical care not requiring an overnight stay. The office of a dentist in which activities are limited to dentistry and oral or maxillofacial surgical procedures shall not be deemed an ambulatory surgical center for purposes of this subchapter. In order to be considered an ambulatory surgical center, a facility shall meet all the following criteria: (A) charge, or intend to charge, a facility fee in addition to professional fees for the services performed; (B) have an operating room or recovery room in the facility;(C) use an anesthesiologist or nurse anesthetist;(D) provide one or more outpatient services for which Medicare coverage is provided.(2) Annual operating expense means that expense which, by generally accepted accounting principles, is incurred by a new health care service during the first fiscal year in which the service is in full operation after completion of the project. (3) Applicant means a person who has submitted an application or proposal requesting issuance of a certificate of need. (4) Bed capacity means the number of licensed beds operated by the facility under its most current license under chapter 43 of this title and of facilities under 33 V.S.A. chapter 71. (5) Capital expenditure means an expenditure for the plant or equipment that is not properly chargeable as an expense of operation and maintenance and includes acquisition by purchase, donation, leasehold expenditure, or lease that is treated as capital expense in accordance to the accounting standards established for lease expenditures by the Financial Accounting Standards Board, calculated over the length of the lease for plant or equipment, and includes assets having an expected life of at least three years. A capital expenditure includes the cost of studies, surveys, designs, plans, working drawings, specifications, and other activities essential to the acquisition, improvement, expansion, or replacement of the plant and equipment. (6) Construction means actual commencement of any construction or fabrication of any new building, or addition to any existing facility, or any expenditure relating to the alteration, remodeling, renovation, modernization, improvement, relocation, repair, or replacement of a health care facility, including expenditures necessary for compliance with life and health safety codes. (7) To develop, when used in connection with health services, means to undertake activities which on their completion will result in the offer of a new health care project, or the incurring of a financial obligation in relation to the offering of a service. (8) Health care facility means all persons or institutions, including mobile facilities, whether public or private, proprietary or not for profit, which offer diagnosis, treatment, inpatient, or ambulatory care to two or more unrelated persons, and the buildings in which those services are offered. The term shall not apply to any institution operated by religious groups relying solely on spiritual means through prayer for healing, but shall include: (A) hospitals, including general hospitals, mental hospitals, chronic disease facilities, birthing centers, maternity hospitals, and psychiatric facilities including any hospital conducted, maintained, or operated by the State of Vermont, or its subdivisions, or a duly authorized agency thereof; (B) nursing homes, health maintenance organizations, home health agencies, outpatient diagnostic or therapy programs, kidney disease treatment centers, mental health agencies or centers, diagnostic imaging facilities, independent diagnostic laboratories, cardiac catheterization laboratories, radiation therapy facilities, or any inpatient or ambulatory surgical, diagnostic, or treatment center. (9) Health care provider means a person, partnership, corporation, facility, or institution, licensed or certified or authorized by law to provide professional health care service in this State to an individual during that individuals medical care, treatment, or confinement. (10) Health services mean activities and functions of a health care facility that are directly related to care, treatment, or diagnosis of patients. (11) Material change means a change to a health care project for which a certificate of need has been issued which: (A) constitutes a new health care project as defined in section 9434 of this title; or(B) increases the total costs of the project by more than 10 percent of the approved amount.(12) Nonmaterial change means a modification that does not meet the cost threshold of a material change as defined in subdivision (11) of this section, but otherwise modifies the kind, scope, or capacity of a project for which a certificate of need has been granted under this subchapter. (13) Obligation means an obligation for a capital expenditure which is deemed to have been incurred by or on behalf of a health care facility or health maintenance organization. (14) To offer, when used in connection with health services, means that a health care provider holds itself out as capable of providing, or as having the means for the provision of, specified health services. (Added 1979, No. 65,  1; amended 1985, No. 151 (Adj. Sess.),  16; 1985, No. 234 (Adj. Sess.),  1; 1987, No. 96,  8; 1989, No. 180 (Adj. Sess.),  1; 1989, No. 225 (Adj. Sess.),  25(b); 1991, No. 160 (Adj. Sess.),  24, eff. May 11, 1992; 1993, No. 114 (Adj. Sess.),  3, 4; 1995, No. 180 (Adj. Sess.),  23; 1997, No. 159 (Adj. Sess.),  7, eff. April 29, 1998; 2003, No. 53,  9, 26; 2005, No. 71,  77c; 2007, No. 139 (Adj. Sess.),  1; 2009, No. 49,  13.) 
 9433. Administration
(a) The Green Mountain Care Board shall exercise such duties and powers as necessary for the implementation of the certificate of need program as provided by and consistent with this subchapter. The Board shall issue or deny certificates of need and administer the program. (b) The Board shall adopt rules governing the review of certificate of need applications consistent with and necessary to the proper administration of this subchapter. All rules shall be adopted pursuant to 3 V.S.A. chapter 25. (c) The Board shall consult with hospitals and other health care facilities, professional associations and societies, the Secretary of Human Services, the Office of the Health Care Advocate, and other interested parties in matters of policy affecting the administration of this subchapter. (d) [Repealed.] (Added 1979, No. 65,  1; amended 1987, No. 96  9, 21(a); 1991, No. 160 (Adj. Sess.),  25, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  24, 38(a); 2003, No. 53,  26; 2011, No. 48,  23; 2011, No. 171 (Adj. Sess.),  15, eff. Jan. 1, 2013; 2017, No. 167 (Adj. Sess.),  6.)
 9434. Certificate of need; general rules
(a) A health care facility other than a hospital shall not develop or have developed on its behalf a new health care project without issuance of a certificate of need by the Board. For purposes of this subsection, a new health care project includes the following: (1) The construction, development, purchase, renovation, or other establishment of a health care facility, or any capital expenditure by or on behalf of a health care facility, for which the capital cost exceeds $1,500,000.00. (2) A change from one licensing period to the next in the number of licensed beds of a health care facility through addition or conversion, or through relocation from one physical facility or site to another. (3) The offering of any home health service, or the transfer or conveyance of more than a 50 percent ownership interest in a health care facility other than a hospital or nursing home. (4) The purchase, lease, or other comparable arrangement of a single piece of diagnostic and therapeutic equipment for which the cost, or in the case of a donation the value, is in excess of $1,000,000.00. For purposes of this subdivision, the purchase or lease of one or more articles of diagnostic or therapeutic equipment that are necessarily interdependent in the performance of their ordinary functions or that would constitute any health care facility included under subdivision 9432(8)(B) of this title, as determined by the Board, shall be considered together in calculating the amount of an expenditure. The Boards determination of functional interdependence of items of equipment under this subdivision shall have the effect of a final decision and is subject to appeal under section 9381 of this title. (5) The offering of a health care service or technology having an annual operating expense that exceeds $500,000.00 for either of the next two budgeted fiscal years, if the service or technology was not offered or employed, either on a fixed or a mobile basis, by the health care facility within the previous three fiscal years. (6) The construction, development, purchase, lease, or other establishment of an ambulatory surgical center. (b) A hospital shall not develop or have developed on its behalf a new health care project without issuance of a certificate of need by the Board. For purposes of this subsection, a new health care project includes the following: (1) The construction, development, purchase, renovation, or other establishment of a health care facility, or any capital expenditure by or on behalf of a hospital, for which the capital cost exceeds $3,000,000.00. (2) The purchase, lease, or other comparable arrangement of a single piece of diagnostic and therapeutic equipment for which the cost, or in the case of a donation the value, is in excess of $1,500,000.00. For purposes of this subdivision, the purchase or lease of one or more articles of diagnostic or therapeutic equipment that are necessarily interdependent in the performance of their ordinary functions or that would constitute any health care facility included under subdivision 9432(8)(B) of this title, as determined by the Board, shall be considered together in calculating the amount of an expenditure. The Boards determination of functional interdependence of items of equipment under this subdivision shall have the effect of a final decision and is subject to appeal under section 9381 of this title. (3) The offering of a health care service or technology having an annual operating expense that exceeds $1,000,000.00 for either of the next two budgeted fiscal years, if the service or technology was not offered or employed, either on a fixed or a mobile basis, by the hospital within the previous three fiscal years. (4) A change from one licensing period to the next in the number of licensed beds of a health care facility through addition or conversion, or through relocation from one physical facility or site to another. (5) The offering of any home health service.(c) In the case of a project that requires a certificate of need under this section, expenditures for which are anticipated to be in excess of $30,000,000.00, the applicant first shall secure a conceptual development phase certificate of need, in accordance with the standards and procedures established in this subchapter, that permits the applicant to make expenditures for architectural services, engineering design services, or any other planning services, as defined by the Board, needed in connection with the project. Upon completion of the conceptual development phase of the project, and before offering or further developing the project, the applicant shall secure a final certificate of need in accordance with the standards and procedures established in this subchapter. Applicants shall not be subject to sanctions for failure to comply with the provisions of this subsection if such failure is solely the result of good faith reliance on verified project cost estimates issued by qualified persons, which cost estimates would have led a reasonable person to conclude the project was not anticipated to be in excess of $30,000,000.00 and therefore not subject to this subsection. The provisions of this subsection notwithstanding, expenditures may be made in preparation for obtaining a conceptual development phase certificate of need, which expenditures shall not exceed $1,500,000.00 for non-hospitals or $3,000,000.00 for hospitals. (d) If the Board determines that a person required to obtain a certificate of need under this subchapter has separated a single project into components in order to avoid cost thresholds or other requirements under this subchapter, the person shall be required to submit an application for a certificate of need for the entire project, and the Board may proceed under section 9445 of this title. The Boards determination under this subsection shall have the effect of a final decision and is subject to appeal under section 9381 of this title. (e) The Board may periodically adjust the monetary jurisdictional thresholds contained in this section. In doing so, the Board shall reflect the same categories of health care facilities, services, and programs recognized in this section. Any adjustment by the Board shall not exceed an amount calculated using the cumulative Consumer Price Index rate of inflation. (Added 1979, No. 65,  1; amended 1985, No. 234 (Adj. Sess.),  2; 1987, No. 96,  21(b); 1989, No. 180 (Adj. Sess.),  2; 1991, No. 160 (Adj. Sess.),  38, eff. May 11, 1992; 1993, No. 30,  17, eff. May 21, 1993; 1995, No. 160 (Adj. Sess.),  8; 1995, No. 178 (Adj. Sess.),  132a, 306; 1995, No. 180 (Adj. Sess.),  25; 1997, No. 159 (Adj. Sess.),  8, eff. April 29, 1998; 2003, No. 53,  10, 26; 2003, No. 105 (Adj. Sess.),  14, eff. May 4, 2004; 2005, No. 57,  4, eff. June 13, 2005; 2007, No. 27,  7; 2009, No. 49,  10, 10a; 2011, No. 171 (Adj. Sess.),  16, eff. Jan. 1, 2013; 2017, No. 125 (Adj. Sess.),  2; 2017, No. 167 (Adj. Sess.),  6; 2019, No. 72,  E.329.1, eff. June 18, 2019; 2019, No. 72,  E.329.2, eff. July 1, 2020.) 
 9435. Exclusions
(a) Excluded from this subchapter are offices of physicians, dentists, or other practitioners of the healing arts, meaning the physical places that are occupied by such providers on a regular basis in which such providers perform the range of diagnostic and treatment services usually performed by such providers on an outpatient basis unless they are subject to review under subdivision 9434(a)(4) of this title. (b) Excluded from this subchapter are community mental health or developmental disability center health care projects proposed by a designated agency and supervised by the Commissioner of Mental Health or the Commissioner of Disabilities, Aging, and Independent Living, or both, depending on the circumstances and subject matter of the project, provided the appropriate Commissioner or Commissioners make a written approval of the proposed health care project. The designated agency shall submit a copy of the approval with a letter of intent to the Board. (c) The provisions of subsection (a) of this section shall not apply to offices owned, operated, or leased by a hospital or its subsidiary, parent, or holding company, outpatient diagnostic or therapy programs, kidney disease treatment centers, independent diagnostic laboratories, cardiac catheterization laboratories, radiation therapy facilities, ambulatory surgical centers, and diagnostic imaging facilities and similar facilities owned or operated by a physician, dentist, or other practitioner of the healing arts. (d) Excluded from this subchapter are redesignations, designation revocations, and collaborative agreements of home health agencies subject to the supervision of the Commissioner of Disabilities, Aging, and Independent Living under 33 V.S.A. chapter 5. (e) Upon request under 8 V.S.A.  5102(f) by a Program for All-Inclusive Care for the Elderly (PACE) authorized under federal Medicare law, or by a Prepaid Inpatient Health Plan (PIHP) or Prepaid Ambulatory Health Plan (PAHP) established in accordance with federal Medicare or Medicaid laws and regulations, the Board may approve the exemption of the PACE program, PIHP, or PAHP from the provisions of this subchapter and from any other provisions of this chapter if the Board determines that the purposes of this subchapter and the purposes of any other provision of this chapter will not be materially and adversely affected by the exemption. In approving an exemption, the Board may prescribe such terms and conditions as the Board deems necessary to carry out the purposes of this subchapter and this chapter. (f) Excluded from this subchapter are routine replacements of nonmedical equipment and fixtures, including furnaces, boilers, refrigeration units, kitchen equipment, heating and cooling units, and similar items. These replacements purchased by a hospital shall be included in the hospitals budget and may be reviewed in the budget process set forth in subchapter 7 of this chapter. (Added 1979, No. 65,  1; amended 1981, No. 233 (Adj. Sess.),  14a, eff. May 4, 1982; 1985, No. 234 (Adj. Sess.),  3; 1989, No. 180 (Adj. Sess.),  3; 2003, No. 53,  11; 2005, No. 57,  5, eff. June 13, 2005; 2005, No. 71,  77d; 2005, No. 88 (Adj. Sess.),  3, eff. Feb. 15, 2006; 2005, No. 174 (Adj. Sess.),  50; 2007, No. 15,  18; 2007, No. 178 (Adj. Sess.),  8; 2011, No. 171 (Adj. Sess.),  16a, eff. Jan. 1, 2013; 2017, No. 167 (Adj. Sess.),  6.) 
 9437. Criteria
A certificate of need shall be granted if the applicant demonstrates that the project serves the public good and the Board finds: (1) The proposed project aligns with statewide health care reform goals and principles because the project: (A) takes into consideration health care payment and delivery system reform initiatives;(B) addresses current and future community needs in a manner that balances statewide needs, if applicable; and (C) is consistent with appropriate allocation of health care resources, including appropriate utilization of services, as identified in the Health Resource Allocation Plan developed pursuant to section 9405 of this title. (2) The cost of the project is reasonable, because each of the following conditions is met: (A) The applicants financial condition will sustain any financial burden likely to result from completion of the project. (B) The project will not result in an undue increase in the costs of medical care or an undue impact on the affordability of medical care for consumers. In making a finding under this subdivision, the Board shall consider and weigh relevant factors, including: (i) the financial implications of the project on hospitals and other clinical settings, including the impact on their services, expenditures, and charges; and (ii) whether the impact on services, expenditures, and charges is outweighed by the benefit of the project to the public. (C) Less expensive alternatives do not exist, would be unsatisfactory, or are not feasible or appropriate. (D) If applicable, the applicant has incorporated appropriate energy efficiency measures.(3) There is an identifiable, existing, or reasonably anticipated need for the proposed project that is appropriate for the applicant to provide. (4) The project will improve the quality of health care in the State or provide greater access to health care for Vermonts residents, or both. (5) The project will not have an undue adverse impact on any other existing services provided by the applicant. (6) [Repealed.](7) The applicant has adequately considered the availability of affordable, accessible transportation services to the facility, if applicable. (8) If the application is for the purchase or lease of new Health Care Information Technology, it conforms with the Health Information Technology Plan established under section 9351 of this title. (9) The project will support equal access to appropriate mental health care that meets standards of quality, access, and affordability equivalent to other components of health care as part of an integrated, holistic system of care, as appropriate. (Added 1979, No. 65,  1; amended 1985, No. 234 (Adj. Sess.),  5; 1987, No. 96,  12; 1991, No. 160 (Adj. Sess.),  27, eff. May 11, 1992; 1993, No. 50,  4; 1995, No. 180 (Adj. Sess.),  27, 38(a); 1997, No. 159 (Adj. Sess.),  10, eff. March 15, 1999; 2003, No. 53,  13, eff. July 1, 2005; 2003, No. 53,  26; 2005, No. 71,  277a; 2007, No. 70,  34; 2007, No. 139 (Adj. Sess.),  8; 2009, No. 61,  5; 2009, No. 83 (Adj. Sess.),  3, eff. April 21, 2010; 2011, No. 171 (Adj. Sess.),  17, eff. Jan. 1, 2013; 2017, No. 167 (Adj. Sess.),  6; 2017, No. 200 (Adj. Sess.),  18; 2019, No. 14,  57, eff. April 30, 2019.) 
 9439. Competing applications
(a) The Board shall provide by rule a process by which any person wishing to offer or develop a new health care project may submit a competing application when a substantially similar application is pending. The competing application must be filed and completed in a timely manner, and the original application and all competing applications shall be reviewed concurrently. A competing applicant shall have the same standing for administrative and judicial review under this subchapter as the original applicant. (b) When a letter of intent to compete has been filed, the review process is suspended and the time within which a decision must be made as provided in subdivision 9440(d)(4) of this title is stayed until the competing application has been ruled complete or for a period of 55 days from the date of notification under subdivision 9440(c)(8) of this title as to the original application, whichever is shorter. (c) Nothing in this subchapter shall be construed to restrict the Board to granting a certificate of need to only one applicant for a new health care project. (d) [Repealed.](e) [Repealed.](f) Unless an application meets the requirements of subsection 9440(e) of this title, the Board shall consider disapproving a certificate of need application for a hospital if a project was not identified prospectively as needed at least two years prior to the time of filing in the hospitals four-year capital plan required under subdivision 9454(a)(6) of this title. The Board shall review all hospital four-year capital plans as part of the review under subdivision 9437(2)(B) of this title. (Added 1979, No. 65,  1; amended 1985, No. 234 (Adj. Sess.),  6; 1987, No. 96,  13, 21(b); 1991, No. 160 (Adj. Sess.),  28, eff. May 11, 1992; 1993, No. 50,  1; 1995, No. 180 (Adj. Sess.),  28, 38(a); 2003, No. 53,  14, 26; 2007, No. 139 (Adj. Sess.),  2; 2009, No. 128 (Adj. Sess.),  25, eff. May 27, 2010; 2011, No. 171 (Adj. Sess.),  18, eff. Jan. 1, 2013; 2017, No. 167 (Adj. Sess.),  6.) 
 9440. Procedures
(a) Notwithstanding 3 V.S.A. chapter 25, a certificate of need application shall be in accordance with the procedures of this section. (b)(1) The application shall be in such form and contain such information as the Board establishes. In addition, the Board may require of an applicant any or all of the following information that the Board deems necessary: (A) Institutional utilization data, including an explanation of the unique character of services and a description of case mix. (B) A population based description of the institutions service area.(C) The applicants financial statements.(D) Third party reimbursement data.(E) Copies of feasibility studies, surveys, designs, plans, working drawings, or specifications developed in relation to the proposed project. (F) Annual reports and four-year long range plans.(G) Leases, contracts, or agreements of any kind that might affect quality of care or the nature of services provided. (H) The status of all certificates issued to the applicant under this subchapter during the three years preceding the date of the application. As a condition to deeming an application complete under this section, the Board may require that an applicant meet with the Board to discuss the resolution of the applicants compliance with those prior certificates. (I) Additional information as needed by the Board, including information from affiliated corporations or other persons in the control of or controlled by the applicant. (2) In addition to the information required for submission, an applicant may submit, and the Board shall consider, any other information relevant to the application or the review criteria. (c) The application process shall be as follows:(1) [Repealed.](2)(A) Prior to filing an application for a certificate of need, an applicant shall file an adequate letter of intent with the Board not less than 30 days prior to the date on which the application is to be filed. The letter of intent shall form the basis for determining the applicability of this subchapter to the proposed expenditure or action. A letter of intent shall become invalid if an application is not filed within six months after the date that the letter of intent is received. The Board shall post public notice of such letters of intent on its website electronically within five business days after receipt. The public notice shall identify the applicant, the proposed new health care project, and the date by which a competing application or petition to intervene must be filed. (B) Applicants who agree that their proposals are subject to jurisdiction pursuant to section 9434 of this title shall not be required to file a letter of intent pursuant to subdivision (A) of this subdivision (2) and may file an application without further process. Public notice of the application shall be posted electronically on the Boards website as provided for in subdivision (A) of this subdivision (2) for letters of intent. (3) The Board shall review each letter of intent and, if the letter contains the information required for letters of intent as established by the Board by rule, within 30 days, determine whether the project described in the letter will require a certificate of need. If the Board determines that a certificate of need is required for a proposed expenditure or action, an application for a certificate of need shall be filed before development of the project begins. (4) Within 90 days of receipt of an application, the Board shall notify the applicant that the application contains all necessary information required and is complete, or that the application review period is complete notwithstanding the absence of necessary information. The Board may extend the 90-day application review period for an additional 60 days, or for a period of time in excess of 150 days with the consent of the applicant. The time during which the applicant is responding to the Boards notice that additional information is required shall not be included within the maximum review period permitted under this subsection. The Board may determine that the certificate of need application shall be denied if the applicant has failed to provide all necessary information required to review the application. (5)(A) An applicant seeking expedited review of a certificate of need application may simultaneously file with the Board a request for expedited review and an application. After receiving the request and an application, the Board shall issue public notice of the request and application in the manner set forth in subdivision (2) of this subsection. (B)(i) At least 20 days after the public notice was issued, if no competing application has been filed and no party has sought and been granted, nor is likely to be granted, interested party status, the Board may issue a certificate of need in accordance with such expedited process as the Board deems appropriate, if the Board determines that: (I) the proposed project appears likely not to be contested and does not substantially alter services; or (II) the application relates to a health care facility affected by bankruptcy proceedings.(ii) Any order granting expedited review shall include the procedures and timelines that the Board shall follow for the expedited review process. If practicable, the expedited review process shall include acceptance of public comment until at least 10 days after the expedited application is complete. (C) If a competing application is filed or a person is granted interested party status, the applicant shall follow the certificate of need standards and procedures in this section, except that: (i) a competing applicant or interested party may waive, in writing, the requirement for a public hearing; and (ii) in the case of a health care facility affected by bankruptcy proceedings, the Board may, after notice and an opportunity to be heard, issue a certificate of need with such abbreviated process as the Board deems appropriate, notwithstanding the contested nature of the application. (D) The Board shall review applications for the following projects on an expedited basis, unless a request for intervention as a competing applicant or interested party is granted: (i) the repair, renovation, or replacement of facility infrastructure, or a combination thereof that does not involve new construction; and (ii) the routine replacement of medical equipment if the technology and capability of the new equipment is comparable to that of the replaced equipment. (6) If an applicant fails to respond to an information request under subdivision (4) of this subsection within 90 days, the application shall be deemed inactive unless the applicant, within six months after the expiration of the 90-day period, requests in writing and shows good cause that the application should be reactivated, and the Board grants the request. If an applicant fails to respond to an information request within six months, the application shall become invalid unless the applicant requests, and the Board grants, an extension. (7) For purposes of this section, interested party status shall be granted to persons or organizations representing the interests of persons who demonstrate that they will be substantially and directly affected by the new health care project under review. Persons able to render material assistance to the Board by providing nonduplicative evidence relevant to the determination may be admitted in an amicus curiae capacity but shall not be considered parties. A petition seeking party or amicus curiae status shall be filed not later than five business days after the application is complete. The Board shall grant or deny a petition to intervene under this subdivision within 15 days after the petition is filed. The Board shall grant or deny the petition within an additional 30 days upon finding that good cause exists for the extension. Once interested party status is granted, the Board shall provide the information necessary to enable the party to participate in the review process, including information about procedures, copies of all written correspondence, and copies of all entries in the application record. (8) Once an application has been deemed to be complete, public notice of the application shall be provided electronically on the Boards website. The notice shall identify the applicant, the proposed new health care project, and the date, time, and location of any public hearing. (9) The Office of the Health Care Advocate established under chapter 229 of this title or, in the case of nursing homes, the Long-Term Care Ombudsmans Office established under 33 V.S.A.  7502, is authorized but not required to participate in any administrative or judicial review of an application under this subchapter and shall be considered an interested party in such proceedings upon filing a notice of intervention with the Board. Once either office files a notice of intervention pursuant to this subchapter, the Board shall provide that office with the information necessary to participate in the review process, including information about procedures, copies of all written correspondence, and copies of all entries in the application record for all certificate of need proceedings, regardless of whether expedited status has been granted. (d) The review process shall be as follows:(1) The Board shall review:(A) the application materials provided by the applicant; and(B) any information, evidence, or arguments raised by interested parties or amicus curiae, and any other public input. (2) Except as otherwise provided in subdivision (c)(5) and subsection (e) of this section, the Board shall hold a public hearing during the course of a review. (3) The Board shall make a final decision within 120 days after the date of notification under subdivision (c)(4) of this section. Whenever it is not practicable to complete a review within 120 days, the Board may extend the review period up to an additional 30 days. (4) After reviewing each application, the Board shall make a decision either to issue or to deny the application for a certificate of need. The decision shall be in the form of an approval in whole or in part, or an approval subject to such conditions as the Board may impose in furtherance of the purposes of this subchapter, or a denial. In granting a partial approval or a conditional approval, the Board shall not mandate a new health care project not proposed by the applicant or mandate the deletion of any existing service. Any partial approval or conditional approval must be directly within the scope of the project proposed by the applicant and the criteria used in reviewing the application. (5) If the Board proposes to render a final decision denying an application in whole or in part, or approving a contested application, the Board shall serve the parties with notice of a proposed decision containing proposed findings of fact and conclusions of law, and shall provide the parties an opportunity to file exceptions and present briefs and oral argument to the Board. The Board may also permit the parties to present additional evidence. (6) Notice of the final decision shall be sent to the applicant, competing applicants, and interested parties. The final decision shall include written findings and conclusions stating the basis of the decision. (7) The Board shall establish rules governing the compilation of the record used by the Board in connection with decisions made on applications filed and certificates issued under this subchapter. (e) The Board shall adopt rules governing procedures for the expeditious processing of applications for replacement, repair, rebuilding, or reequipping of any part of a health care facility or health maintenance organization destroyed or damaged as the result of fire, storm, flood, act of God, or civil disturbance, or any other circumstances beyond the control of the applicant where the Board finds that the circumstances require action in less time than normally required for review. If the nature of the emergency requires it, an application under this subsection may be reviewed by the Board only, without notice and opportunity for public hearing or intervention by any party. (f) Any applicant, competing applicant, or interested party aggrieved by a final decision of the Board under this section may appeal pursuant to the provisions of section 9381 of this title. (g) If the Board has reason to believe that the applicant has violated a provision of this subchapter, a rule adopted pursuant to this subchapter, or the terms or conditions of a prior certificate of need, the Board may take into consideration such violation in determining whether to approve, deny, or approve the application subject to conditions. The applicant shall be provided an opportunity to contest whether such violation occurred, unless such an opportunity has already been provided. The Board may impose as a condition of approval of the application that a violation be corrected or remediated before the certificate may take effect. (h) As used in this section, an application or proposed project is contested if one or more interested parties have intervened in the proceeding. If an interested party withdraws from the application or signifies its support of the application in writing before the Board renders a final decision, the application shall not be considered contested and the Board shall not be required to hold a public hearing on the application pursuant to subdivision (d)(2) of this section or issue a proposed decision pursuant to subdivision (d)(5) of this section. (Added 1979, No. 65,  1; amended 1985, No. 234 (Adj. Sess.),  7; 1987, No. 96,  14; 1991, No. 160 (Adj. Sess.),  29-32, 38, eff. May 11, 1992; 1993, No. 50,  2, 3; 1995, No. 180 (Adj. Sess.),  29; 1997, No. 159 (Adj. Sess.),  11, eff. April 29, 1998; 2003, No. 53,  15, 26; 2005, No. 71,  77e; 2007, No. 27,  8; 2007, No. 139 (Adj. Sess.),  3-5, 5d; 2007, No. 139 (Adj. Sess.),  5a, eff. May 9, 2008; 2007, No. 139 (Adj. Sess.),  5e, eff. July 1, 2009; 2009, No. 49,  11; 2009, No. 128 (Adj. Sess.),  21, eff. May 27, 2010; 2011, No. 48,  24; 2011, No. 171 (Adj. Sess.),  19, eff. Jan. 1, 2013; 2013, No. 79,  35e, eff. Jan. 1, 2014; 2015, No. 54,  40; 2017, No. 167 (Adj. Sess.),  6.) 
 9440a. Applications, information, and testimony; oath required
(a) Each application filed under this subchapter, any written information required or permitted to be submitted in connection with an application or with the monitoring of an order, decision, or certificate issued by the Board, and any testimony taken before the Board or a hearing officer appointed by the Board shall be submitted or taken under oath. The form and manner of the submission shall be prescribed by the Board. The authority granted to the Board under this section is in addition to any other authority granted to the Board under law. (b) Each application shall be filed by the applicants chief executive officer under oath, as provided by subsection (a) of this section. The Board may direct that information submitted with the application be submitted under oath by persons with personal knowledge of such information. (c) A person who knowingly makes a false statement under oath or who knowingly submits false information under oath to the Board or a hearing officer appointed by the Board or who knowingly testifies falsely in any proceeding before the Board or a hearing officer appointed by the Board shall be guilty of perjury and punished as provided in 13 V.S.A.  2901. (Added 2003, No. 53,  16; amended 2011, No. 48,  25; 2011, No. 171 (Adj. Sess.),  20, eff. Jan. 1, 2013.) 
 9440b. Information technology; review procedures
Notwithstanding the procedures in section 9440 of this title, the Board shall establish by rule standards and expedited procedures for reviewing applications for the purchase or lease of health care information technology that otherwise would be subject to review under this subchapter. Such applications shall not be granted or approved unless they are consistent with the Health Information Technology Plan developed under section 9351 of this title and the Health Resource Allocation Plan. (Added 2005, No. 71,  277b; amended 2007, No. 70,  35; 2009, No. 61,  6; 2011, No. 171 (Adj. Sess.),  20a, eff. Jan. 1, 2013; 2017, No. 167 (Adj. Sess.),  6.) 
 9441. Fees
(a) The Board shall charge a fee for the filing of certificate of need applications. The fee shall be calculated at the rate of 0.125 percent of project costs. (b) The maximum fee shall not exceed $20,000.00 and the minimum filing fee is $250.00 regardless of project cost. No fee shall be charged on projects amended as part of the review process. (c) The Board may retain such additional professional or other staff as needed to assist in particular proceedings under this subchapter and may assess and collect the reasonable expenses for such additional staff from the applicant. The Board, on petition by the applicant and opportunity for hearing, may reduce such assessment upon a proper showing by the applicant that such expenses were excessive or unnecessary. The authority granted to the Board under this section is in addition to any other authority granted to the Board under law. (d) All fees collected pursuant to this section shall be deposited into the Green Mountain Care Board Regulatory and Administrative Fund established by subsection 9404(d) of this title and may be used by the Board to administer its obligations, responsibilities, and duties as required by law. (Added 1985, No. 234 (Adj. Sess.),  7a, eff. Oct. 1, 1986; amended 1991, No. 160 (Adj. Sess.),  33, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  30, 38(a); 1995, No. 186 (Adj. Sess.),  16; 1999, No. 49,  223; 2003, No. 53,  17, eff. June 4, 2003; 2011, No. 171 (Adj. Sess.),  20b, eff. Jan. 1, 2013; 2017, No. 167 (Adj. Sess.),  6.) 
 9442. Bonds
In any circumstance in which bonds are to be or may be issued in connection with a new health care project subject to the provisions of this subchapter, the certificate of need shall include the requirement that all information required to be provided to the bonding agency shall be provided also to the Board within a reasonable period of time. The Board shall be authorized to obtain any information from the bonding agency deemed necessary to carry out the duties of monitoring and oversight of a certificate of need. The bonding agency shall consider the recommendations of the Board in connection with any such proposed authorization. (Added 1979, No. 65,  1; amended 1985, No. 234 (Adj. Sess.),  8; 1987, No. 96,  15, 21(a), 22; 1991, No. 160 (Adj. Sess.),  34, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  38(a); 2003, No. 53,  18, 26; 2011, No. 171 (Adj. Sess.),  20c, eff. Jan. 1, 2013.) 
 9443. Expiration of certificates of need
(a) Unless otherwise specified in the certificate of need, a project shall be implemented within five years or the certificate shall be invalid. (b) No later than 180 days before the expiration date of a certificate of need, an applicant that has not yet implemented the project approved in the certificate of need may petition the Board for an extension of the implementation period. The Board may grant an extension in its discretion. (c) Certificates of need shall expire on the date the Board accepts the final implementation report filed in connection with the project implemented pursuant to the certificate. (d) An action or expenditure that is related to a service or expenditure that was the subject of a certificate of need shall not be considered a material or nonmaterial change to that project if the original certificate of need expired, as provided in this section, at least two years before the action is proposed. The proposed action shall require a certificate of need only if the change itself would be considered a new health care project under section 9434 of this title. (Added 1979, No. 65,  1; amended 1985, No. 234 (Adj. Sess.),  9; 1987, No. 96,  1; 1991, No. 160 (Adj. Sess.),  35, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  31; 2009, No. 49,  12; 2011, No. 171 (Adj. Sess.),  20d, eff. Jan. 1, 2013; 2013, No. 192 (Adj. Sess.),  25.) 
 9444. Revocation of certificates; material change
(a) The Board may revoke a certificate of need for substantial noncompliance with the scope of the project as designated in the application, or for failure to comply with the conditions set forth in the certificate of need granted by the Board. (b)(1) In the event that after a project has been approved, its proponent wishes to materially change the approved project, all such changes are subject to review under this subchapter. (2) Applicants shall notify the Board of a nonmaterial change to the approved project. If the Board decides to review a nonmaterial change, the Board may provide for any necessary process, including a public hearing, before approval. Where the Board decides not to review a change, such change will be deemed to have been granted a certificate of need. (Added 1979, No. 65,  1; amended 1987, No. 96,  17; 1991, No. 160 (Adj. Sess.),  38(a), eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  38(a); 2003, No. 53,  26; 2007, No. 139 (Adj. Sess.),  6; 2009, No. 49,  14; 2011, No. 171 (Adj. Sess.),  21, eff. Jan. 1, 2013.) 
 9445. Enforcement
(a) Any person who offers or develops any new health care project within the meaning of this subchapter without first obtaining a certificate of need as required by this subchapter, or who otherwise violates any of the provisions of this subchapter or any rule adopted or order issued pursuant to this subchapter, may be subject to one or both of the following administrative sanctions by the Board, after notice and an opportunity to be heard: (1) The Board may order that no license or certificate permitted to be issued by any State agency may be issued to any health care facility to operate, offer, or develop any new health care project for a specified period of time, or that remedial conditions be attached to the issuance of such licenses or certificates. (2) The Board may order that payments or reimbursements to the entity for claims made under any health insurance policy, subscriber contract, or health benefit plan offered or administered by any public or private health insurer, including the Medicaid program and any other health benefit program administered by the State be denied, reduced, or limited, and in the case of a hospital that the hospitals annual budget approved under subchapter 7 of this chapter be adjusted, modified, or reduced. (b) In addition to all other sanctions, if any person offers or develops any new health care project without first having been issued a certificate of need or certificate of exemption for the project, or violates any other provision of this subchapter or any rule adopted or order issued pursuant to this subchapter, the Board, the Office of the Health Care Advocate, the State Long-Term Care Ombudsman, and health care providers and consumers located in the State shall have standing to maintain a civil action in the Superior Court of the county in which such alleged violation has occurred, or in which such person may be found, to enjoin, restrain, or prevent such violation. Upon written request by the Board, it shall be the duty of the Vermont Attorney General to furnish appropriate legal services and to prosecute an action for injunctive relief to an appropriate conclusion, which shall not be reimbursed under subdivision (a)(2) of this section. (c)(1) After notice and an opportunity for hearing, the Board may impose on a person who violates a provision of this subchapter or a rule adopted or order issued pursuant to this subchapter, one or more of the following: (A) a civil administrative penalty of not more than $75,000.00, or in the case of a continuing violation, a civil administrative penalty of not more than $200,000.00 or one-tenth of one percent of the gross annual revenues of the health care facility, whichever is greater, which shall not be reimbursed under subdivision (a)(2) of this section; (B) an order that the person cease and desist from further violations; and(C) any such other actions necessary to remediate a violation.(2) A person aggrieved by a decision of the Board under this subchapter may appeal under section 9381 of this title. (d) The Board shall adopt by rule criteria for assessing the circumstances in which a violation of a provision of this subchapter, a rule adopted pursuant to this subchapter, or the terms or conditions of a certificate of need require that a penalty under this section shall be imposed, and criteria for assessing the circumstances in which a penalty under this section may be imposed. (Added 1979, No. 65,  1; amended 1991, No. 160 (Adj. Sess.),  36, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  38(a); 2003, No. 53,  19; 2007, No. 139 (Adj. Sess.),  5c, 7; 2011, No. 171 (Adj. Sess.),  21a, eff. Jan. 1, 2013; 2013, No. 79,  35f, eff. Jan. 1, 2014; 2015, No. 54,  41; 2017, No. 167 (Adj. Sess.),  6.) 
 9446. Home health agencies; geographic service areas
The terms of a certificate of need relating to the boundaries of the geographic service area of a home health agency may be modified by the Board, in consultation with the Commissioner of Disabilities, Aging, and Independent Living, after notice and opportunity for hearing, or upon written application to the Board by the affected home health agencies or consumers, demonstrating a substantial need for the modification. Service area boundaries may be modified by the Board to take account of natural or physical barriers that may make the provision of existing services uneconomical or impractical, to prevent or minimize unnecessary duplication of services or facilities, or otherwise to promote the public interest. The Board shall issue an order granting such application only upon a finding that the granting of such application is consistent with the purposes of 33 V.S.A. chapter 63, subchapter 1A and the Health Resource Allocation Plan established under section 9405 of this title and after notice and an opportunity to participate on the record by all interested persons, including affected local governments. (Added 2005, No. 57,  6, eff. June 13, 2005; amended 2011, No. 171 (Adj. Sess.),  22, eff. Jan. 1, 2013; 2017, No. 167 (Adj. Sess.),  6.) 
 9451. Definitions
As used in this subchapter:(1) Hospital means a hospital licensed under chapter 43 of this title, except a hospital that is conducted, maintained, or operated by the State of Vermont. (2) Volume means the number of inpatient days of care or admissions and the number of all inpatient and outpatient ancillary services rendered to patients by a hospital. (Added 1983, No. 93,  1, eff. May 4, 1983; amended 1991, No. 160 (Adj. Sess.),  9, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  33; 2019, No. 140 (Adj. Sess.),  2, eff. July 6, 2020.) 
 9453. Powers and duties
(a) The Board shall:(1) adopt uniform formats that hospitals shall use to report financial, scope-of-services, and utilization data and information; (2) designate a data organization with which hospitals shall file financial, scope-of-services, and utilization data and information; and (3) designate a data organization or organizations to process, analyze, store, or retrieve data or information. (b) To effectuate the purposes of this subchapter, the Board may adopt rules under 3 V.S.A. chapter 25. (Added 1983, No. 93  1, eff. May 4, 1983; amended 1991, No. 160 (Adj. Sess.),  11, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  34, 38(a); 2003, No. 53,  22, 26; 2011, No. 171 (Adj. Sess.),  23, eff. May 16, 2012.) 
 9454. Hospitals; duties
(a) Hospitals shall file the following information at the time and place and in the manner established by the Board: (1) a budget for the forthcoming fiscal year;(2) financial information, including costs of operation, revenues, assets, liabilities, fund balances, other income, rates, charges, units of services, and wage and salary data; (3) scope-of-service and volume-of-service information, including inpatient services, outpatient services, and ancillary services by type of service provided; (4) utilization information;(5) new hospital services and programs proposed for the forthcoming fiscal year;(6) known depreciation schedules on existing buildings, a four-year capital expenditure projection, and a one-year capital expenditure plan; and (7) such other information as the Board may require.(b) Hospitals shall adopt a fiscal year which shall begin on October 1. (Added 1983, No. 93,  1, eff. May 4, 1983; amended 1991, No. 160 (Adj. Sess.),  17, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  38; 2003, No. 53,  23; 2011, No. 171 (Adj. Sess.),  23, eff. May 16, 2012; 2015, No. 97 (Adj. Sess.),  51a.)
 9456. Budget review
(a) The Board shall conduct reviews of each hospitals proposed budget based on the information provided pursuant to this subchapter and in accordance with a schedule established by the Board.  [Subsection (b) effective until January 1, 2023; for subsection (b) effective January 1, 2023 see below.] (b) In conjunction with budget reviews, the Board shall:(1) review utilization information;(2) consider the Health Resource Allocation Plan identifying Vermonts critical health needs, goods, services, and resources developed pursuant to section 9405 of this title; (3) consider the expenditure analysis for the previous year and the proposed expenditure analysis for the year under review; (4) consider any reports from professional review organizations;(5) solicit public comment on all aspects of hospital costs and use and on the budgets proposed by individual hospitals; (6) meet with hospitals to review and discuss hospital budgets for the forthcoming fiscal year; (7) give public notice of the meetings with hospitals, and invite the public to attend and to comment on the proposed budgets; (8) consider the extent to which costs incurred by the hospital in connection with services provided to Medicaid beneficiaries are being charged to non-Medicaid health benefit plans and other non-Medicaid payers; (9) require each hospital to file an analysis that reflects a reduction in net revenue needs from non-Medicaid payers equal to any anticipated increase in Medicaid, Medicare, or another public health care program reimbursements, and to any reduction in bad debt or charity care due to an increase in the number of insured individuals; (10) require each hospital to provide information on administrative costs, as defined by the Board, including specific information on the amounts spent on marketing and advertising costs; and (11) require each hospital to create or maintain connectivity to the States Health Information Exchange Network in accordance with the criteria established by the Vermont Information Technology Leaders, Inc., pursuant to subsection 9352(i) of this title, provided that the Board shall not require a hospital to create a level of connectivity that the States Exchange is unable to support.  [Subsection (b) effective January 1, 2023; for subsection (b) effective until January 1, 2023 see above.] (b) In conjunction with budget reviews, the Board shall:(1) review utilization information;(2) consider the Health Resource Allocation Plan identifying Vermonts critical health needs, goods, services, and resources developed pursuant to section 9405 of this title; (3) consider the expenditure analysis for the previous year and the proposed expenditure analysis for the year under review; (4) consider any reports from professional review organizations;(5) solicit public comment on all aspects of hospital costs and use and on the budgets proposed by individual hospitals; (6) meet with hospitals to review and discuss hospital budgets for the forthcoming fiscal year; (7) give public notice of the meetings with hospitals, and invite the public to attend and to comment on the proposed budgets; (8) consider the extent to which costs incurred by the hospital in connection with services provided to Medicaid beneficiaries are being charged to non-Medicaid health benefit plans and other non-Medicaid payers; (9) require each hospital to file an analysis that reflects a reduction in net revenue needs from non-Medicaid payers equal to any anticipated increase in Medicaid, Medicare, or another public health care program reimbursements, and to any reduction in bad debt or charity care due to an increase in the number of insured individuals; (10) require each hospital to provide information on administrative costs, as defined by the Board, including specific information on the amounts spent on marketing and advertising costs; (11) require each hospital to create or maintain connectivity to the States Health Information Exchange Network in accordance with the criteria established by the Vermont Information Technology Leaders, Inc., pursuant to subsection 9352(i) of this title, provided that the Board shall not require a hospital to create a level of connectivity that the States Exchange is unable to support; (12) review the hospitals investments in workforce development initiatives, including nursing workforce pipeline collaborations with nursing schools and compensation and other support for nurse preceptors; and (13) consider the salaries for the hospitals executive and clinical leadership and the hospitals salary spread, including a comparison of median salaries to the medians of northern New England states. (c) Individual hospital budgets established under this section shall:(1) be consistent with the Health Resource Allocation Plan;(2) take into consideration national, regional, or in-state peer group norms, according to indicators, ratios, and statistics established by the Board; (3) promote efficient and economic operation of the hospital;(4) reflect budget performances for prior years;(5) include a finding that the analysis provided in subdivision (b)(9) of this section is a reasonable methodology for reflecting a reduction in net revenues for non-Medicaid payers; and (6) demonstrate that they support equal access to appropriate mental health care that meets standards of quality, access, and affordability equivalent to other components of health care as part of an integrated, holistic system of care. (d)(1) Annually, the Board shall establish a budget for each hospital on or before September 15, followed by a written decision by October 1. Each hospital shall operate within the budget established under this section. (2)(A) It is the General Assemblys intent that hospital cost containment conduct is afforded state action immunity under applicable federal and State antitrust laws, if: (i) the Board requires or authorizes the conduct in any hospital budget established by the Board under this section; (ii) the conduct is in accordance with standards and procedures prescribed by the Board; and (iii) the conduct is actively supervised by the Board.(B) A hospitals violation of the Boards standards and procedures shall be subject to enforcement pursuant to subsection (h) of this section. (3)(A) The Office of the Health Care Advocate shall have the right to receive copies of all materials related to the hospital budget review and may: (i) ask questions of employees of the Green Mountain Care Board related to the Boards hospital budget review; (ii) submit written questions to the Board that the Board will ask of hospitals in advance of any hearing held in conjunction with the Boards hospital review: (iii) submit written comments for the Boards consideration; and(iv) ask questions and provide testimony in any hearing held in conjunction with the Boards hospital budget review. (B) The Office of the Health Care Advocate shall not further disclose any confidential or proprietary information provided to the Office pursuant to this subdivision (3). (e) The Board may establish a process to define, on an annual basis, criteria for hospitals to meet, such as utilization and inflation benchmarks. The Board may waive one or more of the review processes listed in subsection (b) of this section. (f) The Board may, upon application, adjust a budget established under this section upon a showing of need based upon exceptional or unforeseen circumstances in accordance with the criteria and processes established under section 9405 of this title. (g) The Board may request, and a hospital shall provide, information determined by the Board to be necessary to determine whether the hospital is operating within a budget established under this section. For purposes of this subsection, subsection (h) of this section, and subdivision 9454(a)(7) of this title, the Boards authority shall extend to an affiliated corporation or other person in the control of or controlled by the hospital to the extent that such authority is necessary to carry out the purposes of this subsection, subsection (h) of this section, or subdivision 9454(a)(7) of this title. As used in this subsection, a rebuttable presumption of control is created if the entity, hospital, or other person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing 20 percent or more of the voting securities or membership interest or other governing interest of the hospital or other controlled entity. (h)(1) If a hospital violates a provision of this section, the Board may maintain an action in the Superior Court of the county in which the hospital is located to enjoin, restrain, or prevent such violation. (2)(A) After notice and an opportunity for hearing, the Board may impose on a person who knowingly violates a provision of this subchapter, or a rule adopted pursuant to this subchapter, a civil administrative penalty of no more than $40,000.00, or in the case of a continuing violation, a civil administrative penalty of no more than $100,000.00 or one-tenth of one percent of the gross annual revenues of the hospital, whichever is greater. This subdivision shall not apply to violations of subsection (d) of this section caused by exceptional or unforeseen circumstances. (B)(i) The Board may order a hospital to:(I)(aa) cease material violations of this subchapter or of a regulation or order issued pursuant to this subchapter; or (bb) cease operating contrary to the budget established for the hospital under this section, provided such a deviation from the budget is material; and (II) take such corrective measures as are necessary to remediate the violation or deviation and to carry out the purposes of this subchapter. (ii) Orders issued under this subdivision (2)(B) shall be issued after notice and an opportunity to be heard, except where the Board finds that a hospitals financial or other emergency circumstances pose an immediate threat of harm to the public or to the financial condition of the hospital. Where there is an immediate threat, the Board may issue orders under this subdivision (2)(B) without written or oral notice to the hospital. Where an order is issued without notice, the hospital shall be notified of the right to a hearing at the time the order is issued. The hearing shall be held within 30 days of receipt of the hospitals request for a hearing, and a decision shall be issued within 30 days after conclusion of the hearing. The Board may increase the time to hold the hearing or to render the decision for good cause shown. Hospitals may appeal any decision in this subsection to Superior Court. Appeal shall be on the record as developed by the Board in the administrative proceeding and the standard of review shall be as provided in 8 V.S.A.  16. (3)(A) The Board shall require the officers and directors of a hospital to file under oath, on a form and in a manner prescribed by the Board, any information designated by the Board and required pursuant to this subchapter. The authority granted to the Board under this subsection is in addition to any other authority granted to the Board under law. (B) A person who knowingly makes a false statement under oath or who knowingly submits false information under oath to the Board or to a hearing officer appointed by the Board or who knowingly testifies falsely in any proceeding before the Board or a hearing officer appointed by the Board shall be guilty of perjury and punished as provided in 13 V.S.A.  2901. (Added 1983, No. 93,  1, eff. May 4, 1983; amended 1987, No. 96,  19; 1991, No. 160 (Adj. Sess.),  13, eff. May 11, 1992; 1995, No. 180 (Adj. Sess.),  35; 1999, No. 81 (Adj. Sess.),  1, eff. Oct. 1, 2000; 2001, No. 63,  123b; 2003, No. 53,  24; 2005, No. 71,  77f; 2005, No. 191 (Adj. Sess.),  25; 2007, No. 27,  9; 2009, No. 128 (Adj. Sess.),  16, 22-24, eff. May 27, 2010; 2011, No. 21,  17, eff. May 11, 2011; 2011, No. 48,  25a; 2011, No. 171 (Adj. Sess.),  23, eff. May 16, 2012; 2013, No. 79,  34, eff. June 7, 2013; 2015, No. 54,  42; 2015, No. 152 (Adj. Sess.),  2a; 2017, No. 167 (Adj. Sess.),  5, eff. May 22, 2018; 2017, No. 200 (Adj. Sess.),  19; 2019, No. 14,  58, eff. April 30, 2019; 2021, No. 183 (Adj. Sess.),  30, eff. January 1, 2023.) 
 9457. Information available to the public
(a) Information required to be filed under this subchapter shall be made available to the public upon request in accordance with 1 V.S.A. chapter 5, subchapter 3 (Public Records Act), except that information that directly or indirectly identifies individual patients or health care practitioners shall be kept confidential. (b) Notwithstanding 1 V.S.A. chapter 5, subchapter 2 (Vermont Open Meeting Law) or any provision of this subchapter to the contrary, the Board may examine and discuss confidential information outside a public hearing or meeting. (Added 1983, No. 93,  1, eff. May 4, 1983; amended 2019, No. 159 (Adj. Sess.),  9, eff. Nov. 1, 2020.) 
 9461. Quality measures
(a) The Department of Financial Regulation shall develop performance quality measures to evaluate and ensure that health insurers, including managed care organizations that contract with health insurers to administer the insurers mental health benefits, comply with the provisions of 8 V.S.A.  4089b and related rules. (b) The Departments of Health and of Mental Health shall develop clinical and performance quality measures to evaluate and ensure that health care professionals and health care facilities in Vermont provide high quality mental health and substance abuse treatment services to their patients. (Added 2011, No. 171 (Adj. Sess.),  11b, eff. May 16, 2012; amended 2015, No. 11,  20.) 
 9462. Quality improvement projects
In addition to reviewing mental health and substance abuse treatment data pursuant to subdivision 9375(b)(12) of this title, the Green Mountain Care Board shall consider the results of any quality improvement projects not otherwise confidential or privileged undertaken by managed care organizations for mental health and substance abuse care and treatment pursuant to 8 V.S.A.  4089b(d)(1)(B)(vii) and subsection 9414(i) of this title. (Added 2011, No. 171 (Adj. Sess.),  11b, eff. May 16, 2012.) 
 9471. Definitions
As used in this subchapter:(1) Beneficiary means an individual enrolled in a health plan in which coverage of prescription drugs is administered by a pharmacy benefit manager and includes his or her dependent or other person provided health coverage through that health plan.  [Subdivision (2) effective until January 1, 2023; for subdivision (2) effective January 1, 2023 see below.] (2) Health insurer is defined by section 9402 of this title and shall include:(A) a health insurance company, a nonprofit hospital and medical service corporation, and health maintenance organizations; (B) an employer, labor union, or other group of persons organized in Vermont that provides a health plan to beneficiaries who are employed or reside in Vermont; (C) the State of Vermont and any agent or instrumentality of the State that offers, administers, or provides financial support to State government; and (D) Medicaid, and any other public health care assistance program. [Subdivision (2) effective January 1, 2023; for subdivision (2) effective until January 1, 2023 see above.] (2) Health insurer is defined by section 9402 of this title and shall include:(A) a health insurance company, a nonprofit hospital and medical service corporation, and health maintenance organizations; (B) an employer, labor union, or other group of persons organized in Vermont that provides a health plan to beneficiaries who are employed or reside in Vermont; and (C) the State of Vermont and any agent or instrumentality of the State that offers, administers, or provides financial support to State government. (3) Health plan means a health benefit plan offered, administered, or issued by a health insurer doing business in Vermont. (4) Pharmacy benefit management means an arrangement for the procurement of prescription drugs at a negotiated rate for dispensation within this State to beneficiaries, the administration or management of prescription drug benefits provided by a health plan for the benefit of beneficiaries, or any of the following services provided with regard to the administration of pharmacy benefits: (A) mail service pharmacy;(B) claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to beneficiaries; (C) clinical formulary development and management services;(D) rebate contracting and administration;(E) certain patient compliance, therapeutic intervention, and generic substitution programs; and (F) disease or chronic care management programs. [Subdivision (5) effective until January 1, 2023; for subdivision (5) effective anuary 1, 2023 see below.] (5) Pharmacy benefit manager means an entity that performs pharmacy benefit management. The term includes a person or entity in a contractual or employment relationship with an entity performing pharmacy benefit management for a health plan.  [Subdivision (5) effective January 1, 2023; for subdivision (5) effective until January 1, 2023 see above.] (5) Pharmacy benefit manager means an entity that performs pharmacy benefit management, except an entity that provides pharmacy benefit management services for Vermont Medicaid. The term includes a person or entity in a contractual or employment relationship with an entity performing pharmacy benefit management for a health plan. (6) Maximum allowable cost means the per unit drug product reimbursement amount, excluding dispensing fees, for a group of equivalent multisource generic prescription drugs.  [Subdivision (7) effective January 1, 2023.] (7) Pharmacy benefit manager affiliate means a pharmacy or pharmacist that, directly or indirectly, through one or more intermediaries, is owned or controlled by, or is under common ownership or control with, a pharmacy benefit manager. (Added 2007, No. 80,  8; amended 2013, No. 79,  21, eff. Jan. 1, 2014; 2015, No. 54,  2, eff. June 5, 2015; 2021, No. 131 (Adj. Sess.),  2, eff. January 1, 2023.) 
 9472. Pharmacy benefit managers; required practices with respect to health insurers and covered persons
(a) A pharmacy benefit manager that provides pharmacy benefit management for a health plan has a fiduciary duty to its health insurer client that includes a duty to be fair and truthful toward the health insurer, to act in the health insurers best interests, and to perform its duties with care, skill, prudence, and diligence. In the case of a health benefit plan offered by a health insurer as defined by subdivision 9471(2)(A) of this title, the health insurer shall remain responsible for administering the health benefit plan in accordance with the health insurance policy or subscriber contract or plan and in compliance with all applicable provisions of Title 8 and this title. (b) A pharmacy benefit manager shall provide notice to the health insurer that the terms contained in subsection (c) of this section may be included in the contract between the pharmacy benefit manager and the health insurer. (c) A pharmacy benefit manager that provides pharmacy benefit management for a health plan shall do all of the following: (1) Provide all financial and utilization information requested by a health insurer relating to the provision of benefits to beneficiaries through that health insurers health plan and all financial and utilization information relating to services to that health insurer. A pharmacy benefit manager providing information under this subsection may designate that material as confidential. Information designated as confidential by a pharmacy benefit manager and provided to a health insurer under this subsection shall not be disclosed by the health insurer to any person without the consent of the pharmacy benefit manager, except that disclosure may be made by the health insurer: (A) in a court filing under the consumer protection provisions of 9 V.S.A. chapter 63, provided that the information shall be filed under seal and that prior to the information being unsealed, the court shall give notice and an opportunity to be heard to the pharmacy benefit manager on why the information should remain confidential; (B) to State and federal government officials;(C) when authorized by 9 V.S.A. chapter 63;(D) when ordered by a court for good cause shown; or(E) when ordered by the Commissioner as to a health insurer as defined in subdivision 9471(2)(A) of this title pursuant to the provisions of Title 8 and this title. (2) Notify a health insurer in writing of any proposed or ongoing activity, policy, or practice of the pharmacy benefit manager that presents, directly or indirectly, any conflict of interest with the requirements of this section. (3) With regard to the dispensation of a substitute prescription drug for a prescribed drug to a beneficiary in which the substitute drug costs more than the prescribed drug and the pharmacy benefit manager receives a benefit or payment directly or indirectly, disclose to the health insurer the cost of both drugs and the benefit or payment directly or indirectly accruing to the pharmacy benefit manager as a result of the substitution. (4) If the pharmacy benefit manager derives any payment or benefit for the dispensation of prescription drugs within the State based on volume of sales for certain prescription drugs or classes or brands of drugs within the State, pass that payment or benefit on in full to the health insurer. (5) Disclose to the health insurer all financial terms and arrangements for remuneration of any kind that apply between the pharmacy benefit manager and any prescription drug manufacturer that relate to benefits provided to beneficiaries under or services to the health insurers health plan, including formulary management and drug-switch programs, educational support, claims processing, and pharmacy network fees charged from retail pharmacies and data sales fees. A pharmacy benefit manager providing information under this subsection may designate that material as confidential. Information designated as confidential by a pharmacy benefit manager and provided to a health insurer under this subsection shall not be disclosed by the health insurer to any person without the consent of the pharmacy benefit manager, except that disclosure may be made by the health insurer: (A) in a court filing under the consumer protection provisions of 9 V.S.A. chapter 63, provided that the information shall be filed under seal and that prior to the information being unsealed, the court shall give notice and an opportunity to be heard to the pharmacy benefit manager on why the information should remain confidential; (B) when authorized by 9 V.S.A. chapter 63;(C) when ordered by a court for good cause shown; or(D) when ordered by the Commissioner as to a health insurer as defined in subdivision 9471(2)(A) of this title pursuant to the provisions of Title 8 and this title. (d) At least annually, a pharmacy benefit manager that provides pharmacy benefit management for a health plan shall disclose to the health insurer, the Department of Financial Regulation, and the Green Mountain Care Board the aggregate amount the pharmacy benefit manager retained on all claims charged to the health insurer for prescriptions filled during the preceding calendar year in excess of the amount the pharmacy benefit manager reimbursed pharmacies. (e) A pharmacy benefit manager contract with a health insurer shall not contain any provision purporting to reserve discretion to the pharmacy benefit manager to move a drug to a higher tier or remove a drug from its drug formulary any more frequently than two times per year. (f)(1) A pharmacy benefit manager shall not require a covered person purchasing a covered prescription drug to pay an amount greater than the lesser of: (A) the cost-sharing amount under the terms of the health benefit plan;(B) the maximum allowable cost for the drug; or(C) the amount the covered person would pay for the drug if the covered person were paying the cash price. (2) Any amount paid by a covered person under subdivision (1) of this subsection shall be attributed toward any deductible and, to the extent consistent with Sec. 2707 of the Public Health Service Act (42 U.S.C.  300gg-6), the annual out-of-pocket maximums under the covered persons health benefit plan. (g) Compliance with the requirements of this section is required for pharmacy benefit managers entering into contracts with a health insurer in this State for pharmacy benefit management in this State. (Added 2007, No. 80,  8; amended 2013, No. 144 (Adj. Sess.),  12, eff. May 27, 2014; 2021, No. 131 (Adj. Sess.),  2, eff. January 1, 2023.) 
 9472. Pharmacy benefit managers; required practices with respect to health insurers
(a) A pharmacy benefit manager that provides pharmacy benefit management for a health plan shall discharge its duties with reasonable care and diligence and be fair and truthful under the circumstances then prevailing that a pharmacy benefit manager acting in like capacity and familiar with such matters would use in the conduct of an enterprise of a like character and with like aims. In the case of a health benefit plan offered by a health insurer as defined by subdivision 9471(2)(A) of this title, the health insurer shall remain responsible for administering the health benefit plan in accordance with the health insurance policy or subscriber contract or plan and in compliance with all applicable provisions of Title 8 and this title. (b) A pharmacy benefit manager shall provide notice to the health insurer that the terms contained in subsection (c) of this section may be included in the contract between the pharmacy benefit manager and the health insurer. (c) A pharmacy benefit manager that provides pharmacy benefit management for a health plan shall: (1) Provide all financial and utilization information requested by a health insurer relating to the provision of benefits to beneficiaries through that health insurers health plan and all financial and utilization information relating to services to that health insurer. A pharmacy benefit manager providing information under this subsection may designate that material as confidential. Information designated as confidential by a pharmacy benefit manager and provided to a health insurer under this subsection may not be disclosed by the health insurer to any person without the consent of the pharmacy benefit manager, except that disclosure may be made by the health insurer: (A) in a court filing under the consumer protection provisions of 9 V.S.A. chapter 63, provided that the information shall be filed under seal and that prior to the information being unsealed, the court shall give notice and an opportunity to be heard to the pharmacy benefit manager on why the information should remain confidential; (B) when authorized by 9 V.S.A. chapter 63;(C) when ordered by a court for good cause shown; or(D) when ordered by the Commissioner as to a health insurer as defined in subdivision 9471(2)(A) of this title pursuant to the provisions of Title 8 and this title. (2) Notify a health insurer in writing of any proposed or ongoing activity, policy, or practice of the pharmacy benefit manager that presents, directly or indirectly, any conflict of interest with the requirements of this section. (3) With regard to the dispensation of a substitute prescription drug for a prescribed drug to a beneficiary in which the substitute drug costs more than the prescribed drug and the pharmacy benefit manager receives a benefit or payment directly or indirectly, disclose to the health insurer the cost of both drugs and the benefit or payment directly or indirectly accruing to the pharmacy benefit manager as a result of the substitution. (4) Unless the contract provides otherwise, if the pharmacy benefit manager derives any payment or benefit for the dispensation of prescription drugs within the State based on volume of sales for certain prescription drugs or classes or brands of drugs within the State, pass that payment or benefit on in full to the health insurer. (5) Disclose to the health insurer all financial terms and arrangements for remuneration of any kind that apply between the pharmacy benefit manager and any prescription drug manufacturer that relate to benefits provided to beneficiaries under or services to the health insurers health plan, including formulary management and drug-switch programs, educational support, claims processing, and pharmacy network fees charged from retail pharmacies and data sales fees. A pharmacy benefit manager providing information under this subsection may designate that material as confidential. Information designated as confidential by a pharmacy benefit manager and provided to a health insurer under this subsection may not be disclosed by the health insurer to any person without the consent of the pharmacy benefit manager, except that disclosure may be made by the health insurer: (A) in a court filing under the consumer protection provisions of 9 V.S.A. chapter 63, provided that the information shall be filed under seal and that prior to the information being unsealed, the court shall give notice and an opportunity to be heard to the pharmacy benefit manager on why the information should remain confidential; (B) when authorized by 9 V.S.A. chapter 63;(C) when ordered by a court for good cause shown; or(D) when ordered by the Commissioner as to a health insurer as defined in subdivision 9471(2)(A) of this title pursuant to the provisions of Title 8 and this title. (d) At least annually, a pharmacy benefit manager that provides pharmacy benefit management for a health plan shall disclose to the health insurer, the Department of Financial Regulation, and the Green Mountain Care Board the aggregate amount the pharmacy benefit manager retained on all claims charged to the health insurer for prescriptions filled during the preceding calendar year in excess of the amount the pharmacy benefit manager reimbursed pharmacies. (e) Compliance with the requirements of this section is required for pharmacy benefit managers entering into contracts with a health insurer in this State for pharmacy benefit management in this State. (Added 2007, No. 80,  8; amended 2013, No. 144 (Adj. Sess.),  12, eff. May 27, 2014.) 
 9473. Pharmacy benefit managers; required practices with respect to pharmacies
(a) Within 14 calendar days following receipt of a pharmacy claim, a pharmacy benefit manager or other entity paying pharmacy claims shall do one of the following: (1) Pay or reimburse the claim.(2) Notify the pharmacy in writing that the claim is contested or denied. The notice shall include specific reasons supporting the contest or denial and a description of any additional information required for the pharmacy benefit manager or other payer to determine liability for the claim. (b) A participation contract between a pharmacy benefit manager and a pharmacist shall not prohibit, restrict, or penalize a pharmacy or pharmacist in any way from disclosing to any covered person any health care information that the pharmacy or pharmacist deems appropriate, including: (1) the nature of treatment, risks, or alternatives to treatment;(2) the availability of alternate therapies, consultations, or tests;(3) the decision of utilization reviewers or similar persons to authorize or deny services;(4) the process that is used to authorize or deny health care services; or(5) information on financial incentives and structures used by the health insurer.(c) A pharmacy benefit manager or other entity paying pharmacy claims shall not:(1) require a pharmacy to pass through any portion of the insureds co- payment, or patient responsibility, to the pharmacy benefit manager or other payer; (2) prohibit a pharmacy or pharmacist from discussing information regarding the total cost for pharmacist services for a prescription drug; (3) prohibit or penalize a pharmacy or pharmacist for providing information to an insured regarding the insureds cost-sharing amount for a prescription drug; or (4) prohibit or penalize a pharmacy or pharmacist for the pharmacist or other pharmacy employee disclosing to an insured the cash price for a prescription drug or selling a lower cost drug to the insured if one is available. (d) A pharmacy benefit manager contract with a participating pharmacist or pharmacy shall not prohibit, restrict, or limit disclosure of information to the Commissioner, law enforcement, or State and federal government officials, provided that: (1) the recipient of the information represents that the recipient has the authority, to the extent provided by State or federal law, to maintain proprietary information as confidential; and (2) prior to disclosure of information designated as confidential, the pharmacist or pharmacy:(A) marks as confidential any document in which the information appears; and(B) requests confidential treatment for any oral communication of the information.(e) A pharmacy benefit manager shall not terminate a contract with or penalize a pharmacist or pharmacy due to the pharmacist or pharmacy: (1) disclosing information about pharmacy benefit manager practices, except for information determined to be a trade secret under State law or by the Commissioner, when disclosed in a manner other than in accordance with subsection (d) of this section; or (2) sharing any portion of the pharmacy benefit manager contract with the Commissioner pursuant to a complaint or query regarding the contracts compliance with the provisions of this chapter. (f) For each drug for which a pharmacy benefit manager establishes a maximum allowable cost in order to determine the reimbursement rate, the pharmacy benefit manager shall do all of the following: (1) Make available, in a format that is readily accessible and understandable by a pharmacist, the actual maximum allowable cost for each drug and the source used to determine the maximum allowable cost, which shall not be dependent upon individual beneficiary identification or benefit stage. (2) Update the maximum allowable cost at least once every seven calendar days. In order to be subject to maximum allowable cost, a drug must be widely available for purchase by all pharmacies in the State, without limitations, from national or regional wholesalers and must not be obsolete or temporarily unavailable. (3) Establish or maintain a reasonable administrative appeals process to allow a dispensing pharmacy provider to contest a listed maximum allowable cost. (4)(A) Respond in writing to any appealing pharmacy provider within 10 calendar days after receipt of an appeal, provided that, except as provided in subdivision (B) of this subdivision (4), a dispensing pharmacy provider shall file any appeal within 10 calendar days from the date its claim for reimbursement is adjudicated. (B) A pharmacy benefit manager shall allow a dispensing pharmacy provider to appeal after the 10-calendar-day appeal period set forth in subdivision (A) of this subdivision (4) if the prescription claim is subject to an audit initiated by the pharmacy benefit manager or its auditing agent. (5) For a denied appeal, provide the reason for the denial and identify the national drug code and a Vermont-licensed wholesaler of an equivalent drug product that may be purchased by contracted pharmacies at or below the maximum allowable cost. (6) For an appeal in which the appealing pharmacy is successful:(A) make the change in the maximum allowable cost within 30 business days after the redetermination; and (B) allow the appealing pharmacy or pharmacist to reverse and rebill the claim in question.[Subsection (g) repealed effective April 1, 2024.](g) A pharmacy benefit manager shall not:(1) require a claim for a drug to include a modifier or supplemental transmission, or both, to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by Medicaid; or (2) restrict access to a pharmacy network or adjust reimbursement rates based on a pharmacys participation in a 340B contract pharmacy arrangement. (h)(1) A pharmacy benefit manager or other third party that reimburses a 340B covered entity for drugs that are subject to an agreement under 42 U.S.C.  256b through the 340B drug pricing program shall not reimburse the 340B covered entity for pharmacy-dispensed drugs at a rate lower than that paid for the same drug to pharmacies that are not 340B covered entities, and the pharmacy benefit manager shall not assess any fee, charge-back, or other adjustment on the 340B covered entity on the basis that the covered entity participates in the 340B program as set forth in 42 U.S.C.  256b. (2) With respect to a patient who is eligible to receive drugs that are subject to an agreement under 42 U.S.C.  256b through the 340B drug pricing program, a pharmacy benefit manager or other third party that makes payment for the drugs shall not discriminate against a 340B covered entity in a manner that prevents or interferes with the patients choice to receive the drugs from the 340B covered entity. (i) A pharmacy benefit manager shall not reimburse a pharmacy or pharmacist in this State an amount less than the amount the pharmacy benefit manager reimburses a pharmacy benefit manager affiliate for providing the same pharmacist services. (j) A pharmacy benefit manager shall not restrict, limit, or impose requirements on a licensed pharmacy in excess of those set forth by the Vermont Board of Pharmacy or by other State or federal law, nor shall it withhold reimbursement for services on the basis of noncompliance with participation requirements. (k) A pharmacy benefit manager shall provide notice to all participating pharmacies prior to changing its drug formulary. (Added 2013, No. 144 (Adj. Sess.),  14; amended 2015, No. 54,  3, eff. June 5, 2015; 2017, No. 193 (Adj. Sess.),  11; 2021, No. 74,  E.227.1; 2021, No. 131 (Adj. Sess.),  2, eff. January 1, 2023 and  7, eff. May 24, 2022.) 
 9473. Pharmacy benefit managers; required practices with respect to pharmacies
(a) Within 14 calendar days following receipt of a pharmacy claim, a pharmacy benefit manager or other entity paying pharmacy claims shall do one of the following: (1) Pay or reimburse the claim.(2) Notify the pharmacy in writing that the claim is contested or denied. The notice shall include specific reasons supporting the contest or denial and a description of any additional information required for the pharmacy benefit manager or other payer to determine liability for the claim. (b) A pharmacy benefit manager or other entity paying pharmacy claims shall not:(1) impose a higher co-payment for a prescription drug than the co-payment applicable to the type of drug purchased under the insureds health plan; (2) impose a higher co-payment for a prescription drug than the maximum allowable cost for the drug; (3) require a pharmacy to pass through any portion of the insureds co-payment to the pharmacy benefit manager or other payer; (4) prohibit or penalize a pharmacy or pharmacist for providing information to an insured regarding the insureds cost-sharing amount for a prescription drug; or (5) prohibit or penalize a pharmacy or pharmacist for the pharmacist or other pharmacy employee disclosing to an insured the cash price for a prescription drug or selling a lower cost drug to the insured if one is available. (c) For each drug for which a pharmacy benefit manager establishes a maximum allowable cost in order to determine the reimbursement rate, the pharmacy benefit manager shall do all of the following: (1) Make available, in a format that is readily accessible and understandable by a pharmacist, the actual maximum allowable cost for each drug and the source used to determine the maximum allowable cost. (2) Update the maximum allowable cost at least once every seven calendar days. In order to be subject to maximum allowable cost, a drug must be widely available for purchase by all pharmacies in the State, without limitations, from national or regional wholesalers and must not be obsolete or temporarily unavailable. (3) Establish or maintain a reasonable administrative appeals process to allow a dispensing pharmacy provider to contest a listed maximum allowable cost. (4) Respond in writing to any appealing pharmacy provider within 10 calendar days after receipt of an appeal, provided that a dispensing pharmacy provider shall file any appeal within 10 calendar days from the date its claim for reimbursement is adjudicated. [Subsection (d) repealed effective January 1, 2023.](d) A pharmacy benefit manager shall not:(1) require a claim for a drug to include a modifier or supplemental transmission, or both, to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by Medicaid; or (2) restrict access to a pharmacy network or adjust reimbursement rates based on a pharmacys participation in a 340B contract pharmacy arrangement. (Added 2013, No. 144 (Adj. Sess.),  14; amended 2015, No. 54,  3, eff. June 5, 2015; 2017, No. 193 (Adj. Sess.),  11; 2021, No. 74,  E.227.1.) 
 9474. Enforcement
(a) Except as provided in subsection (d) of this section, in addition to any remedy available to the Commissioner under this title and any other remedy provided by law, a violation of this subchapter shall be considered a violation of the Vermont Consumer Protection Act in 9 V.S.A. chapter 63, subchapter 1. Except as provided in subsection (d) of this section, all rights, authority, and remedies available to the Attorney General and private parties to enforce the Vermont Consumer Protection Act shall be available to enforce the provisions of this subchapter. (b) In connection with any action for violation of the Vermont Consumer Protection Act, the Commissioners determinations concerning the interpretation and administration of the provisions of this subchapter and any rules adopted hereunder shall carry a presumption of validity. The Attorney General and the Commissioner shall consult with each other prior to the commencement of any investigation or enforcement action with respect to any pharmacy benefit manager. (c) The Commissioner may investigate, examine, or otherwise enforce a violation of this subchapter by a pharmacy benefit manager under section 9412 of this title as if the pharmacy benefit manager were a health insurer. (d) The Commissioner shall have the exclusive authority to investigate, examine, and otherwise enforce the provisions of this subchapter relating to a pharmacy benefit manager in connection with the pharmacy benefit managers contractual relationship with, and any other activity with respect to, a health insurer defined by subdivision 9471(2)(A) of this title. (e) Notwithstanding any provision of this section to the contrary, the Commissioner and the Attorney General may bring a joint enforcement action against any person or entity for a violation of this subchapter. (Added 2007, No. 80,  8; amended 2007, No. 89 (Adj. Sess.),  6; 2013, No. 144 (Adj. Sess.),  13, eff. May 27, 2014; 2017, No. 113 (Adj. Sess.),  110.) 
 9481. Definitions
As used in this subchapter:(1) Amount generally billed means the amount a large health care facility generally bills to individuals for emergency or other medically necessary health care services, determined using the look-back method set forth in 26 C.F.R.  1.501(r)-5(b)(3). (2) Credit reporting agency means a person who, for fees, dues, or on a cooperative basis, regularly engages in whole or in part in the practice of assembling or evaluating information concerning a consumers credit or other information for the purpose of furnishing a credit report to another person. (3) Health care provider means a person, partnership, corporation, facility, or institution licensed, certified, or otherwise authorized by law to provide professional health care services in this State to an individual during that individuals medical care, treatment, or confinement. (4) Health care services means services for the diagnosis, prevention, treatment, cure, or relief of a physical, dental, behavioral, or mental health condition or substance use disorder, including procedures, products, devices, and medications. (5) Household income means income calculated in accordance with the financial methodologies for determining financial eligibility for advance premium tax credits under 26 C.F.R.  1.36B-2, including the method used to calculate household size, with the following modifications: (A) domestic partners, and any individual who is considered a dependent of either partner for federal income tax purposes, shall be treated as members of the same household; (B) married individuals who file federal income tax returns separately but could file jointly, and any individual who is considered a dependent of one or both spouses for federal income tax purposes, shall be treated as members of the same household; (C) married individuals who are living separately while their divorce is pending shall not be treated as members of the same household, regardless of whether they are filing federal income tax returns jointly or separately; and (D) household income for individuals who are not required to file a federal income tax return, and for undocumented immigrants who have not filed a federal income tax return, shall be calculated as if they had filed a federal income tax return. (6) Large health care facility means each of the following health care providers:(A) a hospital licensed pursuant to chapter 43 of this title;(B) an outpatient clinic or facility affiliated with or operating under the license of a hospital licensed pursuant to chapter 43 of this title; and (C) an ambulatory surgical center licensed pursuant to chapter 49 of this title.(7) Medical creditor means a large health care facility to whom a consumer owes money for health care services. (8) Medical debt means a debt arising from the receipt of health care services.(9) Medical debt collector means an individual or entity that regularly collects or attempts to collect, directly or indirectly, medical debts originally owed or due, or asserted to be owed or due, to another individual or entity. (10) Medically necessary health care services means health care services, including diagnostic testing, preventive services, and after care, that are appropriate to the patients diagnosis or condition in terms of type, amount, frequency, level, setting, and duration. Medically necessary care must: (A) be informed by generally accepted medical or scientific evidence and be consistent with generally accepted practice parameters as recognized by health care professions in the same specialties as typically provide the procedure or treatment, or diagnose or manage the medical condition; (B) be informed by the unique needs of each individual patient and each presenting situation; and (C) meet one or more of the following criteria:(i) help restore or maintain the patients health;(ii) prevent deterioration of or palliate the patients condition; or(iii) prevent the reasonably likely onset of a health problem or detect an incipient problem.(11) Patient means the individual who receives or received health care services and shall include a parent if the patient is a minor or a legal guardian if the patient is a minor or adult under guardianship. (12) Vermont resident means an individual, regardless of citizenship and including undocumented immigrants, who resides in Vermont, is employed by a Vermont employer to deliver services for the employer in this State in the normal course of the employees employment, or attends school in Vermont, or a combination of these. The term includes an individual who is living in Vermont at the time that services are received but who lacks stable permanent housing. (Added 2021, No. 119 (Adj. Sess.),  1, eff. July 1, 2022.) 
 9482. Financial assistance policies for large health care facilities
(a) Each large health care facility in this State shall develop a written financial assistance policy that, at a minimum, complies with the provisions of this subchapter and any applicable federal requirements. (b) The financial assistance policy shall:(1) apply, at a minimum, to all emergency and other medically necessary health care services that the large health care facility offers; (2) provide free or discounted care to Vermont residents and to individuals who live in Vermont at the time the services are delivered but who lack stable permanent housing, as follows: (A) for an uninsured patient with household income at or below 250 percent of the federal poverty level (FPL), a 100 percent discount from the amount generally billed for the services received, resulting in free care; (B) for an uninsured patient with household income between 250 and 400 percent FPL, a minimum of a 40 percent discount from the amount generally billed for the services received; (C) for a patient with health insurance or other coverage for the services delivered and with household income at or below 250 percent FPL, a waiver of all out-of-pocket costs that would otherwise be due from the patient; (D) for a patient with health insurance or other coverage for the services delivered and with household income between 250 and 400 percent FPL, a minimum of a 40 percent discount on the patients out-of-pocket costs; and (E) for patients with household income at or below 600 percent FPL, catastrophic assistance in the event that the large health care facilitys medical bills for a patients care exceed 20 percent of the patients household income, in which case the facility shall reduce the amount due from the patient to 20 percent of the patients household income; and (3) include all of the following:(A) the eligibility criteria for financial assistance;(B) the basis for calculating amounts charged to patients;(C) the method and process for applying for financial assistance, including the information and documentation that the facility may require a patient to provide as part of the application; (D) the reasonable steps that the facility will take to determine whether a patient is eligible for financial assistance; (E) the facilitys billing and collections policy, including the actions the facility may take in the event of nonpayment, such as collections action and reporting to credit reporting agencies; (F) an appeals process for patients who are denied financial assistance or who believe the amount of financial assistance granted is inconsistent with the policy or the provisions of this subchapter; and (G) a plain language summary of the policy.(c) The owners or governing body of the large health care facility shall approve the facilitys financial assistance policy and shall review and approve the policy at least once every three years. (d) A large health care facility may require a patient to be a Vermont resident as a condition of eligibility for financial assistance but shall not impose any requirements regarding the duration of a patients status as a Vermont resident. (Added 2021, No. 119 (Adj. Sess.),  1, eff. July 1, 2022.) 
 9483. Implementation of financial assistance policy
(a) In addition to any other actions required by applicable State or federal law, a large health care facility shall take the following steps before seeking payment for any emergency or medically necessary health care services: (1) determine whether the patient has health insurance or other coverage for the services delivered, including whether the health care services may be covered in whole or in part by an automobile insurance, a workers compensation, or other type of policy; (2) if the patient is uninsured, offer to provide the patient with information on how to apply for, and offer to connect the patient with help in applying for, public programs that may assist with health care costs; provided, however, that an undocumented immigrants refusal to apply for public programs shall not be grounds for denying financial assistance under the facilitys financial assistance policy; (3) offer to provide the patient with information on how to apply for, and offer to connect the patient with help in applying for, health insurance and private programs that may assist with health care costs; provided, however, that a patients refusal to apply for private health insurance shall not be grounds for denying financial assistance under the facilitys financial assistance policy; (4) if available, use information in the facilitys possession to determine the patients eligibility for free or discounted care based on the criteria set forth in subdivision 9482(b)(2) of this subchapter; and (5) offer to the patient, at no charge, a financial assistance policy application and assistance in completing the application. (b) A large health care facility shall determine a patients eligibility for financial assistance as follows: (1)(A) The facility shall determine a patients household income using the patients most recent federal or state income tax return. (B)(i) The facility shall give each patient the option to submit pay stubs, documentation of public assistance, or other documentation of household income that the Department of Vermont Health Access identifies as valid documentation for purposes of this subchapter in lieu of or in addition to an income tax return. (ii) A patient who is an undocumented immigrant shall also be given the option to submit other documentation of household income, such as a profit and loss statement, in lieu of an income tax return. (C) The facility shall not require any additional information to verify income beyond the sources of information set forth in subdivisions (A) and (B) of this subdivision (1). (2) The facility may grant financial assistance to a patient notwithstanding the patients failure to provide one of the required forms of household income documentation and may rely on, but not require, other evidence of eligibility. (3) The facility may grant financial assistance based on a determination of presumptive eligibility relying on information in the facilitys possession but shall not presumptively deny an application based on that information. (4)(A) The facility may, but is not required to, include an asset test in its financial assistance eligibility criteria. If the facility chooses to include an asset test in its financial assistance eligibility criteria, the asset test shall only apply to liquid assets. For purposes of determining financial assistance eligibility, liquid assets shall not include the households primary residence, any 401(k) or individual retirement accounts, or any pension plans. (B) Any limit on liquid assets for purposes of financial assistance eligibility shall be set at a dollar amount not less than 400 percent of the federal poverty level for the relevant household size for the year in which the health care services were delivered. (c)(1) Within 30 calendar days following receipt of an application for financial assistance, the large health care facility shall notify the patient in writing as to whether the application is approved or disapproved or, if the application is incomplete, what information is needed to complete the application. (2) If the facility approves the application for financial assistance, the facility shall provide the patient with a calculation of the financial assistance granted and a revised bill. (3) If the facility denies the application for financial assistance, the facility shall allow the patient to submit an appeal within 60 days following receipt of the facilitys decision. The facility shall notify the patient of its approval or denial of the patients appeal within 60 days following receipt of the appeal. (d)(1) A large health care facility or medical debt collector shall, at a minimum, offer to any patient who qualifies for financial assistance a payment plan and shall not require the patient to make monthly payments that exceed five percent of the patients gross monthly household income. (2) A large health care facility or medical debt collector shall not impose any prepayment or early payment penalty or fee on any patient and shall not charge interest on any medical debt owed by a patient who qualifies for the facilitys financial assistance program. (e) A large health care facility shall not discriminate on the basis of race, color, sex, sexual orientation, gender identity, marital status, religion, ancestry, national origin, citizenship, immigration status, primary language, disability, medical condition, or genetic information in its provision of financial assistance or in the implementation of its financial assistance policy. (Added 2021, No. 119 (Adj. Sess.),  1, eff. July 1, 2022.) 
 9484. Public education and information
(a) Each large health care facility shall publicize its financial assistance policy widely by: (1) making the financial assistance policy and application form easily accessible online through the facilitys website and through any patient portal or other online communication portal used by the facilitys patients; (2) providing paper copies of the financial assistance policy and application form upon request at no charge, both by mail and at the facilitys office; for hospitals, copies shall also be available in the hospitals patient reception and admissions areas and in the locations in which patient billing and financial assistance services are provided; (3) providing oral and written translations of the financial assistance policy upon request;(4) notifying and informing members of the community served by the facility about the financial assistance policy in a manner reasonably calculated to reach the members of the community who are most likely to need financial assistance, including members who are non-native English speakers, provided that these efforts shall be commensurate with the facilitys size and income; and (5) conspicuously displaying notices of and information regarding the financial assistance policy in the facilitys offices; for hospitals, the notices and information shall be posted in the hospitals patient reception and admissions areas and in the locations in which patient billing and financial assistance services are provided. (b) Each large health care facility shall directly notify individuals who receive care from the facility about the facilitys financial assistance policy by, at a minimum: (1) offering a paper copy of the financial assistance policy to each patient as part of the patients first visit or, in the case of a hospital, during the intake and discharge processes; and (2) including a conspicuous written notice on billing statements, whether sent by the facility or by a medical debt collector, stating that financial assistance is available to some patients based on income and including: (A) a telephone number that the patient can call to request a financial assistance application and to receive information about the financial assistance policy and the application process; and (B) the specific website address at which copies of the policy and application are available.(c) All written or oral attempts by a medical creditor or medical debt collector to collect a medical debt arising from health care services delivered by a large health care facility shall include information for the patient about the relevant financial assistance policy or policies. (Added 2021, No. 119 (Adj. Sess.),  1, eff. July 1, 2022.) 
 9485. Prohibition on sale of medical debt
No large health care facility shall sell its medical debt. (Added 2021, No. 119 (Adj. Sess.),  1, eff. July 1, 2022.)
 9486. Prohibition of waiver of rights
Any waiver by a patient or other individual of any protection provided by or any right of the patient or other individual under this subchapter is void and shall not be enforced by any court or any other person. (Added 2021, No. 119 (Adj. Sess.),  1, eff. July 1, 2022.) 
 9487. Enforcement
The Office of the Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions for violations of this subchapter as is provided under 9 V.S.A. chapter 63, subchapter 1. (Added 2021, No. 119 (Adj. Sess.),  1, eff. July 1, 2022.) 
 9491. Health care workforce; strategic plan
(a) The Director of Health Care Reform in the Agency of Human Services shall maintain a current health care workforce development strategic plan that continues efforts to ensure that Vermont has the health care workforce necessary to provide care to all Vermont residents. (b)(1) The Director or designee shall consult with an advisory group composed of the following 11 members, at least one of whom shall be a nurse, to develop and maintain the strategic plan: (A) one representative of the Green Mountain Care Boards primary care advisory group;(B) one representative of the Vermont State Colleges;(C) one representative of the Area Health Education Centers workforce initiative;(D) one representative of federally qualified health centers;(E) one representative of Vermont hospitals;(F) one representative of physicians;(G) one representative of mental health professionals;(H) one representative of dentists;(I) one representative of naturopathic physicians;(J) one representative of home health agencies; and(K) one representative of long-term care facilities.(2) The Director or designee shall serve as the chair of the advisory group.(c) The Director of Health Care Reform shall ensure that the strategic plan includes recommendations on how to develop Vermonts health care workforce, including: (1) the current capacity and capacity issues of the health care workforce and delivery system in Vermont, including the shortages of health care professionals, specialty practice areas that regularly face shortages of qualified health care professionals, issues with geographic access to services, and unmet health care needs of Vermonters; (2) how State government, universities and colleges, the States educational system, entities providing education and training programs related to the health care workforce, and others may develop the resources in the health care workforce and delivery system to educate, recruit, and retain health care professionals to achieve Vermonts health care reform principles and purposes; and (3) assessing the availability of State and federal funds for health care workforce development. (Added 2011, No. 48,  12a; amended 2017, No. 85,  E.300.3, eff. June 28, 2017; 2017, No. 113 (Adj. Sess.),  111; 2017, No. 200 (Adj. Sess.),  20; 2019, No. 14,  59, eff. April 30, 2019; 2019, No. 155 (Adj. Sess.),  1, eff. Nov. 1, 2020; 2021, No. 20,  74.)
 9492. Non-emergency walk-in centers; nondiscrimination
(a) A non-emergency walk-in center shall accept patients of all ages for diagnosis and treatment of illness, injury, and disease during all hours that the center is open to see patients. A non-emergency walk-in center shall not discriminate against any patient or prospective patient on the basis of insurance status or type of health coverage. (b) As used in this section, non-emergency walk-in center means an outpatient or ambulatory diagnostic or treatment center at which a patient without making an appointment may receive medical care that is not of an emergency, life threatening nature. The term includes facilities that are self-described as urgent care centers, retail health clinics, and convenient care clinics. (Added 2013, No. 144 (Adj. Sess.),  11, eff. May 27, 2014.) 
 9493. Purpose and policy
(a) The State of Vermont recognizes the fundamental right of every individual to choose or refuse contraception or sterilization. (b) The State of Vermont recognizes the fundamental right of every individual who becomes pregnant to choose to carry a pregnancy to term, to give birth to a child, or to have an abortion. (Added 2019, No. 47,  2, eff. June 10, 2019.) 
 9494. Interference with reproductive choice prohibited
(a) A public entity as defined in section 9496 of this title shall not, in the regulation or provision of benefits, facilities, services, or information, deny or interfere with an individuals fundamental rights to choose or refuse contraception or sterilization or to choose to carry a pregnancy to term, to give birth to a child, or to obtain an abortion. (b) No State or local law enforcement shall prosecute any individual for inducing, performing, or attempting to induce or perform the individuals own abortion. (Added 2019, No. 47,  2, eff. June 10, 2019.) 
 9496. Definitions
As used in this subchapter:(1) Health care provider means a person, partnership, or corporation, including a health care facility, that is licensed, certified, or otherwise authorized by law to provide professional health care services in this State to an individual during that individuals medical care, treatment, or confinement. (2) Public entity means:(A) the Legislative, Executive, or Judicial Branch of State Government, or any agency, department, office, or other subdivision of State government, or any elective or appointive officer or employee within any of those branches; or (B) any municipality, or any agency, department, office, or other subdivision of municipal government, or any elective or appointive officer or employee within municipal government. (Added 2019, No. 47,  2, eff. June 10, 2019.) 
 9497. Abortion; restricting access prohibited
A public entity shall not:(1) deprive a consenting individual of the choice of terminating the individuals pregnancy;(2) interfere with or restrict, in the regulation or provision of benefits, facilities, services, or information, the choice of a consenting individual to terminate the individuals pregnancy; (3) prohibit a health care provider, acting within the scope of the health care providers license, from terminating or assisting in the termination of a patients pregnancy; or (4) interfere with or restrict, in the regulation or provision of benefits, facilities, services, or information, the choice of a health care provider acting within the scope of the health care providers license to terminate or assist in the termination of a patients pregnancy. (Added 2019, No. 47,  2, eff. June 10, 2019.) 
 9498. Enforcement
(a) An individual injured as a result of a violation of this chapter shall have a private right of action in Superior Court against a public entity for injunctive relief arising from the violation. (b) In addition to any injunctive relief awarded, the court may award costs and reasonable attorneys fees to an injured person who substantially prevails in an action brought under this section. (Added 2019, No. 47,  2, eff. June 10, 2019.) 
 9501. Definitions
As used in this chapter:(1) [Repealed.](2) Secretary means the Secretary of Human Services.(3) Agency means the Agency of Human Services, unless the context requires otherwise.(4) Commissioner means the Commissioner of Health.(5) Department means the Department of Health, unless the context requires otherwise.(6) Eligible activity means any activity that will carry out either or both of the dual purposes of freeing Vermonters from addiction to tobacco, and ensuring that the youth of Vermont in this generation and in generations to come are free from tobacco addiction. Eligible activities include the following: (A) establishing anti-addiction programs that are accessible to all Vermonters;(B) creating and fostering anti-tobacco educational programs for use in Vermont schools;(C) creating and fostering anti-tobacco advertising;(D) establishing community outreach programs;(E) supporting tobacco control enforcement activities;(F) evaluating the effectiveness of tobacco cessation, prevention, and control programs.(7) Litigation Settlement Fund means the Vermont Tobacco Litigation Settlement Fund established by 32 V.S.A.  435a. (8) Program means the Vermont tobacco prevention and treatment program established under this chapter. (9) Tobacco litigation settlement means the Master Settlement Agreement between members of the tobacco industry and the State of Vermont, approved by the Vermont Superior Court on December 14, 1998 and finalized in Vermont on January 13, 1999. (10) Trust Fund means the Tobacco Trust Fund established by this chapter. (Added 1999, No. 152 (Adj. Sess.),  271, eff. May 29, 2000; amended 2019, No. 82,  4.)
 9502. Tobacco Trust Fund
(a)(1) The Tobacco Trust Fund is established in the Office of the State Treasurer for the purposes of creating a self-sustaining, perpetual fund for tobacco cessation and prevention that is not dependent upon tobacco sales volume. (2) The Trust Fund shall comprise:(A) appropriations made by the General Assembly;(B) transfers from the Litigation Settlement Fund pursuant to subdivision (b) of this section; and (C) contributions from any other source.(3) The State Treasurer shall not disburse monies from the Trust Fund, except upon appropriation by the General Assembly. In any fiscal year, total appropriations from the Trust Fund shall not exceed seven percent of the fair market value of the Fund at the end of the prior fiscal year. (4) The Trust Fund shall be administered by the State Treasurer. The Treasurer may invest monies in the Fund in accordance with the provisions of 32 V.S.A.  434. All balances in the Fund at the end of the fiscal year shall be carried forward. Interest earned shall remain in the Fund. The Treasurers annual financial report to the Governor and the General Assembly shall contain an accounting of receipts, disbursements, and earnings of the Fund. (b) Unless otherwise authorized by the General Assembly on or before June 30, 2000, and on June 30 of each subsequent fiscal year, any unencumbered balance in the Litigation Settlement Fund shall be transferred to the Trust Fund. (Added 1999, No. 152 (Adj. Sess.),  271, eff. May 29, 2000.) 
 9503. Vermont tobacco prevention and treatment
(a) Except as otherwise specifically provided, the tobacco prevention and treatment program shall be administered and coordinated statewide by the Department of Health, pursuant to the provisions of this chapter. The program shall be comprehensive and research-based. (b) The Department shall establish goals for reducing adult and youth smoking rates, including performance measures for each goal in conjunction with the Substance Misuse Prevention Oversight and Advisory Council established pursuant to section 4803 of this title. The services provided by a quitline approved by the Department of Health shall be offered and made available to any minor, upon his or her consent, who is a smoker or user of tobacco products as defined in 7 V.S.A.  1001. (c) The Department of Liquor and Lottery shall administer the component of the program that relates to enforcement activities. (d) The Agency of Education shall administer school-based programs.(e) The Department shall pay all fees and costs of the surveillance and evaluation activities, including the costs associated with hiring a contractor to conduct an independent evaluation of the program. (f) [Repealed.] (Added 1999, No. 152 (Adj. Sess.),  271, eff. May 29, 2000; amended 2007, No. 26,  1; 2013, No. 92 (Adj. Sess.),  258, eff. Feb. 14, 2014; 2019, No. 73,  26; 2019, No. 82,  4.)
 9505. General powers and duties
The Department shall have all the powers necessary and convenient to carry out and effectuate the purposes and provisions of this section, and shall: (1) Establish the selection criteria for community grants and review and recommend the grants to be funded. (2) Select a contractor responsible for countermarketing activities.(3) Perform ongoing evaluations of tobacco cessation efforts and publish the evaluation measures on the Departments website. (4) Execute a memorandum of understanding developed with the Agency of Education for school-based programs funded through the Tobacco Program Fund. (5) Consult with the Department of Liquor and Lottery concerning enforcement activities administered in accordance with the provisions of this chapter. (6) Propose strategies for program coordination and collaboration with other State agencies, health care providers and organizations, community and school groups, nonprofit organizations dedicated to anti-tobacco activities, and other nonprofit organizations. (Added 1999, No. 152 (Adj. Sess.),  271, eff. May 29, 2000; amended 2013, No. 92 (Adj. Sess.),  260, eff. Feb. 14, 2014; 2013, No. 131 (Adj. Sess.),  122; 2019, No. 73,  27; 2019, No. 82,  4.) 
 9506. Allocation system
In determining the allocation of funds available for the purposes of this chapter, the Department shall consider all relevant factors, including: (1) the level of funding or other participation by private or public sources in the activity being considered for funding; (2) what resources will be required in the future to sustain the program;(3) geographic distribution of funds; and(4) the extent to which the goals of the project can be measured by reductions in adult or youth smoking rates. (Added 1999, No. 152 (Adj. Sess.),  271, eff. May 29, 2000; amended 2013, No. 131 (Adj. Sess.),  123; 2015, No. 11,  23; 2019, No. 82,  4.) 
 9551. All-payer model
In order to implement a value-based payment model allowing participating health care providers to be paid by Medicaid, Medicare, and commercial insurance using a common methodology that may include population-based payments and increased financial predictability for providers, the Green Mountain Care Board and Agency of Administration shall ensure that the model: (1) maintains consistency with the principles established in section 9371 of this title;(2) continues to provide payments from Medicare directly to health care providers or accountable care organizations without conversion, appropriation, or aggregation by the State of Vermont; (3) maximizes alignment between Medicare, Medicaid, and commercial payers to the extent permitted under federal law and waivers from federal law, including: (A) what is included in the calculation of the total cost of care;(B) attribution and payment mechanisms;(C) patient protections;(D) care management mechanisms; and(E) provider reimbursement processes;(4) strengthens and invests in primary care;(5) incorporates social determinants of health;(6) adheres to federal and State laws on parity of mental health and substance abuse treatment, integrates mental health and substance abuse treatment systems into the overall health care system, and does not manage mental health or substance abuse care through a separate entity; provided, however, that nothing in this subdivision (6) shall be construed to alter the statutory responsibilities of the Departments of Health and of Mental Health; (7) includes a process for integration of community-based providers, including home health agencies, mental health agencies, developmental disability service providers, emergency medical service providers, adult day service providers, and area agencies on aging, and their funding streams to the extent permitted under federal law, into a transformed, fully integrated health care system that may include transportation and housing; (8) continues to prioritize the use, where appropriate, of existing local and regional collaboratives of community health providers that develop integrated health care initiatives to address regional needs and evaluate best practices for replication and return on investment; (9) pursues an integrated approach to data collection, analysis, exchange, and reporting to simplify communication across providers and drive quality improvement and access to care; (10) allows providers to choose whether to participate in accountable care organizations, to the extent permitted under federal law; (11) evaluates access to care, quality of care, patient outcomes, and social determinants of health; (12) requires processes and protocols for shared decision making between the patient and his or her health care providers that take into account a patients unique needs, preferences, values, and priorities, including use of decision support tools and shared decision making methods with which the patient may assess the merits of various treatment options in the context of his or her values and convictions, and by providing patients access to their medical records and to clinical knowledge so that they may make informed choices about their care; (13) supports coordination of patients care and care transitions through the use of technology, with patient consent, such as sharing electronic summary records across providers and using telemedicine, home telemonitoring, and other enabling technologies; and (14) ensures, in consultation with the Office of the Health Care Advocate, that robust patient grievance and appeal protections are available. (Added 2015, No. 113 (Adj. Sess.),  2, eff. Jan. 1, 2018.) 
 9571. Definitions
As used in this subchapter:(1) Accountable care organization and ACO means an organization of health care providers that has a formal legal structure, is identified by a federal taxpayer identification number, and agrees to be accountable for the quality, cost, and overall care of the patients assigned to it. (2) Health care provider means a person, partnership, or corporation, including a health care facility, that is licensed, certified, or otherwise authorized by law to provide professional health care services in this State to an individual during that individuals medical care, treatment, or confinement. (Added 2017, No. 59,  2.) 
 9572. Meetings of an accountable care organizations governing body
(a) Application. This section shall apply to all regular, special, and emergency meetings of an accountable care organizations governing body, whether in person or by electronic means, as well as to any other assemblage of members of the ACOs governing body at which binding action is taken on behalf of the ACO. For purposes of this section, the term ACOs governing body shall also include the governing body of any organization acting as a coordinating entity for two or more ACOs. (b) Public meetings; exceptions. Meetings of an accountable care organizations governing body shall be open to the public and shall provide members of the public an opportunity to comment, except that the ACOs governing body may meet in executive session to consider business related to the following: (1) contracts or contract negotiations for which premature general public knowledge would reasonably place the ACO or another person at a substantial disadvantage; (2) pending or probable prosecution or civil litigation to which the ACO is or is likely to be a party; (3) personnel matters;(4) information that reasonably could be considered a trade secret, as defined in 1 V.S.A.  317(c)(9);(5) confidential attorney-client communications;(6) information prohibited from public disclosure by the terms of an enforceable data use contract to which the ACO is bound; and (7) information prohibited from public disclosure by the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, or by any other State or federal law. (c) Notice. An accountable care organization shall make its governing bodys meeting schedule available to the public by posting notice of the time and place of each meeting on the ACOs website at least one week before the meeting and the agenda for each meeting at least 48 hours before the meeting, except that if an unforeseen occurrence or condition requires the governing bodys immediate attention at an emergency meeting, the ACO shall provide public notice as soon as possible before the meeting occurs. (d)(1) Minutes and recordings. All portions of each meeting of an ACOs governing body that are open to the public shall either be recorded or minutes shall be taken, and the recordings and minutes shall be posted on the ACOs website within five business days following the meeting. (2) Meeting minutes shall include the names of all governing body members present at the meeting in person or by electronic means, the names of any other individuals who participated in the meeting, a summary of any public comments provided at the meeting, and all actions taken or considered by the governing body during the meeting. (e) Participation by electronic or other means. (1) One or more members of an ACOs governing body may attend a regular, special, or emergency meeting by electronic or other means without being physically present at a designated meeting location. (2) Any member of the governing body attending a meeting by electronic or other means may participate fully in discussing the governing bodys business and voting to take an action, but any vote of the governing body that is not unanimous shall be taken by roll call. (3) Each member of the governing body who attends a meeting without being physically present at a designated meeting location shall: (A) identify himself or herself when the meeting is convened; and(B) be able to hear the conduct of the meeting and be heard throughout the meeting.(4) If a quorum or more of the members of the governing body attend a meeting without being physically present at a designated meeting location, the agenda required to be posted pursuant to subsection (c) of this section shall designate at least one physical location where a member of the public can attend and participate in the meeting. At least one member of the governing body or one or more members of the ACOs staff shall be present at each designated meeting location. (Added 2017, No. 59,  2.) 
 9573. Medicaid advisory rate case
(a) On or before December 31 of each year, the Green Mountain Care Board shall review any all-inclusive population-based payment arrangement between the Department of Vermont Health Access and an accountable care organization for the following calendar year. The Boards review shall include the number of attributed lives, eligibility groups, covered services, elements of the per member, per month payment, and any other nonclaims payments. The Boards review may include deliberative sessions to the same extent permitted for insurance rate review under 8 V.S.A.  4062. (b) The review shall be nonbinding on the Agency of Human Services, and nothing in this section shall be construed to abrogate the designation of the Agency of Human Services as the single State agency as required by 42 C.F.R.  431.10. (c) The Board shall review the payment arrangement prior to the finalization of a contract between the Department and the accountable care organization and shall maintain the confidentiality of information as needed to preserve the parties contract negotiations. The Board shall release its advisory opinion within 30 days following the finalization of the contract between the parties. (d) The Department of Vermont Health Access shall provide the Board and its contractors with all data and information that the Board requests for its review within the time frame set forth by the Board. (Added 2017, No. 167 (Adj. Sess.),  14, eff. May 22, 2018.) 
 9601. Definitions
As used in this chapter:(1) Green Mountain Care Board or Board means the Board established in chapter 220 of this title. (2) Health insurance plan means a policy, service contract, or other health benefit plan offered or issued by a health insurer and includes beneficiaries covered by the Medicaid program unless they are otherwise provided with similar services. (3) Health insurer shall have the same meaning as in section 9402 of this title. (Added 2013, No. 79,  35a, eff. Jan. 1, 2014.)
 9602. Office of the Health Care Advocate; composition
(a) The Agency of Human Services shall maintain the Office of the Health Care Advocate by contract with any nonprofit organization. (b) The Office shall be administered by the Chief Health Care Advocate, who shall be an individual with expertise and experience in the fields of health care and advocacy. The Advocate may employ legal counsel, administrative staff, and other employees and contractors as needed to carry out the duties of the Office. (Added 2013, No. 79,  35a, eff. Jan. 1, 2014; amended 2017, No. 85,  E.300.4, eff. June 28, 2017.) 
 9603. Duties and authority
(a) The Office of the Health Care Advocate shall:(1) Assist health insurance consumers with health insurance plan selection by providing information, referrals, and assistance to individuals about means of obtaining health insurance coverage and services. The Office shall accept referrals from the Vermont Health Benefit Exchange and Exchange navigators created pursuant to 33 V.S.A. chapter 18, subchapter 1, to assist consumers experiencing problems related to the Exchange. (2) Assist health insurance consumers to understand their rights and responsibilities under health insurance plans. (3) Provide information to the public, agencies, members of the General Assembly, and others regarding problems and concerns of health insurance consumers as well as recommendations for resolving those problems and concerns. (4) Identify, investigate, and resolve complaints on behalf of individual health insurance consumers, and assist those consumers with filing and pursuit of complaints and appeals. (5) Provide information to individuals regarding their obligations and responsibilities under the Patient Protection and Affordable Care Act (Pub. L. No. 111-148). (6) Analyze and monitor the development and implementation of federal, State, and local laws, rules, and policies relating to patients and health insurance consumers. (7) Facilitate public comment on laws, rules, and policies, including policies and actions of health insurers. (8) Suggest policies, procedures, or rules to the Green Mountain Care Board in order to protect patients and consumers interests. (9) Promote the development of citizen and consumer organizations.(10) Ensure that patients and health insurance consumers have timely access to the services provided by the Office. (11) Submit to the Governor; the House Committees on Health Care, on Ways and Means, and on Appropriations; and the Senate Committees on Health and Welfare, on Finance, and on Appropriations, on or before January 1 of each year, a report on the activities, performance, and fiscal accounts of the Office during the preceding calendar year. (b) The Office of the Health Care Advocate may:(1) Review the health insurance records of a consumer who has provided written consent. Based on the written consent of the consumer or his or her guardian or legal representative, a health insurer shall provide the Office with access to records relating to that consumer. (2) Pursue administrative, judicial, and other remedies on behalf of any individual health insurance consumer or group of consumers. (3) Represent the interests of the people of the State in cases requiring a hearing before the Green Mountain Care Board established in chapter 220 of this title. (4) Adopt policies and procedures necessary to carry out the provisions of this chapter.(5) Take any other action necessary to fulfill the purposes of this chapter.(c) The Office of the Health Care Advocate shall be able to speak on behalf of the interests of health care and health insurance consumers and to carry out all duties prescribed in this chapter without being subject to any retaliatory action; provided, however, that nothing in this subsection shall limit the authority of the Agency of Human Services to enforce the terms of the contract. (Added 2013, No. 79,  35a, eff. Jan. 1, 2014; amended 2017, No. 85,  E.300.6, eff. June 28, 2017; 2017, No. 154 (Adj. Sess.),  24, eff. May 21, 2018; 2019, No. 14,  60, eff. April 30, 2019.) 
 9604. Duties of State agencies
All State agencies shall comply with reasonable requests from the Office of the Health Care Advocate for information and assistance. The Agency of Human Services may adopt rules necessary to ensure the cooperation of State agencies under this section. (Added 2013, No. 79,  35a, eff. Jan. 1, 2014; amended 2017, No. 85,  E.300.7, eff. June 28, 2017.) 
 9605. Confidentiality
In the absence of written consent by a complainant or an individual using the services of the Office or by his or her guardian or legal representative or the absence of a court order, the Office of the Health Care Advocate, its employees, and its contractors shall not disclose the identity of the complainant or individual. (Added 2013, No. 79,  35a, eff. Jan. 1, 2014.) 
 9606. Conflicts of interest
The Office of the Health Care Advocate, its employees, and its contractors shall not have any conflict of interest relating to the performance of their responsibilities under this chapter. For the purposes of this chapter, a conflict of interest exists whenever the Office of the Health Care Advocate, its employees, or its contractors or a person affiliated with the Office, its employees, or its contractors: (1) has a direct involvement in the licensing, certification, or accreditation of a health care facility, health insurer, or health care provider; (2) has a direct ownership interest or investment interest in a health care facility, health insurer, or health care provider; (3) is employed by or participating in the management of a health care facility, health insurer, or health care provider; or (4) receives or has the right to receive, directly or indirectly, remuneration under a compensation arrangement with a health care facility, health insurer, or health care provider. (Added 2013, No. 79,  35a, eff. Jan. 1, 2014.) 
 9607. Funding; allocation of expenses
(a) The Office of the Health Care Advocate shall specify in its annual report filed pursuant to this chapter the sums expended by the Office in carrying out its duties, including identifying the specific amount expended for actuarial services. (b)(1) Expenses incurred by the Office of the Health Care Advocate for services related to the Green Mountain Care Boards and Department of Financial Regulations regulatory and supervisory duties shall be borne as follows: (A) 27.5 percent by the State from State monies;(B) 24.2 percent by the hospitals;(C) 24.2 percent by nonprofit hospital and medical service corporations licensed under 8 V.S.A. chapter 123 or 125; and (D) 24.2 percent by health insurance companies licensed under 8 V.S.A. chapter 101.(2) Expenses under subdivision (1) of this subsection shall be billed to persons licensed under Title 8 based on premiums paid for health care coverage, which for the purposes of this section shall include major medical, comprehensive medical, hospital or surgical coverage, and comprehensive health care services plans, but shall not include long-term care or limited benefits, disability, credit or stop loss, or excess loss insurance coverage. (3) The Green Mountain Care Board shall administer the bill back authority created in this subsection on behalf of the Agency of Human Services in support of the Agencys contract with the Office of the Health Care Advocate pursuant to section 9602 of this title to carry out the duties set forth in this chapter. (c) It is the intent of the General Assembly that the Office of the Health Care Advocate shall maximize the amount of federal and grant funds available to support the activities of the Office. (Added 2013, No. 79,  35a, eff. Jan. 1, 2014; amended 2015, No. 134 (Adj. Sess.),  28; 2017, No. 85,  E.300.5, eff. June 28, 2017.) 
 1221. Municipal water treatment plants
If, after public hearing it finds that any public water supply is or is likely to be contaminated, or if waters designated as Class A by 10 V.S.A.  1253 are reclassified by order of the Secretary of Natural Resources, the Board of Health shall order the municipality or person using or supplying such public water supply to construct and install filtration and disinfection facilities to protect the public health or convert to a new source of public water supply. Any such order shall specify a reasonable time schedule for such construction or conversion and shall specify any interim measures necessary for the protection of the public health. (Added 1969, No. 252 (Adj. Sess.),  23, eff. April 4, 1970; amended 2011, No. 138 (Adj. Sess.),  27, eff. May 14, 2012.) 
 1222. Cyanobacteria monitoring and notification
(a) As used in this section:(1) Cyanobacteria means photosynthetic bacteria that have two photosystems, produce molecular oxygen, and use water as an electron-donating substrate in photosynthesis, including microcystis, anabaena, and aphanizomenon. (2) Waters shall have the same meaning as used in 10 V.S.A.  1251.(b) The Commissioner of Health, in consultation with the Secretary of Natural Resources, shall coordinate efforts to monitor the presence of cyanobacteria in the waters of the State. (c) The Department of Health shall maintain a publicly accessible Internet site that provides information concerning the presence of cyanobacteria in areas known to be used for recreation, including swimming or boating. Within one hour of a determination that the presence of cyanobacteria in a recreation area is a public health hazard, the Commissioner of Health shall conduct public outreach describing the area affected and the nature of the public health hazard in the area. (Added 2015, No. 86 (Adj. Sess.),  3.) 
 9700. Purpose and policy
The State of Vermont recognizes the fundamental right of an adult to determine the extent of health care the individual will receive, including treatment provided during periods of incapacity and at the end of life. This chapter enables adults to retain control over their own health care through the use of advance directives, including appointment of an agent and directions regarding health care and disposition of remains. During periods of incapacity, the decisions by the agent shall be based on the express instructions, wishes, or beliefs of the individual, to the extent those can be determined. This chapter also allows, in limited circumstances in which a patient without capacity has neither an agent nor a guardian, for a surrogate to provide or withhold consent on the patients behalf for a do-not-resuscitate order or clinician order for life-sustaining treatment. (Added 2005, No. 55,  1; eff. Sept. 1, 2005; amended 2015, No. 136 (Adj. Sess.),  1, eff. Jan. 1, 2018.) 
 9701. Definitions
As used in this chapter:(1) Advance directive means a written record executed pursuant to section 9703 of this title, which may include appointment of an agent, identification of a preferred primary care clinician, instructions on health care desires or treatment goals, an anatomical gift, disposition of remains, and funeral goods and services. The term includes documents designated under prior law as a durable power of attorney for health care or a terminal care document. (2) Agent means an adult with capacity to whom authority to make health care decisions is delegated under an advance directive, including an alternate agent if the agent is not reasonably available. (3) Anatomical gift shall have the same meaning as provided in subdivision 5250b(3) of this title. (4) Capacity means an individuals ability to make and communicate a decision regarding the issue that needs to be decided. (A) An individual shall be deemed to have capacity to appoint an agent if the individual has a basic understanding of what it means to have another individual make health care decisions for oneself and of who would be an appropriate individual to make those decisions, and can identify whom the individual wants to make health care decisions for the individual. (B) An individual shall be deemed to have capacity to make a health care decision if the individual has a basic understanding of the diagnosed condition and the benefits, risks, and alternatives to the proposed health care. (5) Clinician means a medical doctor licensed to practice under 26 V.S.A. chapter 23, an osteopathic physician licensed pursuant to 26 V.S.A. chapter 33, an advanced practice registered nurse licensed pursuant to 26 V.S.A. chapter 28, subchapter 2, and a physician assistant licensed pursuant to 26 V.S.A. chapter 31 acting within the scope of the license under which the clinician is practicing. (6) Clinician orders for life-sustaining treatment or COLST means a clinicians order or orders for treatment such as intubation, mechanical ventilation, transfer to hospital, antibiotics, artificially administered nutrition, or another medical intervention. A COLST order is designed for use in outpatient settings and health care facilities and may include a DNR order that meets the requirements of section 9708 of this title. (7) Commissioner means the Commissioner of Health.(8) Do-not-resuscitate order or DNR order means a written order of the patients clinician directing health care providers not to attempt resuscitation. (9) DNR identification means a necklace, bracelet, or anklet identifying the patient as an individual who has a DNR order. (10) Emergency medical personnel shall have the same meaning as provided in 24 V.S.A.  2651.(11) Guardian means a person appointed by the Probate Division of the Superior Court who has the authority to make medical decisions pursuant to 14 V.S.A.  3069(c). (12) Health care means any treatment, service, or procedure to maintain, diagnose, or treat an individuals physical or mental condition, including services provided pursuant to a clinicians order, and services to assist in activities of daily living provided by a health care provider or in a health care facility or residential care facility. (13) Health care decision means consent, refusal to consent, or withdrawal of consent to any health care and includes consent to receive out-of-network services. (14) Health care facility shall have the same meaning as provided in section 9432 of this title. (15) Health care provider shall have the same meaning as provided in section 9432 of this title and shall include emergency medical personnel. (16) HIPAA means the Health Insurance Portability and Accountability Act of 1996, codified at 42 U.S.C.  1320d and 45 C.F.R.  160-164. (17) Informed consent means the consent given voluntarily by an individual with capacity, on his or her own behalf or on behalf of another in the role of an agent, guardian, or surrogate, after being fully informed of the nature, benefits, risks, and consequences of the proposed health care, alternative health care, and no health care. (18) Interested individual means:(A) the principals or patients spouse, adult child, parent, adult sibling, adult grandchild, or clergy person; or (B) any adult who has exhibited special care and concern for the principal or patient and who is personally familiar with the principals or patients values. (19) Life sustaining treatment means any medical intervention, including nutrition and hydration administered by medical means and antibiotics, which is intended to extend life and without which the principal or patient is likely to die. (20) Nutrition and hydration administered by medical means means the provision of food and water by means other than the natural ingestion of food or fluids by eating or drinking. Natural ingestion includes spoon feeding or similar means of assistance. (21) Ombudsman means:(A) the State Long-Term Care Ombudsman or a representative of the Ombudsmans Office, as defined in 33 V.S.A.  7501; or (B) a representative of the agency designated as the Office of the Mental Health Care Ombudsman pursuant to section 7259 of this title. (22) Patients clinician means the clinician who currently has responsibility for providing health care to the patient. (23) Principal means an adult who has executed an advance directive.(24) Principals clinician means a clinician who currently has responsibility for providing health care to the principal. (25) Probate Division of the Superior Court designee means a responsible, knowledgeable individual independent of a health care facility designated by the Probate Division of the Superior Court in the district where the principal resides or the county where the facility is located. (26) Procurement organization shall have the same meaning as in subdivision 5250b(22) of this title. (27) Reasonably available means able to be contacted with a level of diligence appropriate to the seriousness and urgency of a principals health care needs, and willing and able to act in a timely manner considering the urgency of the principals health care needs. (28) Registry means a secure, web-based database created by the Commissioner to which individuals may submit an advance directive or information regarding the location of an advance directive that is accessible to principals and agents and, as needed, to individuals appointed to arrange for the disposition of remains, procurement organizations, health care providers, health care facilities, residential care facilities, funeral directors, crematory operators, cemetery officials, Probate Division of the Superior Court officials, and the employees thereof. (29) Residential care facility means a residential care home or an assisted living residence as those terms are defined in 33 V.S.A.  7102. (30) Resuscitate or resuscitation includes chest compressions and mask ventilation; intubation and ventilation; defibrillation or cardioversion; and emergency cardiac medications provided according to the guidelines of the American Heart Associations Cardiac Life Support program. (31) DNR/COLST means a do-not-resuscitate order (DNR) or a clinician order for life-sustaining treatment (COLST), or both. (32) Surrogate means an interested individual who provides or withholds, pursuant to subchapter 2 of this chapter, informed consent for a do-not-resuscitate order or a clinician order for life-sustaining treatment. (33) Suspend means to terminate the applicability of all or part of an advance directive for a specific period of time or while a specific condition exists. (34) Mental health patient representative means the mental health patient representative established by section 7253 of this title. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.),  332; 2009, No. 25,  13; 2009, No. 119 (Adj. Sess.),  4; 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2011, No. 60,  9, eff. June 1, 2011; 2013, No. 34,  30a; 2013, No. 127 (Adj. Sess.),  4, eff. May 10, 2014; 2013, No. 192 (Adj. Sess.),  17; 2015, No. 23,  47; 2015, No. 136 (Adj. Sess.),  1, eff. Jan. 1, 2018; 2017, No. 113 (Adj. Sess.),  112; 2017, No. 121 (Adj. Sess.),  1, eff. May 3, 2018; 2021, No. 137 (Adj. Sess.),  7, eff. July 1, 2022.) 
 9702. Advance directive
(a) An adult may do any or all of the following in an advance directive:(1) except as provided in subsection (c) of this section, appoint one or more agents and alternate agents to whom authority to make health care decisions is delegated and specify the scope of such authority; (2) affirm that the agent and alternate agents have been notified of and have accepted the appointment and will be given copies of the advance directive; (3) specify a circumstance or condition, which may be unrelated to the principals capacity, which, when met, makes the authority of an agent effective or ineffective, and may specify the manner in which the condition shall be determined to have been met; (4) provide that the advance directive will become effective upon execution;(5) direct the type of health care desired or not desired by the principal, which may include instructions regarding transfer from home, hospitalization, and specific treatments that the principal desires or rejects when being treated for a mental or physical condition or disability; (6) execute a provision under subsection 9707(h) of this title which permits the agent to authorize or withhold health care over the principals objection in the event the principal lacks capacity; (7) direct which life sustaining treatments, as defined in subdivision 9701(19) of this title, whether emergency, short-term, or long-term, and including nutrition and hydration administered by medical means, are desired or not desired by the principal; (8) direct which life sustaining treatment the principal would desire or not desire if the principal is pregnant at the time an advance directive becomes effective; (9) identify those persons whom the principal does not want to serve as his or her decision-maker, or those adults or minors with whom the agent shall or shall not consult or to whom the agent is or is not authorized to provide information regarding the principals health care; (10) identify those individuals or entities, whether or not otherwise qualified to bring an action under section 9718 of this title, who shall or shall not have authority to bring an action under that section; (11) authorize release to named individuals in addition to the agent of health information pursuant to HIPAA; (12) provide any other direction that the principal desires to give regarding the principals future health care or personal circumstances; (13) identify a preferred clinician and affirm that the clinician has been notified;(14) nominate one or more individuals to serve as the principals guardian if a guardian should at some later time need to be appointed, or identify those individuals the principal does not want to serve as guardian; (15) make, limit, or refuse to make an anatomical gift pursuant to chapter 110 of this title; (16) direct the manner of disposition of the principals remains and the funeral goods and services to be provided; (17) identify a pre-need contract entered into with a funeral director, crematory, or cemetery; and (18) except as provided in subsection (d) of this section, appoint an individual to make or refuse to make an anatomical gift, and to arrange for the disposition of the principals remains, including funeral goods and services. (b) The absence of an advance directive or of any specific instruction in an advance directive shall have no effect on determining the principals intent or wishes regarding health care or any other matter. (c) The principals health care provider may not be the principals agent. Unless related to the principal by blood, marriage, civil union, or adoption, an agent may not be an owner, operator, employee, agent, or contractor of a residential care facility, a health care facility, or a correctional facility in which the principal resides at the time of execution of an advance directive. (d) Unless related to the principal by blood, marriage, civil union, or adoption, an individual may not exercise the authority pursuant to an advance directive for disposition of remains, anatomical gifts, or funeral goods and services while serving the interests of the principal in one of the following capacities: (1) a funeral director or employee of the funeral director;(2) a crematory operator or employee of the crematory operator;(3) a cemetery official or employee of the cemetery; or(4) an employee or representative of a procurement organization. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.),  333; 2009, No. 119 (Adj. Sess.),  5.)
 9703. Form and execution
(a) An adult with capacity may execute an advance directive at any time.(b) The advance directive shall be dated, executed by the principal or by another individual in the principals presence at the principals express direction if the principal is physically unable to do so, and signed in the presence of two or more witnesses at least 18 years of age, who shall sign and affirm that the principal appeared to understand the nature of the document and to be free from duress or undue influence at the time the advance directive was signed. A health care provider may serve as a witness to the principals execution of the advance directive under this subsection. If the principal is being admitted to or is a resident of a nursing home or residential care facility or is being admitted to or is a patient in a hospital at the time of execution, the individual who explained the nature and effect of the advance directive to the principal pursuant to subsection (d) or (e) of this section may also serve as one of the witnesses to the principals execution of the advance directive under this subsection. (c) Neither the agent appointed by the principal nor the principals spouse, parent, adult sibling, adult child, or adult grandchild may witness the advance directive. (d)(1) An advance directive shall not be effective if, at the time of execution, the principal is being admitted to or is a resident of a nursing home as defined in 33 V.S.A.  7102 or a residential care facility, unless one of the following individuals explains the nature and effect of an advance directive to the principal and signs a statement affirming that he or she has provided the explanation: (A) an ombudsman;(B) a recognized member of the clergy;(C) an attorney licensed to practice in this State;(D) a Probate Division of the Superior Court designee;(E) an individual designated by a hospital pursuant to subsection 9709(d) of this title;(F) a mental health patient representative;(G) an individual who is volunteering at the nursing home or residential care facility without compensation and has received appropriate training regarding the explanation of advance directives; or (H) a clinician, as long as the clinician is not employed by the nursing home or residential care facility at the time of the explanation. (2) It is the intent of this subsection to ensure that residents of nursing homes and residential care facilities are willingly and voluntarily executing advance directives. (e) An advance directive shall not be effective if, at the time of execution, the principal is being admitted to or is a patient in a hospital, unless one of the following individuals has explained the nature and effect of an advance directive to the principal and signs a statement affirming that he or she has provided the explanation: (1) an ombudsman;(2) a recognized member of the clergy;(3) an attorney licensed to practice in this State;(4) a Probate Division of the Superior Court designee;(5) an individual designated by the hospital pursuant to subsection 9709(d) of this title; or (6) a mental health patient representative.(f) A durable power of attorney for health care, terminal care document, or advance directive executed prior to the enactment of this chapter shall be a valid advance directive if the document complies with the statutory requirements in effect at the time the document was executed or with the provisions of this chapter. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2009, No. 154 (Adj. Sess.),  238a, effective February 1, 2011; 2013, No. 192 (Adj. Sess.),  18; 2015, No. 23,  48; 2017, No. 121 (Adj. Sess.),  2, eff. May 3, 2018.) 
 9704. Amendment, suspension, and revocation
(a)(1) A principal with capacity may amend, suspend, or revoke an advance directive or any specific instruction in an advance directive by executing a new advance directive or instruction pursuant to section 9703 of this title. (2) A provision in a subsequently executed advance directive amends an earlier provision in an advance directive to the extent of any conflict between them. (b)(1) Except as provided in subdivision (3) of this subsection, a principal with or without capacity may suspend or revoke all or part of an advance directive, including the designation of an agent: (A) by signing a statement suspending or revoking all or part of an advance directive;(B) by personally informing the principals clinician, who shall make a written record of the suspension or revocation in the principals medical record; or (C) by burning, tearing, or obliterating the advance directive, either by the principal personally or by another person at the principals express direction and in the presence of the principal. (2) Except as provided in subdivision (3) of this subsection, a principal with or without capacity may suspend or revoke any provision other than the designation of an agent, orally, in writing, or by any other act evidencing a specific intent to suspend or revoke. (3) A provision in an advance directive executed pursuant to subsection 9707(h) of this title may be suspended or revoked only if the principal has capacity. (4) To the extent possible, the principal shall communicate any suspension or revocation to the agent or other interested individual. (c)(1) A clinician, health care provider, health care facility, or residential care facility who becomes aware of an amendment, suspension, or revocation while treating an incapacitated principal shall make reasonable efforts to: (A) confirm the amendment, suspension, or revocation;(B) record the amendment, suspension, or revocation in the principals medical record;(C) flag the amendment, suspension, or revocation in the principals medical record on the front of the medical folder or on the front of any advance directive filed in the medical record; (D) notify the principal, agent, and guardian of the amendment, suspension, or revocation; and (E) inform the registry of the amendment, suspension, or revocation.(2) A clinician, health care provider, health care facility, or residential care facility who becomes aware of an amendment, suspension, or revocation while treating a principal with capacity shall comply with the following requirements: (A) satisfy the requirements of subdivisions (1)(A), (B), and (C) of this subsection (c); and (B) on request, assist the principal in notifying agents, guardians, interested individuals, and the registry. (3) A health care provider, health care facility, or residential care facility not currently providing health or residential care to a principal who becomes aware of an amendment, suspension, or revocation shall ensure that the amendment, suspension, or revocation is recorded and flagged in the principals medical record and is submitted to the registry. (4) An agent or guardian who becomes aware of an amendment, suspension, or revocation shall make reasonable efforts to: (A) confirm the amendment, suspension, or revocation;(B) ensure that the amendment, suspension, or revocation is recorded in the principals medical record; and (C) provide notice of the amendment, suspension, or revocation to:(i) the principals clinician, health care provider, health care facility, or residential care facility; (ii) any person designated in the advance directive to receive such notice;(iii) any entity or individual known to hold a copy of the principals advance directive; and (iv) the registry, if the principals advance directive has been submitted to the registry.(d)(1) The filing of an action or motion for annulment, divorce, dissolution of a civil union, legal separation, or an order for relief from abuse under 15 V.S.A. chapter 21 or 33 V.S.A. chapter 69, subchapter 2 by, on behalf of, or against the principal suspends a previous designation of the spouse or other party opposing the principal in the action as agent unless otherwise specified in the advance directive, decree, or order of the court. (2) A designation of agent suspended under subdivision (1) of this subsection shall no longer be in effect, and the agent shall be reinstated, upon the withdrawal of the action or motion for annulment, divorce, dissolution of civil union, legal separation, or order for relief from abuse, or upon the expiration of a temporary order for relief from abuse. (3) A designation of agent suspended under subdivision (1) of this subsection shall become permanent when the annulment, divorce, dissolution of civil union, or legal separation becomes final, or when the motion for relief from abuse is granted. (e) Unless otherwise provided for in an advance directive, each provision of an advance directive is severable from the other provisions in an advance directive if it can be given effect independently. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.),  334.) 
 9705. Duty to deliver
An individual possessing a duly executed advance directive to whom it becomes known that the terms of the advance directive may be applicable shall deliver the advance directive to the principals clinician, other health care provider, health care facility, or residential care facility, unless the individual knows that another copy has previously been delivered and is available. (Added 2005, No. 55,  1, eff. Sept. 1, 2005.) 
 9706. When advance directive becomes effective
(a) An advance directive regarding health care shall become effective:(1) when a principals clinician:(A) determines, after speaking with an interested individual if one is reasonably available, that the principal lacks capacity, and makes specific findings regarding the cause, nature, and projected duration of the principals lack of capacity; (B) has made reasonable efforts to notify the principal of the determination; and(C) has made reasonable efforts to notify the principals agent or guardian of the determination; or (2) when the circumstance or condition specified pursuant to subdivision 9702(a)(3) of this title has been met; or (3) upon execution, if specified pursuant to subdivision 9702(a)(4) of this title.(b) When a principal has a clinician, the clinician shall certify in the principals medical record the facts that have caused an advance directive to become effective. (c) Upon a determination of need by the principals clinician, or upon the request of the principal, agent, guardian, ombudsman, a mental health patient representative, health care provider, or any interested individual, the principals clinician, another clinician, or a clinicians designee shall reexamine the principal to determine whether the principal has capacity. The clinician shall document the results of the reexamination in the principals medical record and shall make reasonable efforts to notify the principal and the agent or guardian, as well as the individual who initiated the new determination of capacity, of the results of the reexamination, if providing such notice is consistent with the requirements of HIPAA. (d) The authority of an agent to make health care decisions for a principal shall cease in accordance with subsection 9711(c) of this title. (e) An advance directive regarding disposition of the principals remains shall become effective upon the death of the principal. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2013, No. 192 (Adj. Sess.),  19; 2017, No. 121 (Adj. Sess.),  2a, eff. May 3, 2018.) 
 9707. Authority and obligations of health care providers, health care facilities, and residential care facilities regarding health care instructions
(a) A health care provider, health care facility, and residential care facility shall not provide health care to a patient without capacity, except on an emergency basis, without first attempting to determine whether the patient has an advance directive in effect. (b) A health care provider, health care facility, and residential care facility having knowledge that a principals advance directive is in effect shall follow the instructions of the person, whether agent or guardian, who has the authority to make health care decisions for the principal, or the instructions contained in the advance directive, unless: (1) the instruction is clearly inconsistent with the advance directive or this chapter, and: (A) the agent has failed to substantiate that the decision is proper under subsection 9711(d) of this title; or (B) the guardian has not obtained an order from the Probate Division of the Superior Court authorizing the instruction; (2) the instruction would cause the provider to violate any criminal law or the standards of professional conduct required by a professional licensing Board or Agency, in which case the provider shall make reasonable efforts to notify the principal, if possible, and any agent and guardian that the provider cannot follow the instruction; or (3) because of a moral, ethical, or other conflict with an instruction in the advance directive or given by the agent or guardian, a principals provider, or an employee thereof is unwilling to follow that instruction, in which case the provider shall promptly: (A) inform the principal, if possible, and any appointed agent and guardian of the conflict;(B) assist the principal, agent, or guardian in the transfer of care to another provider or employee who is willing to honor the instruction; (C) provide ongoing health care until a new provider or employee has been found to provide the services; and (D) document in the principals medical record the conflict, the steps taken to resolve the conflict, and the resolution of the conflict. (c) A health care provider, health care facility, or residential care facility which refuses pursuant to subdivision (b)(1) or (2) of this section to follow the instructions of the agent or the guardian or the instructions contained in the advance directive shall: (1) inform the principal, if possible, and any agent, guardian, or other person making health care decisions for the person of the reasons for the refusal; (2) document in the principals medical record the refusal, the reasons for the refusal, who was notified of the refusal, and any other steps taken to resolve the refusal. (d) An employee with a conflict under subdivision (b)(3) of this section shall be required only to inform the employees employer. The employer shall be responsible for otherwise complying with the requirements of that subdivision. (e) Unless otherwise required by the advance directive, in those circumstances where there is more than one adult identified as the agent, the principals clinician, health care provider, or residential care provider may rely on the decision of one of the identified agents as long as the clinician or provider documents in the principals medical record that the agent confirms that: (1) all agents agree on the pending health care decision;(2) all agents agree that this agent can make any pending health care decisions; or(3) the other agent or agents are not reasonably available.(f) The health care provider shall make reasonable efforts to inform the principal of any proposed health care or of any proposal to withhold or withdraw health care. (g)(1) Health care shall not be given to or withheld from a principal over the principals objection unless: (A)(i) The principals advance directive contains a provision, executed in compliance with subsection (h) of this section, which permits the agent to authorize or withhold health care over the principals objection in the event the principal lacks capacity; and (ii) The agent authorizes providing or withholding the health care; or(B) The principal lacks capacity, will suffer serious and irreversible bodily injury or death if the health care cannot be provided within 24 hours, and: (i) the principal does not have an agent or an applicable provision in an advance directive, or the agent is not reasonably available; or (ii) the agent or advance directive authorizes providing or withholding the health care.(2) The health care provider shall notify the agent or guardian if a principal requests or declines health care which the agent appears to have the authority to authorize or withhold under the principals advance directive. (h)(1) An advance directive executed in accordance with section 9703 of this title may contain a provision permitting the agent, in the event that the principal lacks capacity, to authorize or withhold health care over the principals objection. In order to be valid, the provision shall comply with the following requirements: (A) An agent shall be named in the provision.(B) The agent shall accept in writing the responsibility of authorizing or withholding health care over the principals objection in the event the principal lacks capacity. (C) A clinician for the principal shall sign the provision and affirm that the principal appeared to understand the benefits, risks, and alternatives to the health care being authorized or rejected by the principal in the provision. (D)(i) An ombudsman, a mental health patient representative, attorney licensed to practice law in this State, or the Probate Division of the Superior Court designee shall sign a statement affirming that he or she has explained the nature and effect of the provision to the principal, and that the principal appeared to understand the explanation and be free from duress or undue influence. (ii) If the principal is a patient in a hospital when the provision is executed, the ombudsman, mental health patient representative, attorney, or Probate Division of the Superior Court designee shall be independent of the hospital and not an interested individual. (E) The provision shall specify the treatments to which it applies, and shall include an explicit statement that the principal desires or does not desire the proposed treatments even over the principals objection at the time treatment is being offered or withheld. The provision may include a statement expressly granting to the health care agent the authority to consent to the principals voluntary hospitalization. (F) The provision shall include an acknowledgment that the principal is knowingly and voluntarily waiving the right to refuse or receive treatment at a time of incapacity, and that the principal understands that a clinician will determine capacity. (2) A provision executed in compliance with subdivision (1) of this subsection shall be effective when the principals clinician and a second clinician have determined pursuant to subdivision 9706(a)(1) of this title that the principal lacks capacity. (3) If an advance directive contains a provision executed in compliance with this section:(A) The agent may, in the event the principal lacks capacity, make health care decisions over the principals objection, provided that the decisions are made in compliance with subsection 9711(d) of this title. (B) A clinician shall follow instructions of the agent authorizing or withholding health care over the principals objection. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2009, No. 154 (Adj. Sess.),  238a, effective Feb. 1, 2011; 2013, No. 192 (Adj. Sess.),  20; 2017, No. 121 (Adj. Sess.),  2b, eff. May 3, 2018.) 
 9708. Authority and obligations of health care providers, health care facilities, and residential care facilities regarding DNR orders and COLST
(a) As used in this section, clinician shall have the same meaning as in section 9701 of this title and shall also include a duly licensed medical doctor, osteopathic physician, advanced practice registered nurse or nurse practitioner, or physician assistant who treated the patient outside Vermont and held a valid license to practice in the state in which the patient was located at the time the DNR/COLST was issued. (b) A DNR order and a COLST shall be issued on the Department of Healths Vermont DNR/COLST form as designated by rule by the Department of Health. (c) Notwithstanding subsection (b) of this section, health care facilities and residential care facilities may document DNR/COLST orders in the patients medical record in a facility-specific manner when the patient is in their care. (d) A DNR order must:(1) be signed by the patients clinician;(2) certify that the clinician has consulted, or made an effort to consult, with the patient, and the patients agent or guardian, if there is an appointed agent or guardian; (3) include either:(A) the name of the patient; agent; guardian, in accordance with 14 V.S.A.  3075(g); or surrogate giving informed consent for the DNR and the individuals relationship to the patient; or (B) certification that the patients clinician and one other named clinician have determined that resuscitation would not prevent the imminent death of the patient, should the patient experience cardiopulmonary arrest; and (4) if the patient is in a health care facility or a residential care facility, certify that the requirements of the facilitys DNR protocol required by section 9709 of this title have been met. (e) A COLST must:(1) be signed by the patients clinician; and(2) include the name of the patient; agent; guardian, in accordance with 14 V.S.A.  3075(g); or surrogate giving informed consent for the COLST and the individuals relationship to the patient. (f) [Repealed.](g) A patients clinician issuing a DNR/COLST order shall:(1) place a copy of the completed DNR/COLST order in the patients medical record; and(2) provide instructions to the patient as to the appropriate means of displaying the DNR/COLST order. (h) A clinician who issues a DNR order shall authorize issuance of a DNR identification to the patient. Uniform minimum requirements for DNR identification shall be determined by the Department of Health by rule no later than January 1, 2016. (i) Every health care provider, health care facility, and residential care facility shall honor a DNR/COLST order or a DNR identification unless the provider or facility: (1) believes in good faith, after consultation with the agent or guardian where possible and appropriate, that: (A) the patient wishes to have the DNR/COLST order revoked; or(B) the patient with the DNR identification is not the individual for whom the DNR order was issued; and (2) documents the basis for the good faith belief in the patients medical record.(j) A DNR/COLST order executed prior to July 1, 2011 shall be a valid order if the document complies with the statutory requirements in effect at the time the document was executed or with the provisions of this chapter. (k) A health care provider shall honor in good faith an out-of-state DNR order, orders for life sustaining treatment, or out-of-state DNR identification if there is no reason to believe that what has been presented is invalid. (l) A DNR order precludes efforts to resuscitate only in the event of cardiopulmonary arrest and does not affect other therapeutic interventions that may be appropriate for the patient. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2011, No. 60,  10, eff. June 1, 2011; 2011, No. 76 (Adj. Sess.),  1, eff. March 7, 2012; 2013, No. 50,  E.312.3; 2013, No. 127 (Adj. Sess.),  2, 5, eff. May 10, 2014; 2015, No. 136 (Adj. Sess.),  1, eff. Jan. 1, 2018; 2017, No. 121 (Adj. Sess.),  3, eff. May 3, 2018.) 
 9709. Obligations of health care providers, health care facilities, residential care facilities, and health insurers regarding protocols and nondiscrimination
(a) As used in this section, DNR/COLST shall mean do-not-resuscitate orders (DNR) and clinician orders for life sustaining treatment (COLST) as defined in section 9701 of this title. (b) Every health care provider, health care facility, and residential care facility shall develop protocols: (1) to ensure that a principals advance directive, including any amendment, suspension, or revocation thereof, and DNR/COLST order, if any, are promptly available when services are to be provided, including that the existence of the advance directive, amendment, suspension, revocation, or DNR/COLST order is prominently noted on any file jacket or folder, and that a note is entered into any electronic database of the provider or facility; (2) for maintaining advance directives received from individuals who anticipate future care but are not yet patients of that provider or facility; (3) to ensure that the provider or facility checks the registry at the time any individual without capacity is admitted or provided services to determine whether the individual has an advance directive; (4)(A) to ensure that, unless otherwise specified in an advance directive or guardianship order, an agent or guardian shall have the same rights a principal with capacity would have to: (i) request, review, receive, and copy any oral or written information regarding the principals physical or mental health, including medical and hospital records; (ii) participate in any meetings, discussions, or conferences concerning health care decisions related to the principal; (iii) consent to the disclosure of health care information; and(iv) file a complaint on behalf of the principal regarding a health care provider, health care facility, or residential care facility; (B) the exercise of rights under this subdivision shall not be construed to waive any privilege provided by law; (5) to ensure that the provider or facility complies with its obligations under the Patient Self-Determination Act, 42 U.S.C.  1395cc(a), and the regulations issued thereunder. (c) Every health care facility and residential care facility shall develop written protocols to ensure that: (1) A patient is asked if the patient has an advance directive:(A) prior to an anticipated admission, when possible;(B) if not possible prior to admission, as soon thereafter as possible; and(C) periodically while at the facility.(2)(A) A patients advance directive is reviewed to determine whether the facility would decline to follow any of the advance directives instructions pursuant to subsection 9707(b) of this title, in which case the facility shall comply with the requirements of subsection 9707(c) or subdivision 9707(b)(3) of this title. (B) The review of a patients advance directive required by this subdivision shall occur:(i) prior to an anticipated admission, when possible;(ii) if not possible prior to an anticipated admission, as soon thereafter as possible; and (iii) when a patient executes an advance directive or an amendment to an advance directive.(3) A patient with an advance directive is encouraged and helped to submit the advance directive or a notice of the advance directive to the registry. (4) DNR/COLST orders are issued, revoked, and handled pursuant to the same process and standards that are used for each patient receiving health care. (5) Upon transfer or discharge to another facility, a copy of any advance directive, DNR order, or COLST order shall be transmitted with the principal or patient. If the transfer is to a health care facility or residential care facility, any advance directive, DNR order, or COLST order shall be promptly transmitted to the subsequent facility, unless the sending facility has confirmed that the receiving facility has a copy of the advance directive, DNR order, or COLST order. (6) For a patient for whom DNR/COLST orders are documented in a facility-specific manner, any DNR/COLST orders to be continued upon discharge, during transport, or in another setting shall be documented on the Vermont DNR/COLST form issued pursuant to subsection 9708(b) of this title or on the form as prescribed by the patients state of residence. (d)(1) Each nursing home and residential care facility that chooses to use volunteers to explain to residents the nature and effect of an advance directive as required by subsection 9703(d) of this title shall ensure that the volunteers have received appropriate training regarding the explanation of advance directives. (2) Every hospital shall designate an adequate number of individuals to explain the nature and effect of an advance directive to patients as required by subsection 9703(e) of this title. (e) No health care provider, health care facility, residential care facility, health insurer as defined in section 9402 of this title, insurer issuing disability insurance, or self-insured employee welfare benefit plan shall charge an individual a different rate or require any individual to execute an advance directive or to obtain a DNR/COLST order or DNR identification as a condition of admission to a facility or as a condition of being insured for or receiving health care or residential care. No health care shall be refused except as provided herein because an individual is known to have executed an advance directive. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2011, No. 60,  12, eff. June 1, 2011; 2017, No. 121 (Adj. Sess.),  4, eff. May 3, 2018.) 
 9710. Consent for hospice care
(a) A family member of a patient or a person with a known close relationship to the patient may elect hospice care on behalf of the patient if the patient does not have an agent or guardian or the patients agent or guardian, or both, if applicable, are unavailable. Decisions made by the family member or person with a known close relationship shall protect the patients own wishes in the same manner as decisions made by an agent as described in subsection 9711(d) of this title. (b) As used in this section, hospice care means a program of care and support provided by a Medicare-certified hospice provider to help an individual with a terminal condition to live comfortably by providing palliative care, including effective pain and symptom management. Hospice care may include services provided by an interdisciplinary team that are intended to address the physical, emotional, psychosocial, and spiritual needs of the individual and his or her family. (Added 2013, No. 127 (Adj. Sess.),  1, eff. May 10, 2014.) 
 9711. Authority and obligations of agent
(a) When the requirements of subsection 9706(a) of this title are met, and subject to the provisions of this chapter, other applicable law, and any express instructions regarding the agents authority set forth in an advance directive or a court order, an agent shall have the authority to make any health care decisions on the principals behalf that the principal could make if the principal had capacity. (b) A principal with capacity retains concurrent authority with the principals agent to make health care decisions. In the event the principal and the agent disagree on a decision regarding the principals health care, the decision of the principal shall be controlling. (c) The authority of an agent ceases to be effective:(1) if the advance directive became effective pursuant to subdivision 9706(a)(1) of this title, upon a clinicians determination that the principal has recovered capacity; or (2) when the circumstance or condition specified pursuant to subdivision 9702(a)(3) of this title no longer is met. (d)(1) After consultation with the principal, to the extent possible, and with the principals clinician and any other appropriate health care providers and any individuals identified in the advance directive as those with whom the agent shall consult, the agent shall make health care decisions by attempting to determine what the principal would have wanted under the circumstances. In making the determination, the agent shall consider the following: (A) the principals specific instructions contained in an advance directive to the extent those directions are applicable; (B) the principals wishes expressed to the agent, guardian, or health care provider, since or prior to the execution of an advance directive, if any, to the extent those expressions are applicable; or (C) the agents knowledge of the principals values or religious or moral beliefs.(2) If the agent cannot determine what the principal would have wanted under the circumstances, the agent shall make the determination through an assessment of the principals best interests. When making a decision for the principal on this basis, the agent shall not authorize the provision or withholding of health care on the basis of the principals economic status or preexisting, long-term mental or physical disability. (3) When making a determination under this subsection, the agent shall not consider the agents own interests, wishes, values, or beliefs. (4) If an agent is unable or unwilling to make a health care decision for the principal in compliance with the requirements of this subsection, the agent shall: (A) recuse himself or herself with respect to the decision or resign from being the principals agent; and (B) notify the principal, alternate agent, health care provider, and residential care provider of the recusal or resignation. (e) Unless otherwise specified in an advance directive or guardianship order, an agent or guardian shall have the same rights a principal with capacity would have to: (1) request, review, receive, and copy any oral or written information regarding the principals physical or mental health, including medical and hospital records; (2) participate in any meetings, discussions, or conferences concerning health care decisions related to the principal; (3) consent to the disclosure of health care information; and(4) file a complaint on behalf of the principal regarding a health care provider, health care facility, or residential care facility. (f) Nothing in this chapter shall be construed to give an agent authority to consent to voluntary sterilization. (g) Unless the Probate Division of the Superior Court expressly orders otherwise in a guardianship proceeding pursuant to 14 V.S.A.  3069(b), the authority of an agent appointed and the instructions contained in an advance directive executed prior to the appointment of the guardian shall remain in effect, and the ward may not execute an advance directive. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011.) 
 9712. Obligations of funeral directors, crematory operators, cemetery officials, procurement organizations, and individuals appointed to arrange for the disposition of the principals remains
(a) An individual appointed to arrange for the disposition of the principals remains shall make those decisions based upon the principals specific instructions contained in an advance directive or pre-need contract entered into with a funeral director, crematory operator, or cemetery official, or, if there are no such instructions, in accordance with the principals wishes expressed orally or the knowledge of the agent or guardian of the principals values or religious or moral beliefs. (b) Any funeral director, crematory operator, or cemetery official having knowledge of a principals advance directive shall follow the advance directive and any instructions of the individual appointed in an advance directive to arrange for the disposition of the principals remains, except: (1) if any instruction would cause the director, operator, or official to violate the standards of professional conduct required by a professional licensing board or agency or any criminal law, the director, operator, or official shall notify the individual appointed that the director, operator, or official cannot follow the instruction; or (2) if the principals estate is without sufficient funds to dispose of the remains or provide funeral goods and services in accordance with the advance directive, the disposition shall occur in a manner approximating the principals wishes to the extent it is financially possible. (c) Any procurement organization having knowledge of a principals advance directive shall follow the advance directive and any instructions of the individual appointed in the advance directive to arrange for the recovery of the principals anatomical gifts unless the procurement organization determines such gifts are unsuitable for the purposes for which they are made or if recovery of such gifts would cause the procurement organization to violate standards of professional conduct or any applicable regulation or law. (d) Every funeral director, crematory operator, cemetery official, and procurement organization shall develop systems: (1) to ensure that a principals advance directive is promptly available when services are to be provided, including that the existence of an advance directive is prominently noted on any file jacket or folder, and that a note is entered into any electronic database of the director, operator, official, or organization; (2) within 120 days of the Commissioners announcing the availability of the registry, to ensure that the director, operator, official, or organization checks the registry at the time services are to be provided to determine whether the decedent has an advance directive. (e) In the event the principals instructions in an advance directive regarding disposition of remains or for funeral goods and services are in apparent conflict with a contract entered into by the principal for the disposition of remains, funeral goods, or services, the most recent document created by the principal shall be followed to the extent of the conflict. Nothing in this subsection shall be construed as limiting any other available remedies. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.),  335.) 
 9713. Immunity
(a) No individual acting as an agent, guardian, or surrogate shall be subjected to criminal or civil liability for making a decision in good faith pursuant to the terms of an advance directive, or DNR order, or COLST order and the provisions of this chapter. (b)(1) No health care provider, health care facility, residential care facility, or any other person acting for or under such persons control shall, if the provider or facility has complied with the provisions of this chapter, be subject to civil or criminal liability for: (A) providing or withholding treatment or services in good faith pursuant to the direction of a principal or patient, the provisions of an advance directive, a DNR order, a COLST order, a DNR identification, the consent of a principal or patient with capacity or of the principals or patients agent, guardian, or surrogate, or a decision or objection of a principal or patient; or (B) relying in good faith on a suspended or revoked advance directive, suspended or revoked DNR order, or suspended or revoked COLST order, unless the provider or facility knew or should have known of the suspension, or revocation. (2) A funeral director, crematory operator, cemetery official, procurement organization, or any other person acting for or under such persons control, shall, if the director, operator, official, or organization has complied with the provisions of this chapter, not be subject to civil or criminal liability for providing or withholding its services in good faith pursuant to the provisions of an advance directive, whether or not the advance directive has been suspended or revoked. (3) Nothing in this subsection shall be construed to establish immunity for the failure to follow standards of professional conduct and to exercise due care in the provision of services. (c) No employee shall be subjected to an adverse employment decision or evaluation for:(1) Providing or withholding treatment or services in good faith pursuant to the direction of a principal or patient, the provisions of an advance directive, a DNR order, a COLST order, a DNR identification, the consent of the principal or patient with capacity or principals or patients agent, guardian, or surrogate, a decision or objection of a principal or patient, or the provisions of this chapter. This subdivision shall not be construed to establish a defense for the failure to follow standards of professional conduct and to exercise due care in the provision of services. (2) Relying on an amended, suspended, or revoked advance directive, unless the employee knew or should have known of the amendment, suspension, or revocation. (3) Providing notice to the employer of a moral or other conflict pursuant to subdivision 9707(b)(3) of this title, so long as the employee has provided ongoing health care until a new employee or provider has been found to provide the services. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.),  336; 2011, No. 60,  13, eff. June 1, 2011; 2015, No. 136 (Adj. Sess.),  1, eff. Jan. 1, 2018.) 
 9714. Failure to follow advance directive; unauthorized access of registry; administrative penalties
(a) A health care provider, health care facility, residential care facility, funeral director, crematory operator, or cemetery official, or an employee of any of them having actual knowledge of an advance directive or an instruction of the principal, agent, or guardian is subject to review and disciplinary action by the appropriate licensing entity for failing to act in accordance with the advance directive or instruction or with subsection 9707(b) of this title. (b) A health care provider, health care facility, residential care facility, funeral home director, crematory operator, cemetery official, probate division official, or procurement organization, or an employee of any of them, who accesses the registry without authority or when authority has been denied specifically by the principal, agent, or guardian is subject to review and disciplinary action by the appropriate licensing, accreditation, or approving entity. (c) Nothing in this section shall be construed as limiting any other available remedies.(d) Liability for the cost of health care, disposition of remains, anatomical gifts, or funeral goods and services provided pursuant to an advance directive or pursuant to an instruction of the agent, guardian, or individual designated in an advance directive to make decisions regarding disposition of remains shall be the same as if the services were provided pursuant to the principals decision. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.),  337.) 
 9715. Interpretation with other laws
(a) The withholding or withdrawal of life sustaining treatment from a principal who has executed an advance directive limiting the provision of life sustaining treatment shall not be construed as a suicide. (b) Nothing in this chapter shall be construed to limit or abrogate an individuals ability to create a document of anatomical gift pursuant to chapter 110 of this title. (c) Nothing in this chapter shall be interpreted to affect the statutory or common law in existence at the time of enactment applicable to death intentionally hastened through the use of prescription medication. Professionally appropriate use of medication to relieve suffering which may have the unintended effect of hastening death is not death intentionally hastened through the use of prescription medication. (d) Nothing in this chapter shall be construed to limit the effect of a DD Form 93 (Record of Emergency Data) properly executed by a current or former member of the armed forces of the United States described in 10 U.S.C.  1481(a). (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2009, No. 119 (Adj. Sess.),  6; 2011, No. 80 (Adj. Sess.),  1, eff. April 13, 2012.) 
 9716. Reciprocity; choice of law
Nothing in this chapter limits the enforceability of an advance directive or similar instrument executed in another state or jurisdiction in compliance with the law of that state or jurisdiction. To the extent possible under conflicts of law doctrine, an advance directive executed in Vermont shall be interpreted according to Vermont law. (Added 2005, No. 55,  1, eff. Sept. 1, 2005.) 
 9717. Presumption of validity
An advance directive executed as provided in this chapter shall be presumed valid. No third party shall require an additional or different form of advance directive. A photocopy or facsimile of a duly executed original advance directive shall be relied upon to the same extent as the original. (Added 2005, No. 55,  1, eff. Sept. 1, 2005.) 
 9718. Petition for review by the Probate Division of the Superior Court
(a) A petition may be filed in the Probate Division of the Superior Court under this section by: (1) a principal, guardian, agent, ombudsman, a mental health patient representative, or interested individual other than one identified in an advance directive, pursuant to subdivision 9702(a)(10) of this title, as not authorized to bring an action under this section; (2) a social worker or health care provider employed by or directly associated with the health care provider, health care facility, or residential care facility providing care to the principal; (3) the Defender General if the principal is in the custody of the Department of Corrections;(4) a representative of the State-designated protection and advocacy system if the principal is in the custody of the Department of Mental Health; or (5) an individual or entity identified in an advance directive, pursuant to subdivision 9702(a)(10) of this title, as authorized to bring an action under this section. (b) A petition filed in the Probate Division of the Superior Court under this section shall include a supporting affidavit and may request: (1) that the advance directive be revoked on the grounds that the principal lacked capacity to understand the nature of the advance directive, was under duress, or was the subject of fraud or undue influence when the advance directive was executed, except that, if the principal is deceased, this subdivision shall not apply to any part of an advanced directive making an anatomical gift; (2) that the suspension or revocation of the advance directive be voided and the advance directive be reinstated on the grounds that at the time of the suspension or revocation, the principal was under duress or was the subject of fraud or undue influence; (3) a declaratory judgment concerning the construction of an advance directive or the rights, legal status, or other legal relationship of the parties with respect to an advance directive; or (4) an order for disposition of the remains of the principal.(c) A principal, agent, or interested individual may file an petition in the Probate Division of the Superior Court with a supporting affidavit challenging a determination that the condition specified pursuant to subdivision 9702(a)(3) of this title is met. (d) The principal or an agent may file an petition in the Probate Division of the Superior Court challenging a determination under subdivision 9706(a)(1) or subsection (c) of this title if: (1) the petitioner provides notice to any agent, the principal, an interested individual, or a person entitled to notification of a determination of capacity under subdivision 9706(a)(1) or subsection (c) of this title prior to filing; (2) the petition includes a supporting affidavit setting forth specific facts challenging a capacity determination under subdivision 9706(a)(1) or subsection (c) of this title; (3)(A) prior to filing, the petitioner obtains a determination from a clinician that the principals capacity is not as the principals clinician has determined; or (B) if the petitioner is unable to obtain the determination required by subdivision (A) of this subdivision (3), the petitioner includes in the supporting affidavit the facts regarding the attempts to obtain a second determination of capacity and supporting the challenge to the capacity determination by the petitioners clinician; and (4) the petitioner notifies the principals clinician that an petition challenging the determination of capacity has been filed and provides the supporting determination or affidavit to the principals clinician. (e) The Probate Division of the Superior Court may limit the frequency of a capacity redetermination pursuant to subsection (d) of this section upon a finding that there have been multiple requests for redetermination, and that those requests have been frivolous or requested in bad faith. (f) The agent, if any, shall have the opportunity to appear in any action brought under subdivision (b)(1), (2), or (3) of this section or subsection (c) or (d) of this section. (g) A petitioner filing under subsection (b), (c), or (d) of this section shall, if doing so would be consistent with any obligations the petitioner has under HIPAA, provide notice to the following persons if known: the principal, an agent, a guardian, and interested individuals. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.),  338; 2009, No. 154 (Adj. Sess.),  238a, eff. Feb. 1, 2011; 2013, No. 192 (Adj. Sess.),  21; 2015, No. 23,  52; 2017, No. 121 (Adj. Sess.),  4a, eff. May 3, 2018.) 
 9719. Obligations of State agencies
(a) No later than March 1, 2012, and from time to time thereafter, the Commissioner, in consultation with all appropriate agencies and organizations, shall adopt rules pursuant to 3 V.S.A. chapter 25 to effectuate the intent of this chapter. The rules shall cover at least one optional form of an advance directive with an accompanying form providing an explanation of choices and responsibilities, the Vermont DNR/COLST form as outlined in subsection 9708(b) of this title, the use of experimental treatments, a DNR identification, revocation of a DNR identification, and consistent statewide emergency medical standards for DNR/COLST orders and advance directives for patients and principals in all settings. The Commissioner shall also provide, but without the obligation to adopt a rule, optional forms for advance directives for individuals with disabilities, limited English proficiency, and cognitive translation needs. (b)(1) Within one year of the effective date of this chapter, the Commissioner shall develop and maintain a registry to which a principal may submit his or her advance directive, including a terminal care document and a durable power of attorney. The rules shall describe when health care providers, health care facilities, and residential care facilities may access an advance directive in the registry. In no event shall the information in the registry be accessed or used for any purpose unrelated to decision making for health care or disposition of remains, except that the information may be used for statistical or analytical purposes as long as the individuals identifying information remains confidential. (2)(A) Within one year of the effective date of this chapter, the Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25 on the process for securely submitting, revoking, amending, replacing, and accessing the information contained in the registry. The rules shall provide for incorporation into the registry of notifications of amendment, suspension, or revocation under subsection 9704(c) of this title and revocations of appointment under subsection 9704(d) of this title. (B) The Commissioner shall provide to any individual who submits an advance directive to the registry a sticker that can be placed on a drivers license or identification card indicating that the holder has an advance directive in the registry. (c)(1) Within one year of the effective date of this chapter, the Commissioner shall provide on the Departments public website information on advance directives and the registry to appropriate State offices. The Commissioner shall also include information on advance directives, and on the registry and the optional forms of an advance directive. (2) Within one year of the effective date of this chapter, the Commissioner of Motor Vehicles shall provide motor vehicle licenses and identity cards, as soon as existing licenses or cards have been depleted, which allow the license holder or card holder to indicate that he or she has an advance directive and whether it is in the registry. (Added 2005, No. 55,  1, eff. Sept. 1, 2005; amended 2005, No. 215 (Adj. Sess.),  339; 2011, No. 60,  14, eff. June 1, 2011.) 
 9720. Severability
If any provisions of this chapter or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and, to this end, provisions of this chapter are severable. (Added 2005, No. 55,  1, eff. Sept. 1, 2005.) 
 9721. Advance directives; COVID-19; remote witnesses and explainers
(a) As used in this section, remote witness means a witness who is not physically present when a principal signs an advance directive. (b)(1) Notwithstanding any provision of subsection 9703(b) of this title to the contrary, an advance directive executed by a principal between February 15, 2020 and June 15, 2020 shall be deemed to be valid even if the principal signed the advance directive outside the physical presence of one or both of the required witnesses, provided all of the following conditions were met with respect to each remote witness: (A) the principal and the remote witness were known to each other;(B) the remote witness was informed about the role of a witness to the execution of an advance directive; and (C) the principal included on the advance directive the name and contact information for the witness. (2) An advance directive executed as set forth in subdivision (1) of this subsection shall be valid until June 30, 2021 unless amended, revoked, or suspended by the principal in accordance with this chapter prior to that date. (c)(1) Notwithstanding any provision of subsection 9703(b) of this title to the contrary, an advance directive executed by a principal between June 15, 2020 and March 31, 2023 shall be deemed to be valid even if the principal signed the advance directive outside the physical presence of one or both of the required witnesses, provided all of the following conditions are met with respect to each remote witness: (A) the principal and the remote witness were known to each other;(B) based on video or telephonic communication between the principal and the remote witness, the remote witness attested that the principal seemed to understand the nature of the document and to be free from duress or undue influence at the time the advance directive was signed; and (C) the principal included on the advance directive the name and contact information for the remote witness and the nature of the principals relationship to the remote witness. (2) An advance directive executed as set forth in subdivision (1) of this subsection shall remain valid unless amended, revoked, or suspended by the principal in accordance with this chapter. (d)(1) Notwithstanding any provision of subsection 9703(d) or (e) of this title to the contrary, an advance directive executed by a principal between February 15, 2020 and March 31, 2023 while the principal was being admitted to or was a resident of a nursing home or residential care facility or was being admitted to or was a patient in a hospital shall be deemed to be valid even if the individual who explained the nature and effect of the advance directive to the principal in accordance with subsection 9703(d) or (e) of this title, as applicable, was not physically present in the same location as the principal at the time of the explanation, provided the individual delivering the explanation was communicating with the principal by video or telephone. (2) An advance directive executed in accordance with this subsection shall remain valid as set forth in subsection (b) or (c) of this section, as applicable. (Added 2019, No. 107 (Adj. Sess.),  1, eff. June 15, 2020; amended 2021, No. 6,  10, eff. March 29, 2021; 2021, No. 85 (Adj. Sess.),  7, eff. March 22, 2022.) 
 9731. Informed consent by surrogate for DNR/COLST order
(a)(1) One or more interested individuals may be eligible to act as the surrogate for an adult without capacity in order to provide or withhold informed consent for a do-not-resuscitate order or clinician order for life-sustaining treatment pursuant to this subchapter. Only one interested individual may act as a surrogate at a time. (2)(A) A patients health care provider shall not be considered an interested individual and shall not serve as a patients surrogate to provide or withhold informed consent for a DNR/COLST order pursuant to this chapter unless related to the patient by blood, marriage, civil union, or adoption. (B) The owner, operator, employee, agent, or contractor of a residential care facility, health care facility, or correctional facility in which the patient resides at the time the DNR/COLST order is written shall not be considered an interested individual and shall not act as the patients surrogate to provide or withhold consent for a DNR/COLST order pursuant to this chapter unless related to the patient by blood, marriage, civil union, or adoption. (b) A surrogate may provide or withhold informed consent only if all of the following conditions are met: (1) the patients clinician determines that the patient lacks capacity to provide informed consent; (2) the patient has not appointed an agent through an advance directive;(3) the patient has not indicated in an advance directive that the interested individual or individuals seeking to serve as surrogate should not be consulted on health care decisions or otherwise provided instructions in an advance directive contrary to allowing such individual or individuals to serve as surrogate; (4) the patient does not have a guardian who is authorized to make health care decisions; and (5) the patient does not object to the surrogate providing or withholding consent for a DNR/COLST order or to the treatment proposed to be provided or withdrawn pursuant to a DNR/COLST order, even if the patient lacks capacity. (c)(1) A surrogate shall be an interested individual who is designated by the patient by personally informing the patients clinician. If the patient designates a surrogate to the clinician orally, the clinician shall document the designation in the patients medical record at the time the designation is made. (2) If the patient has not designated a surrogate pursuant to subdivision (1) of this subsection, or if the surrogate designated by the patient is not reasonably available or is unwilling to serve, then the patients clinician shall make a reasonable attempt to notify all reasonably available interested individuals of the need for a surrogate to make a decision regarding whether to provide or withhold consent for a DNR/COLST order. A surrogate shall be an interested individual who is: (A) willing to provide or withhold informed consent for a DNR/COLST order for the patient in accordance with the patients wishes and values, if known; and (B) willing and available to consult with the patients clinician.(3) Notwithstanding the provisions of subdivisions (1) and (2) of this subsection, an individual shall not serve as a surrogate over the patients objection, even if the patient lacks capacity. (d) The patients clinician, health care provider, or residential care provider may rely on the decision of a surrogate identified pursuant to this section as long as the clinician or provider documents in the patients medical record that the surrogate has confirmed that one of the following circumstances applies: (1)(A) All interested individuals agree on the decision to provide or withhold consent for a DNR/COLST order, in which case they shall designate one surrogate, as well as an alternate, if available, who is authorized to provide or withhold consent and whose name will be identified on the DNR/COLST form and in the patients medical record. (B) All interested individuals agree that a specific interested individual may make the decision regarding whether to provide or withhold consent for a DNR/COLST order, in which case they shall designate the individual as the surrogate, as well as an alternate, if available, who is authorized to provide or withhold consent and whose name will be identified on the DNR/COLST form and in the patients medical record. (C) The surrogate or alternate, if applicable, is not reasonably available, in which case the clinician shall consult the interested individuals to request designation of another surrogate and alternate. (2) If at any time the interested individuals are unable to agree on the designation of a surrogate, an interested person, as defined in 14 V.S.A.  3061, may file a petition for guardianship in the Probate Division of the Superior Court. (e) A surrogate providing informed consent for a DNR/COLST order shall use substituted judgment consistent with the patients wishes and values and consistent with the parameters described in subsection 9711(d) of this title. The surrogate shall consult with the patient to the extent possible, and with the patients clinician and any other appropriate health care providers and shall provide or withhold informed consent for a DNR/COLST order by attempting to determine what the patient would have wanted under the circumstances. (f) The patients clinician shall make reasonable efforts to inform the patient of any proposed treatment, or of any proposal to withhold or withdraw treatment, based on the decisions made by the surrogate. (g) If the patients clinician determines that the patient no longer lacks capacity and the DNR/COLST order was based on informed consent provided by a surrogate, the clinician shall seek the informed consent of the patient for any DNR/COLST order, which shall supersede the surrogates consent. (h) A surrogate shall have the same rights as a patient with capacity would have to the following, to the extent that it is related to providing or withholding informed consent for a DNR/COLST order: (1) request, receive, review, and copy any oral or written information regarding the patients physical or mental health, including medical and hospital records; (2) participate in any meetings, discussions, or conferences concerning health care decisions related to the patient; (3) consent to the disclosure of health care information; and(4) file a complaint on behalf of the patient regarding a health care provider, health care facility, or residential care facility. (Added 2015, No. 136 (Adj. Sess.),  1, eff. Jan. 1, 2018.) 
 1241. Purpose
The purpose of this chapter is to require all school districts, supervisory unions, independent schools, and child care providers in Vermont to: (1) test drinking water in their buildings and child care facilities for lead contamination; and (2) develop and implement an appropriate response or lead remediation plan when sampling indicates unsafe lead levels in drinking water at a school or child care facility. (Added 2019, No. 66,  1, eff. June 17, 2019.) 
 1242. Definitions
As used in this chapter:(1) Action level means four parts per billion (ppb) of lead.(2) Alternative water source means:(A) water from an outlet within the building or facility that is below the action level; or (B) containerized, bottled, or packaged drinking water.(3) Building means any structure, facility, addition, or wing that may be occupied or used by children or students. (4) Child care provider has the same meaning as in 33 V.S.A.  3511.(5) Child care facility or facility has the same meaning as in 33 V.S.A.  3511.(6) Commissioner means the Commissioner of Health.(7) Department means the Department of Health.(8) Drinking water has the same meaning as in 10 V.S.A.  1671.(9) Independent school has the same meaning as in 16 V.S.A.  11.(10) Outlet means a drinking water fixture currently or reasonably expected to be used for consumption or cooking purposes, including a drinking fountain, an ice machine, or a faucet as determined by a school district, supervisory union, independent school, or child care provider. (11) School district has the same meaning as in 16 V.S.A.  11.(12) Supervisory union has the same meaning as in 16 V.S.A.  11. (Added 2019, No. 66,  1, eff. June 17, 2019.)
 1243. Testing of drinking water
(a) Scope of testing. (1) Each school district, supervisory union, or independent school in the State shall collect a drinking water sample from each outlet in the buildings it owns, controls, or operates and shall submit the sample to the Department of Health for testing for lead contamination as required under this chapter. (2) Each child care provider in the State shall collect a drinking water sample from each outlet in a child care facility it owns, controls, or operates for lead contamination as required under this chapter. (b) Initial sampling. (1) On or before December 31, 2021, each school district, supervisory union, independent school, or child care provider in the State shall collect a first-draw sample and a second flush sample from each outlet in each building or facility it owns, controls, or operates. Sampling shall occur during the school year of a school district, supervisory union, or independent school. (2) At least five days prior to sampling, the school district, supervisory union, independent school, or child care provider shall notify all staff and all parents or guardians of students directly in writing or by electronic means of: (A) the scheduled sampling;(B) the requirements for testing, why testing is required, and the potential health effects from exposure to lead in drinking water; (C) information, provided by the Department of Health, regarding sources of lead exposure other than drinking water; (D) information regarding how the school district, supervisory union, independent school, or child care provider shall provide notice of the sample results; and (E) how the school district, supervisory union, independent school, or child care provider shall respond to sample results that are at or above the action level. (3) The Department may adopt a schedule for the initial sampling by school districts, supervisory unions, independent schools, and child care providers. (c) Continued sampling. Beginning January 1, 2021, each school district, supervisory union, independent school, or child care provider in the State shall sample each outlet in each building or facility it owns, controls, or operates for lead according to a schedule adopted by the Department by rule under section 1247 of this title. (d) Interim methodology. Prior to adoption of the rules required under section 1247 of this title, sampling under this section shall be conducted according to a methodology established by the Department of Health, provided that the methodology shall be at least as stringent as the sampling methodology provided for under the U.S. Environmental Protection Agencys 3Ts for Reducing Lead in Drinking Water in Schools and shall include a requirement for a first draw sample and a second flush sample. (e) Waiver. (1) The Commissioner shall waive the requirement that a school district, supervisory union, independent school, or child care provider sample drinking water under this section upon a finding that the school district, supervisory union, independent school, or child care provider: (A) completed sampling of all outlets in each building or facility it owns, controls, or operates on or after November 1, 2017; (B) conducted sampling according to a methodology consistent with the Department methodology established under subsection (d) of this section; and (C) implemented or scheduled remediation that ensures that drinking water from all outlets is not at or above the action level. (2) A school district, supervisory union, independent school, or child care provider that receives a waiver under this subsection shall be eligible for assistance from the State for the costs of remediation that has been implemented or scheduled as a result of sampling conducted after April 22, 2019. (f) Laboratory analysis. The analyses of drinking water samples required under this chapter shall be conducted by the Vermont Department of Health Laboratory or by a certified laboratory under contract to the Department. (Added 2019, No. 66,  1, eff. June 17, 2019; amended 2019, No. 133 (Adj. Sess.),  2.) 
 1244. Response to action level; notice; reporting
If a sample of drinking water under section 1243 of this title indicates that drinking water from an outlet is at or above the action level, the school district, supervisory union, independent school, or child care provider that owns, controls, or operates the building or facility in which the outlet is located shall conduct remediation to eliminate or reduce lead levels in the drinking water from the outlet. In conducting remediation, a school district, supervisory union, independent school, or child care provider shall strive to achieve the lowest level of lead possible in drinking water. At a minimum, the school district, supervisory union, independent school, or child care provider shall: (1)(A) prohibit use of an outlet that is at or above the action level until:(i) implementation of a lead remediation plan that is consistent with the U.S. Environmental Protection Agencys 3Ts for Reducing Lead in Drinking Water in Schools; and (ii) sampling indicates that lead levels from the outlet are below the action level; or(B) prohibit use of an outlet that is at or above the action level until the outlet is permanently removed, disabled, or otherwise cannot be accessed by any person for the purposes of consumption or cooking; (2) provide occupants of the building or child care facility an adequate alternative water source until remediation is performed; (3) notify all staff and all parents or guardians of students directly of the test results and the proposed or taken remedial action in writing or by electronic means within 10 school days after receipt of the laboratory report; (4) submit lead remediation plans to the Department as they are completed;(5) notify all staff and all parents or guardians or students in writing or by electronic means of what remedial actions have been taken; and (6) submit notice to the Department of Health that remediation plans have been completed. (Added 2019, No. 66,  1, eff. June 17, 2019.)
 1245. Record keeping; public notification; database
(a) Record keeping. The Department of Health shall retain all records of test results, laboratory analyses, lead remediation plans, and waiver requests for 10 years following the creation or acquisition of the record. Records produced or acquired by the Department under this chapter are public records subject to inspection or copying under the Public Records Act. (b) Public notification. On or before March 1, 2021, the Commissioner shall publish on the Department website the data from testing under section 1243 of this title so that the results of sampling are fully transparent and accessible to the public. The data published by the Department shall include a list of all buildings or facilities owned, controlled, or operated by a school district, supervisory union, independent school, or child care provider at which drinking water from an outlet tested is at or above the action level within the previous two years of reported samples. The Commissioner shall publish all retesting data on the Departments website within two weeks of receipt of the relevant laboratory analysis. The Secretary of Education shall include a link on the Agency of Education website to the Department of Health website required under this subsection. (Added 2019, No. 66,  1, eff. June 17, 2019.) 
 1246. Lead remediation plan; guidance; communication
(a) Consultation. When a laboratory analysis of a sample of drinking water from an outlet at a building or facility owned, controlled, or operated by a school district, supervisory union, independent school, or child care provider is at or above the action level, the school district, supervisory union, independent school, or child care provider may consult with the Commissioner regarding the development of a lead remediation plan or other necessary response. (b) Guidance; lead remediation plan. The Commissioner, after consultation with the Secretary of Natural Resources, the Commissioner for Children and Families, and the Secretary of Education, shall issue guidance on development of a lead remediation plan by a school district, supervisory union, independent school, or child care provider. The guidance provided by the Commissioner shall reference the U.S. Environmental Protection Agencys 3Ts for Reducing Lead in Drinking Water in Schools. (c) Communications. The Department of Health shall develop sample communications for parents for use by school districts, supervisory unions, independent schools, and child care providers concerning lead in water and reducing exposure to lead under this chapter. (Added 2019, No. 66,  1, eff. June 17, 2019.) 
 1247. Rulemaking
(a) The Commissioner shall adopt rules under this chapter to achieve the purposes of this chapter. (b) On or before November 1, 2020, the Commissioner, with continuing consultation with the Secretary of Natural Resources, the Commissioner for Children and Families, and the Secretary of Education, shall adopt rules regarding the implementation of the requirements of this chapter. The rules shall include: (1) requirements or guidance for taking samples of drinking water from outlets in a building or facility owned, controlled, or operated by a school district, supervisory union, independent school, or child care provider that are no less stringent than the requirements of the U.S. Environmental Protection Agencys 3Ts for Reducing Lead in Drinking Water in Schools and that include a first draw sample and second flush sample; (2) the frequency and scope of continued sampling of outlets by school districts, supervisory unions, independent schools, and child care providers, provided that the Department may stagger when continued sampling shall occur by school or provider, school type or provider type, or initial sampling results; (3) requirements for implementation of a lead mitigation plan or other necessary response to a report that drinking water from an outlet is at or above the action level; and (4) any other requirements that the Commissioner deems necessary for the implementation of the requirements of this chapter. (Added 2019, No. 66,  1, eff. June 17, 2019.) 
 1248. Enforcement; penalties
In addition to any other authority provided by law, the Commissioner of Health or a hearing officer designated by the Commissioner may, after notice and an opportunity for hearing, impose an administrative penalty of up to $500.00 for a violation of the requirements of this chapter. The hearing before the Commissioner shall be a contested case subject to the provisions of 3 V.S.A. chapter 25. (Added 2019, No. 66,  1, eff. June 17, 2019.) 
 1331. Definitions
As used in this chapter:(1) Asbestos means the asbestiform varieties of chrysotile (serpentine); crocidolite (riebeckite); amosite (cummingtonite-grunerite); anthophyllite; tremolite; and actinolite. (2) Asbestos abatement means the repair, enclosure, removal, encapsulation, or any other activity for the evaluation or control of any material which contains more than one percent asbestos by weight. (3) Commissioner means the Commissioner of Health or the Commissioners designee. (Added 1985, No. 238 (Adj. Sess.), eff. June 3, 1986.)
 1332. Certification
Any person may apply to the Commissioner for certification as an asbestos contractor permitted to perform asbestos abatement in the State of Vermont. Certification shall be granted to any person who meets the standards for certified asbestos contractors established by the Commissioner by rule. The Commissioner shall provide proof of certification to all successful applicants. The Commissioner shall maintain and, upon request, make available a list of asbestos contractors certified under this chapter. The Commissioner shall, by rule, establish procedures to be followed under this chapter. (Added 1985, No. 238 (Adj. Sess.), eff. June 3, 1986.) 
 1333. Notification of work
Any contractor performing asbestos abatement work must notify the Commissioner 10 working days prior to beginning work. (Added 1985, No. 238 (Adj. Sess.), eff. June 3, 1986.) 
 1334. Application fees
(a) The Commissioner shall require the payment of certification and permit fees at the time of application. The Commissioner shall not process an application for which fees have not been paid. No person shall perform asbestos abatement without obtaining certification and a permit from the Commissioner. (b) Certification and permit fees shall be:(1) Certification fees(A) Entities   $600.00 Initial   $150.00 Additional (B) Consultants   $180.00 Initial   $150.00 Additional (C) Analysts   $ 60.00 (D) Workers   $ 60.00 (E) Supervisors   $120.00 (F) Training coursestwo-year periodInitial   $480.00 Refresher   $300.00 (A) more than 10 square feetthrough 100 square feet   $ 75.00 (B) more than 10 linear feetthrough 100 linear feet   $ 75.00 (C) more than 100 square feetthrough 1,000 square feet   $150.00 (D) more than 100 linear feetthrough 1,000 linear feet   $150.00 (E) more than 1,000 square feet   $300.00 (F) more than 1,000 linear feet   $300.00 (G) permit revision charge   $ 50.00 (c) Fees collected under this section shall be credited to a special fund and shall be available to the Department to offset the costs of providing these services. (Added 1989, No. 210 (Adj. Sess.),  120; amended 1991, No. 5,  35, eff. March 13, 1991; 1997, No. 155 (Adj. Sess.),  58; 2007, No. 76,  10.) 
 1415. Division of Occupational Health
To implement the policy of the State expressed in 21 V.S.A.  201, and to continue the functions of the Division of Industrial Hygiene, there is created within the Department of Health the Division of Occupational Health, which shall be administered by the Director of Occupational Health under direction and control of the Commissioner of Health and the State Board of Health. The Division is the successor to and a continuation of the Division of Industrial Hygiene. (Added 1971, No. 205 (Adj. Sess.),  2.) 
 1416. Definitions
As used in this chapter:(1) Director means the Director of Occupational Health.(2) Division means the Division of Occupational Health.(3) Employee means any person engaged in service to an employer for wages, salary, or other compensation, excluding an independent contractor. (4) Employer means a person, as hereinafter defined, who employs one or more persons.(5) Health hazard means any material, including biological material or energy, or both, in any form from any source that can adversely affect the health of any employee, or can adversely affect the health of any person exposed in a place of employment or any person adversely exposed from a source in a place of employment. (6) Occupational disease means a disease caused by exposure to an occupational health hazard. (7) VOSHA Code means this chapter and 21 V.S.A. chapter 3, subchapters 4 and 5.(8) Person means a natural person, corporation, partnership, trust, society, club, association, or other organization, including municipalities and the State. (9) Place of employment means any work place or place where an employee is engaged in performance of his or her work or duties, or which is used in connection with an employees employment. It includes structures, buildings, machinery, equipment, tools, appliances, and materials used in connection with the employment. It also includes land and premises where an employer is carrying on any activity or business involving the use of one or more employees. (Added 1971, No. 205 (Adj. Sess.),  2; amended 2017, No. 113 (Adj. Sess.),  62.) 
 1417. Functions and duties of Division
The Division of Occupational Health shall:(1) maintain necessary laboratory facilities and equipment required to effectively perform its functions; (2) study occupational health hazards and occupational diseases and procedures necessary for their control or prevention, and recommend necessary rules for such control or prevention to the Board of Health and the Secretary of Human Services; (3) investigate places of employment to determine the presence of health hazards which may be the cause or which may be suspected of being the cause of illness or occupational disease; (4) investigate health hazards in places of employment that cause ill health or occupational disease, or may be suspected of doing so, and recommend rules to the Board of Health and the Secretary of Human Services for the control or elimination of the health hazards; (5) advise employers of the existence of conditions at work places which cause ill health or occupational disease; (6) make inspections and investigations to discover violation of health standards and rules promulgated by the Secretary of Human Services under the VOSHA Code, and report any violation other than de minimis violations to the Commissioner of Labor, and cooperate with that Commissioner in taking action against violators of the VOSHA Code; (7) test the effectiveness of control appliances and equipment used by employers and report any deficiency in performance to the employer and the Commissioner of Labor; (8) consult, advise, and assist employers in the development and maintenance of medical services and programs for employees. (Added 1971, No. 205 (Adj. Sess.),  2; amended 2005, No. 103 (Adj. Sess.),  3, eff. April 5, 2006; 2017, No. 113 (Adj. Sess.),  63.) 
 1418. Control equipment
The Commissioner of Health may by order require an employer to provide protective equipment, install and maintain control appliances and equipment, or take any other action necessary to remove or control a health hazard or to prevent a health hazard from becoming injurious. Failure to do so within the time limited by the Director shall be a violation of the VOSHA Code and shall be reported to the Commissioner of Labor. (Added 1971, No. 205 (Adj. Sess.),  2; amended 2005, No. 103 (Adj. Sess.),  3, eff. April 5, 2006.) 
 1421. Smoking in the workplace; prohibition
(a) The possession of lighted tobacco products or use of tobacco substitutes as defined in 7 V.S.A.  1001 is prohibited in any workplace. (b)(1) As used in this subchapter, workplace means an enclosed structure where employees perform services for an employer, including restaurants, bars, and other establishments in which food or drinks, or both, are served. In the case of an employer who assigns employees to departments, divisions, or similar organizational units, workplace means the enclosed portion of a structure to which the employee is assigned. (2) Except for schools, workplace does not include areas commonly open to the public or any portion of a structure that also serves as the employees or employers personal residence. (3) For schools, workplace includes any enclosed location where instruction or other school-sponsored functions are occurring. (4) For lodging establishments used for transient traveling or public vacationing, such as resorts, hotels, and motels, workplace includes the sleeping quarters and adjoining rooms rented to guests. (5) The prohibition on using tobacco substitutes in a workplace shall not apply to a business that does not sell food or beverages but is established for the sole purpose of providing a setting for patrons to purchase and use tobacco substitutes and related paraphernalia. (c) Nothing in this section shall be construed to restrict the ability of residents of the Vermont Veterans Home to possess lighted tobacco products or use tobacco substitutes in the indoor area of the facility in which smoking is permitted. (Added 1987, No. 69,  2, eff. July 1, 1988; amended 1987, No. 162 (Adj. Sess.),  2; 2009, No. 32,  1; 2013, No. 135 (Adj. Sess.),  1; 2015, No. 108 (Adj. Sess.),  2.) 
 1426. Enforcement
(a) An employee aggrieved by an employers failure to comply with the provisions of this subchapter may file a complaint with the Department of Health. (b) In addition to any other authority provided by law, the Commissioner of Health or a hearing officer designated by the Commissioner may, after notice and an opportunity for hearing, impose an administrative penalty of $100.00 against an employer who violates this chapter. The hearing before the Commissioner shall be a contested case subject to the provisions of 3 V.S.A. chapter 25 (Administrative Procedure Act). (Added 1987, No. 69,  2, eff. July 1, 1988; amended 2009, No. 32,  2.) 
 1427. Employee rights
(a) An employer shall not discharge or discipline or otherwise discriminate against an employee because that employee assisted in the supervision or enforcement of this chapter. (b) Any employee who believes that he or she has been discharged or otherwise discriminated against in violation of this section may, within 30 days after such violation occurs, file a complaint with the Commissioner of Health alleging such discrimination. Upon receipt of such complaint, the Commissioner shall cause such investigation to be made as the Commissioner deems appropriate. If upon investigation, the Commissioner determines that the provisions of this section have been violated, he or she shall bring an action in Superior Court against such person. In any such action, the court shall have jurisdiction for cause shown to restrain violations of subsection (a) of this section and order all appropriate relief including rehiring or reinstatement of the employee to his or her former position with back pay. (c) Within 90 days of the receipt of a complaint filed under this section, the Commissioner shall notify the complainant of the determination under subsection (b) of this section. (Added 1987, No. 69,  2, eff. July 1, 1988.) 
 1428. Municipal ordinances
Nothing in this subchapter shall be construed to supersede or in any manner affect a municipal smoking ordinance provided that the provisions of such ordinance are at least as protective of the rights of nonsmokers as the provisions of this subchapter. (Added 1987, No. 69,  2, eff. July 1, 1988.) 
 1504. Distribution of samples of medicine
A person, firm, or corporation that distributes or causes to be distributed a free or trial sample of a medicine, drug, chemical, or chemical compound, by leaving the same exposed upon the ground, sidewalks, porch, doorway, letter box, or in any other manner that children may become possessed of the same shall be fined not more than $300.00 nor less than $100.00. 
 1510. Improper possession, use, or sale of glues and hazardous inhalants; penalty
(a) As used in this section:(1) Glue containing a solvent having the property of releasing toxic vapors or fumes means any glue, cement, or other adhesive containing one or more of the following chemical compounds: acetone, cellulose acetate, benzene, butyl alcohol, ethyl alcohol, ethylene dichloride, ethylene trichloride, isopropyl alcohol, methyl alcohol, methyl ethyl ketone, pentachlorophenol, petroleum ether, toluene, or such other similar material as the Commissioner shall by regulation prescribe. (2) Hazardous inhalants means any of the preparation of compounds containing one or more of the chemical compounds amyl nitrite, isoamyl nitrite, butyl nitrite, isobutyl nitrite, pentyl nitrite, or any other akyl nitrite compound that is either designed to be used, or commonly used, as an inhalant. (b) No person shall, for the purpose of causing a condition of intoxication, inebriation, excitement, stupefaction, or the dulling of the brain or nervous system, intentionally smell or inhale the fumes from any hazardous inhalants or from any glue containing a solvent having the property of releasing toxic vapors or fumes. Nothing in this subsection shall be interpreted as applying to the inhalation of any anesthesia or inhalant for medical or dental purposes. (c) No person shall, for the purpose of violating subsection (b) of this section, use or possess for the purpose of using any hazardous inhalants or any glue containing a solvent having the property of releasing toxic vapors or fumes. (d) A person who violates this section shall be fined not more than $25.00.(e) The States Attorney may require as a condition of diversion that a person who is charged with a violation of this section shall attend and complete a substance abuse program at the persons own expense. A person who is convicted of violating this section and who is placed on probation, shall, as a condition of probation, be required to attend and complete a substance abuse program at the persons own expense. (Added 1993, No. 150 (Adj. Sess.),  1.) 
 1511. Phthalates
(a) As used in this section:(1) Child care article means any product designed or intended by the manufacturer to facilitate sleep, relaxation, or the feeding of children, or to help children with sucking or teething. (2) Phthalate means any one of a group of chemicals used as plasticizers to provide flexibility and durability to plastics such as polyvinyl chloride (PVC). (3) Toy means any product designed or intended by the manufacturer to be used by children when they play. (b) Beginning July 1, 2009, no person or entity shall manufacture, sell, or distribute in commerce any toy or child care article intended for use by a child under three years of age if that product contains di-(2-ethylhexyl) phthalate (DEHP), dibutyl phthalate (DBP), or benzyl butyl phthalate (BBP), in concentrations exceeding 0.1 percent. (c) Beginning July 1, 2009, no person or entity shall manufacture, sell, or distribute in commerce any toy or child care article intended for use by a child under three years of age if that product can be placed in the childs mouth and contains diisononyl phthalate (DINP), diisodecyl phthalate (DIDP), or di-n-octyl phthalate (DnOP), in concentrations exceeding 0.1 percent. (d) Manufacturers shall use the least toxic alternative when replacing phthalates in accordance with this section. (e) Manufacturers shall not replace phthalates, pursuant to this section, with carcinogens rated by the U.S. Environmental Protection Agency (EPA) as A, B, or C carcinogens or substances listed on the EPAs List of Chemicals Evaluated for Carcinogenic Potential as known or likely carcinogens, known to be human carcinogens, likely to be human carcinogens, or suggestive of being carcinogens. (f) Manufacturers shall not replace phthalates, pursuant to this section, with reproductive toxicants that the EPA has identified as causing birth defects, reproductive harm, or developmental harm. (g) A violation of this section shall be deemed a violation of the Consumer Protection Act, 9 V.S.A. chapter 63. The Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions, and private parties have the same rights and remedies as provided under 9 V.S.A. chapter 63, subchapter 1. (h) Nothing in this section shall be construed to regulate firearms; ammunition or components thereof; pellets from air rifles; shooting ranges or circumstances resulting from shooting, handling, storing, casting, or reloading ammunition; or hunting or fishing equipment or components thereof. (Added 2007, No. 171 (Adj. Sess.),  1; amended 2011, No. 136 (Adj. Sess.),  1b, eff. May 18, 2012.) 
 1512. Bisphenol A
(a) As used in this section:(1) Baby food means a prepared solid food consisting of a soft paste or an easily chewed food that is intended for consumption by children two years of age or younger and that is commercially available. (2) Bisphenol A means an industrial chemical used primarily in the manufacture of polycarbonate plastic and epoxy resins. (3) Infant formula means a milk-based or soy-based powder, concentrated liquid, or ready-to-feed substitute for human breast milk that is intended for infant consumption and that is commercially available. (4) Reusable food or beverage container means a receptacle for storing food or beverages, including baby bottles, spill-proof cups, sports bottles, and thermoses. The term does not include food or beverage containers intended for disposal after initial usage. The term shall not include commercial water cooler jugs. (b) Beginning July 1, 2012, no person or entity shall manufacture, sell, or distribute in commerce in this State any reusable food or beverage container containing bisphenol A. (c)(1) Beginning July 1, 2012, no person or entity shall manufacture, sell, or distribute in commerce in this State any infant formula or baby food stored in a plastic container or jar that contains bisphenol A. (2) Beginning July 1, 2014, no person or entity shall manufacture, sell, or distribute in commerce in this State any infant formula or baby food stored in a can that contains bisphenol A. (d) Manufacturers shall use the least toxic alternative when replacing bisphenol A in accordance with this section. (e) Manufacturers shall not replace bisphenol A, pursuant to this section, with carcinogens rated by the U.S. Environmental Protection Agency (EPA) as A, B, or C carcinogens or substances listed on the EPAs List of Chemicals Evaluated for Carcinogenic Potential as known or likely carcinogens, known to be human carcinogens, likely to be human carcinogens, or suggestive of being carcinogens. (f) Manufacturers shall not replace bisphenol A, pursuant to this section, with reproductive toxicants that the EPA has identified as causing birth defects, reproductive harm, or developmental harm. (g) A violation of this section shall be deemed a violation of the Consumer Protection Act, 9 V.S.A. chapter 63. The Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions, and private parties have the same rights and remedies, as provided under 9 V.S.A. chapter 63, subchapter 1. (Added 2009, No. 112 (Adj. Sess.),  2, eff. May 19, 2010; amended 2011, No. 109 (Adj. Sess.),  3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.),  1b, eff. May 18, 2012.) 
 1513. Tanning facilities; minors; penalty
(a) As used in this section:(1) Operator means a person designated by the tanning facility owner or tanning equipment lessee to operate or to assist and instruct in the operation and use of the tanning facility or tanning equipment. (2) Tanning equipment means any device that emits electromagnetic radiation with wavelengths in the air between 200 and 400 nanometers used for tanning of the skin, including a sunlamp, tanning booth, or tanning bed. (3) Tanning facility means any location, place, area, structure, or business that provides persons access to any tanning equipment, including tanning salons, health clubs, apartments, and condominiums, regardless of whether a fee is charged for access to the tanning equipment. (b) This section shall apply to any tanning facility in Vermont; provided, however, that it shall not apply to any physician duly licensed to practice medicine who uses, in the practice of medicine, medical diagnostic and therapeutic equipment that emits ultraviolet radiation or to any person who owns tanning equipment exclusively for personal, noncommercial use. (c) It shall be unlawful for a tanning facility or operator to allow any person who has not yet reached the age of 18 to use any tanning equipment. (d) Any tanning facility or operator that allows a person under 18 years of age to use any tanning equipment shall be subject to a civil penalty of not more than $100.00 for the first offense and not more than $500.00 for any subsequent offense. An action to enforce this section shall be brought in the Judicial Bureau pursuant to 4 V.S.A. chapter 29. (e) The Commissioner of Health shall adopt such rules as are necessary to carry out the provisions of this section. (f) A tanning facility owner, lessee, or operator shall post in a conspicuous place in each tanning facility that the individual owns, leases, or operates in this State a notice developed by the Commissioner of Health addressing the following: (1) that it is unlawful for a tanning facility or operator to allow a person under the age of 18 to use any tanning equipment; (2) that a tanning facility or operator that violates the provisions of this section shall be subject to a civil penalty; (3) that an individual may report a violation of the provisions of this section to his or her local law enforcement agency; and (4) the health risks associated with tanning. (Added 2011, No. 97 (Adj. Sess.),  1.)
 101. State Board of Health, appointment and qualification
(a) There shall be, within the Department of Health, a board to be known and designated as the State Board of Health. Such Board shall consist of seven members who shall be appointed biennially in the month of February by the Governor, with the advice and consent of the Senate. The members shall be appointed for a term of six years. Any vacancy occurring in the membership of such Board shall be filled by the Governor for the unexpired portion of the term. The Governor shall designate the Chair of the Board. (b) Three members of such Board shall be doctors, one of whom shall be licensed to practice medicine and surgery in the State, one of whom shall possess special training and ability in psychiatry, and one of whom shall be licensed to practice osteopathy, surgery, and obstetrics in the State; one member of such Board shall be licensed to practice dentistry in the State; and three members of such Board shall be persons not of the medical or dental profession. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 102. Duties of Board
The Board shall supervise and direct the execution of all laws vested in the Department of Health by virtue of this title, and shall formulate and carry out all policies relating thereto, and shall adopt such rules as are necessary to administer this title and shall make a biennial report with recommendations to the Governor and to the General Assembly. The Board may delegate such powers and assign such duties to the Commissioner as it may deem appropriate and necessary for the proper execution of provisions of this title. The authority of the Board to adopt the rules shall extend to all matters relating to the preservation of the public health and consistent with the duties and responsibilities of the Board. The Boards jurisdiction over sewage disposal includes emergent conditions which create a risk to the public health as a result of sewage treatment and disposal, or its effects on water supply, but does not include rulemaking on design standards for on-site sewage disposal systems. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1983, No. 117 (Adj. Sess.),  2; 2015, No. 23,  104.) 
 103. Meetings of Board; per diem; expenses
(a) The Board shall hold such meetings as may be required for the performance of its duties. Such Board shall meet at such times and places as may be designated by the Chair thereof. Such Chair shall call a meeting upon the written request of any three members or upon the written request of the Governor. (b) The members of the Board shall receive a per diem of $30.00 for time actually spent in the performance of their duties and shall be reimbursed for their travel and expenses. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 104. Office of Professional Regulation
(a) The Secretary shall appoint a Commissioner of Health, as provided in 3 V.S.A.  3051, who shall be either a physician licensed to practice medicine and surgery in this State or a health care professional who has at least a masters degree in public health or a related health care field and who, in addition, has had practical experience in the field of public health. (b) The Commissioner may delegate such powers and assign such duties to members of the Department as may be deemed appropriate and necessary for the proper execution of the provisions of this title. If the Commissioner is not a physician licensed to practice medicine and surgery in this State, the Commissioner shall fill an existing exempt position within the Department by appointing a chief medical officer who shall be a physician licensed to practice medicine and surgery in this State and who shall report to the Commissioner. (c) The powers set forth in this title are in addition to the common law and statutory powers or remedies of the State otherwise provided by law. (d) Upon receipt of information regarding a condition that may be a public health hazard, the Commissioner shall conduct an investigation. The investigation may include an inspection of the premises where the public health hazard may exist and may include monitoring and testing. (e) The Commissioner shall establish guidelines for conducting investigations and inspections and for determining whether a public health risk or public health hazard is a local or a State problem. (f) When applicable, the Commissioner shall make use of the best scientific, environmental, medical, engineering, epidemiological, hydrological, geological, ecological, and sanitation practices when issuing permits and orders, and when establishing practices, procedures, rules, and guidelines under this title. (g) The Commissioner may enter into contracts to provide services, provided the Department is not otherwise required to provide such services, and provision of such services does not interfere with the Departments statutory purposes and programs. The Department may charge for services provided under this subsection. Charges collected under this subsection shall be credited to separate special funds for each type of contractual service, and shall be available to the Department to offset the costs of each type of service. (h) The Commissioner may bill a third party insurer for services provided by the Department to persons covered by such insurance. Charges collected under this subsection shall be credited to a special fund and shall be available to the Department to offset the cost of such services. (i) The Commissioner may accept and retain any product rebates received for items purchased in support of departmental programs. Charges collected under this subsection shall be credited to separate special funds and shall be available to the Department to offset the cost of such programs. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1985, No. 267 (Adj. Sess.),  3; 1997, No. 155 (Adj. Sess.),  55, eff. April 29, 1998; 2007, No. 152 (Adj. Sess.),  1.) 
 104a. Commissioner of Health; designation of advisor to Commissioner of Motor Vehicles
The Commissioner of Health, upon request by the Commissioner of Motor Vehicles, shall designate an appropriate professional member of the Department to serve as advisor to the Commissioner of Motor Vehicles on health aspects of the licensing of motor vehicle operators. (Added 1967, No. 251 (Adj. Sess.),  1, eff. Feb. 20, 1968.) 
 104b. Community health and wellness grants
(a) The Commissioner shall establish a program for awarding competitive, substantial, multi-year grants to comprehensive community health and wellness projects. Successful projects must: (1) use comprehensive approaches designed to promote healthy behavior and disease prevention across the community and across the lifespan of individual Vermonters and address issues which may include promoting nutrition and exercise for children, community recreation programs, elderly wellness, lead poisoning abatement, obesity prevention, maternal and child health and immunization, mental health and substance abuse, and tobacco prevention and cessation; (2) be consistent with the Blueprint for Health and other State health initiatives as well as the overall goals of the applicant community; (3) be goal and result driven;(4) use strategies that have been demonstrated to be effective in reaching the desired goal; (5) provide data for evaluating and monitoring progress;(6) include a plan for ensuring that all food vending machines located in public buildings within the control of the grant recipient contain foods and portion sizes consistent with the Vermont nutrition and fitness policy guidelines or other relevant science-based resources; and (7) address socioeconomic or other barriers that stand in the way of fit and healthy lifestyles in their communities. (b) The Commissioner, through the 12 district health offices, shall assist communities by: (1) providing technical assistance to support communities in following a consistent and coordinated approach to planning and implementation, including practices such as needs assessment, defined priorities, action plans, and evaluation; (2) providing access to best and promising practices and approved public policies;(3) providing assistance to help communities develop public awareness materials and communication tools with well-researched and well-coordinated messaging; (4) helping communities obtain and maximize funding from all applicable sources; and(5) providing other assistance as appropriate.(c)-(e) [Repealed.](f) The Commissioner may adopt regulations pursuant to 3 V.S.A. chapter 25, the Administrative Procedure Act, necessary for the implementation of this program. (g) The Commissioner is authorized to accept donations or contributions from private sources for community wellness grants. (Added 2005, No. 215 (Adj. Sess.),  322; amended 2007, No. 203 (Adj. Sess.),  14, eff. June 10, 2008; 2009, No. 135 (Adj. Sess.),  26, eff. May 29, 2010; 2011, No. 139 (Adj. Sess.),  51, eff. May 14, 2012; 2015, No. 11,  16.) 
 106. Delegation of duties by Board through Commissioner
Any delegation of responsibility and authority by the Board shall be made through the Commissioner and shall in no way relieve the Board of its accountability for the proper administration of the provisions of this title. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 113 (Adj. Sess.),  51.) 
 107. Life and health of inhabitants; inspections; investigations
(a) The Commissioner shall take cognizance of the interest of the life and health of the inhabitants of the State, shall make or cause to be made inspections, investigations, and inquiries respecting causes of disease and the means of preventing the same and the effect of all circumstances relating to or affecting the public health. With the approval of the Governor, the Commissioner may apply for and accept research grants for such funded research projects as have as their objective the advancement of knowledge in the health sciences, provided that the Commissioner may staff and equip such projects only from such research grants. (b) A health officer may conduct inspections, review records, and take samples, photographs, and other evidence to detect violations of any State or local health statute, rule, ordinance, or permit, or any public health hazard or public health risk. Inspections shall be conducted at a reasonable time and in a reasonable manner. The health officer may, upon presentation of credentials, seek permission to inspect any premises not open to the public. If permission is refused, the health officer may, pursuant to section 121 of this title, seek a search warrant authorizing the inspection of such premises. (c) This section shall not limit or conflict with the duties or powers of a health officer to inspect public water sources, public water systems, or public water source protection areas and food or lodging establishments under chapters 24 and 85 of this title. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1963, No. 102,  5, eff. May 22, 1963; 1985, No. 267 (Adj. Sess.),  4; 1989, No. 105,  4; 2021, No. 15,  6.) 
 108. Water supply; sanitation
When requested, or when, in its opinion, it is necessary, the Board shall advise with municipal officers in regard to drainage, water supply, and sewerage of towns and villages and in regard to the erection, construction, heating, ventilation, and sanitary arrangements of public buildings. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 109. Board exercising powers of local Board of Health or health officer
In its discretion the Board may exercise all the powers and authority, in each town and village, which is given to a local board of health. The Commissioner may likewise exercise all the power and authority of a local health officer throughout the State. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 110. Reports by Commissioner
From the reports required to be made to him or her, the Commissioner shall issue in each even year registration reports. He or she shall make a biennial report to the Board relating to his or her work for the period with such recommendations as seem advisable, which report shall be incorporated into the biennial report of the Board. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 111. Forms for reports of infectious and contagious diseases
The Board shall devise and furnish health officers suitable forms upon which to make reports of infectious and contagious diseases. It shall also devise and furnish forms for physicians to report to health officers. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 112. Circulars of information
The Board shall prepare and distribute to local boards of health, physicians, and other persons such printed circulars as it deems necessary and such rules as the Board may adopt and, upon request of the Board, the Commissioner thereof shall give information relative to the cause and prevention of disease and directions as to modes of management, quarantine, and means of prevention of contagious and infectious diseases. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2015, No. 23,  105.) 
 113. Services and expenditures; cooperation with other agencies; attendance upon meetings
The Board may perform such services and incur such expenditures as it deems necessary for the protection of the public health, may cooperate with health agencies of other states and countries; and a committee of the Board may attend meetings of health authorities outside the State. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 115. Public health surveillance assessment and planning
(a) The Department of Health may, in the discretion of the Commissioner, accept for treatment children who have chronic diseases or developmental disabilities. (b) The Commissioner of Health is authorized to:(1) study the prevalence of chronic disease;(2) make such morbidity studies as may be necessary to evaluate the overall problem of chronic disease and developmental disabilities; (3) develop an early case-finding program, in cooperation with the medical profession;(4) develop and carry on an educational program as to the causes, prevention, and alleviation of chronic disease and developmental disabilities; and (5) adopt rules for the purpose of screening chronic diseases and developmental disabilities in newborns. (c) The Department of Health is directed to consult and cooperate with the medical profession and interested official and voluntary agencies and societies in the development of this program. (d) The Department is authorized to accept contributions or gifts which are given to the State for any of the purposes as stated in this section, and the Department is authorized to charge and retain monies to offset the cost of providing newborn screening program services. (Amended 1959 (Adj. Sess.),  27, eff. March 1, 1961; 1973, No. 77,  60, eff. April 14, 1973; 1997, No. 59,  84, eff. June 30, 1997; 2013, No. 96 (Adj. Sess.),  86; 2015, No. 152 (Adj. Sess.),  11.) 
 116. Mother and child health service; training of nurses and workers
(a) The Board shall continue the existing health service for mothers and children established in a manner harmonious with Parts One and Two of Title V of the Act of Congress approved August 14, 1935 and entitled Social Security Act and shall continue its existing health service for children with physical disabilities. (b) The Board may pay for the graduate training of public health nurses and other professional health department workers whom it employs. (Amended 1959, No. 75, eff. April 1, 1959; 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2013, No. 96 (Adj. Sess.),  88.) 
 117. Chronic fatigue syndrome
(a) The Commissioner of Health shall establish a statewide network of resources to provide education through the distribution of information regarding persons with chronic fatigue syndrome, also known as chronic fatigue immune dysfunction syndrome (CFIDS), to persons with chronic fatigue syndrome, health care providers, and the public. (b) The Department shall work in collaboration with the Vermont CFIDS Association, Inc. and health care providers with expertise in chronic fatigue syndrome to prepare an informational packet about the clinical significance, diagnosis, and treatment of chronic fatigue syndrome. The informational packet shall be based upon the publication A Consensus Manual for the Primary Care and Management of Chronic Fatigue Syndrome published by the Academy of Medicine of New Jersey and the New Jersey Department of Health and Senior Services, to the extent allowable under federal copyright protections. The Department shall distribute the informational packet to all primary care physicians in the State, and it shall be available on the Department of Healths website. The informational packet may contain any other information that the Commissioner of Health deems necessary and shall be revised by the Department when new information about chronic fatigue syndrome becomes available. The Department shall publicize the informational packet and make it widely available to the public. (Added 2005, No. 215 (Adj. Sess.),  116.) 
 120. Contract for payment of certain health benefits
The Board of Health may contract with a private organization to process the payment of in-patient hospital care, and physician, radiological, and other medical costs related thereto under the maternal, child health, and children with physical disabilities plans of the Department of Health. Such a contract shall provide for cancellation upon reasonable notification by the Board. In furtherance of the purposes of the contract, the Board may requisition funds, with the approval of the Governor, and the Commissioner of Finance and Management shall issue his or her warrant in favor of the contracting party to permit the contracting party to make payments to vendors under the contract. The Board shall quarterly, and at such other times as the Commissioner of Finance and Management requires, render an account in such form as the Commissioner of Finance and Management prescribes of the expenditures of monies so advanced. (Added 1967, No. 267 (Adj. Sess.),  1, eff. July 1, 1968; amended 2013, No. 96 (Adj. Sess.),  89.) 
 121. Issuance of search warrants
(a) Upon application by a health officer or a law enforcement officer, a District or Superior Court judge shall, upon a finding of probable cause, issue a warrant to search a premises for violation of any State or local health statute, rule, ordinance, or permit, or for any public health hazard or public health risk. (b) Probable cause for a search warrant under this section exists when:(1) a health officer or law enforcement officer has reason to believe that a State or local health statute, rule, ordinance, or permit has been violated; or (2) a health officer or law enforcement officer has reason to believe that a public health hazard or public health risk may exist on the premises to be searched; or (3) permission to inspect has been refused and the premises to be searched are subject to routine inspections in connection with a regulatory program conducted pursuant to this title. (c) The provisions of the Vermont Rules of Criminal Procedure 41(c) shall apply to warrants issued under this section. (Added 1985, No. 267 (Adj. Sess.),  5.) 
 122. Private right of action
(a) Any person injured or damaged by a violation of this title, of a rule adopted pursuant thereto, or of a permit or order issued thereunder, or by a public health hazard may bring an action for equitable relief or damages arising from such violation or public health hazard. (b) A judicial determination of a violation of this title, of a rule adopted pursuant thereto, or of a permit or order issued thereunder, or of a public health hazard shall be prima facie evidence of the existence of the violation or the hazard, which evidence may be rebutted by the defendant. (c) The remedies provided by this section are in addition to any common law or statutory remedies otherwise available and do not amend or conflict with the provisions of 24 V.S.A. chapter 129, the powers and authority of the Agency of Agriculture, Food and Markets, the Department of Labor, the Agency of Natural Resources, or the Public Utility Commission, or the power of the Commissioner to issue a health or emergency health order. (d) The limitations and defenses of 12 V.S.A. chapter 189 and the provisions of 29 V.S.A. chapter 55 shall apply to actions against the State or any of its political subdivisions under this section. (e) Notwithstanding any provision of this section or the existence of any other remedy existing at law or in equity, no cause of action or grounds for enforcement shall lie against any municipal corporation as defined in 24 V.S.A.  3301 or any company as defined in 30 V.S.A.  201(a) for any defect, liability, condition, violation, or hazard which exists on the date such municipal corporation or company acquires by purchase, donation, or condemnation any public water source or public water system as defined in 10 V.S.A.  1671(4) and (5), unless such acquiring municipal corporation or company expressly assumes the same. The provisions of this subsection shall not be construed to relieve such municipal corporation or company from any obligation or responsibility to correct or abate any violation of this title or of 10 V.S.A. chapter 56 on and after the date of such acquisition. This subsection shall be liberally construed to immunize municipal corporations and companies from liability for preexisting conditions in public water sources and systems subsequently acquired by such entities. This section shall not be read to immunize municipalities from suits or claims in existence on the date a municipality acquires any public water source or system arising from the taking of water or land. (Added 1985, No. 267 (Adj. Sess.),  6; amended 1989, No. 256 (Adj. Sess.),  10(a), eff. Jan. 1, 1991; 1993, No. 164 (Adj. Sess.),  10; 2003, No. 42,  2, eff. May 27, 2003; 2005, No. 103 (Adj. Sess.),  3, eff. April 5, 2006; 2013, No. 34,  11.) 
 123. Revocation of permits
(a) The Commissioner may, after notice and opportunity for hearing, revoke, modify, or suspend any permit issued pursuant to the Commissioners authority under this title if the Commissioner finds that: (1) the permit holder submitted materially false or inaccurate information;(2) the permit holder has violated any material requirement, restriction, or condition of any permit, any rule, statute, or order; or (3) there is a change in any condition that requires either a temporary or permanent restriction, limitation, or elimination of the permitted use. (b) Revocation shall be effective upon actual notice thereof to the permit holder or permit holders designated agent. (Added 1985, No. 267 (Adj. Sess.),  7.) 
 124. Voluntary compliance
(a) When appropriate, the health officer shall make all practicable efforts to secure voluntary compliance. This requirement shall not restrict the health officers authority to use any enforcement powers authorized by this title or the common law. (b) Means of securing voluntary compliance may include the following:(1) encouraging voluntary cooperation by persons and affected groups to achieve the purposes of this title; (2) encouraging local units of government to handle violation problems within their respective jurisdiction by compact on a cooperative basis, and providing technical and consultative assistance therefor; (3) advising, consulting, contacting, and cooperating with other agencies of the State, local governments, industries, other states, interstate or interlocal agencies, and the federal government, and with interested persons or groups; and (4) encouraging voluntary compliance through warning, conference, or any other similar means. (Added 1985, No. 267 (Adj. Sess.),  8.) 
 125. Assurance of discontinuance
(a) In any case where the Commissioner has authority to institute an action or proceeding against a person under this title, the Commissioner may, in lieu thereof, accept from such person an assurance that the violation, or the action or inaction contributing to a public health hazard or a significant public health risk, will be discontinued. An assurance of discontinuance may include: (1) specific action to be taken;(2) abatement or mitigation schedules;(3) payment of a civil penalty and the costs of investigation;(4) payment of an amount to be held in escrow pending the outcome of an action, or as restitution to aggrieved persons. (b) An assurance of discontinuance shall be in writing, shall be filed with the Superior Court having jurisdiction over the subject matter, and shall become an order of the court. Evidence of a violation of an assurance of discontinuance shall be prima facie proof of the violation cited in the assurance. (Added 1985, No. 267 (Adj. Sess.),  9.) 
 126. Health orders
(a) The Commissioner or the selectboard may issue a health order to:(1) prevent, remove, or destroy any public health hazard;(2) mitigate a significant public health risk;(3) correct any violation of this title or any rules promulgated thereunder; or(4) correct any violation of a permit restriction or requirement.(b) The issuing authority for a State health order shall be the Commissioner. The issuing authority for a local health order shall be the selectboard. (c) Prior to issuance of a health order under this section, the issuing authority shall provide notice as provided in this subsection. (1) The health officer shall prepare a notice of intent to seek a health order, setting forth the health officers reasons to believe a health order should be issued. (2) The notice of intent, together with the supporting evidence, and a statement of procedural rights available under this section, shall be served in person by a health officer on the person against whom the health order is sought or in accordance with the procedures set forth in Vermont Rules of Civil Procedure. If the person resides out of state, the notice of intent shall be served on the person against whom the health order is sought through certified mail. (3) Upon request of the person against whom the health order is sought, a hearing shall be held before the issuing authority. At such hearing, the person against whom the order is sought shall be given an opportunity to rebut the allegations and demonstrate that no health order should issue. (d) A health order shall be effective upon issuance and may require any person responsible for contributing to the public health hazard or significant public health risk to take actions to protect the public health. Such actions may include, the following: (1) the prohibition of transportation, sale, distribution, or supplying of water, food, or any other materials or services; (2) the repair, installation, construction, operation, or implementation of purification equipment or methods; (3) testing, sampling, monitoring, surveying, or other analytical operations required to determine the nature, extent, duration, or severity of the public health hazard or public health risk; (4) the impounding, destruction, or removal of any public health hazard;(5) the quarantine or isolation of any area, persons, animals, or materials;(6) the closing of, and the prohibition of assemblage in any food or lodging establishment, church, school, or any other place of assemblage; (7) the cessation of any acts, discharges, or processes contributing to a public health hazard or public health risk; (8) the medical or veterinary treatment of any agent that is contributing to a public health hazard or a public health risk; (9) the giving of notice to potential users, including travelers, of the goods or services, of the nature, extent, and possible health effects of the public health hazard or public health risk, and precautions to be taken by such users; or (10) any other affirmative acts or prohibitions necessary to mitigate a significant public health risk. (Added 1985, No. 267 (Adj. Sess.),  10; amended 2021, No. 15,  7.) 
 127. Emergency health orders
(a) A health officer may, without a prior hearing, issue an emergency health order when necessary to prevent, remove, or destroy an imminent and substantial public health hazard, or to mitigate an imminent and substantial significant public health risk. Such order may include any actions available under section 126 of this title. An emergency health order shall be effective upon actual notice to the person against whom the order is directed. (b) The health officer may issue an emergency health order only after preparation of a written statement of reasons stating the need for an emergency health order together with the supporting evidence and a statement of procedural rights available under this section. The order, together with the statement and the evidence, shall be made available as soon as possible to the person to whom the order is directed. An emergency order shall be served in person by a health officer or in accordance with the procedures set forth in Rule 4 of the Vermont Rules of Civil Procedure. If the person resides out of state, the emergency health order shall be served on the person against whom the order is sought through certified mail. (c) A person to whom an emergency health order is directed shall be given the opportunity for a hearing within five business days of the issuance of such order. A person who is in full compliance with an emergency health order may request, and shall be granted, an extension of the hearing date. If the emergency order was issued by the Commissioner, such hearing shall be in front of the Commissioner. If the emergency order was issued by a local health officer, such hearing shall be in front of the selectboard. At the hearing, the person to whom the order is directed shall be given the opportunity to rebut allegations upon which the emergency health order is based. After the hearing, the Commissioner or selectboard shall issue a health order pursuant to section 126 of this title affirming, modifying, or terminating the emergency health order. (Added 1985, No. 267 (Adj. Sess.),  11; amended 2021, No. 15,  8.) 
 128. Appeal
(a) Any person aggrieved by an act, decision, or order of the Commissioner, local board of health, or selectboard pursuant to this title may appeal to the Board within 30 days. Hearings by the Board under this section shall be subject to the provisions of 3 V.S.A. chapter 25 relating to contested cases (the Administrative Procedure Act). The Board shall consider the matter de novo, and all persons and parties in interest, as determined by Board rule, may appear and be heard. The Board shall issue an order within 30 days following the conclusion of the hearing. (b) An appeal from the decision of the Board shall be to the Vermont Supreme Court. (Added 1985, No. 267 (Adj. Sess.),  12.)
 129. Stay
An appeal filed pursuant to section 128 of this title shall not stay the effectiveness of the order appealed from unless the Board or the Court, as appropriate, otherwise orders. (Added 1985, No. 267 (Adj. Sess.),  13.) 
 130. Civil enforcement
(a) The Commissioner, or a local board of health, may bring an action in the Superior Court of the county in which a violation or a public health hazard or public health risk has occurred or is occurring, to enforce the provisions of this title, or the rules, permits, or orders issued pursuant thereto, including the terms of an assurance of discontinuance entered into under section 125 of this title. (b) The court may grant temporary and permanent injunctive relief and may exercise all the powers available to it, including: (1) Enjoining future activities which may contribute to a public health hazard or a public health risk. (2) Ordering remedial actions to be taken to mitigate a public health risk or to remove or destroy a public health hazard. (3) Ordering the design, construction, installation, and operation of facilities designed to mitigate a public health risk or to assure compliance with any permit issued under this chapter. (4) Fixing and ordering compensation for any public or private property destroyed or damaged.(5) Ordering reimbursement from any person who caused governmental expenditures for the investigation and mitigation of the public health risk or the investigation, abatement, or removal of public health hazards. (6) Levying civil penalties not to exceed $10,000.00 for each violation. In the case of a continuing violation, each days continuance may be deemed a separate violation. (Added 1985, No. 267 (Adj. Sess.),  14; amended 2017, No. 74,  25.) 
 131. Criminal penalty
(a) Any person who violates a provision of this title, or who fails or neglects to obey or comply with an order or the terms of a permit issued under this title shall be fined not more than $5,000.00. Each violation shall be a separate offense and, in the case of a continuing violation, each days continuance shall be deemed a separate violation. (b) Any person who refuses to obey or comply with an order or the terms of a permit issued under this title or who knowingly creates a public health hazard or knowingly contributes to a significant public health risk shall be fined not more than $25,000.00 or be imprisoned not more than six months, or both. Each violation shall be a separate offense and, in the case of a continuing violation, each days continuance shall be deemed a separate violation. (c) Any person who knowingly makes a false statement, representation, or certification as to any material fact in any application, record, report, plan, testing result, or other document filed or required to be maintained under this title, or who falsifies, tampers with, or knowingly renders inaccurate a testing device or method required to be maintained under this title or required by a permit, rule, regulation, or order issued under this title shall be fined not more than $10,000.00 or be imprisoned for not more than six months, or both. (d) Any person who hinders or attempts to hinder any actions taken pursuant to this chapter shall be fined not more than $1,000.00. (Added 1985, No. 267 (Adj. Sess.),  15.) 
 1551. Definitions
As used in this chapter:(1) Maternal mortality or maternal death means:(A) pregnancy-associated death;(B) pregnancy-related death; or(C) pregnancy-associated but not pregnancy-related death.(2) Pregnancy-associated death means the death of a woman while pregnant or within one year following the end of pregnancy, irrespective of cause. (3) Pregnancy-associated, but not pregnancy-related death means the death of a woman while pregnant or within one year following the end of pregnancy due to a cause unrelated to pregnancy. (4) Pregnancy-related death means the death of a woman while pregnant or within one year following the end of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by her pregnancy or its management, but not from accidental or incidental causes. (Added 2011, No. 35,  2, eff. May 18, 2011.) 
 1552. Maternal Mortality Review Panel established
(a) There is established the Maternal Mortality Review Panel to conduct comprehensive, multidisciplinary reviews of maternal deaths in Vermont for the purposes of identifying factors associated with the deaths and making recommendations for system changes to improve health care services for women in this State. The Panel shall consider health disparities and social determinants of health, including race and ethnicity in maternal death reviews. (b)(1) The members of the Panel shall be appointed by the Commissioner of Health as follows:(A) Two members from the Vermont section of the American College of Obstetricians and Gynecologists, one of whom shall be a generalist obstetrician and one of whom shall be a maternal fetal medicine specialist. (B) One member from the Vermont chapter of the American Academy of Pediatrics, specializing in neonatology. (C) One member from the Vermont chapter of the American College of Nurse-Midwives.(D) One member who is a midwife licensed pursuant to 26 V.S.A. chapter 85.(E) One member from the Vermont section of the Association of Womens Health, Obstetric and Neonatal Nurses. (F) The Director of the Division of Maternal and Child Health in the Vermont Department of Health or designee. (G) An epidemiologist from the Department of Health with experience analyzing perinatal data or designee. (H) The Chief Medical Examiner or designee.(I) A representative of the community mental health centers.(J) A member of the public.(2) The Commissioner may appoint any of the following members to one-year terms:(A) a licensed clinical provider specializing in substance use disorder;(B) an expert in the pharmaceutical management of mental health; and(C) a social worker.(3) The Panel may consult experts as needed on a case by case basis. An expert consulted pursuant to this subdivision shall be subject to the same restrictions and protections as Panel members with regard to privacy, security, and the disclosure of information. (c) The term of each member listed in subdivision (b)(1) of this section shall be three years and the terms shall be staggered. The Commissioner shall appoint the initial Chair of the Panel, who shall call the first meeting of the Panel and serve as Chair for six months, after which time the Panel shall elect its Chair. (d) The Commissioner may delegate to the Northern New England Perinatal Quality Improvement Network (NNEPQIN) the functions of collecting, analyzing, and disseminating maternal mortality information; organizing and convening meetings of the Panel; and such other substantive and administrative tasks as may be incident to these activities. The activities of the NNEPQIN and its employees or agents shall be subject to the same confidentiality provisions as apply to members of the Panel. (e) The Department may enter into reciprocal agreements with other states that have maternal mortality review panels provided access under such agreements is consistent with privacy, security, and disclosure protections in this chapter. (f) The Panels review process shall not commence until any criminal prosecution arising out of the maternal mortality is concluded by the Attorney General and a States Attorney provides written notice to the Panel that no criminal charges shall be filed. (g) Annually, on or before January 15, the Panel shall submit a report with its findings and recommendations to the House Committee on Human Services and to the Senate Committee on Health and Welfare, provided that releasing the information complies with the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191. (h) Members of the Panel shall be entitled to per diem compensation and reimbursement of expenses as permitted under 32 V.S.A.  1010 for not more than three meetings annually. These payments shall be made from monies appropriated to the Department of Health. (Added 2011, No. 35,  2, eff. May 18, 2011; amended 2019, No. 142 (Adj. Sess.),  1.) 
 1553. Duties
(a) The Panel, in collaboration with the Commissioner of Health or designee, shall conduct comprehensive, multidisciplinary reviews of maternal mortality in Vermont. (b) Each member of the Panel shall be responsible for disseminating Panel recommendations to his or her respective institution and professional organization, as applicable. All such information shall be disseminated through the institutions or organizations quality assurance program in order to protect the confidentiality of all participants and patients involved in any incident. (c) [Repealed.](d) The Panel shall not:(1) call witnesses or take testimony from any individual involved in the investigation of a maternal death; (2) enforce any public health standard or criminal law or otherwise participate in any legal proceeding, except to the extent that a member of the Panel is involved in the investigation of a maternal death or resulting prosecution and must participate in a legal proceeding in the course of performing his or her duties outside the Panel. (Added 2011, No. 35,  2, eff. May 18, 2011; amended 2015, No. 131 (Adj. Sess.),  11.) 
 1554. Confidentiality
(a) The Panels meetings are confidential and shall be exempt from the Open Meeting Law, 1 V.S.A. chapter 5, subchapter 2. The records produced or acquired by the Panel are exempt from public inspection and copying under the Public Records Act and shall be kept confidential. The records of the Panel are not subject to discovery, subpoena, or introduction into evidence in any civil or criminal proceeding; provided, however, that nothing in this subsection shall be construed to limit or restrict the right to discover or use in any civil or criminal proceeding anything that is available from another source and entirely independent of the Panels proceedings. (b) Members of the Panel shall not be questioned in any civil or criminal proceeding regarding the information presented in or opinions formed as a result of a meeting of the Panel; provided, however, that nothing in this subsection shall be construed to prevent a member of the Panel from testifying to information obtained independently of the Panel or that is public information. (Added 2011, No. 35,  2, eff. May 18, 2011; amended 2019, No. 142 (Adj. Sess.),  2.) 
 1555. Information related to maternal mortality
(a)(1) Health care providers; health care facilities; clinics; laboratories; medical records departments; and State offices, agencies, and departments shall report all maternal mortality deaths to the Chair of the Maternal Mortality Review Panel and to the Commissioner of Health or designee. (2) The Commissioner and the Chair may acquire the information described in subdivision (1) of this subsection from health care facilities, maternal mortality review programs, and other sources in other states to ensure that the Panels records of Vermont maternal mortality cases are accurate and complete. (b)(1) In any case under review by the Panel, upon written request of the Commissioner or designee, a person who possesses information or records that are necessary and relevant to the review of a maternal mortality shall, as soon as practicable, provide the Panel with the information and records. All requests for information or records by the Commissioner or designee related to a case under review shall be provided by the person possessing the information or records to the Panel at no cost. (2) The Commissioner or designee may retain identifiable information regarding facilities where maternal deaths occur and geographic information on each case solely for the purposes of trending and analysis over time. In accordance with the rules adopted pursuant to subdivision 1556(4) of this title, all individually identifiable information on individuals and identifiable information on facilities shall be removed prior to any case review by the Panel. (3) The Chair shall not acquire or retain any individually identifiable information.(4) As used in this subsection, individually identifiable information includes vital records; hospital discharge data; prenatal, fetal, pediatric, or infant medical records; hospital or clinic records; laboratory reports; records of fetal deaths or induced terminations of pregnancies; and autopsy reports. (c) If a root cause analysis of a maternal mortality event has been completed, the findings of such analysis shall be included in the records supplied to the review Panel. (Added 2011, No. 35,  2, eff. May 18, 2011; amended 2019, No. 142 (Adj. Sess.),  3.) 
 1556. Rulemaking
The Commissioner of Health, with the advice and recommendation of a majority of the members of the Panel, shall adopt rules pursuant to 3 V.S.A. chapter 25 related to the following: (1) The system for identifying and reporting maternal deaths to the Commissioner or designee.(2) The form and manner through which the Panel may acquire information under section 1555 of this title. (3) The protocol to be used in carefully and sensitively contacting a family member of the deceased woman for a discussion of the events surrounding the death, including allowing grieving family members to delay or refuse such an interview. (4) Ensuring de-identification of all individuals and facilities involved in the Panels review of cases. (Added 2011, No. 35,  2, eff. May 18, 2011.) 
 1561. Child Fatality Review Team
(a) Creation. There is created the Child Fatality Review Team within the Department of Health for the following purposes: (1) to examine cases of child fatality in Vermont in which the fatality is either unexpected, unexplained, or preventable; (2) to identify system gaps and risk factors associated with child fatalities that are either unexpected, unexplained, or preventable; (3) to educate the public, service providers, and policymakers about unexpected, unexplained, or preventable child fatalities and strategies for intervention; (4) to recommend legislation, rules, policies, practices, training, and coordination of services that promote interagency collaboration and prevent future unexpected, unexplained, or preventable child fatalities. (b) Membership. (1) The Team shall comprise the following members:(A) the Chief Medical Examiner or designee;(B) the Commissioner of Health or designee;(C) the Commissioner for Children and Families or designee;(D) the Commissioner of Mental Health or designee;(E) the Commissioner of Public Safety or designee;(F) the Secretary of Education or designee;(G) the Attorney General or designee;(H) a physician licensed to practice pursuant to 26 V.S.A. chapter 23 or 33 who specializes in the practice of pediatrics, appointed by the Vermont chapter of the American Academy of Pediatrics; (I) a physician licensed to practice pursuant to 26 V.S.A. chapter 23 or 33 who specializes in the practice of child psychiatry, appointed by the Vermont Psychiatric Association; (J) a municipal law enforcement officer, appointed by the Vermont Association of Chiefs of Police; and (K) any other professional specializing in child abuse or neglect, health, social work, child care, education, or law enforcement and who is appointed by the Secretary of Human Services. (2)(A) The members of the Team specified in subdivision (1) of this subsection shall serve three-year terms, except that of the members first appointed pursuant to subdivisions (1)(H)-(K) of this subsection, two shall serve a term of one year and two shall serve a term of two years. (B) Any vacancy on the Team shall be filled in the same manner as the original appointment. The replacement member shall serve for the remainder of the unexpired term. (c) Meetings. (1) The Team shall meet at such times as may reasonably be necessary to carry out its duties, but at least once in each calendar quarter. (2) The Commissioner of Health or designee shall call the first meeting of the Team to occur on or before September 30, 2018. (3) The Team shall select a chair and vice chair from among its members at the first meeting, and biannually thereafter. (d) Assistance. The Team shall have the administrative, technical, and legal assistance of the Department of Health. (e) Access to information and records. (1) In any case under review by the Team, upon written request of the Chair, a person who possesses information or records that are necessary and relevant to the review of a child fatality that is either unexpected, unexplained, or preventable shall, as soon as practicable, provide the Team with the information and records. All requests for information or records by the Chair related to a case under review shall be provided by the person possessing the information or records to the Team at no cost. (2) A person shall not be held criminally or civilly liable for disclosing or providing information or records to the Team pursuant to this subsection. (3) The Team shall not have access to the proceedings, reports, and records of a peer review committee as defined in 26 V.S.A.  1441. (f) Limitations. (1) The Teams review process shall not commence until:(A) any criminal prosecution arising out of the child fatality is concluded or the Attorney General and States Attorney provide written notice to the Team that no criminal charges shall be filed; and (B) any investigation by the Department for Children and Families is concluded.(2) The Team shall seek to obtain information or records generated in the course of an investigation from State agencies or law enforcement officials before making a request to health care providers and educators. (g) Confidentiality. (1)(A) The records produced or acquired by the Team are exempt from public inspection and copying under the Public Records Act and shall be kept confidential. The records of the Team are not subject to subpoena, discovery, or introduction into evidence in a civil or criminal action. Nothing in this section shall be construed to limit or restrict the right to discover or use in any civil or criminal proceedings information or records that are available from another source and entirely outside the Teams review. The Team shall not use the information or records generated during the course of its review for purposes other than those described in this section. (B) The Department may share deidentified data produced or acquired by the Team with other states that have child fatality review panels, provided access under such agreements is consistent with the privacy, security, and disclosure protections in this chapter. (2) The Teams meetings are confidential and shall be exempt from 1 V.S.A. chapter 5, subchapter 2 (the Vermont Open Meeting Law). (3) Members of the Team and persons invited to testify before the Team shall not disclose information, records, discussions, and opinions stated in connection to the Teams review. Members of the Team and persons invited to testify before the Team shall execute a sworn statement honoring the confidentiality of all information, records, discussions, and opinions related to the Teams review, which shall be maintained by the Chair. (h) Report. Notwithstanding 2 V.S.A.  20(d), the Team shall report its conclusions and recommendations to the Governor and General Assembly, as the Team deems necessary, but not less frequently than once per calendar year. The report shall disclose individually identifiable information only to the extent necessary to convey the Teams conclusions and recommendations, and any such disclosures shall be limited to information already known to the public. The report shall be available to the public through the Department of Health. (i) Definition. As used in this chapter, child means an individual from the time of birth to 18 years of age. (Added 2017, No. 103 (Adj. Sess.),  1; amended 2019, No. 14,  48, eff. April 30, 2019; 2021, No. 115 (Adj. Sess.),  10, eff. July 1, 2022.) 
 1601. PurposesArticle I
The purposes of this compact are to:(1) Promote the radiological health protection of the public and individuals within the party states. (2) Provide mutual aid and assistance in radiological health matters, including radiation incidents. (3) Encourage and facilitate the efficient use of personnel and equipment by furthering the orderly acquisition and sharing of resources useful for programs of radiation protection. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1602. EnactmentArticle II
This compact shall become effective when enacted into law by any two or more of the states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. Thereafter it shall become effective with respect to any other aforementioned state upon its enacting this compact into law. Any state not mentioned in this article which is contiguous to any party state may become a party to this compact by enacting the same. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1603. Duties of stateArticle III
(a) It shall be the duty of each party state to formulate and put into effect an intrastate radiation incident plan which is compatible with the interstate radiation incident plan formulated pursuant to this compact. (b) Whenever the compact administrator of a party state requests aid from the compact administrator of any other party state pursuant to this compact, it shall be the duty of the requested state to render all possible aid to the requesting state which is consonant with the maintenance of protection of its own people. The compact administrator of a party state may delegate any or all of his or her authority to request aid or respond to requests for aid pursuant to this compact to one or more subordinates, in order that requests for aid and responses thereto shall not be impeded by reason of the absence or unavailability of the compact administrator. Any compact administrator making such a delegation shall inform all the other compact administrators thereof, and also shall inform them of the identity of the subordinate or subordinates to whom the delegation has been made. (c) Each party state shall maintain adequate radiation protection personnel and equipment to meet normal demands for radiation protection within its borders. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1604. LiabilityArticle IV
(a) Whenever the officers or employees of any party state are rendering outside aid pursuant to the request of another party state under this compact, the officers or employees of such state shall, under the direction of the authorities of the state to which they are rendering aid, have the same powers, duties, rights, privileges, and immunities as comparable officers and employees of the state to which they are rendering aid. (b) No party state or its officers or employees rendering outside aid pursuant to this compact shall be liable on account of any act or omission on their part while so engaged, or on account of the maintenance or use of any equipment or supplies in connection therewith. (c) All liability that may arise either under the laws of the requesting state or under the laws of the aiding state or under the laws of a third state, on account of or in connection with a request for aid, shall be assumed and borne by the requesting state. (d) Any party state rendering outside aid to cope with a radiation incident shall be reimbursed by the party state receiving such aid for any loss or damage to, or expense incurred in the operation of any equipment answering a request for aid, and for the cost of all materials, transportation, and maintenance of officers, employees and equipment incurred in connection with such request: provided that nothing herein contained shall prevent any assisting party state from assuming such loss, damage, expense, or other cost or from loaning such equipment or from donating such services to the receiving party state without charge or cost. (e) Each party state shall provide for the payment of compensation and death benefits to injured officers and employees and the representatives of deceased officers and employees in case officers or employees sustain injuries or are killed while rendering outside aid pursuant to this compact, in the same manner and on the same terms as if the injury or death were sustained within the state for or in which the officer or employee was regularly employed. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1605. Facilities, equipment and personnelArticle V
(a) Whenever a department, agency, or officer of a party state responsible for and having control of facilities or equipment designed for or useful in radiation control, radiation research, or any other phase of a radiological health program or programs determines that such a facility or item of equipment is not being used to its full capacity by such party state, or that temporarily it is not needed for current use by such state, a department, agency, or officer may, upon request of an appropriate department, agency, or officer of another party state, make such facility or item of equipment available for use by such requesting department, agency, or officer. Unless otherwise required by law, the availability and use resulting therefrom may be with or without charge, at the discretion of the lending department, agency, or officer. Any personal property made available pursuant to this paragraph may be removed to the requesting state, but no such property shall be made available, except for a specified period and pursuant to written agreement. Except when necessary to meet an emergency, no supplies or materials intended to be consumed prior to return shall be made available pursuant to this paragraph. (b) In recognition of the mutual benefits, in addition to those resulting from article IV, accruing to the party states from the existence and flexible use of professional or technical personnel having special skills or training related to radiation protection, such personnel may be made available to a party state by appropriate departments, agencies, and officers of other party states; provided that the borrower reimburses such party state regularly employing the personnel in question for any cost of making such personnel available, including a prorated share of the salary or other compensation of the personnel involved. (c) Nothing in this article shall be construed to limit or to modify in any way the provisions of article IV of this compact. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1606. Compact administratorsArticle VI
Each party state shall have a compact administrator who shall be the head of the state agency having principal responsibility for radiation protection, and who: (1) Shall coordinate activities pursuant to this compact in and on behalf of his state.(2) Serving jointly with the compact administrators of the other party states, shall develop and keep current an interstate radiation incident plan; consider such other matters as may be appropriate in connection with programs of cooperation in the field of radiation protection and allied areas of common interest; and formulate procedures for claims and reimbursement under the provisions of article IV. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1607. Other responsibilities and activitiesArticle VII
Nothing in this compact shall be construed to:(1) Authorize or permit any party state to curtail or diminish its radiation protection program, equipment, services, or facilities. (2) Limit or restrict the powers of any state ratifying the same to provide for the radiological health protection of the public and individuals, or to prohibit the enactment or enforcement of state laws, rules, or regulations intended to provide for such radiological health protection. (3) Affect any existing or future cooperative relationship or arrangement between federal, state or local governments and a party state or states. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1608. WithdrawalArticle VIII
Any party state may withdraw from this compact by enacting a statute repealing the same, but no such withdrawal shall take effect until one year after the governor of the withdrawing state has given notice in writing of the withdrawal to the governors of all other party states. No withdrawal shall affect any liability already incurred by or chargeable to a party state prior to the time of such withdrawal. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1609. Construction and severabilityArticle IX
It is the legislative intent that the provisions of this compact be reasonably and liberally construed. The provisions of this compact shall be severable and if any phrase, clause, sentence, or provision of this compact is declared to be unconstitutional or the applicability thereof, to any state, agency, person, or circumstance is held invalid, the constitutionality of the remainder of this compact and the applicability thereof, to any other state, agency, person, or circumstance shall not be affected thereby. (Added 1967, No. 26,  1, eff. March 14, 1967.) 
 1621. Board of health; duties
The State Board of Health shall formulate and keep current a radiation incident plan for this State, in accordance with the duty assumed pursuant to article III(a) of the compact. (Added 1967, No. 26,  2, eff. March 14, 1967.) 
 1622. Administrator
The compact administrator for this State, as required by article VI of the compact, shall be the Commissioner of Health. (Added 1967, No. 26,  3, eff. March 14, 1967.) 
 1651. Definitions
In this chapter:(1) By-product material means each of the following:(A) Any radioactive material, other than special nuclear material, that is yielded in or made radioactive by exposure to the radiation incident to the process of producing or utilizing special nuclear material. (B) The tailings or wastes produced by the extraction or concentration of uranium or thorium from any ore processed primarily for its source material content, including discrete surface wastes resulting from uranium solution extraction processes. However, by-product material does not include underground ore bodies depleted by these solution extraction operations. (C) Any discrete source of radium-226 that is produced, extracted, or converted after extraction for use for a commercial, medical, or research activity. (D) Any material that has been made radioactive by use of a particle accelerator and is produced, extracted, or converted after extraction for use for a commercial, medical, or research activity. (E) Any discrete source of naturally occurring radioactive material, other than source material, that is extracted or converted after extraction for use in a commercial, medical, or research activity, if the Governor, after determination by the NRC, declares by order that the source would pose a threat similar to the threat posed by a discrete source of radium-226 to the public health and safety. (2) Commissioner means the Commissioner of Health.(3) Department means the Department of Health.(4) General license means a license effective under regulations promulgated by the State radiation control agency without the filing of an application to transfer, acquire, own, possess, or use quantities of, or devices or equipment utilizing by-product, source, or special nuclear materials or other radioactive material occurring naturally or produced artificially. (5) Ionizing radiation means gamma rays and X-rays, alpha and beta particles, high speed electrons, neutrons, protons, and other nuclear particles. (6) Nonionizing radiation means radiations of any wavelength in the entire electromagnetic spectrum except those radiations defined in this section as ionizing. Nonionizing radiations include ultraviolet, visible, infrared, microwave, radiowave, low frequency electromagnetic radiation; infrasonic, sonic, and ultrasonic waves; electrostatic and magnetic fields. (7) NRC means the U.S. Nuclear Regulatory Commission or any successor agency of the United States to the Commission. (8) Radioactive material means any material, whether solid, liquid, or gas, that emits ionizing radiation spontaneously. The term includes material made radioactive by a particle accelerator, by-product material, naturally occurring radioactive material, source material, and special nuclear material. (9) Specific license means a license, issued to a named person after application to use, manufacture, produce, transfer, receive, acquire, own, or possess quantities of, or devices or equipment utilizing byproduct, source, or special nuclear materials or other radioactive material occurring naturally or produced artificially. (10) Source material means each of the following:(A) uranium, thorium, or any combination of those elements, in any physical or chemical form; (B) any other material that the Governor declares by order to be source material after the NRC has determined the material to be source material; or (C) ores that contain uranium, thorium, or any combination of those elements in a concentration by weight of 0.05 percent or more or in such lower concentration as the Governor declares by order to be source material after the NRC has determined the material in such concentration to be source material. (11) Special nuclear material means:(A) plutonium, uranium 233, uranium enriched in the isotope 233 or in the isotope 235, and any other material that the Governor declares by order to be special nuclear material after the NRC has determined the material to be such special nuclear material, but does not include source material; or (B) any material artificially enriched by any elements, isotopes, or materials listed in subdivision (A) of this subdivision (11), but does not include source material. (Added 1967, No. 27,  1; amended 1977, No. 83,  1; 2015, No. 82 (Adj. Sess.),  1.) 
 1652. State radiation control
(a) The Department is the radiation control agency for the State of Vermont. The Commissioner may designate the Radiation Control Director within the Department as the individual who shall perform the functions vested in the Department by this chapter. (b) The Department shall, for the protection of the occupational and public health and safety, develop programs for the control of ionizing and nonionizing radiation compatible with federal programs for regulation of by-product, source, and special nuclear materials. (c) The Department may adopt, amend, and repeal rules under 3 V.S.A. chapter 25 that may provide for licensing and registration for the control of sources of ionizing radiation and that may provide for the control and regulation of sources of nonionizing radiation. (d) The Department shall advise, consult, and cooperate with other agencies of the State, the federal government, other states and interstate agencies, political subdivisions, industries, and with groups concerned with control of sources of ionizing and nonionizing radiation. (e) Applicants for registration of X-ray equipment shall pay an annual registration fee of $85.00 per piece of equipment. (f) Fees collected under this section shall be credited to a special fund established and managed pursuant to 32 V.S.A. chapter 7, subchapter 5 and shall be available to the Department to offset the costs of providing services relating to licensing and registration and controlling sources of ionizing radiation. (Added 1967, No. 27,  2; amended 1977, No. 83,  2; 2007, No. 76,  11; 2009, No. 134 (Adj. Sess.),  27; 2011, No. 128 (Adj. Sess.),  4; 2015, No. 57,  8; 2015, No. 82 (Adj. Sess.),  1.) 
 1653. Federal-State agreements
(a) The Governor, on behalf of the State of Vermont, may enter into agreements with the federal government providing for discontinuance of certain of the federal governments responsibilities with respect to by-product, source, and special nuclear materials and the assumption of these responsibilities by the State of Vermont. (b) In the event of such agreement:(1) The Department shall provide by rule for general or specific licensing of by-product, source, special nuclear materials, or devices or equipment utilizing such materials. The rule shall provide for amendment, suspension, or revocation of licenses. A rule adopted under this subsection shall be consistent with regulations duly adopted by the NRC except as the Commissioner determines is necessary to protect public health. (2) The Department shall have authority to:(A) impose conditions that are individual to a license when necessary to protect public health and safety; (B) reciprocate in the recognition of specific licenses issued by the NRC or another state that has reached agreement with the NRC pursuant to 42 U.S.C.  2021(b) (agreement state); (C) require that licensees and unlicensed individuals comply with the federal statutes and regulations relating to the authority assumed by the Department under this section and with the rules adopted by the Department under this section; and (D) exempt certain by-product, source, or special nuclear materials or kinds of uses or users from the licensing or registration requirements set forth in this section when the Department makes a finding that the exemption of such materials or kinds of uses or users will not constitute a significant risk to the health and safety of the public. (3) The Department may collect a fee for licenses issued under this section. The fee schedule for these licenses shall be the schedule adopted by the U.S. Nuclear Regulatory Commission and published in 10 C.F.R.  170.31 that is in effect as of July 1, 2016. Fees collected under this section shall be credited to the Nuclear Regulatory Fund established and managed under subdivision (4) of this subsection and shall be available to the Department to offset the costs of providing services under this section. (4) There is established the Nuclear Regulatory Fund to consist of the fees collected under subdivision (3) of this subsection and any other monies that may be appropriated to or deposited into the Fund. Balances in the Nuclear Regulatory Fund shall be expended solely for the purposes set forth in this section and shall not be used for the general obligations of government. All balances in the Fund at the end of any fiscal year shall be carried forward and remain part of the Fund, and interest earned by the Fund shall be deposited in the Fund. The Nuclear Regulatory Fund is established in the State Treasury pursuant to 32 V.S.A. chapter 7, subchapter 5. (5) Any person having a license immediately before the effective date of an agreement under subsection (a) of this section from the federal government or agreement state relating to by-product material, source material, or special nuclear material and which on the effective date of this agreement is subject to the control of this State shall be considered to have a like license with the State of Vermont until the expiration date specified in the license from the federal government or agreement state or until the end of the 90th day after the person receives notice from the Department that the license will be considered expired. (6) The Department shall require each person who possesses or uses by-product, source, or special nuclear materials to maintain records relating to the receipt, storage, transfer, or disposal of such materials and such other records as the Department may require subject to such exemptions as may be provided by rule. (7) Violations:(A) A person shall not use, manufacture, produce, transport, transfer, receive, acquire, own, or possess any by-product, source, or special nuclear material unless licensed by or registered with the Department in accordance with the provisions of this chapter or rules adopted under this chapter. (B) The Department shall have the authority in the event of an emergency to impound or order the impounding of by-product, source, and special nuclear materials in the possession of any person who is not equipped to observe or fails to observe the provisions of this chapter or any rules adopted under this chapter. (8) The provisions of this section relating to the control of by-product, source, and special nuclear materials shall become effective on the effective date of an agreement between the federal government and this State as provided in subsection (a) of this section. (c) This section does not confer authority to regulate materials or activities reserved to the NRC under 42 U.S.C.  2021(c) and 10 C.F.R. Part 150. (Added 1967, No. 27,  3; amended 2015, No. 82 (Adj. Sess.),  1.) 
 1654. Inspection
The Department or its duly authorized representatives may enter at all reasonable times upon any private or public property for the purpose of determining whether or not there is compliance with or violation of this chapter and rules and regulations issued thereunder, except that entry into areas under the jurisdiction of the federal government shall be made only with the concurrence of the federal government or its duly designated representative. (Added 1967, No. 27,  4; amended 2015, No. 82 (Adj. Sess.),  1.) 
 1655. Hearings and judicial review
(a) In any proceeding under this chapter for the issuance or modification of rules relating to control of by-products, source, and special nuclear materials; or for granting, suspending, revoking, or amending any license; or for determining compliance with or granting exemptions from rules and regulations of the Department, the Department shall hold a public hearing upon the request of any person whose interest may be affected by the proceeding, and shall admit any such person as a party to the proceeding, subject to the emergency provisions in subsection (b) of this section. (b) Whenever the Department finds that an emergency exists requiring immediate action to protect the public health and safety, the Department may, without notice or hearing, issue an order reciting the existence of the emergency and requiring that such action be taken as is necessary to meet it. Notwithstanding any contrary provision of this chapter, the order shall be effective immediately. Any person to whom the order is directed shall comply with the order immediately, but on application to the Department shall be afforded a hearing within ten days. On the basis of the hearing, the emergency order shall be continued, modified, or revoked within ten days after the hearing. (c) Any final order entered in any proceeding under subsections (a) and (b) of this section shall be subject to judicial review in the Civil Division of the Superior Court. (Added 1967, No. 27,  5; amended 1997, No. 161 (Adj. Sess.),  11, eff. Jan. 1, 1998; 2015, No. 82 (Adj. Sess.),  1.) 
 1656. Injunction proceedings
Whenever, in the judgment of the Department, any person has engaged in or is about to engage in any acts or practices which constitute or will constitute a violation of any provision of this chapter, or any rule issued thereunder, the Attorney General shall make application to the appropriate court for an order enjoining such acts or practices, or for an order directing compliance, and upon a showing by the Department that such person has engaged or is about to engage in any such acts or practices, a permanent or temporary injunction, restraining order, or other order may be granted. (Added 1967, No. 27,  6; amended 2015, No. 82 (Adj. Sess.),  1.) 
 1657. Penalties
Any person who violates this chapter or rules in effect pursuant thereto shall, upon conviction thereof, be imprisoned not more than six months or fined not more than $500.00 or less than $100.00, or be both imprisoned and fined. (Added 1967, No. 27,  7.) 
 1661. Definitions
As used in this chapter:(1) Class B firefighting foam means chemical foams designed for flammable liquid fires.(2) Intentionally added means the addition of a chemical in a product that serves an intended function in the product component. (3) Manufacturer means any person, firm, association, partnership, corporation, organization, joint venture, importer, or domestic distributor of firefighting agents or equipment. As used in this subsection, importer means the owner of the product. (4) Municipality means any city, town, incorporated village, town fire district, or other political subdivision that provides firefighting services pursuant to general law or municipal charter. (5) Perfluoroalkyl and polyfluoroalkyl substances or PFAS means a class of fluorinated organic chemicals containing at least one fully fluorinated carbon atom. (6) Personal protective equipment means clothing designed, intended, or marketed to be worn by firefighting personnel in the performance of their duties, designed with the intent for use in fire and rescue activities, and includes jackets, pants, shoes, gloves, helmets, and respiratory equipment. (7) Terminal means an establishment primarily engaged in the wholesale distribution of crude petroleum and petroleum products, including liquefied petroleum gas from bulk liquid storage facilities. (Added 2021, No. 36,  1, eff. July 1, 2022.) 
 1662. Prohibition of certain class B firefighting foam
A person, municipality, or State agency shall not discharge or otherwise use for training or testing purposes class B firefighting foam that contains intentionally added PFAS. (Added 2021, No. 36,  1, eff. July 1, 2022.) 
 1663. Restriction on manufacture, sale, and distribution; exceptions
(a)(1) Unless otherwise required under federal law, but not later than October 1, 2023, a manufacturer of class B firefighting foam shall not manufacture, sell, offer for sale, or distribute for sale or use in this State class B firefighting foam to which PFAS have been intentionally added. (2) Notwithstanding subdivision (1) of this subsection, the restriction on the manufacture, sale, offer for sale, or distribution of class B firefighting foam containing intentionally added PFAS for use at a terminal shall not apply until January 1, 2024. (b) A person operating a terminal after January 1, 2024, and who seeks to purchase class B firefighting foam containing intentionally added PFAS for the purpose of fighting emergency class B fires, may apply to the Department of Environmental Conservation for a temporary exemption from the restrictions on the manufacture, sale, offer for sale, or distribution of class B firefighting foam for use at a terminal. An exemption shall not exceed one year. The Department of Environmental Conservation, in consultation with the Department of Health, may grant an exemption under this subsection if the applicant provides: (1) clear and convincing evidence that there is not a commercially available alternative that: (A) does not contain intentionally added PFAS; and(B) is capable of suppressing a large atmospheric tank fire or emergency class B fire at the terminal; (2) information on the amount of class B firefighting foam containing intentionally added PFAS that is annually stored, used, or released at the terminal; (3) a report on the progress being made by the applicant to transition at the terminal to class B firefighting foam that does not contain intentionally added PFAS; and (4) an explanation of how:(A) all releases of class B firefighting foam containing intentionally added PFAS shall be fully contained at the terminal; and (B) existing containment measures prevent firewater, wastewater, runoff, and other wastes from being released into the environment, including into soil, groundwater, waterways, and stormwater. (c) Nothing in this section shall prohibit a terminal from providing class B firefighting foam in the form of aid to another terminal in the event of a class B fire. (Added 2021, No. 36,  1, eff. July 1, 2022.) 
 1664. Sale of personal protective equipment containing PFAS
(a) A manufacturer or other person that sells firefighting equipment to any person, municipality, or State agency shall provide written notice to the purchaser at the time of sale, citing to this chapter, if the personal protective equipment contains PFAS. The written notice shall include a statement that the personal protective equipment contains PFAS and the reason PFAS are added to the equipment. (b) The manufacturer or person selling personal protective equipment and the purchaser of the personal protective equipment shall retain the notice for at least three years from the date of the transaction. (Added 2021, No. 36,  1, eff. July 1, 2022.) 
 1665. Notification; recall of prohibited products
(a) A manufacturer of class B firefighting foam containing intentionally added PFAS shall provide written notice to persons that sell the manufacturers products in this State about the restrictions imposed by this chapter not less than one year prior to the effective date of the restrictions. (b) Unless a class B firefighting foam containing intentionally added PFAS is intended for use at a terminal, and if after January 1, 2024, the person operating a terminal holds a temporary exemption pursuant to subsection (b) of section 1663 of this title, a manufacturer that produces, sells, or distributes a class B firefighting foam containing intentionally added PFAS shall: (1) recall the product and reimburse the retailer or any other purchaser for the product; and (2) issue either a press release or notice on the manufacturers website describing the product recall and reimbursement requirement established in this subsection. (Added 2021, No. 36,  1, eff. July 1, 2022.) 
 1666. Certificate of compliance
The Attorney General may request a certificate of compliance from a manufacturer of class B firefighting foam or firefighting personal protective equipment. Within 30 days after receipt of the Attorney Generals request for a certificate of compliance, the manufacturer shall: (1) provide the Attorney General with a certificate attesting that the manufacturers product or products comply with the requirements of this chapter; or (2) notify persons who are selling a product of the manufacturers in this State that the sale is prohibited because the product does not comply with this chapter and submit to the Attorney General a list of the names and addresses of those persons notified. (Added 2021, No. 36,  1, eff. July 1, 2022.) 
 1667. Penalties
(a) A violation of this chapter shall be deemed a violation of the Consumer Protection Act, 9 V.S.A. chapter 63. The Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions, and private parties have the same rights and remedies as provided under 9 V.S.A. chapter 63, subchapter 1. (b) Nothing in this section shall be construed to preclude or supplant any other statutory or common law remedies. (Added 2021, No. 36,  1, eff. July 1, 2022.) 
 1671. Definitions
As used in this chapter:(1) Bisphenols means any member of a class of industrial chemicals that contain two hydroxyphenyl groups. Bisphenols are used primarily in the manufacture of polycarbonate plastic and epoxy resins. (2) Department means the Department of Health.(3) Food package or food packaging means a package or packaging component that is intended for direct food contact. (4) Intentionally added means the addition of a chemical in a product that serves an intended function in the product component. (5) Ortho-phthalates means any member of the class of organic chemicals that are esters of phthalic acid containing two carbon chains located in the ortho position. (6) Package means a container providing a means of marketing, protecting, or handling a product and shall include a unit package, an intermediate package, and a shipping container. Package also means unsealed receptacles, such as carrying cases, crates, cups, pails, rigid foil and other trays, wrappers and wrapping films, bags, and tubs. (7) Packaging component means an individual assembled part of a package, such as any interior or exterior blocking, bracing, cushioning, weatherproofing, exterior strapping, coatings, closures, inks, and labels, and disposable gloves used in commercial or institutional food service. (8) Perfluoroalkyl and polyfluoroalkyl substances or PFAS has the same meaning as in section 1661 of this title. (Added 2021, No. 36,  2, eff. July 1, 2023.) 
 1672. Food packaging
(a) A manufacturer, supplier, or distributor shall not manufacture, sell, offer for sale, distribute for sale, or distribute for use in this State a food package to which PFAS have been intentionally added and are present in any amount. (b)(1) Pursuant to 3 V.S.A. chapter 25, the Department may adopt rules prohibiting a manufacturer, supplier, or distributor from selling or offering for sale or for promotional distribution a food package or the packaging component of a food package to which bisphenols have been intentionally added and are present in any amount. The Department may exempt specific chemicals within the bisphenol class when clear and convincing evidence suggests they are not endocrine-active or otherwise toxic. (2) The Department may only prohibit a manufacturer, supplier, or distributor from selling or offering for sale or for promotional distribution a food package or the packaging component of a food package in accordance with this subsection if the Department or at least one other state has determined that a safer alternative is readily available in sufficient quantity and at a comparable cost and that the safer alternative performs as well as or better than bisphenols in a specific application of bisphenols to a food package or the packaging component of a food package. (3) If the Department prohibits a manufacturer, supplier, or distributor from selling or offering for sale or for promotional distribution a food package or the packaging component of a food package in accordance with this subsection, the prohibition shall not take effect until two years after the Department adopts the rules. (c) A manufacturer, supplier, or distributor shall not manufacture, sell, offer for sale, distribute for sale, or distribute for use in this State a food package that includes inks, dyes, pigments, adhesives, stabilizers, coatings, plasticizers, or any other additives to which ortho-phthalates have been intentionally added and are present in any amount. (d) This section shall not apply to the sale or resale of used products. (Added 2021, No. 36,  2, eff. July 1, 2023.)
 1673. Certificate of compliance
The Attorney General may request a certificate of compliance from a manufacturer of food packaging. Within 30 days after receipt of the Attorney Generals request for a certificate of compliance, the manufacturer shall: (1) provide the Attorney General with a certificate attesting that the manufacturers product or products comply with the requirements of this chapter; or (2) notify persons who are selling a product of the manufacturers in this State that the sale is prohibited because the product does not comply with this chapter and submit to the Attorney General a list of the names and addresses of those persons notified. (Added 2021, No. 36,  2, eff. July 1, 2023.) 
 1674. Rulemaking
Pursuant to 3 V.S.A. chapter 25, the Commissioner of Health shall adopt any rules necessary for the implementation, administration, and enforcement of this chapter. (Added 2021, No. 36,  2, eff. July 1, 2023.) 
 1675. Penalties
(a) A violation of this chapter shall be deemed a violation of the Consumer Protection Act, 9 V.S.A. chapter 63. The Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions, and private parties have the same rights and remedies as provided under 9 V.S.A. chapter 63, subchapter 1. (b) Nothing in this section shall be construed to preclude or supplant any other statutory or common law remedies. (Added 2021, No. 36,  2, eff. July 1, 2023.) 
 1681. Definitions
As used in this chapter:(1) Aftermarket stain and water resistant treatments means treatments for textile and leather consumer products used in residential settings that have been treated during the manufacturing process for stain, oil, and water resistance but excludes products marketed or sold exclusively for use at industrial facilities during the manufacture of a carpet, rug, clothing, or shoe. (2) Department means the Department of Health.(3) Intentionally added means the addition of a chemical in a product that serves an intended function in the product component. (4) Perfluoroalkyl and polyfluoroalkyl substances or PFAS has the same meaning as in section 1661 of this title. (5) Rug or carpet means a thick fabric used to cover floors. (Added 2021, No. 36,  3, eff. July 1, 2023.)
 1682. Rugs and carpets
(a) A manufacturer, supplier, or distributor shall not manufacture, sell, offer for sale, distribute for sale, or distribute for use in this State a residential rug or carpet to which PFAS have been intentionally added in any amount. (b) This section shall not apply to the sale or resale of used products. (Added 2021, No. 36,  3, eff. July 1, 2023.)
 1683. Aftermarket stain and water resistant treatments
(a) A manufacturer, supplier, or distributor shall not manufacture, sell, offer for sale, distribute for sale, or distribute for use in this State aftermarket stain and water resistant treatments for rugs or carpets to which PFAS have been intentionally added in any amount. (b) This section shall not apply to the sale or resale of used products. (Added 2021, No. 36,  3, eff. July 1, 2023.)
 1684. Certificate of compliance
The Attorney General may request a certificate of compliance from a manufacturer of rugs, carpets, or aftermarket stain and water resistant treatments. Within 30 days after receipt of the Attorney Generals request for a certificate of compliance, the manufacturer shall: (1) provide the Attorney General with a certificate attesting that the manufacturers product or products comply with the requirements of this chapter; or (2) notify persons who are selling a product of the manufacturers in this State that the sale is prohibited because the product does not comply with this chapter and submit to the Attorney General a list of the names and addresses of those persons notified. (Added 2021, No. 36,  3, eff. July 1, 2023.) 
 1685. Rulemaking
Pursuant to 3 V.S.A. chapter 25, the Commissioner shall adopt any rules necessary for the implementation, administration, and enforcement of this chapter. (Added 2021, No. 36,  3, eff. July 1, 2023.) 
 1686. Penalties
(a) A violation of this chapter shall be deemed a violation of the Consumer Protection Act, 9 V.S.A. chapter 63. The Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions, and private parties have the same rights and remedies as provided under 9 V.S.A. chapter 63, subchapter 1. (b) Nothing in this section shall be construed to preclude or supplant any other statutory or common law remedies. (Added 2021, No. 36,  3, eff. July 1, 2023.) 
 1691. Definitions
As used in this chapter:(1) Department means the Department of Health.(2) Intentionally added means the addition of a chemical in a product that serves an intended function in the product component. (3) Perfluoroalkyl and polyfluoroalkyl substances or PFAS has the same meaning as in section 1661 of this title. (4) Ski wax means a lubricant applied to the bottom of snow runners, including skis and snowboards, to improve their grip and glide properties. (Added 2021, No. 36,  4, eff. July 1, 2023.) 
 1692. Ski wax
(a) A manufacturer, supplier, or distributor shall not manufacture, sell, offer for sale, distribute for sale, or distribute for use in this State ski wax or related tuning products to which PFAS have been intentionally added in any amount. (b) This section shall not apply to the sale or resale of used products. (Added 2021, No. 36,  4, eff. July 1, 2023.)
 1693. Certificate of compliance
The Attorney General may request a certificate of compliance from a manufacturer of ski wax. Within 30 days after receipt of the Attorney Generals request for a certificate of compliance, the manufacturer shall: (1) provide the Attorney General with a certificate attesting that the manufacturers product or products comply with the requirements of this chapter; or (2) notify persons who are selling a product of the manufacturers in this State that the sale is prohibited because the product does not comply with this chapter and submit to the Attorney General a list of the names and addresses of those persons notified. (Added 2021, No. 36,  4, eff. July 1, 2023.) 
 1694. Rulemaking
Pursuant to 3 V.S.A. chapter 25, the Commissioner shall adopt any rules necessary for the implementation, administration, and enforcement of this chapter. (Added 2021, No. 36,  4, eff. July 1, 2023.) 
 1695. Penalties
(a) A violation of this chapter shall be deemed a violation of the Consumer Protection Act, 9 V.S.A. chapter 63. The Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions, and private parties have the same rights and remedies as provided under 9 V.S.A. chapter 63, subchapter 1. (b) Nothing in this section shall be construed to preclude or supplant any other statutory or common law remedies. (Added 2021, No. 36,  4, eff. July 1, 2023.) 
 1700. Creation; membership; officers; quorum
(a) There is created the Nuclear Decommissioning Citizens Advisory Panel that shall consist of the following: (1) The Secretary of Human Services, ex officio, or designee.(2) The Secretary of Natural Resources, ex officio, or designee.(3) The Commissioner of Public Service, ex officio, or designee.(4) The Secretary of Commerce and Community Development, ex officio, or designee.(5) One member of the House Committee on Energy and Technology, chosen by the Speaker of the House. (6) One member of the Senate Committee on Natural Resources and Energy, chosen by the Committee on Committees. (7) One representative of the Windham Regional Commission or designee, selected by the Regional Commission. (8) Two representatives of the Town of Vernon or designees, selected by the legislative body of that town. (9) Six members of the public, two each selected by the Governor, the Speaker of the House, and the President Pro Tempore of the Senate. Under this subdivision, each appointing authority initially shall appoint a member for a three-year term and a member for a four-year term. Subsequent appointments under this subdivision shall be for terms of four years. (10) Two representatives of the owners of the Vermont Yankee site.(11) One optional member who will represent collectively the Towns of Chesterfield, Hinsdale, Richmond, Swanzey, and Winchester, New Hampshire, when selected by the Governor of New Hampshire at the invitation of the Commissioner of Public Service. (12) One optional member who will represent collectively the Towns of Bernardston, Colrain, Gill, Greenfield, Leyden, Northfield, and Warwick, Massachusetts, when selected by the Governor of Massachusetts at the invitation of the Commissioner of Public Service. (b) Ex officio members shall serve for the duration of their time in office or until a successor has been appointed. Members of the General Assembly shall be appointed for two years or until their successors are appointed, beginning on or before January 15 in the first year of the biennium. Representatives designated by ex officio members shall serve at the direction of the designating authority. (c) The Commissioner of Public Service shall serve as the Chair until the Panel elects a chair or co-chairs under subsection (d) of this section. (d) The Panel annually shall elect a chair or co-chairs, and a vice chair, for one-year terms commencing with its first meeting following the effective date of this section. (e) A majority of the Panels members shall constitute a quorum. The Panel shall act only by vote of a majority of its entire membership and only at meetings called by the Chair or Co-Chair or by any five of the members. The person or persons calling the meeting shall provide adequate notice to all its members. (f) Members of the panel who are not ex officio members, employees of the State of Vermont, representatives of the owners of the Vermont Yankee site, or members representing towns outside Vermont, and who are not otherwise compensated or reimbursed for their attendance, shall be entitled to $50.00 per diem and their necessary and actual expenses. Funds for this purpose shall come from the monies collected under 30 V.S.A.  22 for the purpose of maintaining the Department of Public Service. Legislative members shall not be entitled to a per diem under this section for meetings while the General Assembly is in session. (g) The Commissioner of Public Service shall:(1) manage the provision of administrative support to the Panel, including scheduling meetings and securing meeting locations, providing public notice of meetings, producing minutes of meetings, and assisting in the compilation and production of the Panels annual report described in section 1701 of this title; (2) keep the Panel informed of the status of matters within the jurisdiction of the Panel;(3) notify members of the Panel in a timely manner upon receipt of information relating to matters within the jurisdiction of the Panel; (4) upon request, provide to all members of the Panel all relevant information within the control of the Department of Public Service relating to subjects within the scope of the duties of the Panel; (5) provide workshops or training for Panel members as may be appropriate; and(6) hire experts, contract for services, and provide for materials and other reasonable and necessary expenses of the Panel as the Commissioner may consider appropriate on request of the Panel from time to time. Funds for this purpose shall come from the owners of the Vermont Yankee site as the Commissioner of Public Service may consider appropriate, not to exceed $35,000.00 annually. The obligation to support the Panels activities shall cease upon the submission of the application for Partial License Termination by the owners of the Vermont Yankee site to the U.S. Nuclear Regulatory Commission. On or before June 30 annually, the Commissioner of Public Service shall render to the owners of the Vermont Yankee site a statement detailing the amount of money expended or contracted for under this subdivision (6), which shall be paid within 30 days by the owners of the Vermont Yankee site into the special fund established pursuant to 30 V.S.A.  22 for the purpose of maintaining the Department of Public Service and Public Utility Commission. The funds paid into the special fund by the owners of the Vermont Yankee site shall be paid solely to the Department. Within 30 days after receiving the statement of funds due, the owners of the Vermont Yankee site may petition the Public Utility Commission for a hearing to review and determine the necessity and reasonableness of such expenses. Following the review, the Public Utility Commission may amend or revise the cost assessments as it deems appropriate. (Added 1997, No. 147 (Adj. Sess.),  271, eff. April 29, 1998; amended 2009, No. 135 (Adj. Sess.),  7; 2013, No. 179 (Adj. Sess.),  E.233, eff. June 9, 2014; 2017, No. 113 (Adj. Sess.),  63a; 2021, No. 54,  13.) 
 1701. Duties
The Panel shall serve in an advisory capacity only and shall not have authority to direct decommissioning of the Vermont Yankee site. The duties of the Panel shall be: (1) To hold a minimum of three public meetings each year for the purpose of discussing issues relating to the decommissioning of Vermont Yankee. The Panel may hold additional meetings. (2) To advise the Governor, the General Assembly, the agencies of the State, and the public on issues related to the decommissioning of Vermont Yankee, with a written report being provided annually to the Governor and to the energy committees of the General Assembly. The provisions of 2 V.S.A.  20(d) (expiration of reports) shall not apply to this report. (3) To serve as a conduit for public information and education on and to encourage community involvement in matters related to the decommissioning of Vermont Yankee and to receive written reports and presentations on the decommissioning of the site at its regular meetings. (4) To periodically receive reports, including those required by the Public Utility Commission Docket No. 8880 Order, on the Decommissioning Trust Fund and other funds associated with decommissioning of or site restoration at Vermont Yankee, including fund balances, expenditures made, and reimbursements received. (5) To receive reports and presentations at regular meetings regarding the decommissioning progress and plans for Vermont Yankee, including any site assessments and post-shutdown decommissioning assessment reports; provide a forum for receiving public comment on these plans and reports; and provide comment on these plans and reports as the Panel may consider appropriate to State agencies and the owner of Vermont Yankee and in the annual report described in subdivision (2) of this subsection. (Added 1997, No. 147 (Adj. Sess.),  271, eff. April 29, 1998; amended 2009, No. 135 (Adj. Sess.),  8; 2013, No. 179 (Adj. Sess.),  E.233, eff. June 9, 2014; 2021, No. 54,  14.) 
 1702. Assistance
The Department of Public Service, the Agency of Human Services, and the Agency of Natural Resources shall furnish administrative support to the Panel, with assistance from the owners of the Vermont Yankee site as the Commissioner of Public Service may consider appropriate. (Added 1997, No. 147 (Adj. Sess.),  271, eff. April 29, 1998; amended 2013, No. 179 (Adj. Sess.),  E.233, eff. June 9, 2014; 2021, No. 54,  15.) 
 1741. Definitions
As used in this chapter:(1) Tobacco products shall have the meaning given in 7 V.S.A.  1001.(2) A place of public access means any place of business, commerce, banking, financial service, or other service-related activity, whether publicly or privately owned and whether operated for profit or not, to which the general public has access or which the general public uses. The term includes: (A) buildings;(B) offices;(C) means of transportation;(D) common carrier waiting rooms;(E) arcades;(F) restaurants, bars, and cabarets;(G) retail stores;(H) grocery stores;(I) libraries;(J) theaters, concert halls, auditoriums, and arenas;(K) barber shops and hair salons;(L) laundromats;(M) shopping malls;(N) museums and art galleries;(O) sports and fitness facilities;(P) planetariums;(Q) historical sites;(R) common areas of nursing homes and hospitals, including the lobbies, hallways, elevators, restaurants, restrooms, and cafeterias; and (S) buildings or facilities owned or operated by a social, fraternal, or religious club.(3) Hospital means a place devoted primarily to the maintenance and operation of diagnostic and therapeutic facilities for inpatient medical or surgical care of individuals suffering from illness, disease, injury, or deformity, or for obstetrics. (4) Publicly owned buildings and offices means enclosed indoor places or portions of such places owned, leased, or rented by State, county, or municipal governments, or by agencies supported by appropriation of, or by contracts or grants from, funds derived from the collection of federal, State, county, or municipal taxes. (5) Tobacco substitutes shall have the same meaning as in 7 V.S.A.  1001. (Added 1993, No. 46,  2; amended 2005, No. 34,  1, eff. Sept. 1, 2005; 2013, No. 135 (Adj. Sess.),  2; 2015, No. 108 (Adj. Sess.),  3.)
 1742. Restrictions on smoking in public places
(a) The possession of lighted tobacco products or use of tobacco substitutes in any form is prohibited in: (1) the common areas of all enclosed indoor places of public access and publicly owned buildings and offices; (2) all enclosed indoor places in lodging establishments used for transient traveling or public vacationing, such as resorts, hotels, and motels, including sleeping quarters and adjoining rooms rented to guests; (3) designated smoke-free areas of property or grounds owned by or leased to the State or a municipality; and (4) any other area within 25 feet of State-owned buildings and offices, except that to the extent that any portion of the 25-foot zone is not on State property, smoking is prohibited only in that portion of the zone that is on State property unless the owner of the adjoining property chooses to designate his or her property smoke-free. (b) The possession of lighted tobacco products or use of tobacco substitutes in any form is prohibited on the grounds of any hospital or secure residential recovery facility owned or operated by the State, including all enclosed places in the hospital or facility and the surrounding outdoor property. (c) Nothing in this section shall be construed to restrict the ability of residents of the Vermont Veterans Home to possess lighted tobacco products or use tobacco substitutes in the indoor area of the facility in which smoking is permitted. (d) Nothing in this chapter shall be construed to prohibit the use of tobacco substitutes in a business that does not sell food or beverages but is established for the sole purpose of providing a setting for patrons to purchase and use tobacco substitutes and related paraphernalia. (Added 1993, No. 46,  2; amended 2013, No. 135 (Adj. Sess.),  3; 2015, No. 108 (Adj. Sess.),  4; 2017, No. 130 (Adj. Sess.),  8.) 
 1743. Exceptions
The restrictions in this chapter on possession of lighted tobacco products and use of tobacco substitutes do not apply to areas not commonly open to the public of owner-operated businesses with no employees. (Added 1993, No. 46,  2; amended 2005, No. 34,  2, eff. Sept. 1, 2005; 2009, No. 32,  3; 2015, No. 108 (Adj. Sess.),  5.) 
 1745. Enforcement
A proprietor, or the agent or employee of a proprietor, who observes a person in possession of lighted tobacco products or using tobacco substitutes in apparent violation of this chapter shall ask the person to extinguish all lighted tobacco products or cease using the tobacco substitutes. If the person persists in the possession of lighted tobacco products or use of tobacco substitutes, the proprietor, agent, or employee shall ask the person to leave the premises. (Added 1993, No. 46,  2; amended 2015, No. 108 (Adj. Sess.),  6.) 
 1746. Municipal ordinances
Nothing in this chapter shall be construed to supersede or in any manner affect a municipal smoking ordinance, provided that the provisions of such ordinance are at least as protective of the rights of nonsmokers as the provisions of this chapter. (Added 1993, No. 46,  2.) 
 1751. Definitions
(a) Words and phrases used in this chapter shall have the same meaning as provided in the federal Residential Lead-Based Paint Hazard Reduction Act of 1992 unless there is an inconsistency, in which case any definition provided in this section that narrows, limits, or restricts shall control. (b) As used in this chapter:(1) Abatement means any set of measures designed to eliminate lead hazards permanently in accordance with standards established by appropriate State and federal agencies. The term includes: (A) removal of lead-based paint and lead-contaminated dust, permanent containment or encapsulation of lead-based paint, replacement of lead-painted surfaces or components, and removal or covering of lead-contaminated soil; and (B) all preparation, cleanup, disposal and post-abatement clearance testing activities associated with such measures. (2) Accredited training program means a training program that has been approved by the Commissioner of Health to provide training for individuals engaged in lead-based paint activities or RRPM activities. Training program accreditation is issued to a specific training provider who shall receive accreditation for each training discipline that the accredited training program offers as a course. (3) Certified means completion of an accredited training program by an individual.(4) Child or children means an individual or individuals under 18 years of age, except where specified as a child or children six years of age or younger. (5) Child care facility means a child care facility or family child care home as defined in 33 V.S.A.  3511 that was constructed prior to 1978. (6) Child-occupied facility means a building or portion of a building constructed prior to 1978, visited regularly by the same child, six years of age or under, on at least two different days within any week, provided that each days visit lasts at least three hours and the combined weekly visits last at least six hours and the combined annual visits last at least 60 hours. Child-occupied facilities include child care facilities, preschools, and kindergarten classrooms. (7) Commercial facility means any building constructed for the purposes of commercial or industrial activity and not primarily intended for use by the general public, including office complexes, industrial buildings, warehouses, factories, and storage facilities. (8) Component or building component means specific design or structural elements or fixtures of a facility or residential dwelling that are distinguished from each other by form, function, and location. These include interior components such as ceilings; crown moldings; walls; chair rails; doors; door trim; floors; fireplaces; radiators and other heating units; shelves; shelf supports; stair treads; stair risers; stair stringers; newel posts; railing caps; balustrades; windows and trim, including sashes, window heads, jambs, sills, or stools and troughs; built-in cabinets; columns; beams; bathroom vanities; countertops; air conditioners; and exterior components such as painting; roofing; chimneys; flashing; gutters and downspouts; ceilings; soffits; fascias; rake boards; cornerboards; bulkheads; doors and door trim; fences; floors; joists; lattice work; railings and railing caps; siding; handrails; stair risers and treads; stair stringers; columns; windowsills or stools and troughs; casings; sashes and wells; and air conditioners. (9) Contractor means any firm, partnership, association, corporation, sole proprietorship, or other business concern as well as any governmental, religious, or social organization or union that agrees to perform services. (10) Deteriorated paint means any interior or exterior lead-based paint or other coating that is peeling, chipping, chalking, or cracking or any paint or other coating located on an interior or exterior surface or component that is otherwise damaged or separated from the substrate. (11) Due date means the date by which an owner of rental target housing or a child care facility shall file with the Department the RRPM compliance statement required by section 1759 of this title. The due date shall be one of the following: (A) not later than 365 days after the most recent RRPM compliance statement was received by the Department; (B) within 60 days after the closing of the purchase of the property if no RRPM compliance statement was filed with the Department within the past 12 months; (C) any other date agreed to by the owner and the Department; or(D) any other date set by the Department.(12) Dwelling means any residential unit, including attached structures such as porches and stoops, used as the home or residence of one or more persons. (13) Elevated blood lead level means having a blood lead level of at least five micrograms per deciliter of human blood, or a lower threshold as determined by the Commissioner. (14) Facility means any institutional, commercial, public, private, or industrial structure, installation, or building or private residence and its grounds. (15) Firm means a company, partnership, corporation, sole proprietorship, or individual doing business; an association or business entity; a State or local government agency; or a nonprofit organization. (16) Independent dust clearance means a visual examination and collection of dust samples, by a lead-based paint inspector or lead-based paint inspector-risk assessor who has no financial interest in either the work being performed or the property to be inspected and is independent of both the persons performing the work and the owner of the property. The lead-based paint inspector or lead-based paint inspector-risk assessor shall use methods specified by the Department and analysis by an accredited laboratory to determine that lead exposures do not exceed limits set by the Department. (17) Inspection means a surface-by-surface investigation to determine the presence of lead-based paint and other lead hazards and the provision of a report explaining the results of the investigation. (18) Interim controls means a set of measures designed temporarily to reduce human exposure or likely exposure to lead hazards, including specialized cleaning, repairs, maintenance, painting, temporary containment, ongoing monitoring of lead hazards or potential hazards, and the establishment of management and resident education programs. (19) Lead-based paint means paint or other surface coatings that contain lead in an amount:(A) equal to 1.0 mg/cm2 or 0.5 percent by weight or greater;(B) lower than that described in subdivision (A) of this subdivision (19) as may be established by the Secretary of the U.S. Department of Housing and Urban Development pursuant to Section 302(c) of the Lead-Based Paint Poisoning Prevention Act; or (C) lower than that described in subdivision (A) of this subdivision (19) as may be established by the Administrator of the U.S. Environmental Protection Agency. (20) Lead-based paint abatement supervisor means any individual who has satisfactorily completed an accredited training program approved by the Commissioner and has a current license issued by the Department to perform abatement work supervision. (21) Lead-based paint abatement worker means any individual who has satisfactorily completed an accredited training program approved by the Commissioner and has a current license issued by the Department to perform abatement work. (22) Lead-based paint activities means:(A) with regard to target housing or a child care facility: risk assessment, inspection, visual inspection for risk assessment, project design, abatement, visual inspection for clearance, dust clearance after an abatement project, and lab analysis of paint chip or dust wipe samples collected for the purpose of an inspection or risk assessment; and (B) with regard to a public facility constructed before 1978, a commercial building, bridge, or other structure: inspection, risk assessment, project design, abatement, de-leading, removal of lead from bridges and other superstructures, visual inspection for clearance, dust clearance after an abatement project, and lab analysis of paint chip or dust wipe samples collected for the purposes of an inspection or risk assessment. As used in this subdivision (B), de-leading means activities conducted by a person who offers to eliminate or plan for the elimination of lead-based paint or lead hazards. (23) Lead-based paint contractor means an entity that employs one or more individuals licensed by the Department under this chapter and has a current license issued by the Department to conduct lead-based paint activities or RRPM activities. (24) Lead-based paint inspector means an individual who has satisfactorily completed an accredited training program approved by the Commissioner and has a current license issued by the Department to conduct lead-based paint inspections. (25) Lead-based paint inspector-risk assessor means an individual who has satisfactorily completed an accredited training program approved by the Commissioner and has a current license issued by the Department to conduct lead-based paint inspections and risk assessments. (26) Lead-based paint project designer means an individual who has satisfactorily completed an accredited training program approved by the Commissioner and has a current license issued by the Department to prepare lead abatement project designs, occupant protection plans, and abatement reports. (27) Lead hazard means a condition that causes exposure to lead from contaminated dust, lead-contaminated soil, lead-containing coatings, or lead-contaminated paint that is deteriorated or present in accessible surfaces, friction surfaces, or impact surfaces that would result in adverse human health effects. (28) Lead-safe RRPM supervisor means an individual who has completed an accredited RRPM training program approved by the Commissioner and, if performing services for compensation, has a current license issued by the Department. This individual is authorized to perform or supervise RRPM activities in target housing or a child-occupied facility in which interior or exterior lead-based paint will be disturbed. (29) License means the document issued to an individual, entity, or firm indicating that the standards for licensure for each discipline, category of entity, or firm established in this chapter have been met. (30) Licensee means a person who engages in lead-based paint activities or RRPM activities and has obtained a license to perform such activities for compensation. (31) Maintenance means work intended to maintain and preserve target housing, a child-occupied facility, a pre-1978 facility, a commercial facility, bridge, or other superstructure. It does not include minor RRPM activities. (32) Minor RRPM activities means maintenance and repair activities that disturb less than one square foot of painted surface for interior activities or 20 square feet or less of painted surface for exterior activities if the work does not involve window replacement or demolition of painted surface areas. With regard to removing painted components or portions of painted components, the entire surface area removed is the amount of painted surface disturbed. Work, other than emergency renovations, performed in the same room within the same 30-day period shall be considered the same work for the purposes of determining whether the work is a minor RRPM activity. (33) Occupant means any person who resides in, or regularly uses, a dwelling, mobile dwelling, or structure. (34) Owner means any person who, alone or jointly or severally with others:(A) Has legal title to any dwelling or child care facility with or without actual possession of the property. (B) Is the Chief Executive Officer of the municipal or State agency that owns, leases, or controls the use of publicly owned target housing or a child care facility. (C) Is a person who has taken full legal title of a dwelling or child care facility through foreclosure, deed in lieu of foreclosure, or otherwise. Owner does not include a person who holds indicia of ownership given by the person in lawful possession for the primary purpose of assuring repayment of a financial obligation. Indicia of ownership includes interests in real or personal property held as security or collateral for repayment of a financial obligation such as a mortgage, lien, security interest, assignment, pledge, surety bond, or guarantee and includes participation rights of a financial institution used for legitimate commercial purposes in making or servicing the loan. (35) Owners representative means a person who has charge, care, or control of a dwelling or child care facility as property manager, agent, or guardian of the estate. (36) Public facility means a house of worship; courthouse; jail; municipal room; State or county institution; railroad station; school building; social hall; hotel, restaurant, or building used or rented to boarders or roomers; place of amusement; factory; mill; workshop or building in which persons are employed; building used as a nursery, convalescent home, or home for the aged; tent or outdoor structure used for public assembly; and barn, shed, office building, store, shop, shop other than a workshop, or space where goods are offered for sale, wholesale, or retail. It does not include a family residence registered as a child care facility. (37) Renovation means the modification of any existing structure or portion of an existing structure that results in the disturbance of a painted surface unless the activity is performed as part of a lead-based paint abatement activity or is a minor RRPM activity. Renovation includes the following when it results in the disturbance of a painted surface: the removal, modification, re-coating, or repair of a painted surface or painted component of a surface; the removal of building components; a weatherization project; and interim controls that disturb painted surfaces. Renovation includes the performance of activities for the purpose of converting a building or part of a building into target housing or a child-occupied facility when it results in the disturbance of a painted surface. (38) RRPM means the Renovation, Repair, Painting, and Maintenance Program that pertains to projects that disturb lead-based paint on target housing and child-occupied facilities. (39) RRPM activities means lead-safe renovation, repair, painting, and maintenance practices as required by section 1759 of this chapter and as adopted by rule by the Commissioner. It does not include minor RRPM activities. (40) RRPM firm means a company, partnership, corporation, sole proprietorship, or individual doing business; association; or other business entity that regularly engages in RRPM activities for compensation and that employs or contracts with persons to perform RRPM activities as determined by the Department. (41) Rental target housing means target housing offered for lease or rental under a rental agreement as defined in 9 V.S.A.  4451. Rental target housing does not include a rented single room located within a dwelling in which the owner of the dwelling resides unless a child six years of age or younger resides in or is expected to reside in that dwelling. Rental target housing shall not include units in a hotel, motel, or other lodging, including condominiums that are rented for transient occupancy for 30 days or less. (42) Repair means the restoration of paint or other coatings that have been damaged, including the repair of permanent containment around lead-based paint materials in a facility. Repair of previously encapsulated lead-based paint may involve filling damaged areas with non-lead paint substitutes and reencapsulating. It shall not include minor RRPM activities. (43) Risk assessment means an on-site investigation by a lead-based paint inspector-risk assessor to determine and report the existence, nature, severity, and location of lead hazards, including information gathering about the age and history of the property and occupancy by children six years of age or younger, visual inspection, limited wipe sampling, or other environmental sampling techniques, other appropriate risk assessment activities, and a report on the results of the investigation. (44) Screen, screened, or screening relating to blood lead levels, means the initial blood test to determine the presence of lead in a human. (45) Superstructure means a large steel or other industrial structure, such as a bridge or water tower, that may contain lead-based paint. (46) Target housing means any dwelling constructed prior to 1978, except any 0-bedroom dwelling or any dwelling located in multiple-unit buildings or projects reserved for the exclusive use of elders or persons with disabilities, unless a child six years of age or younger resides in or is expected to reside in that dwelling. (Added 1993, No. 94,  3; amended 1995, No. 165 (Adj. Sess.),  2; 1997, No. 37,  1; 2007, No. 172 (Adj. Sess.),  4; 2007, No. 176 (Adj. Sess.),  26, eff. July 1, 2008; 2013, No. 96 (Adj. Sess.),  93; 2013, No. 131 (Adj. Sess.),  115; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022; 2019, No. 4 (Adj. Sess.),  1.) 
 1752. Accreditation of training programs; individuals, entities, or firms involved in lead-based paint or RRPM activities
(a) The Department shall develop a program to administer and enforce lead-based paint activities and RRPM activities with regard to training and licensing standards, rules, or other requirements established by the Commissioner, which are at least as protective of human health and the environment as the applicable federal programs, for persons engaged in lead-based paint activities and RRPM activities performed on target housing, child-occupied facilities, pre-1978 facilities, commercial facilities, and bridges or other superstructures. (b) The Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25 establishing standards and specifications for the accreditation of training programs for lead-based paint activities and RRPM activities, including the mandatory topics of instruction, the knowledge and performance standards that must be demonstrated by graduates in order to be certified or licensed, and required accreditation qualifications for training programs and instructors. The standards shall be designed to protect children, their families, and workers from improperly conducted lead-based paint activities and RRPM activities, and shall be at least as protective of human health and the environment as the federal programs. Hands-on instruction and instruction for identification and proper handling of historic fabric and materials shall be components of the required training. (c) The Commissioner shall license consulting contractors, analytical contractors, lead-based paint abatement supervisors, lead-based paint abatement workers, project designers, inspector-risk assessors, RRPM firms, and RRPM supervisors, who have successfully completed an accredited training program and met other requirements as the Commissioner may, by rule, impose. (d) The Commissioner shall certify individuals engaged in RRPM activities for no compensation and who have successfully completed an accredited training program and met all other requirements as the Commissioner may impose by rule. (e) After the adoption of rules pursuant to this section, a person shall not perform lead-based paint activities or RRPM activities for compensation without first obtaining a license from the Commissioner. The Commissioner may grant a license to a person who holds a valid license from another state. (f) Nothing in this chapter shall be construed to limit the authority of the Secretary or the Commissioner of Health, of Labor, or of Environmental Conservation under the provisions of any other law. (Added 1993, No. 94,  3; amended 2005, No. 103 (Adj. Sess.),  3, eff. April 5, 2006; 2007, No. 76,  11a; 2017, No. 149,  2, eff. October 21, 2022.) 
 1753. Accreditation, license, permit, notification, registration, and administrative fees
(a) The Commissioner shall assess fees for accrediting training programs, licenses, license renewals, and permits issued in accordance with this chapter. Fees shall not be imposed on any State or local government, agent of the State, or nonprofit training program and may be waived for the purpose of training State employees. (b) Each accredited training program and licensee shall be subject to the following annual fees, except where otherwise noted: (c) Each licensee seeking to complete a lead-based paint abatement project or RRPM activities project involving prohibited or unsafe work practices shall be subject to the following permit fees: (1) Project permit   $50.00 (2) Project permit revision  $25.00 (d) Fees imposed by this section and monies collected under section 1766 of this chapter shall be deposited into the Lead-Based Paint Accreditation and Licensing Special Fund. Monies in the Fund may be used by the Commissioner only to support Departmental accreditation, certification, licensing, education, and training activities related to this chapter. The Fund shall be subject to the provisions of 32 V.S.A. chapter 7, subchapter 5. (Added 1993, No. 94,  3; amended 1997, No. 155 (Adj. Sess.),  59, eff. April 29, 1998; 1999, No. 49,  189; 2001, No. 65,  6; 2007, No. 76,  11b; 2007, No. 176 (Adj. Sess.),  27; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1754. Public education
(a) The Commissioner shall prepare and distribute clear and simple materials describing the dangers of lead poisoning, the need for parents to have their child screened, how to have a child tested, and recommended nutrition and housekeeping practices. The Commissioner shall work with persons and organizations involved in occupations that may involve lead hazards or childhood lead poisoning to distribute the materials to their tenants, clients, patients, students, or customers, such as realtors, subcontractors, apartment owners, public housing authorities, pediatricians, family practitioners, nurse clinics, child clinics, other health care providers, child care and preschool operators, and kindergarten teachers. The Commissioner shall also identify those points in time or specific occasions when members of the public are in contact with public agencies and lead might be an issue, such as building permits, home renovations, the WIC program, and programs established under 33 V.S.A. chapters 10, 11, and 12, and make the materials available on these occasions. (b) The Commissioner shall prepare an appropriate media campaign to educate the public on lead poisoning prevention. The campaign shall include education targeting owner-occupied residences regarding the importance of following safe maintenance and work practices when there is a potential for exposure to lead-based paint. (Added 1993, No. 94,  3; amended 1995, No. 165 (Adj. Sess.),  3; 2013, No. 131 (Adj. Sess.),  116; 2015, No. 97 (Adj. Sess.),  47; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1755. Universal testing
(a) All health care providers who provide primary health care to children shall test children one and two years of age for elevated blood lead levels in accordance with rules adopted by the Commissioner. (b) [Repealed.](c) All health care providers who provide primary medical care shall ensure that parents and guardians of children six years of age or younger are advised of the availability and advisability of screening and testing their children for lead in accordance with the Commissioners guidelines. No health care provider shall be liable for not performing a screening or confirmation test for blood lead level when a parent or guardian has refused to consent or has failed to follow through in response to a referral for a screening or confirmation test. No later than 120 days after the Department has notified health care providers that it has implemented lead screening reports within the immunization registry, a health care provider shall report to the Department regarding lead screening of children ages one and two pursuant to the guidelines in subsection (a) of this section in a form and as required by the Department. (d) Any laboratory that analyzes blood samples of Vermont residents for lead levels shall report to the Department all information required by the Department. All health care providers who analyze blood samples for lead levels or who use laboratories outside Vermont to analyze blood samples for lead levels shall report all information required by the Department to the Department immediately by telephone if the result of any analysis is 45 micrograms or more of lead per deciliter of blood, or by electronic means within 14 days of analysis if the result of the analysis is less than 45 micrograms of lead per deciliter of blood. All blood lead data reports to the Department shall include the name, date of birth, date of blood test, and address of the individual whose blood is analyzed and, if known, the owner of the residence of the individual. (e) No later than 120 days after the Department has notified laboratories that it has implemented lead screening reports within the immunization registry, a laboratory shall report to the Department regarding lead screening of children ages one and two pursuant to the guidelines in subsection (a) of this section in a form and as required by the Department. (Added 1993, No. 94,  3; amended 1995, No. 180 (Adj. Sess.),  38(a); 2007, No. 176 (Adj. Sess.),  28; 2013, No. 142 (Adj. Sess.),  92; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1756. Annual report
(a) The Commissioner shall, at least annually, analyze and summarize all aggregate lead screening and testing information provided by physicians, health care facilities, and laboratories and provide this information to all other local and State agencies involved with case management and lead hazard reduction. (b) The Commissioner shall also at least annually provide to the General Assembly, the health community, and the general public an analysis and summary of such data and a progress report on the Commissioners efforts to prevent lead poisoning in young children in a format that is easily understandable to nontechnical readers. The report shall include: (1) The number and percentage of children under the age of six who have been screened and tested for lead poisoning, and the number found to have lead poisoning at various levels. (2) Estimates of the public and private costs incurred since July 1, 1993 to prevent, correct, or treat lead poisoning. (3) An analysis of barriers to universal blood screening of children under the age of six years. (4) The Commissioners recommendations for action. (Added 1993, No. 94,  3.)
 1757. Children with elevated blood lead levels
(a) The Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25 regarding:(1) the method and frequency with which children shall be tested for elevated blood lead levels; (2) the reporting requirements for the lead test result; and(3) the action required for children found to have elevated blood lead levels.(b) If the child has an elevated blood lead level, the Commissioner shall provide information on lead hazards to the parents or guardians of the child. (c) If a child six years of age or younger has a confirmed blood lead level at or above the level determined by the Commissioner, and if resources permit, the Commissioner: (1) Shall, with the consent of the parent or guardian, provide an inspection of the dwelling occupied by the child or the child-occupied facility the child attends by a State or private lead-based paint inspector-risk assessor, and develop a plan in consultation with the parents, owner, physician, and others involved with the child to minimize the exposure of the child to lead. The plan developed under this subdivision shall require that any lead hazards identified through the inspection be addressed. The owner of rental target housing or a child care facility shall address those lead hazards within the owners control, and shall not be required to abate lead hazards if interim controls are effective. (2) May inspect and evaluate other dwelling units in the building in which the child is living if it is reasonable to believe that a child six years of age or younger occupies, receives care in, or otherwise regularly frequents the other dwellings in that building. (d) Nothing in this section shall be construed to limit the Commissioners authority under any other provision of Vermont law. (Added 1993, No. 94,  3; amended 1995, No. 165 (Adj. Sess.),  4; 2007, No. 176 (Adj. Sess.),  29; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1759. RRPM activities
(a)(1) RRPM activities include activities that disturb lead-based paint on target housing and child-occupied facilities, unless the property has been certified as lead-free pursuant to subsection (e) of this section. RRPM practices for target rental housing and child care facilities shall minimally include regular inspection of painted surfaces for deterioration, prompt and safe repairs to deteriorated paint, and specialized cleaning after any work that disturbs painted surfaces and at tenant turnover. (2) RRPM activities, including worksite preparation and cleanup of work areas, in target housing and child-occupied facilities shall be performed only by a person who has successfully completed an accredited RRPM training program or a person who works under the direct, on-site supervision of a person who has successfully completed the training, unless the property is exempt pursuant to subsection (b) or (e) of this section. (3) A person engaging in RRPM activities shall comply with section 1760 of this chapter and related rules adopted by the Commissioner. (4) A person engaging in RRPM activities shall take all reasonable precautions to avoid creating lead hazards during any RRPM project that is not a minor RRPM activity. (5) RRPM activities performed for compensation shall be conducted only by a licensed RRPM supervisor or under the direct, on-site supervision of a licensed RRPM supervisor. (b) A homeowner residing in and intending to perform RRPM activities in his or her own private residence: (1) is exempt from this section;(2) shall comply with section 1760 of this chapter; and(3) shall dispose of all lead-based paint in accordance with the rules adopted by the Department of Environmental Conservation. (c) An owner of rental target housing or a child care facility or the owners representative shall: (1) file with the Department an RRPM compliance statement pursuant to rules adopted by the Commissioner, unless the property is exempt pursuant to subsection (e) of this section; and (2) abide by any rules pertaining to the maintenance of lead-based paint and provision of notice to tenants as may be prescribed by the Commissioner. (d)(1) Prior to entering into a lease agreement, an owner or owners representative shall provide approved tenants with written materials approved by the Department regarding lead hazards and a copy of the owners most recent RRPM compliance statement. The written materials approved by the Department pursuant to this subsection shall include information indicating that lead is highly toxic to humans, particularly young children, and may cause permanent neurological damage, even at low exposure levels. (2) An owner of a facility, or owners representative, shall fully inform a tenant who intends to operate a child care facility on the premises of the requirements of this section. (e)(1) A property is exempt from this section if a written inspection report from a licensed lead-based paint inspector-risk assessor states that all accessible surfaces are free of lead-based paint and the owner and person performing RRPM activities have been provided with a copy of the report. (2) An owner of rental target housing or a child care facility or owners representative shall provide a copy of the written inspection report to the Department for review and determination of exempt status. (3) A new written inspection report shall be required to maintain exempt status if lead hazards are created as a result of RRPM activities performed or if previously inaccessible components are exposed after the date of the original written inspection report. (4) If a property has been remodeled, it is not exempt from this section unless the full requirements of this section have been met. (f) The Commissioner may adopt rules pursuant to 3 V.S.A. chapter 25 as necessary for the implementation, administration, and enforcement of this section. (Added 1995, No. 165 (Adj. Sess.),  6; amended 1997, No. 37,  2-4; 2007, No. 176 (Adj. Sess.),  30; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1760. Presumption of lead-based paint; prohibited and unsafe work practices
(a) All paint in target housing, child-occupied facilities, and pre-1978 public facilities, commercial facilities, and bridges or other superstructures is presumed to be lead-based unless the component affected by the RRPM activity is exempt pursuant to subsection (c) of this section. Unsafe work practices are prohibited and include the following, unless specifically authorized by the Department: (1) Removing lead-based paint by:(A) open flame burning or torching;(B) use of heat guns operated above 1,100 degrees Fahrenheit;(C) dry scraping or dry sanding;(D) powered tools;(E) hydro-blasting or high-pressure washing;(F) abrasive blasting or sandblasting; and(G) chemical stripping.(2) Failing to employ one or more of the lead-safe work practice standards that the Commissioner shall adopt by rule. (b) A person shall not use unsafe work practices in target housing, child-occupied facilities, pre-1978 public facilities, commercial facilities, and bridges or other superstructures. (c) A component is exempt from this section if a written inspection report by a licensed lead-based paint inspector or lead-based paint inspector-risk assessor states that the component affected by an RRPM activity is free of lead-based paint, and the owner or firm, or both, conducting the activity has been provided with a copy of the report. Removal of all paint from a component does not exempt the component from the requirements of this section. (Added 1995, No. 165 (Adj. Sess.),  7; amended 2007, No. 176 (Adj. Sess.),  31; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022; 2019, No. 4 (Adj. Sess.),  1.) 
 1761. Duty of reasonable care; negligence; liability
(a) An owner of rental target housing or a child care facility or an owners representative shall take reasonable care to prevent exposure to, and the creation of, lead hazards. In an action brought under this section, evidence of actions taken or not taken to satisfy the requirements of this chapter, including performing RRPM activities, may be admissible evidence of reasonable care or negligence. (b) Any person who suffers an injury proximately caused by an owners breach of this duty of reasonable care shall have a cause of action to recover damages and for all other appropriate relief. (c) The owner of rental target housing or a child care facility or the owners representative shall not be liable to a tenant of the housing or facility in an individual action for habitability under common law or pursuant to 9 V.S.A. chapter 63 or chapter 137, 10 V.S.A. chapter 153, or 12 V.S.A. chapter 169 for injury or other relief claimed to be caused by exposure to lead if, during the relevant time period, the owner is in compliance with section 1759 of this chapter and any of the following, should they exist: (1) the specific recommendations of a lead-based paint risk assessment report provided by a lead-based paint inspector-risk assessor; (2) any plan issued pursuant to section 1757 of this chapter; or(3) any assurance of discontinuance, order of the Commissioner, or court order regarding lead hazards. (d) The immunity under subsection (c) of this section shall not be available if:(1) there was fraud in the RRPM compliance statement under section 1759 of this chapter; or (2) the owner or owners representative did not follow the recommendations of a lead-based paint risk assessment report provided by a licensed lead-based paint inspector-risk assessor; or (3) the owner or owners representative created or allowed for the creation of lead hazards during renovation, remodeling, maintenance, or repair; or (4) the owner or the owners representative failed to respond in a timely fashion to notification that lead hazards may have recurred on the premises. (e) A defendant in an action brought under this section or at common law has a right to seek contribution from any other person who may be responsible, in whole or in part, for the childs blood lead level. (f) Nothing in this section shall be construed to limit the right of the Commissioner or any agency or instrumentality of the State of Vermont to seek remedies available under any other provision of Vermont statutory law. (Added 1995, No. 165 (Adj. Sess.),  8; amended 2007, No. 176 (Adj. Sess.),  33; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1762. Secured lenders and fiduciaries; liability
(a) A person who holds indicia of ownership in rental target housing or a child care facility furnished by the owner or person in lawful possession, for the primary purpose of assuring repayment of a financial obligation, and who takes full legal title through foreclosure or deed in lieu of foreclosure or otherwise shall not be liable as an owner of the property for injury or loss claimed to be caused by exposure to lead of a child on the premises, provided that, on or before the 120th day after the date of possession, the person: (1) performs RRPM activities as required by section 1759 of this chapter; and(2) fully discloses to all potential purchasers, operators, or tenants of the property any information in the possession of such person or the persons agents, regarding the presence of lead hazards or a lead-poisoned child on the property and, upon request, provides copies of all written reports on lead hazards to potential purchasers, operators, or tenants. (b) The immunity provided in subsection (a) of this section shall expire 365 days after the secured lender or fiduciary takes full legal title. (c) A person who holds legal title to rental target housing or a child care facility as an executor, administrator, trustee, or the guardian of the estate of the owner and demonstrates that in that fiduciary capacity the person does not have either the legal authority or the financial resources to fund capital or major property rehabilitation necessary to conduct RRPM activities shall not be personally liable as an owner for injury or loss caused by exposure of a child on the premises to lead. However, nothing in this section shall limit the liability of the trust estate for such claims and those claims may be asserted against the trustee as a fiduciary of the trust estate. (Added 1995, No. 165 (Adj. Sess.),  9; amended 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1763. Public financial assistance; rental target housing and child care facilities
Every State agency or instrumentality that makes a commitment to provide public financial assistance for the purchase or rehabilitation of rental target housing or child care facilities shall give priority to projects in which the property is exempt pursuant to subsection 1759(e) of this chapter or lead hazards have been or will be identified and controlled and have passed or will pass an independent dust clearance test that determines that the property contains no lead-contaminated dust prior to occupancy or use. Priority rental target housing projects may include units occupied by severely lead-poisoned children and units in a building that are likely to contain lead hazards. As used in this section, public financial assistance means any grant, loan, or allocation of tax credits funded by the State or the federal government or any of their agencies or instrumentalities. (Added 1995, No. 165 (Adj. Sess.),  10; amended 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1764. Lead inspectors; financial responsibility
The Commissioner shall require that a licensee or an applicant for a license under subsection 1752(e) of this chapter provide evidence of ability to indemnify properly a person who suffers damage from lead-based paint activities or RRPM activities such as proof of effective liability insurance coverage or a surety bond in an amount to be determined by the Commissioner, which shall not be less than $300,000.00. This section shall not restrict or enlarge the liability of any person under any applicable law. (Added 1995, No. 165 (Adj. Sess.),  11; amended 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1765. Liability insurance
(a) If the Commissioner of Financial Regulation determines that lead hazards have substantially diminished the availability of liability insurance for owners of rental target housing or child care facilities and that a voluntary market assistance plan will not adequately restore availability, the Commissioner shall order liability insurers to provide or continue to provide liability coverage or to participate in any other appropriate remedial program as determined by the Commissioner, provided the prospective insured is otherwise in compliance with the provisions of this chapter. (b) A determination pursuant to subsection (a) of this section shall be made by the Commissioner after a hearing held in accordance with 3 V.S.A. chapter 25. Upon a finding that emergency action is required to protect the public health, safety, or welfare, the Commissioner shall issue an appropriate summary order pending completion of administrative proceedings. No order issued under this section may be stayed pending appeal. (Added 1995, No. 165 (Adj. Sess.),  12; amended 1995, No. 180 (Adj. Sess.),  38(a); 2011, No. 78 (Adj. Sess.),  2, eff. April 2, 2012; 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1766. Enforcement; administrative penalties
(a) A person who violates this chapter may be subject to an administrative penalty not to exceed $5,000.00 for each determination of a separate violation. If the Commissioner determines that a violation is continuing, each days continuance may be deemed a separate offense beginning from the date the violator is served with notice of the violation. (b) The Commissioner may use the enforcement powers as set forth in chapter 3 of this title to enforce any violations of this chapter or of any related rules, permits, or orders issued. (Added 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.) 
 1767. Transfer of ownership of target housing; RRPM compliance
(a) Prior to the time a purchase and sale agreement for target housing is executed, the seller shall provide the buyer with materials approved by the Commissioner, including a lead hazard brochure and materials on other lead hazards in housing. The seller shall also provide a disclosure form that shall include any lead-based paint inspection or risk assessment report or letter of exemption, assurance of discontinuance, administrative order, or court order the terms of which are not completed and, if the property is rental target housing, verification that the RRPM was utilized pursuant to this chapter and that a current RRPM compliance statement has been filed with the Department. (b) At the time of purchase of target housing, sellers and other transferors shall provide the buyer or transferee with any materials delineated in subsection (a) of this section not previously disclosed and a lead-safe renovation practices packet approved by the Commissioner and shall disclose any lead-based paint inspection or risk assessment report or letter of exemption, assurance of discontinuance, administrative order, or court order not disclosed pursuant to subsection (a) of this section the terms of which are not completed. (c) No sale of rental target housing, building, or unit may occur if the building or unit is currently the subject of an assurance of discontinuance, administrative order, or court order unless the assurance or order is amended in writing to transfer to the buyer or other transferee all remaining obligations under the assurance or order. (d) Prior to the time of purchase of rental target housing, the real estate agents, sellers, and other transferors of title shall provide the buyer or transferee with information approved by the Commissioner explaining RRPM obligations. (e) A buyer or other transferee of title of rental target housing shall at the time of sale or transfer of ownership, or both, disclose this transfer to the Department. (f) A buyer or other transferee of title to rental target housing who has purchased or received a building or unit that is not in full compliance with section 1759 of this chapter shall bring the rental target housing into compliance with section 1759 of this chapter within 60 days after the closing. Within the 60-day period, the buyer or transferee may submit a written request for an extension of time for compliance, which the Commissioner may grant in writing for a stated period of time for good cause only. Failure to comply with this subsection shall result in an administrative penalty in accordance with section 1766 of this chapter. (g) Noncompliance with this section shall not affect marketability of title. (Added 2007, No. 176 (Adj. Sess.),  34; amended 2017, No. 149 (Adj. Sess.),  2, eff. October 21, 2022.)
 1771. Policy
It is the policy of the State of Vermont:(1) to protect public health and the environment by reducing exposure of its citizens and vulnerable populations, such as children, to toxic chemicals, particularly when safer alternatives exist; and (2) that the State attempt, when possible, to regulate toxic chemicals in a manner that is consistent with regulation of toxic chemicals in other states. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014.) 
 1772. Definitions
As used in this chapter:(1) Aircraft shall have the same meaning as in 5 V.S.A.  202.(2) Chemical means a substance with a distinct molecular composition or a group of structurally related substances and includes the breakdown products of the substance or substances that form through decomposition, degradation, or metabolism. Chemical shall not mean crystalline silica in any form, as derived from ordinary sand or as present as a naturally occurring component of any other mineral raw material, including granite, gravel, limestone, marble, slate, soapstone, and talc. (3) Chemical of high concern to children means a chemical listed under section 1773 or designated by the Department as a chemical of high concern by rule under section 1776 of this title. (4) Child or children means an individual or individuals under 12 years of age.(5) Childrens cosmetics means cosmetics that are made for, marketed for use by, or marketed to children. Childrens cosmetics includes cosmetics that meet any of the following conditions: (A) are represented in its packaging, display, or advertising as appropriate for use by children; (B) are sold in conjunction with, attached to, or packaged together with other products that are packaged, displayed, or advertised as appropriate for use by children; or (C) are sold in any of the following:(i) a retail store, catalogue, or online website, in which a person exclusively offers for sale consumer products that are packaged, displayed, or advertised as appropriate for use by children; or (ii) a discrete portion of a retail store, catalogue, or online website, in which a person offers for sale products that are packaged, displayed, or advertised as appropriate for use by children. (6) Childrens jewelry means jewelry that is made for, marketed for use by, or marketed to children and shall include jewelry that meets any of the following conditions: (A) is represented in its packaging, display, or advertising as appropriate for use by children; (B) is sold in conjunction with, attached to, or packaged together with other products that are packaged, displayed, or advertised as appropriate for use by children; (C) is sized for children and not intended for use by adults; or(D) is sold in any of the following:(i) a vending machine;(ii) a retail store, catalogue, or online website, in which a person exclusively offers for sale products that are packaged, displayed, or advertised as appropriate for use by children; or (iii) a discrete portion of a retail store, catalogue, or online website, in which a person offers for sale products that are packaged, displayed, or advertised as appropriate for use by children. (7)(A) Childrens product means any consumer product, marketed for use by, marketed to, sold, offered for sale, or distributed to children in the State of Vermont, including: (i) toys;(ii) childrens cosmetics;(iv) a product designed or intended by the manufacturer to help a child with sucking or teething, to facilitate sleep, relaxation, or the feeding of a child, or to be worn as clothing by children; or (v) child car seats.(B) Childrens product shall not mean or include the following:(i) batteries;(ii) snow sporting equipment, including skis, poles, boots, snowboards, sleds, and bindings;(iii) inaccessible components of a consumer product that during reasonably foreseeable use and abuse of the consumer product would not come into direct contact with a childs skin or mouth; and (8) Consumer product means any product that is regularly used or purchased to be used for personal, family, or household purposes. Consumer product shall not mean: (A) a product primarily used or purchased for industrial or business use that does not enter the consumer product market or is not otherwise sold at retail; (B) a food or beverage or an additive to a food or beverage;(C) a tobacco product;(D) a pesticide regulated by the U.S. Environmental Protection Agency;(E) a drug, or biologic regulated by the U.S. Food and Drug Administration (FDA), or the packaging of a drug, or biologic that is regulated by the FDA, including over the counter drugs, prescription drugs, dietary supplements, medical devices, or products that are both a cosmetic and a drug regulated by the FDA; (F) ammunition or components thereof, firearms, air rifles, hunting or fishing equipment or components thereof; (G) an aircraft, motor vehicle, wheelchair, or vessel;(H) consumer electronic products, including personal computers, audio and video equipment, calculators, wireless telephones, game consoles, and hand-held devices incorporating a video screen used to access interactive software intended for leisure and entertainment and their associated peripherals; (I) interactive software, intended for leisure and entertainment, such as computer games, and their storage media, such as compact discs; or (J) the packaging in which a product is sold, offered for sale, or distributed.(9) Contaminant means a trace amount of a chemical or chemicals that is incidental to manufacturing and serves no intended function in the childrens product or component of the childrens product, including an unintended by-product of chemical reactions during the manufacture of the childrens product, a trace impurity in feed-stock, an incompletely reacted chemical mixture, and a degradation product. (10) Cosmetics means articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body or any part thereof for cleansing, beautifying, promoting attractiveness, or altering appearance, and articles intended for use as a component of such an article. Cosmetics shall not mean soap, dietary supplements, or food and drugs approved by the U.S. Food and Drug Administration. (11) Intentionally added means the addition of a chemical in a product that serves an intended function in the product component. (12) Manufacturer means:(A) any person who manufactures a childrens product or whose name is affixed to a childrens product or its packaging or advertising, and the childrens product is sold or offered for sale in Vermont; or (B) any person who sells a childrens product to a retailer in Vermont when the person who manufactures the childrens product or whose name is affixed to the childrens product or its packaging or advertising does not have a presence in the United States other than the sale or offer for sale of the manufacturers products. (13) Motor vehicle means all vehicles propelled or drawn by power other than muscular power, including snowmobiles, motorcycles, all-terrain vehicles, farm tractors, vehicles running only upon stationary rails or tracks, motorized highway building equipment, road-making appliances, or tracked vehicles or electric personal assistive mobility devices. (14) Persistent bioaccumulative toxic means a chemical or chemical group that, based on credible scientific information, meets each of the following criteria: (A) the chemical can persist in the environment as demonstrated by the fact that:(i) the half-life of the chemical in water is greater than or equal to 60 days;(ii) the half-life of the chemical in soil is greater than or equal to 60 days; or(iii) the half-life of the chemical in sediments is greater than or equal to 60 days; and(B) the chemical has a high potential to bioaccumulate based on credible scientific information that the bioconcentration factor or bioaccumulation factor in aquatic species for the chemical is greater than 1,000 or, in the absence of such data, that the log-octanol water partition coefficient (log Kow) is greater than five; and (C) the chemical has the potential to be toxic to children as demonstrated by the fact that: (i) the chemical or chemical group is a carcinogen, a developmental or reproductive toxicant, or a neurotoxicant; (ii) the chemical or chemical group has a reference dose or equivalent toxicity measure that is less than 0.003 mg/kg/day; or (iii) the chemical or chemical group has a chronic no observed effect concentration (NOEC) or equivalent toxicity measure that is less than 0.1 mg/L or an acute NOEC or equivalent toxicity measure that is less than 1.0 mg/L. (15) Practical quantification limit (PQL) means the lowest concentration that can be reliably measured within specified limits of precision, accuracy, representativeness, completeness, and comparability during routine laboratory operating conditions. (16) Toy means a consumer product designed or intended by the manufacturer to be used by a child at play. (17) Vessel means every description of watercraft used or capable of being used as a means of transportation on water. (iii) childrens jewelry;(iv) used consumer products that are sold in second-hand product markets. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014; amended 2015, No. 158 (Adj. Sess.),  81, eff. June 2, 2016.)
 1773. Chemicals of high concern to children
(a) List of chemicals of high concern to children. The following chemicals are designated as chemicals of high concern to children for the purposes of the requirements of this chapter: (1) Formaldehyde.(2) Aniline.(3) N-Nitrosodimethylamine.(4) Benzene.(5) Vinyl chloride.(6) Acetaldehyde.(7) Methylene chloride.(8) Carbon disulfide.(9) Methyl ethyl ketone.(10) 1,1,2,2-Tetrachloroethane.(11) Tetrabromobisphenol A.(12) Bisphenol A.(13) Diethyl phthalate.(14) Dibutyl phthalate.(15) Di-n-hexyl phthalate.(16) Phthalic anhydride.(17) Butyl benzyl phthalate (BBP).(18) N-Nitrosodiphenylamine.(19) Hexachlorobutadiene.(20) Propyl paraben.(21) Butyl paraben.(22) 2-Aminotoluene.(23) 2,4-Diaminotoluene.(24) Methyl paraben.(25) p-Hydroxybenzoic acid.(26) Ethylbenzene.(27) Styrene.(28) 4-Nonylphenol; 4-NP and its isomer mixtures, including CAS 84852-15-3 and CAS 25154-52-3.(29) para-Chloroaniline.(30) Acrylonitrile.(31) Ethylene glycol.(32) Toluene.(33) Phenol.(34) 2-Methoxyethanol.(35) Ethylene glycol monoethyl ester.(36) Tris(2-chloroethyl) phosphate.(37) Di-2-ethylhexyl phthalate.(38) Di-n-octyl phthalate (DnOP).(39) Hexachlorobenzene.(40) 3,3-Dimethylbenzidine and dyes metabolized to 3,3-Dimethylbenzidine.(41) Ethyl paraben.(42) 1,4-Dioxane.(43) Perchloroethylene.(44) Benzophenone-2 (Bp-2); 2,2,4,4-Tetrahydroxybenzophenone.(45) 4-tert-Octylphenol; 4(1,1,3,3-Tetramethylbutyl) phenol.(46) Estragole.(47) 2-Ethylhexanoic acid.(48) Octamethylcyclotetrasiloxane.(49) Benzene, Pentachloro.(50) C.I. Solvent yellow 14.(51) N-Methylpyrrolidone.(52) 2,2,3,3,4,4,5,5,6,6-Decabromodiphenyl ether; BDE-209.(53) Perfluorooctanyl sulphonic acid and its salts; PFOS.(54) Phenol, 4-octyl.(55) 2-Ethyl-hexyl-4-methoxycinnamate.(56) Mercury and mercury compounds, including methyl mercury (22967-92-6).(57) Molybdenum and molybdenum compounds.(58) Antimony and Antimony compounds.(59) Arsenic and Arsenic compounds, including arsenic trioxide (1327-53-3) and dimethyl arsenic (75-60-5). (60) Cadmium and cadmium compounds.(61) Cobalt and cobalt compounds.(62) Tris(1,3-dichloro-2-propyl)phosphate.(63) Butylated hydroxyanisole; BHA.(64) Hexabromocyclododecane.(65) Diisodecyl phthalate (DIDP).(66) Diisononyl phthalate (DINP).(67) PFHxS (perfluorohexane sulfonic acid).(68) PFHpA (perfluoroheptanoic acid).(69) PFNA (perfluorononanoic acid).(70) Any other chemical designated by the Commissioner as a chemical of high concern to children by rule under section 1776 of this title. (b) Commissioners review of list of chemicals. Beginning on July 1, 2017, and biennially thereafter, the Commissioner of Health shall review the list of chemicals of high concern to children to determine if additional chemicals should be added to the list under subsection 1776(b) of this title. In reviewing the list of chemicals of high concern to children, the Commissioner of Health may consider designations made by other states, the federal government, other countries, or other governmental agencies. (c) Publication of list. The Commissioner shall post the list of chemicals of high concern to children on the Department of Health website by chemical name and Chemical Abstracts Service number. (d) Addition or removal from list. Under 3 V.S.A.  806, any person may request that the Commissioner add or remove a chemical from the list of chemicals of high concern to children. (e) PQL value. A PQL value established under this chapter for individual chemicals shall depend on the analytical method used for each chemical. The PQL value shall be based on scientifically defensible, standard analytical methods as advised by guidance published by the Department. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014; amended 2021, No. 36,  5, eff. July 1, 2022.) 
 1774. Chemicals of High Concern to Children Working Group
(a) Creation. The Chemicals of High Concern to Children Working Group (Working Group) is created within the Department of Health for the purpose of providing the Commissioner of Health advice and recommendations regarding implementation of the requirements of this chapter. (b) Membership. (1) The Working Group shall be composed of the following members who, except for ex officio members, shall be appointed by the Governor after consultation with the Commissioner of Health: (A) the Commissioner of Health or designee, who shall be the Chair of the Working Group;(B) the Commissioner of Environmental Conservation or designee;(C) the State Toxicologist or designee;(D) a representative of a public interest group in the State with experience in advocating for the regulation of toxic substances; (E) a representative of an organization within the State with expertise in issues related to the health of children or pregnant women; (F) one representative of businesses in the State that use chemicals in a manufacturing or production process or use chemicals that are used in a childrens product manufactured in the State; (G) a scientist with expertise regarding the toxicity of chemicals; and(H) a representative of the childrens products industry with expertise in existing State and national policies impacting childrens products. (2)(A) In addition to the members of the Working Group appointed under subdivision (1) of this subsection, the Governor may appoint up to three additional adjunct members. (B) An adjunct member appointed under this subdivision (2) shall have expertise or knowledge of the chemical or childrens product under review or shall have expertise or knowledge in the potential health effects of the chemical at issue. (C) Adjunct members appointed under this subdivision (2) shall have the same authority and powers as a member of the Working Group appointed under subdivision (1) of this subsection (b). (3) The members of the Working Group appointed under subdivision (1) of this subsection shall serve staggered three-year terms. The Governor may remove members of the Working Group who fail to attend three consecutive meetings and may appoint replacements. The Governor may reappoint members to serve more than one term. (c) Powers and duties. The Working Group shall:(1) review proposed chemicals for listing as a chemical of high concern to children under section 1773 of this title; and (2) recommend to the Commissioner of Health whether rules should be adopted under section 1776 of this title to regulate the sale or distribution of a childrens product containing a chemical of high concern to children. (d) Commissioner of Health recommendation; assistance. (1) Beginning on July 1, 2017, and biennially thereafter, the Commissioner of Health shall recommend at least two chemicals of high concern to children in childrens products for review by the Working Group. The Commissioners recommendations shall be based on the degree of human health risks, exposure pathways, and impact on sensitive populations presented by a chemical of high concern to children. (2) The Working Group shall have the administrative, technical, and legal assistance of the Department of Health and the Agency of Natural Resources. (e) Meetings. (1) The Chair of the Working Group may convene the Working Group at any time, but no less frequently than at least twice a year. (2) A majority of the members of the Working Group, including adjunct members when appointed, shall constitute a quorum, and all action shall be taken upon a majority vote of the members present and voting. (f) Reimbursement. Members of the Working Group, including adjunct members, whose participation is not supported through their employment or association shall receive per diem compensation pursuant to 32 V.S.A.  1010 and reimbursement of travel expenses. A per diem authorized by this section shall be paid from the budget of the Department of Health. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014; amended 2019, No. 75,  3.) 
 1775. Disclosure of information on chemicals of high concern
(a) Notice of chemical of high concern to children. A manufacturer of a childrens product or a trade association representing a manufacturer of childrens products shall submit to the Department the notice described in subsection (b) of this section for each chemical of high concern to children in a childrens product if a chemical of high concern to children is: (1) intentionally added to a childrens product at a level above the PQL produced by the manufacturer; or (2) present in a childrens product produced by the manufacturer as a contaminant at a concentration of 100 parts per million or greater. (b) Format for notice. The Commissioner shall specify the format for submission of the notice required by subsection (a) of this section, provided that the required format shall be generally consistent with the format for submission of notice in other states with requirements substantially similar to the requirements of this section. Any notice submitted under subsection (a) shall contain the following information: (1) the name of the chemical used or produced and its chemical abstracts service registry number; (2) a description of the product or product component containing the chemical, including the brand name, the product model, and the universal product code if the product has such a code; (3) the amount of the chemical contained in each unit of the product or product component, reported by weight or parts per million as authorized by the Commissioner; (4) the name and address of the manufacturer of the childrens product and the name, address, and telephone number of a contact person for the manufacturer; (5) any other information the manufacturer deems relevant to the appropriate use of the product; and (6) any other information required by the Commissioner under rules adopted pursuant to 3 V.S.A. chapter 25. (c) Reciprocal data-sharing. In order for the Department to obtain the information required in the notice described in subsection (b) of this section, the Department may enter into reciprocal data-sharing agreements with other states in which a manufacturer of childrens products is also required to disclose information related to chemicals of high concern to children in childrens products. The Department shall not disclose trade secret information, confidential business information, or other information designated as confidential by law under a reciprocal data-sharing agreement. (d) Waiver of format. Upon application of a manufacturer on a form provided by the Department, the Commissioner may waive the requirement under subsection (b) of this section that a manufacturer provide notice in a format specified by the Commissioner. The waiver may be granted, provided that: (1) the manufacturer submitted the information required in a notice under this section to: (A) a state with which the Department has entered a reciprocal data-sharing agreement; or (B) a trade association, the Interstate Chemicals Clearinghouse, a federal governmental agency, or other independent third party; (2) the information required to be reported in a notice under this section is provided to the Department in an alternate format, including reference to information publicly available in other states or by independent third parties; and (3) the information required to be reported in a notice under this section is available on or accessible from the Department of Health website. (e) Chemical control program. A manufacturer shall be exempt from the requirements of notice under this section for any chemical of high concern to children that is present in a childrens product or component of a childrens product only as a contaminant if, during manufacture of the childrens product, the manufacturer was implementing a manufacturing control program and exercised due diligence to minimize the presence of the contaminant in the childrens product. (f) Notice of removal of chemical. A manufacturer who submitted the notice required by subsection (a) of this section may at any time submit to the Department notice that a chemical of high concern to children has been removed from the manufacturers childrens product or that the manufacturer no longer sells, offers for sale, or distributes in the State the childrens product containing the chemical of high concern to children. Upon verification of a manufacturers notice under this subsection, the Commissioner shall promptly remove from the Department website any reference to the relevant childrens product of the manufacturer. (g) Certificate of compliance. A manufacturer required to submit notice under this section to the Commissioner may rely on a certificate of compliance from suppliers for determining reporting obligations. A certificate of compliance provided by a supplier under this subsection shall be solely for the purpose of compliance with the requirements of this chapter. (h) Products for sale out of State. A manufacturer shall not be required to submit notice under this section for a childrens product manufactured, stored in, or transported through Vermont solely for use or sale outside the State of Vermont. (i) Publication of information; disclaimer. The Commissioner shall post on the Department of Health website information submitted under this section by a manufacturer. When the Commissioner posts on the Department of Health website information submitted under this section by a manufacturer, the Commissioner shall provide the following notice: The reports on this website are based on data provided to the Department. The presence of a chemical in a childrens product does not necessarily mean that the product is harmful to human health or that there is any violation of existing safety standards or laws. The reporting triggers are not health-based values. (j) Fee. A manufacturer shall pay a fee of $200.00 for each notice required under subsection (a) of this section. If, under subsection (d) of this section, the Commissioner waives the required format for reporting, the fee shall not be waived. Fees collected under this subsection shall be deposited in the Chemicals of High Concern Fund for the purposes of that Fund. (k) Application of section. The requirements of this section shall apply unless a manufacturer is exempt or unless notice according to the requirements of this section is specifically preempted by federal law. In the event of conflict between the requirements of this section and federal law, federal law shall control. (l) Submission of notice; dates. Unless the Commissioner adopts by rule a phased-in reporting requirement under section 1776 of this title, a manufacturer shall submit the notice required under subsection (a) of this section on or before August 31, 2020 and annually thereafter. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014; amended 2015, No. 154 (Adj. Sess.),  11, eff. June 1, 2016; 2019, No. 75,  4.) 
 1776. Rulemaking; additional chemicals of concern to children; prohibition of sale
(a) Rulemaking authority. The Commissioner shall, after consultation with the Secretary of Natural Resources, adopt rules as necessary for the purposes of implementing, administering, or enforcing the requirements of this chapter. (b) Additional chemicals of concern to children. The Commissioner may by rule add additional chemicals to the list of chemicals of high concern to children, provided that the Commissioner of Health, on the basis of credible, scientific evidence, including peer-reviewed studies, has determined that a chemical proposed for addition to the list meets both of the following criteria in subdivisions (1) and (2) of this subsection: (1) The Commissioner of Health has determined that an authoritative governmental entity or accredited research university has demonstrated that the chemical: (A) harms the normal development of a fetus or child or causes other developmental toxicity;(B) causes cancer, genetic damage, or reproductive harm;(C) disrupts the endocrine system;(D) damages the nervous system, immune system, or organs or causes other systemic toxicity; or (E) is a persistent bioaccumulative toxic.(2) The chemical has been found through:(A) biomonitoring to be present in human blood, umbilical cord blood, breast milk, urine, or other bodily tissues or fluids; (B) sampling and analysis to be present in household dust, indoor air, drinking water, or elsewhere in the home environment; or (C) monitoring to be present in fish, wildlife, or the natural environment.(c) Removal of chemical from list. The Commissioner may by rule remove a chemical from the list of chemicals of high concern to children established under section 1773 of this title or rules adopted under this section if the Commissioner determines that the chemical no longer meets both of the criteria of subdivisions (b)(1) and (2) of this section. (d) Rule to regulate sale or distribution. (1) The Commissioner, after consultation with the Chemicals of High Concern to Children Working Group, may adopt a rule to regulate the sale or distribution of a childrens product containing a chemical of high concern to children upon a determination that: (A) children may be exposed to a chemical of high concern to children in the childrens product; and (B) there is a possibility that, due to the degree of exposure or frequency of exposure of a child to a chemical of high concern to children in a childrens product, exposure could cause or contribute to one or more of the adverse health impacts listed under subdivision (b)(1) of this section. (2) In determining whether children may be exposed to a chemical of high concern in a childrens product, the Commissioner shall review available, credible information regarding: (A) the market presence of the childrens product in the State;(B) the type or occurrence of exposures to the relevant chemical of high concern to children in the childrens product; (C) the household and workplace presence of the childrens product; or(D) the potential and likelihood of exposure of children to the chemical of high concern to children in the childrens product. (3) A rule adopted under this section may:(A) prohibit the childrens product containing the chemical of high concern to children from sale, offer for sale, or distribution in the State; or (B) require that the childrens product containing the chemical of high concern to children be labeled prior to sale, offer for sale, or distribution in the State. (4) In any rule adopted under this subsection, the Commissioner shall adopt reasonable time frames for manufacturers, distributors, and retailers to comply with the requirements of the rules. No prohibition on sale or manufacture of a childrens product in the State shall take effect sooner than two years after the adoption of a rule adopted under this section unless the Commissioner determines that an earlier effective date is required to protect human health and the new effective date is established by rule. (5) The Chemicals of High Concern to Children Working Group may, at its discretion, submit to the House Committees on Natural Resources, Fish, and Wildlife and on Human Services and the Senate Committees on Natural Resources and Energy and on Health and Welfare the recommendations or information from a consultation provided to the Commissioner under subdivision (1) of this subsection. (e) Exemption for chemical management strategy. In adopting a rule under this section, the Commissioner may exempt from regulation a childrens product containing a chemical of high concern to children if the manufacturer of the childrens product is implementing a comprehensive chemical management strategy designed to eliminate harmful substances or chemicals from the manufacturing process. (f) Additional rules. (1) The Commissioner of Health shall adopt by rule the process and procedure to be required when the Commissioner of Health adopts a rule under subsection (b), (c), or (d) of this section. The rule shall provide: (A) all relevant criteria for evaluation of the chemical;(B) criteria by which a chemical, due to its presence in the environment or risk of harm, shall be prioritized for addition or removal from the list of chemicals of high concern to children or for regulation under subsection (d) of this section; (C) time frames for labeling or phasing out sale or distribution;(D) requirements for when and how a manufacturer of a childrens product that contains a chemical of high concern to children provides the notice required under subsection 1775(a) of this title when the manufacturer intends to introduce the childrens product for sale between the required dates for reporting; and (E) other information or process determined as necessary by the Commissioner for implementation of this chapter. (2) The Commissioner may, by rule, authorize a manufacturer to report ranges of the amount of a chemical in a childrens product, rather than the exact amount, provided that if there are multiple chemical values for a given component in a particular product category, the manufacturer shall use the largest value for reporting. (3) Notwithstanding the required reporting dates under section 1774 of this title, the Commissioner may adopt by rule phased-in reporting requirements for chemicals of high concern to children in childrens products based on the size of the manufacturer, aggregate sales of childrens products, or the exposure profile of the chemical of high concern to children in the childrens product. (g) Additional public participation. In addition to the public participation requirements of 3 V.S.A. chapter 25 and prior to submitting a rule authorized under this section to the Secretary of State under 3 V.S.A.  838, the Commissioner shall make reasonable efforts to consult with interested parties within the State regarding any proposed prohibition of a chemical of high concern to children. The Commissioner may satisfy the consultation requirement of this section through the use of one or more workshops, focused work groups, dockets, meetings, or other forms of communication. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014; amended 2019, No. 75,  5, eff. June 19, 2019.) 
 1777. Chemicals of High Concern to Children Fund
(a) The Chemicals of High Concern to Children Fund is established in the State Treasury, separate and distinct from the General Fund, to be administered by the Commissioner of Health. Interest earned by the Fund shall be credited to the Fund. Monies in the Fund shall be made available to the Department of Health and the Agency of Natural Resources to pay costs incurred in administration of the requirements of this chapter. (b) The Chemicals of High Concern to Children Fund shall consist of:(1) fees and charges collected under section 1775 of this chapter;(2) private gifts, bequests, grants, or donations made to the State from any public or private source for the purposes for which the Fund was established; and (3) such sums as may be appropriated by the General Assembly. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014.)
 1778. Confidentiality
Information submitted to or acquired by the Department or the Chemicals of High Concern to Children Working Group under this chapter may be subject to public inspection or copying or may be published on the Department website, provided that trade secret information and confidential business information shall be exempt from public inspection and copying under 1 V.S.A.  317(c)(9), and information otherwise designated confidential by law shall be exempt from public inspection and copying under 1 V.S.A.  317(c)(1). It shall be the burden of the manufacturer to assert that information submitted under this chapter is a trade secret, confidential business information, or is otherwise designated confidential by law. When a manufacturer asserts under this section that the specific identity of a chemical of high concern to children in a childrens product is a trade secret, the Commissioner shall, in place of the specific chemical identity, post on the Departments website the generic class or category of the chemical in the childrens product and the potential health effect of the specific chemical of high concern to children. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014.) 
 1779. Violations; enforcement
A violation of this chapter shall be considered a violation of the Consumer Protection Act in 9 V.S.A. chapter 63. The Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions under 9 V.S.A. chapter 63, subchapter 1. Private parties shall not have a private right of action under this chapter. (Added 2013, No. 188 (Adj. Sess.),  2, eff. June 10, 2014.) 
 1781. Definitions
As used in this chapter:(1) Air freshener means an aerosol spray, liquid deodorizer, plug-in product, para-di-chlorbenzene block, scented urinal screen, or other product used to mask odors or freshen the air in a room. (2) Antimicrobial pesticide means a product regulated by the federal Insecticide, Fungicide and Rodenticide Act that is intended to: (A) disinfect, sanitize, reduce, or mitigate growth or development of microbiological organisms; or (B) protect inanimate objects, industrial processes or systems, surfaces, water, or other chemical substances from contamination, fouling, or deterioration caused by bacteria, viruses, fungi, protozoa, algae, or slime. (3) Cleaning product means an institutional compound intended for routine cleaning, including general purpose cleaners, bathroom cleaners, glass cleaners, carpet cleaners, floor care products, and hand soaps. Cleaning product shall not mean an antimicrobial pesticide. (4) Conventional cleaning product means a cleaning product that is not an environmentally preferable cleaning product. (5) Distributor means any person or entity that distributes cleaning products commercially, but excludes retail stores. (6) Environmentally preferable cleaning product means a cleaning product that has a lesser or reduced effect on human health and the environment when compared to competing products serving the same purpose. (7) Green cleaning means a practice that includes:(A) the use of a cleaning product certified as environmentally preferable by an independent third party or an environmentally preferable cleaning product used by the Department of Buildings and General Services; (B) best practices that follow accepted management standards and improve indoor air quality; and (C) equipment that facilitates effective cleaning.(8)(A) Independent third party means a nationally recognized organization that has developed a program for the purpose of certifying environmentally preferable cleaning products. The independent third partys certification program shall: (i) define a manufacturers certification fees;(ii) identify any potential conflicts of interest;(iii) base certification on consideration of human health and safety, ecological toxicity, other environmental impacts, and resource conservation as appropriate for the product and its packaging on a life-cycle basis; (iv) develop certification standards in an open, public, and transparent manner that involves the public and key stakeholders; (v) periodically revise and update the standards to remain consistent with current research about the impacts of chemicals on human health; (vi) monitor and enforce the standards for the purpose of certification, and have the authority to inspect the manufacturing facility and periodically do so, and have a registered or legally protected certification mark; and (vii) make the standards easily accessible to purchasers and manufacturers.(B) In the alternative, independent third party means any organization otherwise deemed by the Department of Health to satisfactorily assess and certify environmentally preferable cleaning products. (9) Manufacturer means any person or entity engaged in the process of manufacturing cleaning products for commercial distribution. (10) School means:(A) A public school in Vermont, including a regional career technical center and a comprehensive high school. (B) An approved independent school. (Added 2011, No. 68 (Adj. Sess.),  1a; amended 2013, No. 92 (Adj. Sess.),  302, eff. Feb. 14, 2014.)
 1782. Environmentally preferable cleaning products
(a) A distributor or manufacturer of cleaning products shall sell, offer for sale, or distribute to a school, school district, supervisory union, or procurement consortium only: (1) environmentally preferable cleaning products utilized by the Department of Buildings and General Services under State contracts; or (2) cleaning products certified as environmentally preferable by an independent third party. (b) A person who contracts with a school, school district, or supervisory union to provide cleaning services for a school only shall use a cleaning product that meets the requirements of subdivisions (a)(1) and (2) of this section. (c) Nothing in this chapter shall be construed to regulate the sale, use, or distribution of antimicrobial pesticides. (d) A distributor or manufacturer of cleaning products shall provide a green cleaning training to each school district it provides with environmentally preferable cleaning products, provided the training is incurred at no cost to the school district. (Added 2011, No. 68 (Adj. Sess.),  1a.) 
 1783. Environmentally preferable air fresheners
(a) A distributor or manufacturer shall sell, offer for sale, or distribute air fresheners to a school, school district, supervisory union, or procurement consortium only if the air fresheners are certified as environmentally preferable by an independent third party. (b) A person who contracts with a school, school district, or supervisory union to provide cleaning services for a school shall only use air fresheners that meet the requirements of subsection (a) of this section. (Added 2011, No. 68 (Adj. Sess.),  1a.) 
 1784. Penalty exemption
Nothing in this chapter shall cause a person to be subject to the fine established in section 7 of this title. (Added 2011, No. 68 (Adj. Sess.),  1a.) 
 151. Definitions
As used in this chapter:(1) Cancer means all malignant neoplasms, regardless of the tissue of origin, including malignant lymphoma, Hodgkins disease, and leukemia, but excluding basal cell and squamous cell carcinoma of the skin. (2) Health care facility shall have the meaning given in section 9432 of this title.(3) Health care provider shall have the meaning given in section 9432 of this title. (Added 1993, No. 90,  2.)
 152. Establishment of cancer registry
(a) The Commissioner shall establish a uniform statewide population-based cancer registry system for the collection of information determining the incidence of cancer and related data. The Secretary shall adopt rules necessary to effect the purposes of this chapter, including the data to be reported and the effective date after which reporting by health care facilities and health care providers shall be required. (b) All cancers diagnosed or treated in the State shall be reported to the representative of the Department of Health authorized by the Commissioner to compile the cancer data, or any individual, agency, or organization designated to cooperate with that representative. (c) The Commissioner shall establish a training program for the personnel of participating health care facilities and a quality control program for cancer data. The Commissioner shall collaborate in studies with clinicians and epidemiologists and publish reports on the results of such studies. The Commissioner shall cooperate with the National Institutes of Health and the Centers for Disease Control and Prevention in providing cancer incidence data. (Added 1993, No. 90,  2.) 
 153. Participation in program
(a) Any health care facility diagnosing or providing treatment to patients with cancer shall report each case of cancer to the Commissioner or his or her authorized representative in a format prescribed by the Commissioner within 180 days of admission or diagnosis. If the facility fails to report in a format prescribed by the Commissioner, the Commissioners authorized representative may enter the facility, obtain the information, and report it in the appropriate format. In these cases, the facility shall reimburse the Commissioner or the authorized representative for the cost of obtaining and reporting the information. (b) Any health care provider diagnosing or providing treatment to patients with cancer shall report each cancer case to the Commissioner or his or her authorized representative within 180 days of diagnosis. Those cases diagnosed or treated at a Vermont facility or previously admitted to a Vermont facility for diagnosis or treatment of that instance of cancer are exceptions and do not need to be reported by the health care provider. (c) All health care facilities and health care providers who provide diagnostic or treatment services to patients with cancer shall report to the Commissioner any further demographic, diagnostic, or treatment information requested by the Commissioner concerning any person now or formerly receiving services, diagnosed as having or having had a malignant tumor. Additionally, the Commissioner or his or her authorized representative shall have physical access to all records that would identify cases of cancer or would establish characteristics of the cancer, treatment of the cancer, or medical status of any identified patient with cancer. Willful failure to grant access to such records shall be punishable by a fine of up to $500.00 for each day access is refused. Any fines collected pursuant to this subsection shall be deposited in the General Fund. (Added 1993, No. 90,  2; amended 2015, No. 37,  1.) 
 154. Confidentiality
(a) All information reported pursuant to this chapter shall be confidential and privileged. The Commissioner shall take strict measures to ensure that all identifying information is kept confidential. (b) All identifying information regarding an individual patient, health care provider, or health care facility contained in records of interviews, written reports, and statements procured by the Commissioner or by any other person, agency, or organization acting jointly with the Commissioner in connection with cancer morbidity and mortality studies shall be confidential and privileged and shall be used solely for the purposes of the study. Nothing in this section shall prevent the Commissioner from publishing statistical compilations relating to morbidity and mortality studies which do not identify individual cases or sources of information. (Added 1993, No. 90,  2.) 
 155. Disclosure
(a) The Commissioner may enter into agreements to exchange confidential information with other cancer registries in order to obtain complete reports of Vermont residents diagnosed or treated in other states and to provide information to other states regarding their residents diagnosed or treated in Vermont. (b) The Commissioner may furnish confidential information to the National Breast and Cervical Cancer Early Detection Program, other states cancer registries, federal cancer control agencies, or health researchers in order to collaborate in a national cancer registry or to collaborate in cancer control and prevention research studies. However, before releasing confidential information, the Commissioner shall first obtain from such state registries, agencies, or researchers an agreement in writing to keep the identifying information confidential and privileged. In the case of researchers, the Commissioner shall also first obtain evidence of the approval of their academic committee for the protection of human subjects established in accordance with 45 C.F.R. part 46. (Added 1993, No. 90,  2; amended 2015, No. 37,  1.) 
 156. Liability
(a) No action for damages arising from the disclosure of confidential or privileged information may be maintained against any person, or the employer or employee of any person, who participates in good faith in the reporting of cancer registry data or data for cancer morbidity or mortality studies in accordance with this chapter. (b) No license of a health care facility or health care provider may be denied, suspended, or revoked for the good faith disclosure of confidential or privileged information in the reporting of cancer registry data or data for cancer morbidity or mortality studies in accordance with this chapter. (c) Nothing in this section shall be construed to apply to the unauthorized disclosure of confidential or privileged information when such disclosure is due to gross negligence or willful misconduct. (Added 1993, No. 90,  2.) 
 157. Vermont Mammography Registry
The confidentiality, disclosure, and liability provisions of sections 154, 155, and 156 of this title shall likewise apply to all mammography and pathology data relating to breast cancer and any associated identifying information acquired by the Vermont Mammography Registry (VMR). In the case of VMR, the rights and obligations of the Commissioner of Health shall be assumed by the appropriate VMR governing body or official. (Added 1993, No. 140 (Adj. Sess.),  107a, eff. April 15, 1994.) 
 158. Dense breast notification and education
(a) All health care facilities that perform mammography examinations shall include in the summary of the mammography report to be provided to a patient information that identifies the patients individual breast tissue classification based on the Breast Imaging Reporting and Data System established by the American College of Radiology. If a facility determines that a patient has heterogeneously dense or extremely dense breasts, the summary of the mammography report shall also include a notice substantially similar to the following: Your mammogram indicates that you have dense breast tissue. Dense breast tissue is a normal finding that is present in about 40 percent of women. Dense breast tissue can make it more difficult to detect cancer on a mammogram and may be associated with a slightly increased risk for breast cancer. This information is provided to raise your awareness of the impact of breast density on cancer detection and to encourage you to discuss this issue, as well as other breast cancer risk factors, with your health care provider as you decide together which screening options may be right for you. (b) Facilities that perform mammography examinations may update the language in their notices over time to reflect advances in science and technology, as long as they continue to notify patients about the frequency of dense breast tissue and its effect on the accuracy of mammograms and encourage patients to discuss the issue with their health care provider. Facilities shall notify the Department of Health each time they make changes to the notice required by this section and shall provide an updated copy for the Departments information and review. (c) Nothing in this section shall be construed to create a duty of care or other legal obligation beyond the duty to provide notice as set forth in this section. (Added 2015, No. 139 (Adj. Sess.),  1.) 
 1791. Definitions
As used in this chapter:(1) Place of public accommodation has the same meaning as in 9 V.S.A.  4501.(2) Public building has the same meaning as in 20 V.S.A.  2730.(3) Single-user toilet facility means a single-occupancy restroom with at least one water closet and with an outer door that can be locked by the occupant. (Added 2017, No. 127 (Adj. Sess.),  1.) 
 1792. Single-user restrooms
(a) Notwithstanding any other provision of law, any single-user toilet facility in a public building or place of public accommodation shall be made available for use by persons of any gender, and designated for use by not more than one occupant at a time or for family or assisted use. A single-user toilet facility may be identified by a sign, provided that the sign marks the facility as a restroom and does not indicate any specific gender. (b) The Commissioner of Public Safety may inspect for compliance under subsection (a) of this section during any inspection conducted pursuant to 20 V.S.A.  2731(b) or 26 V.S.A.  2173 or 2174. (Added 2017, No. 127 (Adj. Sess.),  1.) 
 1793. Application of plumbing rules
(a) Notwithstanding the requirements of any plumbing code adopted by the Plumbers Examining Board under 26 V.S.A.  2173(a), a toilet facility may be designated for use by persons of any gender. No separate male or female facility is required if the total number of required plumbing fixtures is provided by toilet facilities designated for use by persons of any gender. (b) When the total number of required plumbing fixtures in a plumbing code adopted by the Plumbers Examining Board under 26 V.S.A.  2173(a) is fixed separately for women and men, the Plumbers Examining Board shall make rules consistent with this chapter to govern how plumbing fixtures in toilet facilities designated for use by persons of any gender shall contribute to the total number of plumbing fixtures required by the plumbing code. (Added 2017, No. 127 (Adj. Sess.),  1.) 
 1801. Definitions
As used in this chapter:(1) Board means the State Board of Health.(2) The federal act means Title VI of the Public Health Service Act (42 U.S.C.  201 et seq.) as now and hereafter amended.(3) Hospital includes public health centers and general, tuberculosis, mental, chronic disease, and other type of hospitals and related facilities, such as laboratories, out-patient departments, nurses homes and training facilities, and central service facilities, operated in connection with hospitals, but does not include any hospital furnishing primarily domiciliary care. (4) Medical facilities means diagnostic or diagnostic and treatment centers, rehabilitation facilities and nursing homes as those terms are defined in the federal act, and such other medical facilities for which federal aid may be authorized under the federal act. (5) Nonprofit hospital and nonprofit medical facility means any hospital or medical facility owned and operated by one or more nonprofit corporations or associations, no part of the net earnings of which inures, or may lawfully inure, to the benefit of any private shareholder or individual. (6) Public health center means a publicly owned facility for the provision of public health services, including related facilities such as laboratories, clinics, and administrative offices operated in connection with public health centers. (7) The Secretary of Health and Human Services means the Secretary of Health and Human Services of the United States. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1802. Powers of State Board of Health
The Board shall constitute the sole agency of the State for the purpose of:(1) making an inventory of existing hospitals and medical facilities, surveying the need for construction of hospitals and medical facilities, and developing a program of construction as provided in sections 1805-1807 of this title; and (2) developing and administering a State plan for the construction of public and other nonprofit hospitals and medical facilities as provided in sections 1808-1814 of this title. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1803. General powers and duties of State Board of Health
In carrying out the purposes of this chapter, the Board is authorized and directed:(1) to require such reports, make such inspections and investigations, and prescribe such regulations as it deems necessary; (2) to provide such methods of administration, appoint personnel, and take such other action as may be necessary to comply with the requirements of the federal act and the regulations thereunder; (3) to procure, in its discretion, the temporary or intermittent services of experts or consultants or organizations thereof, by contract, when such services are to be performed on a part time or fee-for-service basis and do not involve the performance of administrative duties; (4) to the extent that it considers desirable to effectuate the purposes of this chapter to enter into agreements for the utilization of the facilities and services of other departments, agencies, and institutions, public or private; (5) to accept on behalf of the State and to deposit with the State Treasurer any grant, gift, or contribution made to assist in meeting the cost of carrying out the purposes of this chapter, and to expend the same for such purposes; (6) to do all other things on behalf of the State necessary to obtain full benefits under the federal act as now and hereafter amended. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1805. Survey and planning activities
The Board is authorized and directed to make an inventory of existing hospitals and medical facilities, including public, nonprofit, and proprietary hospitals and medical facilities, to survey the need for construction of hospitals and medical facilities, and, on the basis of such inventory and survey, to develop a program for the construction of such public and other nonprofit hospitals and medical facilities as will, in conjunction with existing facilities, afford the necessary physical facilities for furnishing adequate hospital and medical facility services to all the people of the State. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1806. Construction program
The construction program shall provide, in accordance with the regulations prescribed under the federal act, for adequate hospital and medical facilities for the people residing in this State and, insofar as possible, shall provide for their distribution throughout the State in such manner as to make all types of hospital and medical facility services reasonably accessible to all persons in the State. 
 1807. Application for federal funds for survey and planning; expenditure
The Board is authorized to make application to the Secretary of Health and Human Services for federal funds to assist in carrying out the survey and planning activities herein provided. Such funds shall be deposited in the State Treasury and shall be available to the Board for expenditure for carrying out the purposes of sections 1805-1807 of this title. Any such funds received and not expended for such purposes shall be repaid to the Treasury of the United States. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1808. State plan
The Board shall prepare and submit to the Secretary of Health and Human Services a State plan which shall include the hospital and medical facilities construction program developed under sections 1805-1807 of this title, and which shall provide for the establishment, administration, and operation of hospital and medical facilities construction activities in accordance with the requirements of the federal act and regulations thereunder. The Board shall, prior to the submission of such plan to the Secretary of Health and Human Services, give adequate publicity to a general description of all the provisions proposed to be included therein, and hold a public hearing at which all persons or organizations with a legitimate interest in such plan may be given an opportunity to express their views. After approval of the plan by the Secretary of Health and Human Services, the Board shall publish a general description of the provisions thereof in newspapers having general circulation in the State, and shall make the plan or a copy thereof available upon request to all interested persons or organizations. The Board shall, from time to time, review the construction program and submit to the Secretary of Health and Human Services any modifications thereof which it may find necessary and may submit to the Secretary of Health and Human Services such modifications of the State plan, not inconsistent with the requirements of the federal act, as it may deem advisable. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1809. Minimum standards for hospital and medical facilities maintenance and operation
The Board shall, by regulation, prescribe minimum standards for the maintenance and operation of hospitals and medical facilities which receive federal aid for construction under the State plan. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1810. Priority of projects
The State plan shall set forth the relative need for the several projects included in the construction program determined in accordance with regulations prescribed pursuant to the federal act, and provide for the construction, insofar as financial resources available therefor and for maintenance and operation make possible, in the order of such relative need. 
 1811. Construction projects; applications
Applications for hospital and medical facilities construction projects for which federal funds are requested shall be submitted to the Board and may be submitted by the State or any political subdivision thereof or by any public or other nonprofit agency authorized to construct and operate a hospital or a medical facility, provided that no application for a diagnostic or treatment center shall be approved unless the applicant is (1) a State, political subdivision, or public agency, or (2) a corporation or association which owns and operates a nonprofit hospital. Each application for a construction project shall conform to federal and State requirements. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1812. Consideration and forwarding of applications
The Board shall afford to every applicant for a construction project an opportunity for a fair hearing. If the Board, after affording a reasonable opportunity for development and presentation of applications in the order of relative need, finds that a project application complies with the requirements of section 1811 of this title and is otherwise in conformity with the State plan, it shall approve such application and shall recommend and forward it to the Secretary of Health and Human Services. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1813. Inspection of projects
From time to time, the Board shall inspect each construction project approved by the Secretary of Health and Human Services, and, if the inspection so warrants, the Board shall certify to the Secretary of Health and Human Services that work has been performed upon the project, or purchases have been made, in accordance with the approved plans and specifications, and that payment of an installment of federal funds is due to the applicant. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1814. Hospital and Medical Facilities Construction Fund
The Board is hereby authorized to receive federal funds in behalf of, and transmit them to, such applicants. There is hereby established, separate and apart from all public monies and funds of this State, the Hospital and Medical Facilities Construction Fund. Money received from the federal government for a construction project approved by the Secretary of Health and Human Services shall be deposited to the credit of this Fund and shall be used solely for payments due applicants for work performed, or purchases made, in carrying out approved projects. Warrants for all payments for the Hospital and Medical Facilities Construction Fund shall bear the signature of the Chair of the Board or the duly authorized agent of the Board for such purpose. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 1851. Definitions
As used in this subchapter:(1) Hospital means a hospital required to be licensed under chapter 43 of this title.(2) Patient means a person admitted to a hospital on an inpatient basis. (Added 1985, No. 163 (Adj. Sess.),  1; amended 2019, No. 53,  1.)
 1852. Patients bill of rights; adoption
(a) The General Assembly hereby adopts the Bill of Rights for Hospital Patients as follows:(1) The patient has the right to considerate and respectful care at all times and under all circumstances with recognition of his or her personal dignity. (2) The patient shall have an attending physician who is responsible for coordinating a patients care. (3) The patient has the right to obtain, from the physician coordinating his or her care, complete and current information concerning diagnosis, treatment, and any known prognosis in terms the patient can reasonably be expected to understand. If the patient consents or if the patient is incompetent or unable to understand, immediate family members or a guardian may also obtain this information. The patient has the right to know by name the attending physician primarily responsible for coordinating his or her care. (4) Except in emergencies, the patient has the right to receive from the patients physician information necessary to give informed consent prior to the start of any procedure or treatment, or both. Such information for informed consent should include the specific procedure or treatment, or both, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient also has the right to know the name of the person responsible for the procedures or treatment, or both. (5) The patient has the right to refuse treatment to the extent permitted by law. In the event the patient refuses treatment, the patient shall be informed of the medical consequences of that action, and the hospital shall be relieved of any further responsibility for that refusal. (6) The patient has the right to every consideration of privacy concerning the patients own medical care program. Case discussion, consultation, examination, and treatment are confidential and shall be conducted discreetly. Those not directly involved in the patients care must have the permission of the patient to be present. This right includes the right, upon request, to have a person of ones own sex present during certain parts of a physical examination, treatment, or procedure performed by a health care professional of the opposite sex; and the right not to remain disrobed any longer than is required for accomplishing the medical purpose for which the patient was asked to disrobe. The patient has the right to wear appropriate personal clothing and religious or other symbolic items so long as they do not interfere with diagnostic procedures or treatment. (7) The patient has the right to expect that all communications and records pertaining to his or her care shall be treated as confidential. Only medical personnel, or individuals under the supervision of medical personnel, directly treating the patient, or those persons monitoring the quality of that treatment, or researching the effectiveness of that treatment, shall have access to the patients medical records. Others may have access to those records only with the patients written authorization. (8) The patient has the right to expect that within its capacity a hospital shall respond reasonably to the request of a patient for services. The right shall include if physically possible a transfer to another room or place if another person in that room or place is disturbing the patient by smoking or other unreasonable actions. When medically permissible a patient may be transferred to another facility only after receiving complete information and explanation concerning the needs for and alternatives to such a transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer. (9) The patient has the right to know the identity and professional status of individuals providing service to him or her, and to know which physician or other practitioner is primarily responsible for his or her care. This includes the patients right to know of the existence of any professional relationship among individuals who are treating him or her, as well as the relationship to any other health care or educational institutions involved in his or her care. (10) The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting the patients care or treatment. Participation by patients in clinical training programs or in the gathering of data for research purposes shall be voluntary. The patient has the right to refuse to participate in such research projects. (11) The patient has the right to expect reasonable continuity of care. The patient has the right to be informed by the attending physician of any continuing health care requirements following discharge. (12) The patient has the right to receive an itemized, detailed, and understandable explanation of charges regardless of the source of payment and to be provided with information about financial assistance and billing and collections practices. (13) The patient has the right to know what hospital rules and regulations apply to his or her conduct as a patient. (14) Whenever possible, guardians or parents have the right to stay with their children 24 hours per day. Whenever possible, agents, guardians, or immediate family members have the right to stay with terminally ill patients 24 hours per day. (15) A patient who does not speak or understand the predominant language of the community has a right to an interpreter if the language barrier presents a continuing problem to patient understanding of the care and treatment being provided. A patient who is hard of hearing has a right to an interpreter if the impairment presents a continuing problem to patient understanding of the care and treatments being provided. (16) The patient has the right to receive professional assessment of pain and professional pain management. (17) The patient has the right to be informed in writing of the availability of hospice services and the eligibility criteria for those services. (18) The patient has the right to know the maximum patient census and the full-time equivalent numbers of registered nurses, licensed practical nurses, and licensed nursing assistants who provide direct care for each shift on the unit where the patient is receiving care. (b) Failure to comply with any provision of this section may constitute a basis for disciplinary action against a physician under 26 V.S.A. chapter 23. A complaint may be filed with the Board of Medical Practice. (c) A summary of the hospitals obligations under this section, written in clear language and in easily readable print, shall be distributed to patients upon admission and posted conspicuously at each nurses station. Such notice shall also indicate that as an alternative or in addition to the hospitals complaint procedures, the patient may directly contact the licensing agency or the Board of Medical Practice. The address and telephone number of the licensing agency and Board of Medical Practice shall be included in the notice. (Added 1985, No. 163 (Adj. Sess.),  1; amended 1989, No. 219 (Adj. Sess.),  4; 1999, No. 91 (Adj. Sess.),  35; 2005, No. 55,  5, eff. Sept. 1, 2005; 2005, No. 153 (Adj. Sess.),  2; 2009, No. 25,  6; 2013, No. 96 (Adj. Sess.),  94; 2017, No. 113 (Adj. Sess.),  64; 2019, No. 53,  1.) 
 1854. Public access to information
(a) A hospital shall make public the maximum patient census and the number of registered nurses, licensed practical nurses, and licensed nursing assistants providing direct patient care in each unit during each shift. Each units information shall be reported in full-time equivalents, with either every eight hours or 12 hours worked by a registered nurse, licensed practical nurse, or licensed nursing assistant during the shift as one full-time equivalent. The reporting of this information shall be in a manner consistent with the requirements for public reporting for measures of nurse staffing selected by the Commissioner of Health under subdivision 9405b(a)(4) of this title, but shall not in any way change what is required to be posted as set forth in this subsection. Each units information shall be posted in a prominent place that is readily accessible to patients and visitors in that unit at least once each day. The posting shall include the information for the preceding seven days. (b) The hospital shall provide a telephone number to the public for requesting public information, including information required under this section and sections 1852 and 9405b of this title. The information shall be provided within 24 hours of the request. (Added 2005, No. 153 (Adj. Sess.),  3; amended 2007, No. 27,  1, eff. May 16, 2007; 2011, No. 78 (Adj. Sess.),  2, eff. April 2, 2012; 2015, No. 152 (Adj. Sess.),  9.) 
 1855. Ambulatory surgical patients; explanation of charges
(a) As used in this section:(1) Ambulatory surgical center has the same meaning as in section 9432 of this title.(2) Hospital means a hospital required to be licensed under chapter 43 of this title.(b) A patient receiving outpatient surgical services or an outpatient procedure at an ambulatory surgical center or hospital shall receive an itemized, detailed, and understandable explanation of charges regardless of the source of payment and shall be provided with information about the ambulatory surgical centers or hospitals financial assistance and billing and collections practices. (Added 2019, No. 53,  1.) 
 1871. Patients bill of rights for palliative care and pain management
(a) A patient has the right to be informed of all evidence-based options for care and treatment, including palliative care, in order to make a fully informed patient choice. (b) A patient with a terminal illness has the right to be informed by a clinician of all available options related to terminal care; to be able to request any, all, or none of these options; and to expect and receive supportive care for the specific option or options available. (c) A patient with pain has the right to request or reject the use of any or all treatments in order to relieve his or her pain. (d) A patient with a chronic condition has the right to competent and compassionate medical assistance in managing his or her physical and emotional symptoms. (e) A pediatric patient with a serious or life-limiting illness or condition has the right to receive palliative care while seeking and undergoing potentially curative treatment. (Added 2009, No. 25,  3; amended 2013, No. 96 (Adj. Sess.),  95.) 
 1881. Disclosure of protected health information prohibited
(a) As used in this section:(1) Covered entity shall have the same meaning as in 45 C.F.R.  160.103.(2) Protected health information shall have the same meaning as in 45 C.F.R.  160.103.(b) A covered entity shall not disclose protected health information unless the disclosure is permitted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). (Added 2015, No. 169 (Adj. Sess.),  1, eff. Oct. 1, 2016.) 
 1882. Disclosures of protected health information to avert a serious risk of danger
(a) It is the intent of the General Assembly in this section to negate the Vermont Supreme Courts decision in 2016 VT 54A, and limit mental health professionals duty to that as established in common law by 146 Vt. 61 (1985). (b) A mental health professionals duty is established in common law by Peck v. Counseling Service of Addison County, Inc. and requires that a mental health professional who knows or, based upon the standards of the mental health profession, should know that his or her patient poses a serious risk of danger to an identifiable victim has a duty to exercise reasonable care to protect him or her from that danger. This duty shall be applied in accordance with State and federal privacy and confidentiality laws. (c) This section does not limit or restrict claims under State or federal law related to safe patient care, including federal discharge planning regulations within the Conditions of Participation for hospitals, patient care regulations for other federally certified facilities, the Emergency Medical Treatment and Active Labor Act of 1986, Pub. L. No. 99-272, professional licensing standards, or facility licensing standards. (d) To the extent permitted under federal law, this section does not affect the requirements for mental health professionals to communicate with individuals involved in a patients care in a manner that is consistent with legal and professional standards, including section 7103 of this title. (Added 2017, No. 51,  2, eff. May 30, 2017.) 
 1901. Policy
The purpose of this chapter is to provide for the development, establishment, and enforcement of standards for the construction, maintenance, and operation of hospitals, which, in the light of advancing knowledge, will promote safe and adequate treatment of persons in hospitals. (Amended 1963, No. 154,  1.) 
 1902. Definitions
The following words and phrases, as used in this chapter, shall have the following meanings unless otherwise provided: (1) Hospital means a place devoted primarily to the maintenance and operation of diagnostic and therapeutic facilities for in-patient medical or surgical care of individuals who have an illness, disease, injury, or physical disability, or for obstetrics. (A) General hospital is a hospital of which not more than 50 percent of the total patient days during the year are customarily assignable to the following categories of cases: chronic, convalescent and rest, drug and alcoholic, epilepsy, developmental and psychiatric disabilities and mental conditions, and tuberculosis, and which provides adequate and separate facilities and equipment for the performance of surgery and obstetrics, or either, and for diagnostic X-ray and laboratory services. (B) Psychiatric hospital means a hospital for the diagnosis and treatment of mental illness. (C) Tuberculosis facility means a hospital (excluding preventoria), or the separate tuberculosis unit of a general, psychiatric, or chronic disease hospital for the diagnosis and treatment of tuberculosis. (D) Chronic disease facility means a hospital, or the separate chronic disease unit of a general hospital, for the treatment of chronic illness, including the degenerative diseases. The term does not include facilities primarily for the care of individuals with mental conditions and psychiatric disabilities or tuberculosis, nursing homes, and institutions the primary purpose of which is domiciliary care. (E) Maternity hospital means a hospital which receives maternity patients exclusively, for care during pregnancy, during delivery, or within ten days after delivery. (F) Nonprofit hospital means any hospital owned and operated by a corporation or association, no part of the net earnings of which is applied, or may lawfully be applied, to the benefit of any private shareholder or individual. (G) Proprietary hospital means any hospital operated for individual gain or reward.(H) Psychiatric facility means a type of psychiatric hospital, or separate unit of a general hospital, where patients may obtain diagnostic services and receive intensive treatment for mental illness and where only a minimum of continued treatment facilities will be afforded. (I) The provisions of this subdivision (1) do not apply to any of the following institutions:(i) Nursing and convalescent homes, boarding homes, homes for the aged, nurseries, and institutions used primarily for domiciliary care; (ii) Any hospital conducted, maintained, or operated by the U.S. government or a duly authorized agency thereof. (2) Person means any individual, firm, partnership, corporation, company, association, or joint stock association, and the legal successor thereof. (3) Governmental unit means a state, or political subdivision thereof, or any department, division, board, or other agency of any of the foregoing. (4) Licensing agency means the State Board of Health. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1963, No. 154,  2; 2003, No. 122 (Adj. Sess.),  141d; 2013, No. 96 (Adj. Sess.),  96; 2017, No. 113 (Adj. Sess.),  65.)
 1903. License
No person or governmental unit may establish, conduct, or maintain a hospital in this State without first obtaining a license in accordance with this chapter. (Amended 1963, No. 154,  3; 2017, No. 113 (Adj. Sess.),  66.) 
 1904. Application, fee
(a) An application for a license shall be made to the licensing agency upon forms provided by it and shall contain such information as the licensing agency reasonably requires. Each application for license shall be accompanied by a license fee. (b) Annual license fees.(1) Base fee of $7,667.00.(2) Per-bed fee of $25.00.(3) The base fee for applicants presenting evidence of current accreditation by the Joint Commission on Accreditation of Health Care Organizations shall be reduced by $2,750.00. (c) Fees collected under this section shall be credited to a special fund established and managed pursuant to 32 V.S.A. chapter 7, subchapter 5, and shall be available to the Department to offset the costs of providing those services. (Amended 1963, No. 154,  4; 2003, No. 163 (Adj. Sess.),  2; 2007, No. 76,  14; 2009, No. 134 (Adj. Sess.),  26.) 
 1905. License requirements
Upon receipt of an application for a license and the license fee, the licensing agency shall issue a license when it determines that the applicant and hospital facilities meet the following minimum standards: (1) All hospitals receiving federal aid in their construction and equipment costs shall comply with Title VI of the Public Health Service Act and with Public Health Service regulations, Part 53, and with Appendix A of same, as amended. (2) There shall be full compliance with safety and sanitary standards as required by State and local building and sanitary codes in order to assure maximum safety to patients and the public. (3) All general hospitals shall provide adequate and separate facilities and equipment for the performance of surgery and obstetrics, or either, and for diagnostic X-ray and laboratory services. (4) Remodeling or expansion of any hospital subject to the provisions of this statute shall be approved by the licensing agency prior to starting of such remodeling or expansion, whether or not federal aid is to be requested for the additional projects. (5) All patients admitted to the hospital shall be under the care of a State registered and licensed practicing physician as defined by the laws of the State of Vermont. All hospitals shall use the uniform credentialing application form described in subsection 9408a(b) of this title. (6) The nursing service of the hospital shall be directed at all times by a registered professional nurse currently licensed to practice nursing in Vermont. (7) The care of maternity patients and newborns shall comply with such reasonable regulations as the licensing agency may establish and thereafter modify in the public interest. (8) Professional case records shall be compiled for all patients and signed by the attending physician. These records shall be kept on file for a minimum of 10 years. (9) Every hospital shall have an organized medical staff of not fewer than three members which shall meet as often annually as recommended by the Joint Commission on Accreditation of Hospitals. (10) All employees shall have a preemployment screening by a licensed physician, licensed physician assistant, or licensed advanced practice registered nurse who is acting within his or her scope of practice, or by a designee acting under the direction of one of these licensed health care professionals. This screening shall include medically indicated radiological, hematological, biochemical, immunological, or serological screenings to exclude the presence of a communicable disease prior to employment. These screenings may be repeated annually as a condition of employment and the results shall be made available, on request, to the licensing agency for review. (11) All employees shall have such additional examinations, tests, and immunization treatments as the licensing agency may determine to be necessary in the public interest. (12) Accounting records of all operating procedures shall be kept on a monthly basis and complete operating and financial statements shall be compiled at least once annually and kept on file for 20 years. (13) The hospital grounds and buildings shall be subject to inspection by the licensing agency and other legalized authorities at all times. (14) A license is not transferable or assignable and shall be issued only for the premises and persons named in the application. (15) The licensee shall file an annual report containing such information as the licensing agency may reasonably require; a copy of the hospitals annual report to its governing board shall be provided to the licensing agency within 30 days after publication of this document. (16) All new construction involving hospitals and related buildings on hospital premises shall comply with standards of the State Fire Marshal and State Board of Health, whether or not federal aid under Title VI of the Public Health Service Act is received for such construction. (17) The Board of Health may, when circumstances warrant, issue a temporary license for such period or periods and subject to such conditions as the Board shall deem proper, subject to the limitation that such a temporary license shall not be issued for a total period of more than 36 months. Such circumstances shall include issues concerning indicators in the hospitals community report which may result in the Boards issuing a license conditioned upon corrective measures or a temporary license with conditions. (18) All hospitals shall submit to the licensing agency a plan for implementing the provisions of section 1852 of this title and a plan for handling patient complaints, which shall become effective upon approval by the licensing agency. Plans under this subdivision shall include: (A) the designation of a person or persons qualified as a patient representative;(B) a method by which each patient shall be made aware of the complaint procedure;(C) an appeals mechanism within the hospital itself;(D) a published time frame for processing and resolving complaints and appeals within the hospital, and notification that further appeals of the hospitals resolution of complaints may be made to the licensing agency under chapter 43 of this title; and (E) periodic reporting to the licensing agency of the nature of complaints filed, and action taken. (19) All hospitals shall accept payment for compensation claims of uninsured crime victims paid for by the Victims Compensation Board established in 13 V.S.A.  5352 at 70 percent of billed charges and shall not bill any balance to the uninsured crime victim. (20) All hospitals shall comply with the rules adopted by the Commissioner pursuant to section 1914 of this title. License applications shall certify compliance with the rules. (21) In conducting its reviews, the licensing agency shall evaluate the quality and financial indicators published by the Commissioner of Health under subsection 9405b(c) of this title. (22) All hospitals shall provide oral and written notices to each individual that the hospital places in observation status as required by section 1911a of this title. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1963, No. 154,  5; 1981, No. 238 (Adj. Sess.),  1; 1985, No. 163 (Adj. Sess.),  2; 2005, No. 215 (Adj. Sess.),  75a, 323; 2007, No. 27,  2, 3; 2011, No. 78 (Adj. Sess.),  2, eff. April 2, 2012; 2015, No. 23,  44; 2015, No. 54,  4, eff. Dec. 1, 2015; 2015, No. 97 (Adj. Sess.),  49; 2015, No. 152 (Adj. Sess.),  4; 2017, No. 113 (Adj. Sess.),  67; 2017, No. 199 (Adj. Sess.),  1, eff. May 30, 2018.) 
 1906. Revocation of license, hearing
The licensing agency, after notice and opportunity for hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under this chapter. Such notice shall be served by registered mail or by personal service setting forth the reasons for the proposed action and fixing a date not less than 60 days from the date of such mailing or service, at which the applicant or licensee shall be given opportunity for a hearing. After such hearing, or upon default of the applicant or licensee, the licensing agency shall file its findings of fact and conclusions of law. A copy of such findings and decision shall be sent by registered mail or served personally upon the applicant or licensee. The procedure governing hearings authorized by this section shall be in accordance with the usual and customary rules provided for such hearings. 
 1907. Appeal
Any applicant or licensee, or the State acting through the Attorney General, aggrieved by the decision of the licensing agency after a hearing, may, within 30 days after entry of the decision as provided in section 1906 of this title, appeal to the Superior Court wherein the appellant is located. The court may affirm, modify, or reverse the decision of the licensing agency and either the applicant or licensee or licensing agency or State may appeal to the Supreme Court for such further review as is provided by law. Pending final disposition of the matter, the status quo of the applicant or licensee shall be preserved, except as the court otherwise orders in the public interest. (Amended 1971, No. 185 (Adj. Sess.),  185, eff. March 29, 1972; 1973, No. 193 (Adj. Sess.),  3, eff. April 9, 1974.) 
 1908. Rules; exceptions
(a) The licensing agency shall adopt and enforce rules and standards with respect to the different types of hospitals to be licensed hereunder as may be designed to further the accomplishment of the purposes herein set forth; such rules and standards shall be modified, amended, or rescinded from time to time by the licensing agency as may be in the public interest. (b) No such rules and standards shall be adopted or enforced which would have the effect of denying a license to a hospital solely by reason of the school or system of practice employed or permitted to be employed by physicians therein; provided that such school or system of practice is recognized by the laws of the State. Provided, however, that no rule or requirement shall be made under this chapter for any hospital conducted for those who rely upon treatment by spiritual means or prayer in accordance with the creed or tenets of any recognized church or religious denomination, except as to the sanitary and safe condition of the premises, cleanliness of operation, and its physical equipment. (Amended 2015, No. 23,  106.) 
 1909. Inspections
The licensing agency shall make or cause to be made such inspections and investigations as it deems necessary. If the licensing agency finds a violation as the result of an inspection or investigation, the licensing agency shall post a report on the licensing agencys website summarizing the violation and any corrective action required. (Amended 2019, No. 55,  2.) 
 1910. Records
(a) Information received by the licensing agency through filed reports, inspection, or as otherwise authorized by law shall: (1) not be disclosed publicly in a manner that identifies or may lead to the identification of one or more individuals or hospitals; (2) be exempt from public inspection and copying under the Public Records Act; and(3) be kept confidential except as it relates to a proceeding regarding licensure of a hospital. (b) The provisions of subsection (a) of this section shall not apply to the summary reports of violations required to be posted on the licensing agencys website pursuant to section 1909 of this chapter. (Amended 2019, No. 55,  3.) 
 1911. Construction
This chapter shall not be construed in any way to restrict or modify any law pertaining to the placement and adoption of children or the care of unmarried mothers. 
 1911a. Notice of hospital observation status
(a)(1) Each hospital shall provide oral and written notice to each Medicare beneficiary that the hospital places in observation status as soon as possible but no later than 24 hours following such placement, unless the individual is discharged or leaves the hospital before the 24-hour period expires. The written notice shall be a uniform form developed by the Department of Health, in consultation with interested stakeholders, for use in all hospitals. (2) If a patient is admitted to the hospital as an inpatient before the notice of observation has been provided, and under Medicare rules the observation services may be billed as part of the inpatient stay, the hospital shall not be required to provide notice of observation status. (b) Each oral and written notice shall include:(1) a statement that the individual is under observation as an outpatient and is not admitted to the hospital as an inpatient; (2) a statement that observation status may affect the individuals Medicare coverage for hospital services, including medications and pharmaceutical supplies, and for rehabilitative or skilled nursing services at a skilled nursing facility if needed upon discharge from the hospital; and (3) a statement that the individual may contact the Office of the Health Care Advocate or the Vermont State Health Insurance Assistance Program to understand better the implications of placement in observation status. (c) Each written notice shall include the name and title of the hospital representative who gave oral notice; the date and time oral and written notice were provided; the means by which written notice was provided, if not provided in person; and contact information for the Office of the Health Care Advocate and the Vermont State Health Insurance Assistance Program. (d) Oral and written notice shall be provided in a manner that is understandable by the individual placed in observation status or by his or her representative or legal guardian. (e) The hospital representative who provided the written notice shall request a signature and date from the individual or, if applicable, his or her representative or legal guardian, to verify receipt of the notice. If a signature and date were not obtained, the hospital representative shall document the reason. (Added 2015, No. 54,  5, eff. Dec. 1, 2015.) 
 1912. Definitions
As used in this chapter:(1) Adverse event is any untoward incident, therapeutic misadventure, iatrogenic injury, or other undesirable occurrence directly associated with care or services provided by a health care provider or health care facility. (2) Causal analysis means a formal root cause analysis, similar analytic methodologies, or any similarly effective but simplified processes that use a systematic approach to identify the basic or causal factors that underlie the occurrence or possible occurrence of a reportable adverse event, adverse event, or near miss. (3) Corrective action plan means a plan to implement strategies intended to eliminate or significantly reduce the risk of a recurrence of an adverse event and to measure the effectiveness of such strategies. (4) Hospital shall have the same meaning as in subdivision 1902(1) of this title.(5) Health care provider shall have the same meaning as in subdivision 9402(7) of this title. (6) Intentional unsafe act shall mean an adverse event or near miss that results from:(A) a criminal act;(B) a purposefully unsafe act;(C) alcohol or substance abuse; or(D) patient abuse.(7) Near miss means any process variation that did not affect the outcome, but for which a recurrence carries a significant chance of a serious adverse outcome. (8) Reportable adverse event means those adverse events a hospital is required to report to the Department pursuant to regulations adopted under this chapter. (9) Safety system means the comprehensive patient safety surveillance and improvement system established pursuant to this chapter and the regulations adopted hereunder. (10) Serious bodily injury means bodily injury that creates a substantial risk of death or that causes substantial loss or impairment of the function of any bodily member or organ or substantial impairment of health or substantial disfigurement. (Added 2005, No. 215 (Adj. Sess.),  324.) 
 1913. Creation; implementation
(a) The Commissioner shall establish a comprehensive patient safety surveillance and improvement system for the purpose of improving patient safety, eliminating adverse events in Vermont hospitals, and supporting and facilitating quality improvement efforts by hospitals. The Department may contract with a qualified organization having expertise in patient safety to develop and implement all or part of the safety system. (b) The Department shall:(1) collect data concerning the occurrence of reportable adverse events;(2) aggregate and analyze data for the purpose of developing and implementing strategies to target and eliminate specific adverse events; (3) verify that hospitals are in compliance with all the requirements of this chapter and regulations adopted hereunder; (4) for reportable adverse events, verify that hospitals are conducting causal analyses and developing corrective action plans consistent with standards set by the Department, current patient safety science, and relevant clinical standards; (5) provide technical assistance or assist hospitals in locating technical assistance resources for analyzing adverse events and near misses and developing and implementing corrective action plans; and (6) encourage hospitals to utilize anonymous in-hospital reporting when possible.(c) The Commissioner may retain or contract with such additional professional or other staff as needed to carry out responsibilities under this chapter. (d) Beginning on July 1, 2007, expenses incurred for development and implementation of the safety system shall be borne as follows: 50 percent from General Fund monies and 50 percent by the hospitals. (e) Not later than January 15, 2008, the Commissioner of Health shall provide an interim report to the Senate Committee on Health and Welfare and the House Committees on Human Services and on Health Care on the status of the safety system, its effectiveness in improving patient safety and health care quality in the State, and cost savings. Not later than January 15, 2009, the Commissioner shall make a final report to those Committees on those subjects and shall make recommendations regarding expansion of the system to include health care facilities other than hospitals. (f) The authority granted to the Commissioner under this chapter is in addition to any other authority granted to the Commissioner under law. (Added 2005, No. 215 (Adj. Sess.),  324.) 
 1914. Rulemaking
(a) The Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25 establishing the hospital obligations listed in section 1915 of this title and otherwise necessary for the implementation of the safety system. (b) The rules shall list reportable adverse events, which shall include the serious reportable events published by the National Quality Forum. The Commissioner shall consult with experts and hospitals when making changes to the list of reportable adverse events and shall consider the implications of reporting requirements that may be established as a result of the federal Patient Safety and Quality Improvement Act of 2005. The Department shall consult with other regulatory agencies and departments and, to the extent possible, avoid imposing duplicative reporting requirements. (Added 2005, No. 215 (Adj. Sess.),  324.) 
 1915. Hospital obligations
The rules adopted pursuant to this chapter shall require hospitals to:(1) develop, maintain, and implement internal policies and procedures that meet the standards of the Department to: (A) identify, track, and analyze reportable adverse events, adverse events, and near misses;(B) determine what type of causal analysis, if any, is appropriate;(C) conduct causal analyses and develop corrective action plans; and(D) disclose to patients, or, in the case of a patient death, an adult member of the immediate family, at a minimum, adverse events that cause death or serious bodily injury; (2) report reportable adverse events to the Department;(3) provide the Department with copies of its causal analysis and corrective action plan in connection with each reportable adverse event; (4) for reportable adverse events that must also by law be reported to other departments or agencies, notify the Department of Health or provide a copy of any written report and provide any causal analysis information required by the Department; (5) for the purpose of evaluating a hospitals compliance with the provisions of this chapter, provide the Commissioner and designees reasonable access to: (A) information protected by the provisions of the patients privilege under 12 V.S.A.  1612(a) or otherwise required by law to be held confidential; and(B) the minutes and records of a peer review committee and any other information subject to peer review protection under 26 V.S.A.  1443. (Added 2005, No. 215 (Adj. Sess.),  324.) 
 1916. Intentional unsafe acts
(a) A hospital shall notify the Department, within the time frames established by regulation, if the information available supports a reasonable, good faith belief that an intentional unsafe act as it pertains to patients has occurred. (b) For intentional unsafe acts reportable to other departments or agencies, a hospital shall notify the Department of Health or provide a copy of any written report. Such reports shall not constitute a waiver of peer review or any other privilege. (c) If the Department confirms or independently concludes, based on a reasonable, good faith belief, that an intentional unsafe act occurred, it shall notify relevant State and federal licensing and other regulatory entities and, in the case of possible criminal activity, relevant State and federal law enforcement authorities. (d) There shall be no liability on the part of and no cause of action for damages shall arise against any individual or hospital for any act or proceeding related to activities undertaken or performed within the scope of the obligations imposed by this section, provided that the individual or hospital acts without malice and with the reasonable belief that the action is warranted by the facts known after making reasonable efforts to obtain all the facts. (e) Nothing in this section shall prevent a hospital from conducting its own investigation or peer review. (Added 2005, No. 215 (Adj. Sess.),  324; amended 2017, No. 113 (Adj. Sess.),  68.) 
 1917. Protection and disclosure of information
(a) All information made available to the Department and its designees under this chapter shall be confidential and privileged, exempt from the public access to records law, and, in any civil or administrative action against a provider of professional health services arising out of the matters which are subject to evaluation and review by the Department, immune from subpoena or other disclosure and not subject to discovery or introduction into evidence. (b) No person with access to information made available to the Commissioner or his or her designees under this chapter shall be permitted or required to testify as to any findings, recommendations, evaluations, opinions, or other actions of the Department in any civil or administrative action against a provider of professional health services arising out of the matters which are subject to evaluation and review by the Department. (c) Within the Department, access to peer review protected information shall be limited to individuals responsible for verifying compliance with the safety system and for providing necessary consultation and supervision to that program. (d) Reports made to the Department pursuant to subdivision 1915(4) of this chapter shall not constitute a waiver of peer review or any other privilege. (e) Hospitals may replace health care provider identifying information in peer review materials with a surrogate identifier that allows for tracking of adverse events involving the same provider without disclosing the providers identity. (f) Notwithstanding subsections (a) and (b) of this section:(1) Hospitals and the Department staff responsible for verifying compliance with the safety system are authorized to disclose information necessary to comply with their reporting obligations in section 1916 of this chapter. (2) The Department staff responsible for verifying compliance with the patient safety surveillance and improvement system may disclose information to others in the Department, and the Department may disclose information to the Board of Health and others responsible for carrying out the Departments enforcement responsibilities with respect to this chapter if the Department reasonably believes that a hospital deliberately or repeatedly has not complied with the requirements of this chapter and any rules adopted hereunder. The Commissioner, the Board of Health, and others responsible for carrying out the Departments enforcement responsibilities with respect to this chapter are authorized to disclose such information during the course of any legal or regulatory action taken against a hospital for deliberate or repeated noncompliance with the requirements of this chapter and any rules adopted hereunder. Information disclosed under this subdivision shall otherwise maintain all applicable protections under this section and otherwise provided by law. (g) Nothing in this section shall prohibit a hospital from making a good faith report to regulatory or law enforcement authorities based on information, documents, or records known or available to it from original sources. Information, documents, or records otherwise available from original sources are not to be construed as immune from discovery or use in any other action merely because they were made available to the Departments patient safety surveillance and improvement system. (Added 2005, No. 215 (Adj. Sess.),  324; amended 2017, No. 113 (Adj. Sess.),  69.) 
 1918. Enforcement
(a) If the Commissioner determines that a hospital has failed to comply with any of the provisions of this chapter, the Commissioner may sanction the hospital as provided in this title. In evaluating compliance, the Commissioner shall place primary emphasis on assuring good faith compliance and effective corrective action by the facility, reserving punitive enforcement or disciplinary action for those cases in which the facility has displayed recklessness, gross negligence, or willful misconduct or in which there is evidence, based on other similar cases known to the Department, the Agency of Human Services, or the Office of the Attorney General, of a pattern of significant substandard performance that has the potential for or has actually resulted in harm to patients. (b) After notice and an opportunity for hearing, the Commissioner may impose on a hospital that knowingly violates a provision of this chapter or a rule or order adopted pursuant to this chapter a civil administrative penalty of not more than $10,000.00 or, in the case of a continuing violation, a civil administrative penalty of not more than $100,000.00 or one-tenth of one percent of the gross annual revenues of the health care facility, whichever is greater. A hospital aggrieved by a decision of the Commissioner under this section may appeal the Commissioners decision pursuant to section 128 of this title. (Added 2005, No. 215 (Adj. Sess.),  324.) 
 1919. Inclusion of data in hospital community reports
The Commissioner shall consult with the Commissioner of Financial Regulation and with patient safety experts, hospitals, health care professionals, and members of the public and shall make recommendations to the Commissioner of Financial Regulation concerning which data should be included in the hospital community reports required by section 9405b of this title. Beginning in 2013, the community reports shall include at a minimum data from all Vermont hospitals of reportable adverse events aggregated in a manner that protects the privacy of the patients involved and does not identify the individual hospitals in which an event occurred together with analysis and explanatory comments about the information contained in the report to facilitate the publics understanding of the data. The Commissioner shall make such recommendations no more than 18 months after data collection is initiated. (Added 2005, No. 215 (Adj. Sess.),  324; amended 2011, No. 171 (Adj. Sess.),  24f, eff. Feb. 1, 2013.) 
 2051. Definitions
For the purposes of this chapter, unless the context otherwise clearly requires:(1) Director means the Director of the Office of Professional Regulation.(2) Nursing home means any institution or facility, whether proprietary or nonproprietary, defined as a nursing home for licensing purposes pursuant to 33 V.S.A.  7102(7), or the equivalent facility or facilities as defined by the Secretary of the U.S. Department of Health and Human Services. (3) Nursing home administrator means a person who is duly licensed by the Director and who is charged with the general administration of a nursing home whether or not the individual has an ownership interest in the home and whether or not his or her functions and duties are shared with one or more other individuals. (4) [Repealed.] (Added 1969, No. 248 (Adj. Sess.),  2, eff. April 1, 1970; amended 2005, No. 27,  9; 2007, No. 29,  3.)
 2052. Advisor appointees
(a) The Secretary of State shall appoint two advisors as set forth in 3 V.S.A.  129b. One of the initial appointments may be for less than a five-year term. One of the appointees shall have not less than three years experience as a nursing home administrator immediately preceding appointment and shall be actively engaged in nursing home administration in Vermont during incumbency. The other appointee shall have not less than three years experience as a licensed health care provider engaged in the care of the chronically ill. (b) The Director shall seek the advice of the advisors in carrying out the provisions of this chapter. Advisor appointees shall be entitled to compensation and necessary expenses in the amount provided in 32 V.S.A.  1010 for attendance at any meeting called by the Director for this purpose. (Added 1969, No. 248 (Adj. Sess.),  2, eff. April 1, 1970; amended 1973, No. 72,  1, 2, eff. July 1, 1973; 1989, No. 251 (Adj. Sess.),  2; 1997, No. 40,  14; 1999, No. 133 (Adj. Sess.),  34; 2005, No. 27,  10; 2007, No. 29,  3.) 
 2053. Director; duties; powers
(a) The Director shall:(1) set requirements for licensure;(2) provide general information to applicants;(3) explain complaint and appeal procedures to licensees, applicants, and the public;(4) receive applications for licensure; license applicants under this chapter; renew licenses; and revoke, reinstate, or condition licenses as ordered by an administrative law officer. (b) The Director may:(1) adopt rules concerning continuing education requirements;(2) adopt rules necessary to perform his or her duties under this chapter;(3) adopt rules of professional conduct. (Added 1969, No. 248 (Adj. Sess.),  2, eff. April 1, 1970; amended 2005, No. 27,  11; 2007, No. 29,  3.)
 2054. Exclusive jurisdiction of the Director
The Director, with the advice of the advisors appointed under this chapter, shall have exclusive authority to determine the qualifications, skill, and fitness of any person to serve as an administrator of a nursing home under the provisions of this chapter, and a licensee under the provisions of this chapter shall be qualified to serve as the administrator of a nursing home. (Added 1969, No. 248 (Adj. Sess.),  2, eff. April 1, 1970; amended 2007, No. 29,  3.) 
 2055. General requirements for licensure
A person may not practice nursing home administration in this State unless:(1) the applicant has made written application for license to the Director, accompanied by satisfactory proof that he or she is at least 18 years of age and is not in violation of the rules regarding this profession or Vermont law; (2) in the judgment of the Director, the applicant has satisfactorily completed a course of instruction or training and met the requirements adopted by rule; or (3) the applicant has passed an examination administered by the Director or his or her designee which is designed to test for proficiency and competence and an examination covering Vermont statutes and rules relating to nursing home administration. (Added 1969, No. 248 (Adj. Sess.),  2, eff. April 1, 1970; amended 2005, No. 27,  12; 2007, No. 29,  3.) 
 2057. Licensing
(a) The Director shall license nursing home administrators in accordance with rules adopted, and from time to time revised. A nursing home administrators license may not be transferred and shall be valid until surrendered for cancellation or suspended or revoked for violation of this chapter or any other laws or regulations relating to the proper administration and management of a nursing home. Denial of issuance or renewal, suspension, or revocation under any section of this chapter shall be appealable in the manner provided in 3 V.S.A.  130a. (b) Every holder of a nursing home administrators license shall renew it biennially, by making application to the Director. Renewals of licenses shall be granted as a matter of course, unless an administrative law officer finds, after due notice and hearing, that the applicant has acted or failed to act in such manner, or under circumstances, as would constitute grounds for suspension or revocation of a license. The Director may by rule require that a license holder complete not more than 40 hours of approved instruction every two years as a condition of renewal. (Added 1969, No. 248 (Adj. Sess.),  2, eff. April 1, 1970; amended 1971, No. 185 (Adj. Sess.),  186, eff. March 29, 1972; 1993, No. 108 (Adj. Sess.),  16; 2007, No. 29,  3.) 
 2058. License fees
Applicants and persons regulated under this chapter shall be subject to the following fees: 
 2059. Licensure by endorsement
The Director may issue a nursing home administrators license, without examination for proficiency and competence, to any person who holds a current license as a nursing home administrator from another jurisdiction, provided that the Director finds that the standards for licensing in the other jurisdiction are substantially equivalent to those in this State. (Added 1969, No. 248 (Adj. Sess.),  2, eff. April 1, 1970; amended 2005, No. 27,  13; 2007, No. 29,  3.) 
 2060. Violations and penalties
A person who practices, or offers to practice, nursing home administration in this State, without being licensed in accordance with this chapter; or any person presenting or attempting to use as his or her own the license of another; or a person who gives any false or forged evidence of any kind in attempting to obtain a license; or a person who falsely impersonates another licensee; or a person who attempts to use an expired or revoked license or any person who violates any of the provisions of this chapter shall be subject to the penalties provided in 3 V.S.A.  127(c). (Added 1969, No. 248 (Adj. Sess.),  2, eff. April 1, 1970; amended 2007, No. 29,  3.) 
 2061. Provisional license
In the event of the inability of the regular licensed administrator of a nursing home to perform his or her duties or if, through death or other causes, a nursing home is without a licensed administrator, a provisional administrator may, in the discretion of the Director, be issued a provisional license to administer that home for a period not to exceed 90 days from the date on which the regular licensed administrator first ceased to perform his or her duties. The Director shall not renew such a provisional license, nor shall the Director issue a provisional license to any other person to administer a home which has been administered for the preceding 90 days by a provisional administrator. (Added 1973, No. 72,  4, eff. July 1, 1973; amended 2005, No. 27,  14; 2007, No. 29,  3.) 
 2141. Definitions
As used in this chapter:(1) Ambulatory surgical center means any distinct entity that operates primarily for the purpose of providing surgical services to patients not requiring hospitalization and for which the expected duration of services would not exceed 24 hours following an admission. The term does not include: (A) a facility that is licensed as part of a hospital; or(B) a facility that is used exclusively as an office or clinic for the private practice of one or more licensed health care professionals, unless one or more of the following descriptions apply: (i) the facility holds itself out to the public or to other health care providers as an ambulatory surgical center, surgical center, surgery center, surgicenter, or similar facility using a similar name or a variation thereof; (ii) procedures are carried out at the facility using general anesthesia, except as used in oral or maxillofacial surgery or as used by a dentist with a general anesthesia endorsement from the Board of Dental Examiners; or (iii) patients are charged a fee for the use of the facility in addition to the fee for the professional services of one or more of the health care professionals practicing at that facility. (2) Health care professional means:(A) a physician licensed pursuant to 26 V.S.A. chapter 23 or 33;(B) an advanced practice registered nurse licensed pursuant to 26 V.S.A. chapter 28;(C) a physician assistant licensed pursuant to 26 V.S.A. chapter 31;(D) a podiatrist licensed pursuant to 26 V.S.A. chapter 7; or(E) a dentist licensed pursuant to 26 V.S.A. chapter 12.(3) Patient means a person admitted to or receiving health care services from an ambulatory surgical center. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2151. License
No person shall establish, maintain, or operate an ambulatory surgical center in this State without first obtaining a license for the ambulatory surgical center in accordance with this subchapter. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2152. Application; fee
(a) An application for licensure of an ambulatory surgical center shall be made to the Department of Health on forms provided by the Department and shall include all information required by the Department. Each application for a license shall be accompanied by a license fee. (b) The annual licensing fee for an ambulatory surgical center shall be $600.00.(c) Fees collected under this section shall be credited to the Hospital Licensing Fees Special Fund and shall be available to the Department of Health to offset the costs of licensing ambulatory surgical centers. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2153. License requirements
(a) Upon receipt of an application for a license and the licensing fee, the Department of Health shall issue a license if it determines that the applicant and the ambulatory surgical center facilities meet the following minimum standards: (1) The applicant shall demonstrate the capacity to operate an ambulatory surgical center in accordance with rules adopted by the Department. (2) The applicant shall demonstrate that its facilities comply fully with standards for health, safety, and sanitation as required by State law, including standards set forth by the State Fire Marshal and the Department of Health, and municipal ordinance. (3) The applicant shall have a clear process for responding to patient complaints.(4) The applicant shall participate in the Patient Safety Surveillance and Improvement System established pursuant to chapter 43A of this title. (5) The applicant shall maintain certification from the Centers for Medicare and Medicaid Services and shall accept Medicare and Medicaid patients for ambulatory surgical center facility services. (6) The ambulatory surgical center facilities, including the buildings and grounds, shall be subject to inspection by the Department, its designees, and other authorized entities at all times. (b) A license is not transferable or assignable and shall be issued only for the premises and persons named in the application. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2154. Revocation of license; hearing
The Department of Health, after notice and opportunity for hearing to the applicant or licensee, is authorized to deny, suspend, or revoke a license in any case in which it finds that there has been a substantial failure to comply with the requirements established under this chapter. Such notice shall be served by registered mail or by personal service, shall set forth the reasons for the proposed action, and shall set a date not less than 60 days from the date of the mailing or service on which the applicant or licensee shall be given opportunity for a hearing. After the hearing, or upon default of the applicant or licensee, the Department shall file its findings of fact and conclusions of law. A copy of the findings and decision shall be sent by registered mail or served personally upon the applicant or licensee. The procedure governing hearings authorized by this section shall be in accordance with the usual and customary rules provided for such hearings. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2155. Appeal
Any applicant or licensee, or the State acting through the Attorney General, aggrieved by the decision of the Department of Health after a hearing may, within 30 days after entry of the decision as provided in section 2154 of this title, appeal to the Superior Court for the district in which the appellant is located. The court may affirm, modify, or reverse the Departments decision, and either the applicant or licensee or the Department or State may appeal to the Vermont Supreme Court for such further review as is provided by law. Pending final disposition of the matter, the status quo of the applicant or licensee shall be preserved, except as the court otherwise orders in the public interest. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2156. Inspections
The Department of Health shall make or cause to be made such inspections and investigations as it deems necessary. If the Department finds a violation as the result of an inspection or investigation, the Department shall post a report on the Departments website summarizing the violation and any corrective action required. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2157. Records
(a) Information received by the Department of Health through filed reports, inspections, or as otherwise authorized by law shall: (1) not be disclosed publicly in a manner that identifies or may lead to the identification of one or more individuals or ambulatory surgical centers; (2) be exempt from public inspection and copying under the Public Records Act; and(3) be kept confidential except as it relates to a proceeding regarding licensure of an ambulatory surgical center. (b) The provisions of subsection (a) of this section shall not apply to the summary reports of violations required to be posted on the Departments website pursuant to section 2156 of this chapter. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2158. Nonapplicability
The provisions of chapter 42 of this title, Bill of Rights for Hospital Patients, do not apply to ambulatory surgical centers. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 2159. Rules
The Department of Health shall adopt rules pursuant to 3 V.S.A. chapter 25 as needed to carry out the purposes of this chapter. The rules shall include requirements regarding: (1) the ambulatory surgical centers maintenance of a transport agreement with at least one emergency medical services provider for emergency patient transportation; (2) the ambulatory surgical centers maintenance of a publicly accessible policy for providing charity care to eligible patients; and (3) the ambulatory surgical centers participation in quality reporting programs offered by the Centers for Medicare and Medicaid Services. (Added 2019, No. 55,  1, eff. Jan. 1, 2020.) 
 171. Definitions
As used in this chapter:(1) Amyotrophic lateral sclerosis or ALS means a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. (2) Health care provider means a person, partnership, corporation, facility, or institution licensed or certified or authorized by law to provide professional health care service in this State to an individual during that individuals medical care, treatment, or confinement. (3) Registry means the statewide amyotrophic lateral sclerosis incidence registry. (Added 2021, No. 149 (Adj. Sess.),  1, eff. July 1, 2023.)
 172. Registry established
The Commissioner shall establish, maintain, and operate a statewide amyotrophic lateral sclerosis incidence registry. (Added 2021, No. 149 (Adj. Sess.),  1, eff. July 1, 2023.) 
 173. Duty of health care providers
A health care provider that screens for, diagnoses, or provides therapeutic services to patients with amyotrophic lateral sclerosis shall report to the Department all individuals diagnosed as having amyotrophic lateral sclerosis not later than six months from the date of diagnosis. The report shall include information on each individuals usual occupation and industry of employment and other elements determined by rule to be appropriate. (Added 2021, No. 149 (Adj. Sess.),  1, eff. July 1, 2023.) 
 174. Confidentiality
(a)(1) All identifying information regarding an individual patient or health care provider is exempt from public inspection and copying under the Public Records Act and shall be kept confidential. (2) Notwithstanding subdivision (1) of this subsection, the Commissioner may enter into data sharing and protection agreements with researchers or state, regional, or national amyotrophic lateral sclerosis registries for bidirectional data exchange, provided access under such agreements is consistent with the privacy, security, and disclosure protections in this chapter. In the case of researchers, the Commissioner shall also first obtain evidence of the approval of their academic committee for the protection of human subjects established in accordance with 45 C.F.R. Part 46. The Commissioner shall disclose the minimum information necessary to accomplish a specified research purpose. (b) The Department may disclose aggregated and deidentified information from the registry. (Added 2021, No. 149 (Adj. Sess.),  1, eff. July 1, 2023.)
 175. Annual report
Annually, on or before January 15, the Department shall submit a written report to the Governor, the House Committee on Human Services, and the Senate Committee on Health and Welfare containing the statewide prevalence and incidence estimates of amyotrophic lateral sclerosis, including any trends occurring over time across the State. Reports shall not contain information that directly or indirectly identifies an individual patient or health care provider. (Added 2021, No. 149 (Adj. Sess.),  1, eff. July 1, 2023.) 
 176. Rulemaking
The Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25 to implement this chapter, including rules to govern the operation of the registry, data reported to the registry, and data release protocols. (Added 2021, No. 149 (Adj. Sess.),  1, eff. July 1, 2023.) 
 177. Liability
(a) No action for damages arising from the disclosure of confidential or privileged information shall be maintained against any person, or the employer or employee of any person, who participates in good faith in the reporting of amyotrophic lateral sclerosis registry data or data for amyotrophic lateral sclerosis morbidity or mortality studies in accordance with this chapter. (b) No license of a health care provider shall be denied, suspended, or revoked for the good faith disclosure of confidential or privileged information in the reporting of amyotrophic lateral sclerosis registry data or data for amyotrophic lateral sclerosis morbidity or mortality studies in accordance with this chapter. (c) Nothing in this section shall be construed to apply to the unauthorized disclosure of confidential or privileged information when such disclosure is due to gross negligence or willful misconduct. (Added 2021, No. 149 (Adj. Sess.),  1, eff. July 1, 2023.) 
 201. Cancer control; tumor clinics
The Board shall establish, organize, and conduct a statewide cancer control program and may organize and conduct tumor clinics or cooperate with and subsidize hospital or locally organized tumor clinics in such parts of the State as such Board may deem most advantageous for the public health. In so far as is practicable, the Board shall conduct a professional and lay educational program in regard to the early diagnosis, care, and cure of cancer. (Amended 1959, No. 123,  1, eff. April 17, 1959; 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 202. Clinical care of cancer patients; State aid
The Board may furnish clinical care or diagnostic procedures for persons with cancer or suspicion of cancer. The Board may grant State aid for the care of persons who have cancer or suspicion of cancer and are without means of providing for themselves adequate care as required by their condition, provided that the aid so granted shall not, in any individual case, exceed one-half the total bill. Notwithstanding any provisions of law to the contrary, the names of persons receiving aid under this section shall not be printed in any public report, and the State Board of Health shall fix the maximum amount to be paid in any given case not to exceed $500.00 in any patient year. (Amended 1959, No. 123,  2, eff. April 17, 1959; 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 203. Contributions
The Board is authorized to receive voluntary contributions for the purposes of this chapter and of section 116 of this title from any source other than the State Treasury and any sums allotted to and received by the State or the Board from the federal government for such purposes and to administer and expend the same for the purposes specified. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 2201. Furnishing supervision to home health agencies; contracts
The Department may furnish supervision to any public agency or private organization engaged in providing skilled nursing services and other therapeutic services, or to any subdivision of such an agency or organization, for the purpose of enabling the agency or organization to qualify as a home health agency under Title I of Pub. L. No. 89-97, the Health Insurance for the Aged Act, at the request of the agency or organization. The Department may enter into agreements with any person, firm, corporation, association, agency, or organization, public or private, for the purpose of furnishing or coordinating supervisory services for a home health agency under this section, and may collect fees for the services rendered under the terms of such agreements. Supervision or supervisory services as used in this section, shall mean supervision by a physician or a registered professional nurse as required for a home health agency under the Health Insurance for the Aged Act. (Added 1969, No. 217 (Adj. Sess.), eff. March 27, 1970.) 
 2202. Contracts for departmental programs and services
(a) Notwithstanding the provisions of 3 V.S.A. chapter 13, the Department may enter into agreements with a private or public organization for such organization to provide services or conduct programs for the benefit of the public which the Department by law is authorized to provide or conduct if the Department of Health finds that the organization is properly equipped and qualified for this purpose. (b) This section shall apply to all services and programs which the Department conducts under this chapter, including the initiation of new combinations of public health and home health nursing services. (Added 1969, No. 217 (Adj. Sess.), eff. March 27, 1970; amended 1977, No. 144 (Adj. Sess.),  1, eff. March 28, 1978.) 
 2203. Collection of fees
The Department may provide home health care services, including public health nursing and other therapeutic services, to the public in geographical areas where such services are not otherwise available through public or private organizations, and may collect fees for such services where such service is of the type authorized under Pub. L. No. 89-97, the Social Security Amendments of 1965. (Added 1969, No. 217 (Adj. Sess.), eff. March 27, 1970.) 
 2251. Lien established
A hospital in Vermont, as defined in section 1801 of this title, furnishing medical or other service, including charges of private duty nurses, to a patient injured by reason of an accident not covered by the Workers Compensation Act, 21 V.S.A.  601 et seq., shall have a lien upon any recovery for damages to be received by the patient, or by his or her heirs or personal representatives in the case of his or her death, whether by judgment or by settlement or compromise after the date of the services. This lien shall not attach to one-third of the recovery or $500.00, whichever shall be the lesser, and in addition the lien shall be subordinate to an attorneys lien. (Added 1963, No. 209,  1, eff. Oct. 1, 1963; amended 1981, No. 165 (Adj. Sess.),  1.) 
 2252. Notice
The lien shall not be effective, however, unless a written notice containing the name and address of the injured person, the date of the accident, the name and location of the hospital, and the name of the person alleged to be liable is filed in the office of the clerk of the town in which the hospital is located, before the payment of any monies to the injured person, his or her attorneys, or legal representatives as compensation for the injuries; nor unless the hospital also mails, postage prepaid, a copy of the notice with a statement of the date of filing thereof to the injured person, and to the person alleged to be liable before payment to the injured person, his or her attorneys, or legal representative of compensation for the injuries. The hospital shall mail a copy of the notice to any insurance carrier which has insured the person against liability for the accident. (Added 1963, No. 209,  2, eff. Oct. 1, 1963.) 
 2253. Liability
A person making payment to the patient or to his or her attorneys or heirs or legal representatives as compensation for the injury sustained, after the filing and mailing of the notice without paying to the hospital the amount of its lien or so much thereof as can be satisfied out of the monies due after any final judgment or compromise or settlement agreement after paying the amount of any prior liens, shall, for one year from the date of payment, be liable to the hospital for the amount which the hospital was entitled to receive; and the hospital may, within that year, enforce its lien by a civil action against the person making any such payment. Provided, however, that unless said action is brought within said year, such lien shall be void. (Added 1963, No. 209,  3, eff. Oct. 1, 1963.) 
 2254. Hospital lien docket
Every town clerk shall, at the expense of the town, provide a suitable well-bound book to be called the hospital lien docket in which, upon the filing of any lien claim under this chapter, he or she shall enter the name of the injured person, the name of the person alleged to be liable for the injuries, the date of the accident, and the name of the hospital or other institution making the claim. The clerk shall index the docket in the name of the injured person and the hospital. (Added 1963, No. 209,  4, eff. Oct. 1, 1963.) 
 2255. Extension of lien
In the event that a hospital entitled to a lien hereunder shall have served a notice as provided for by 33 V.S.A.  821, the lien herein provided for shall extend to the town receiving such notice, provided that the town so served shall follow the provisions of sections 2252 and 2253 of this title. (Added 1963, No. 209,  5, eff. Oct. 1, 1963.) 
 2256. Discharge
The hospital or town asserting a lien pursuant to the provisions of this chapter shall, within 30 days from the date its claim is satisfied, file its certificate of discharge with the town clerk where the lien is filed, and the town clerk shall make proper entry and index of the discharge in the hospital lien docket. All fees for recording of notices or discharges shall be at the expense of the hospital or town filing the same. (Added 1963, No. 209,  6, eff. Oct. 1, 1963.) 
 251. Definitions
As used in this chapter:(1) Cultural competency means a set of integrated attitudes, knowledge, and skills that enables a health care professional to care effectively for patients from cultures, groups, and communities other than that of the health care professional. At a minimum, cultural competency should include the following: (A) awareness and acknowledgement of the health care professionals own culture;(B) utilization of cultural information to establish therapeutic relationships;(C) eliciting and incorporating pertinent cultural data in diagnosis and treatment;(D) understanding and applying cultural and ethnic data to the process of clinical care; and (E) the ability to recognize the importance of communication, language fluency, and interpretation in the provision of health care services and assist with access to interpretation and appropriate communication services. (2) Cultural humility means the ability to maintain an interpersonal stance that is other-oriented, or open to the other, in relation to aspects of cultural identity that are most important to the client or patient. (3) Health disparity means differences that exist among specific population groups in the United States in attaining individuals full health potential that can be measured by differences in incidence, prevalence, mortality, burden of disease, and other adverse health conditions. (4) Health equity means all people have a fair and just opportunity to be healthy, especially those who have experienced socioeconomic disadvantage, historical injustice, and other avoidable systemic inequalities that are often associated with the social categories of race, gender, ethnicity, social position, sexual orientation, and disability. (5) Health equity data means demographic data, including, race, ethnicity, primary language, age, gender, socioeconomic position, sexual orientation, disability, homelessness, or geographic data that can be used to track health equity. (6) LGBTQ means Vermonters who identify as lesbian, gay, bisexual, transgender, queer, or questioning. (7) Non-White means Black, Indigenous, and Persons of Color. It is not intended to reflect self-identity, but rather how people are categorized in the racial system on which discrimination has been historically based in the United States and how Vermont typically disaggregates data solely by White and non-White. (8) Race and ethnicity mean the categories for classifying individuals that have been created by prevailing social perceptions, historical policies, and practices. Race and ethnicity include how individuals perceive themselves and how individuals are perceived by others. (9) Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age, such as poverty, income and wealth inequality, racism, and sex discrimination, that affect a wide range of health, functioning, and quality-of-life outcomes and risks. They can be grouped into five domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. Social determinants of health are systematic, interconnected, cumulative, and intergenerational conditions that are associated with lower capacity to fully participate in society. (Added 2021, No. 33,  3; amended 2021, No. 105 (Adj. Sess.),  346, eff. July 1, 2022.) 
 252. Health Equity Advisory Commission
(a) Creation. There is created the Health Equity Advisory Commission to promote health equity and eradicate health disparities among Vermonters, including particularly those who are Black, Indigenous, and Persons of Color; individuals who are LGBTQ; and individuals with disabilities. The Advisory Commission shall amplify the voices of impacted communities regarding decisions made by the State that impact health equity, whether in the provision of health care services or as the result of social determinants of health. The Advisory Commission shall also provide strategic guidance on the development of the Office of Health Equity, including recommendations on the structure, responsibilities, and jurisdiction of such an office. (b) Membership. (1) The Advisory Commission shall be composed of the following members:(A) the Executive Director of Racial Equity established pursuant to 3 V.S.A.  5001 or designee;(B) the Commissioner of Health or designee;(C) the Commissioner of Mental Health or designee;(D) the Commissioner of Disabilities, Aging, and Independent Living or designee;(E) the Commissioner of Vermont Health Access or designee;(F) the Commissioner for Children and Families or designee;(G) the Commissioner of Housing and Community Development or designee;(H) the Commissioner of Economic Development or designee;(I) the Chief Performance Officer or designee;(J) the Chief Prevention Officer or designee;(K) a member, appointed by the Racial Justice Alliance;(L) a member, appointed by the Rutland Area NAACP;(M) a member, appointed by the Association of Africans Living in Vermont;(N) a member, appointed by the Windham County Vermont NAACP;(O) a member, appointed by the Pride Center of Vermont;(P) a member, appointed by Outright Vermont;(Q) a member, appointed by Migrant Justice;(R) a member, appointed by Out in the Open;(S) a member, appointed by Another Way Community Center;(T) a member, appointed by Vermont Psychiatric Survivors;(U) a member, appointed by the Vermont Center for Independent Living;(V) a member, appointed by the Elnu Abenaki Tribe;(W) a member, appointed by the Nulhegan Abenaki Tribe;(X) a member, appointed by the Koasek Traditional Nation of Missiquoi;(Y) a member, appointed by the Abenaki Nation of Missiquoi;(Z) a member, appointed by the Vermont Commission on Native American Affairs;(AA) a member, appointed by Green Mountain Self-Advocates;(BB) a member, appointed by the Vermont Developmental Disabilities Council;(CC) a member, appointed by Vermont Federation of Families for Childrens Mental Health; and (DD) any other members at large that the Advisory Commission deems necessary to appoint to carry out the functions of this section, including ensuring equitable representation and a balance between impacted communities, and that health care provider perspectives are represented, based on a majority vote of the members. (2) The term of office of each appointed member shall be three years, with the exception that members at large shall each have a term of one year. Of the members first appointed, who are not designated as at-large members, ten shall be appointed for a term of one year, ten shall be appointed for a term of two years, and nine shall be appointed for a term of three years. Members shall hold office for the term of their appointments and until their successors have been appointed. All vacancies shall be filled for the balance of the unexpired term in the same manner as the original appointment. Members are eligible for reappointment. (c) Powers and duties. The Advisory Commission shall:(1) provide guidance on the development of the Office of Health Equity, which shall be established based on the Advisory Commissions recommendations not later than January 1, 2023, including on: (A) the structure, responsibilities, and jurisdiction of the Office;(B) whether the Office shall be independent and, if not, in which State agency or department it shall be situated; (C) how the Office shall be staffed;(D) the populations served and specific issues addressed by the Office;(E) the duties of the Office, including how grant funds shall be managed and distributed; and (F) the time frame and necessary steps to establish the Office;(2) provide advice and make recommendations to the Office of Health Equity once established, including input on: (A) any rules or policies proposed by the Office;(B) the awarding of grants and the development of programs and services;(C) the needs, priorities, programs, and policies relating to the health of individuals who are Black, Indigenous, and Persons of Color; individuals who are LGBTQ; and individuals with disabilities; and (D) any other issue on which the Office of Health Equity requests assistance from the Advisory Commission; (3) review, monitor, and advise all State agencies regarding the impact of current and emerging State policies, procedures, practices, laws, and rules on the health of individuals who are Black, Indigenous, and Persons of Color; individuals who are LGBTQ; and individuals with disabilities; (4) identify and examine the limitations and problems associated with existing laws, rules, programs, and services related to the health status of individuals who are Black, Indigenous, and Persons of Color; individuals who are LGBTQ; and individuals with disabilities; (5) advise the Department of Health and General Assembly on any funding decisions relating to eliminating health disparities and promoting health equity, including the distribution of federal monies related to COVID-19; (6) to the extent funds are available for the purpose, distribute grants that stimulate the development of community-based and neighborhood-based projects that will improve the health outcomes of individuals who are Black, Indigenous, and Persons of Color; individuals who are LGBTQ; and individuals with disabilities; and (7) advise the General Assembly on efforts to improve cultural competency, cultural humility, and antiracism in the health care system through training and continuing education requirements for health care providers and other clinical professionals. (d) Assistance. The Advisory Commission shall have the administrative, legal, and technical assistance of the Agency of Administration at the request of the Executive Director of Racial Equity. (e) Report. Annually, on or before January 15, the Advisory Commission shall submit a written report to the Senate Committee on Health and Welfare and to the House Committees on Health Care and on Human Services with its findings and any recommendations for legislative action. The Advisory Commission is encouraged to base recommendations on the data collected and analysis completed pursuant to section 253 of this title. (f) Meetings. (1) The Executive Director of Racial Equity or designee shall call the first meeting of the Advisory Commission to occur on or before September 1, 2021. (2) The Advisory Commission shall select a chair and vice chair at its first meeting and annually thereafter. (3) The Advisory Commission shall adopt procedures to govern its proceedings, including voting procedures and how the staggered terms shall be apportioned among members. (4) All meetings of the Advisory Commission and any subcommittees of the Advisory Commission shall be open to the public with opportunities for public comment provided on a regular basis. (g) Acceptance of grants and other contributions. The Advisory Commission may accept from any governmental department or agency, public or private body, or any other source grants or contributions to be used in carrying out its responsibilities under this chapter. (h) Compensation and reimbursement. Appointed members of the Advisory Commission shall be entitled to per diem compensation and reimbursement of expenses as permitted under 32 V.S.A.  1010 for meetings as deemed appropriate by the Advisory Commission within the appropriation provided. These payments shall be made from monies appropriated to the Agency of Administration. (Added 2021, No. 33,  3.) 
 253. Data responsive to health equity inquiries
(a) Each State agency, department, board, or commission that collects health-related, individual data shall include in its data collection health equity data disaggregated by race, ethnicity, gender identity, age, primary language, socioeconomic status, disability, and sexual orientation. Data related to race and ethnicity shall use separate collection categories and tabulations, disaggregated beyond non-White and White, in accordance with the recommendation made by the Executive Director of Racial Equity, in consultation with the Advisory Commission. (b)(1) The Department of Health shall systematically analyze such health equity data using the smallest appropriate units of analysis feasible to detect racial and ethnic disparities, as well as disparities along the lines of primary language, sex, disability status, sexual orientation, gender identity, and socioeconomic status, and report the results of such analysis on the Departments website periodically, but not less than biannually. The Departments analysis shall be used to measure over time the impact of actions taken to reduce health disparities in Vermont. The data informing the Departments analysis shall be made available to the public in accordance with State and federal law. (2) Annually, on or before January 15, the Department shall submit a report containing the results of the analysis conducted pursuant to subdivision (1) of this subsection to the Senate Committee on Health and Welfare and to the House Committees on Health Care and on Human Services. (Added 2021, No. 33,  3.) 
 301. Program of dental health established
The State Board of Health shall maintain a statewide program of dental health. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.)
 302. Dental educational program
The Board, through its Dental Health Division, shall cooperate with the dental profession in any educational programs for the purpose of improving the dental health of the people of the State. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 303. Community dental programs
The Board may advise with communities in the establishment of community dental programs. This shall be done in cooperation with the representatives of the dental profession in any given area. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 304. Rules and procedures; personnel
The Board may adopt such rules and procedures and employ such personnel as are necessary to carry out the purposes of this subchapter. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 305. Federal funds and other contributions
The Board is authorized to receive for the purpose of this subchapter voluntary contributions from any source whatever and any sums from the federal government and to administer the same. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 3801. Definitions
As used in this subchapter:(1)(A) Health insurer shall have the same meaning as in section 9402 of this title and shall include: (i) a health insurance company, a nonprofit hospital and medical service corporation, and health maintenance organizations; (ii) an employer, a labor union, or another group of persons organized in Vermont that provides a health plan to beneficiaries who are employed or reside in Vermont; and (iii) except as otherwise provided in section 3805 of this title, the State of Vermont and any agent or instrumentality of the State that offers, administers, or provides financial support to State government. (B) The term health insurer shall not include Medicaid or any other Vermont public health care assistance program. (2) Health plan means a health benefit plan offered, administered, or issued by a health insurer doing business in Vermont. (3) Pharmacy means any individual or entity licensed or registered under 26 V.S.A. chapter 36. (4) Pharmacy benefit management means an arrangement for the procurement of prescription drugs at a negotiated rate for dispensation within this State to beneficiaries, the administration or management of prescription drug benefits provided by a health plan for the benefit of beneficiaries, or any of the following services provided with regard to the administration of pharmacy benefits: (A) mail service pharmacy;(B) claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to beneficiaries; (C) clinical formulary development and management services;(D) rebate contracting and administration;(E) certain patient compliance, therapeutic intervention, and generic substitution programs; and (F) disease or chronic care management programs.(5) Pharmacy benefit manager means an entity that performs pharmacy benefit management. The term includes a person or entity in a contractual or employment relationship with an entity performing pharmacy benefit management for a health plan. (6) Responsible party means the entity, including a health insurer or pharmacy benefit manager, responsible for payment of claims for health care services other than: (A) the individual to whom the health care services were rendered;(B) that individuals guardian or legal representative; or(C) the Agency of Human Services, its agents, and contractors. (Added 2011, No. 150 (Adj. Sess.),  4; amended 2013, No. 79,  18, eff. Jan. 1, 2014.)
 3802. Pharmacy rights during an audit
Notwithstanding any provision of law to the contrary, whenever a health insurer, a third-party payer, or an entity representing a responsible party conducts an audit of the records of a pharmacy, the pharmacy shall have a right to all of the following: (1) To have an audit involving clinical or professional judgment be conducted by a pharmacist licensed to practice pharmacy in one or more states, who has at least a familiarity with Vermont pharmacy statutes and rules and who is employed by or working with an auditing entity. (2) If an audit is to be conducted on-site at a pharmacy, the entity conducting the audit:(A) shall give the pharmacy at least 14 days advance written notice of the audit and the specific prescriptions to be included in the audit; (B) shall not audit a pharmacy on Mondays or on weeks containing a federal holiday, unless the pharmacy agrees to alternative timing for the audit; and (C) shall not audit claims that:(i) were submitted to the pharmacy benefit manager more than 18 months prior to the date of the audit, unless: (I) required by federal law; or(II) the originating prescription was dated within the 24- month period preceding the date of the audit; or (ii) exceed 200 selected prescription claims.(3) If any audit is to be conducted remotely, the entity conducting the audit:(A) shall give the pharmacy at least seven business days following the pharmacys confirmation of receipt of the notice of the audit to respond to the audit; and (B) shall not audit claims that:(i) were submitted to the pharmacy benefit manager more than three months prior to the date of the audit or on a date earlier than that for which the pharmacy could electronically retransmit a corrected claim; or (ii) exceed five selected prescription claims.(4) To have auditors enter the prescription department only when accompanied by or authorized by a member of the pharmacy staff, and not to have auditors disrupt the provision of services to the pharmacys customers. (5) Not to have clerical or recordkeeping errors, including typographical errors, scriveners errors, and computer errors, on a required document or record deemed fraudulent in the absence of any financial harm or other evidence; provided that this subdivision shall not be construed to prohibit recoupment of actual fraudulent payments. (6) If required under the terms of the contract, to have the auditing entity provide to the pharmacy, upon request, all records related to the audit in an electronic or digital media format. (7) In order to validate a pharmacy record with respect to a prescription or refill, to have the properly documented records of a hospital or of any person authorized by law to prescribe medication transmitted by any means of communication. (8) To use any prescription that meets the requirements to be a legal prescription under Vermont law, including prescriber notations such as as directed and as needed which require the professional judgment of the pharmacist to determine that the dose dispensed is within normal guidelines, to validate claims submitted for reimbursement for dispensing of original and refill prescriptions, or changes made to prescriptions. (9) To dispense and receive reimbursement for the full quantity of the smallest commonly available commercially packaged product, including eye drops, insulin, and topical products, that contains the total amount required to be dispensed to meet the days supply ordered by the prescriber, even if the full quantity of the commercially prepared package exceeds the maximum days supply allowed. (10) To determine the days supply using the highest daily total dose that may be utilized by the patient pursuant to the prescribers directions, and for prescriptions with a titrated dose schedule, to use the schedule to determine the days supply. (11) To be subject to recoupment only following the correction of a claim and to have recoupment limited to amounts paid in excess of amounts payable under the corrected claim. (12) Not to have a demand for recoupment, repayment, or offset against future reimbursement for overpayment of a claim for dispensing of an original or refill prescription include the dispensing fee, unless the prescription that is the subject of the claim was not actually dispensed, was not valid, was fraudulent, or was outside the provisions of the contract; provided that this subdivision shall not apply if a pharmacy is required to correct an error in a claim submitted in good faith. (13) Unless otherwise agreed to by contract, not to have an audit finding or demand for recoupment, repayment, or offset against future reimbursement made for any claim for dispensing of an original or refill prescription due to information missing from a prescription or to information not placed in a particular location when the information or location is not required or specified by State or federal law. The pharmacy shall be allowed 30 days to document and correct the missing information. (14) In the event the actual quantity dispensed on a valid prescription for a covered beneficiary exceeded the allowable maximum days supply of the product as defined in the contract, to have the amount to be recouped, repaid, or offset against future reimbursement limited to an amount calculated based on the quantity of the product dispensed found to be in excess of the allowed days supply quantity and using the cost of the product as reflected on the original claim. (15) Not to have the accounting practice of extrapolation used in calculating any recoupment or penalty, unless otherwise required by federal law or by federal health plans. (16) Except for cases of federal Food and Drug Administration regulation or drug manufacturer safety programs, to be free of recoupments based on either: (A) documentation requirements in addition to or in excess of State Board of Pharmacy documentation creation or maintenance requirements; or (B) a requirement that a pharmacy or pharmacist perform a professional duty in addition to or in excess of State Board of Pharmacy professional duty requirements. (17) Except for Medicare claims, to be subject to reversals of approval for drug, prescriber, or patient eligibility upon adjudication of a claim only in cases in which the pharmacy obtained the adjudication by fraud or misrepresentation of claim elements. (18) To be audited under the same standards and parameters as other similarly situated pharmacies audited by the same entity. (19) To have the preliminary audit report delivered to the pharmacy within 30 days following the pharmacys preliminary response. (20) To have at least 30 days following receipt of the preliminary audit report to produce documentation to address any discrepancy found during the audit. (21) To have a final audit report delivered to the pharmacy within 30 days after the end of the appeals period, as required by section 3803 of this title. (22) Except for audits initiated to address an identified problem, to be subject to no more than one audit per calendar year, unless fraud or misrepresentation is reasonably suspected. (23) Not to have audit information from an audit conducted by one auditing entity shared with or utilized by another auditing entity, except as required by State or federal law. (24) To have all payment data related to audited claims, including:(A) payment amount;(B) any direct and indirect remuneration (DIR) or generic effective rate (GER) fees assessed or other financial offsets; (C) date of electronic payment or check date and number;(D) the specific contracted reimbursement basis for each claim, including its basis, such as maximum allowable cost (MAC), wholesale acquisition cost (WAC), average wholesale price (AWP), or average manufacturer price (AMP); and (E) the respective values used to calculate each claim payment. (Added 2011, No. 150 (Adj. Sess.),  4; amended 2021, No. 131 (Adj. Sess.),  3, eff. January 1, 2023.)
 3802. Pharmacy rights during an audit
Notwithstanding any provision of law to the contrary, whenever a health insurer, a third-party payer, or an entity representing a responsible party conducts an audit of the records of a pharmacy, the pharmacy shall have a right to all of the following: (1) To have an audit involving clinical or professional judgment be conducted by a pharmacist licensed to practice pharmacy in one or more states, who has at least a familiarity with Vermont pharmacy statutes and rules and who is employed by or working with an auditing entity. (2) If an audit is to be conducted on-site at a pharmacy, the entity conducting the audit:(A) shall give the pharmacy at least 14 days advance written notice of the audit and the specific prescriptions to be included in the audit; and (B) may not audit a pharmacy on Mondays or on weeks containing a federal holiday, unless the pharmacy agrees to alternative timing for the audit. (3) Not to have an entity audit claims that:(A) were submitted to the pharmacy benefit manager more than 18 months prior to the date of the audit, unless: (i) required by federal law; or(ii) the originating prescription was dated within the 24-month period preceding the date of the audit; or (B) exceed 200 selected prescription claims.(4) To have auditors enter the prescription department only when accompanied by or authorized by a member of the pharmacy staff, and not to have auditors disrupt the provision of services to the pharmacys customers. (5) Not to have clerical or recordkeeping errors, including typographical errors, scriveners errors, and computer errors, on a required document or record deemed fraudulent in the absence of any financial harm or other evidence; provided that this subdivision shall not be construed to prohibit recoupment of actual fraudulent payments. (6) If required under the terms of the contract, to have the auditing entity provide to the pharmacy, upon request, all records related to the audit in an electronic or digital media format. (7) In order to validate a pharmacy record with respect to a prescription or refill, to have the properly documented records of a hospital or of any person authorized by law to prescribe medication transmitted by any means of communication. (8) To use any prescription that meets the requirements to be a legal prescription under Vermont law, including prescriber notations such as as directed and as needed which require the professional judgment of the pharmacist to determine that the dose dispensed is within normal guidelines, to validate claims submitted for reimbursement for dispensing of original and refill prescriptions, or changes made to prescriptions. (9) To dispense and receive reimbursement for the full quantity of the smallest commonly available commercially packaged product, including eye drops, insulin, and topical products, that contains the total amount required to be dispensed to meet the days supply ordered by the prescriber, even if the full quantity of the commercially prepared package exceeds the maximum days supply allowed. (10) To determine the days supply using the highest daily total dose that may be utilized by the patient pursuant to the prescribers directions, and for prescriptions with a titrated dose schedule, to use the schedule to determine the days supply. (11) To be subject to recoupment only following the correction of a claim and to have recoupment limited to amounts paid in excess of amounts payable under the corrected claim. (12) Not to have a demand for recoupment, repayment, or offset against future reimbursement for overpayment of a claim for dispensing of an original or refill prescription include the dispensing fee, unless the prescription that is the subject of the claim was not actually dispensed, was not valid, was fraudulent, or was outside the provisions of the contract; provided that this subdivision shall not apply if a pharmacy is required to correct an error in a claim submitted in good faith. (13) Unless otherwise agreed to by contract, not to have an audit finding or demand for recoupment, repayment, or offset against future reimbursement made for any claim for dispensing of an original or refill prescription due to information missing from a prescription or to information not placed in a particular location when the information or location is not required or specified by State or federal law. The pharmacy shall be allowed 30 days to document and correct the missing information. (14) In the event the actual quantity dispensed on a valid prescription for a covered beneficiary exceeded the allowable maximum days supply of the product as defined in the contract, to have the amount to be recouped, repaid, or offset against future reimbursement limited to an amount calculated based on the quantity of the product dispensed found to be in excess of the allowed days supply quantity and using the cost of the product as reflected on the original claim. (15) Not to have the accounting practice of extrapolation used in calculating any recoupment or penalty, unless otherwise required by federal law or by federal health plans. (16) Except for cases of federal Food and Drug Administration regulation or drug manufacturer safety programs, to be free of recoupments based on either: (A) documentation requirements in addition to or in excess of State Board of Pharmacy documentation creation or maintenance requirements; or (B) a requirement that a pharmacy or pharmacist perform a professional duty in addition to or in excess of State Board of Pharmacy professional duty requirements. (17) Except for Medicare claims, to be subject to reversals of approval for drug, prescriber, or patient eligibility upon adjudication of a claim only in cases in which the pharmacy obtained the adjudication by fraud or misrepresentation of claim elements. (18) To be audited under the same standards and parameters as other similarly situated pharmacies audited by the same entity. (19) To have the preliminary audit report delivered to the pharmacy within 60 days following the conclusion of the audit. (20) To have at least 30 days following receipt of the preliminary audit report to produce documentation to address any discrepancy found during the audit. (21) To have a final audit report delivered to the pharmacy within 120 days after the end of the appeals period, as required by section 3803 of this title. (22) Except for audits initiated to address an identified problem, to be subject to no more than one audit per calendar year, unless fraud or misrepresentation is reasonably suspected. (23) Not to have audit information from an audit conducted by one auditing entity shared with or utilized by another auditing entity, except as required by State or federal law. (Added 2011, No. 150 (Adj. Sess.),  4.) 
 3803. Appeals
(a) An entity that audits a pharmacy shall provide the pharmacy with a preliminary audit report, which shall be delivered to the pharmacy or to its corporate office of record within 60 days following completion of the audit. (b) A pharmacy shall have 30 days following receipt of the preliminary audit report in which to respond to questions, provide additional documentation, and comment on and clarify audit findings. Receipt of the report shall be based on the date postmarked on the envelope or the date of a computer transmission, if transferred electronically. (c) If an audit results in the dispute or denial of a claim, the entity conducting the audit shall allow the pharmacy to resubmit the claim using any commercially reasonable method, including U.S. mail, facsimile, or electronic claims submission, as long as the period of time during which a claim may be resubmitted has not expired. (d) Within 120 days after the completion of the appeals process established by this section, a final audit report shall be delivered to the pharmacy or to its corporate office of record. The final audit report shall include a disclosure of any funds recovered by the entity that conducted the audit. (e) An entity that audits a pharmacy shall have in place a written appeals process by which a pharmacy may appeal the preliminary audit report and the final audit report, and shall provide the pharmacy with notice of the appeals process. (f) A pharmacy shall be entitled to request a mediator agreed upon by both parties to resolve any disagreements; such request shall not be deemed to waive any existing rights of appeal. (Added 2011, No. 150 (Adj. Sess.),  4.) 
 3804. Pharmacy audit recoupments
(a) Recoupment of any disputed funds shall occur only after the final internal disposition of an audit, including the appeals process set forth in section 3803 of this title. (b) An entity conducting an audit may not:(1) include dispensing fees in calculations of overpayments unless the prescription is determined to have been dispensed in error; (2) recoup funds for clerical or recordkeeping errors, including typographical errors, scriveners errors, and computer errors on a required document or record unless the error resulted in overpayment or the entity conducting the audit has evidence that the pharmacys actions reasonably indicate fraud or other intentional or willful misrepresentation; (3) collect any funds, charge-backs, or penalties until the audit and all appeals are final, unless the entity conducting the audit is alleging fraud or other intentional or willful misrepresentation; (4) recoup an amount in excess of the actual overpayment.(c) Recoupment on an audit shall be refunded to the responsible party as contractually agreed upon by the parties. (d) The entity conducting the audit may charge or assess the responsible party, directly or indirectly, based on amounts recouped if both of the following conditions are met: (1) the responsible party and the entity conducting the audit have entered into a contract that explicitly states the percentage charge or assessment to the responsible party; and (2) a commission or other payment to an agent or employee of the entity conducting the audit is not based, directly or indirectly, on amounts recouped. (Added 2011, No. 150 (Adj. Sess.),  4.) 
 3805. Applicability
The provisions of this chapter shall not apply to any audit or investigation undertaken by any State agency, including the Office of the Attorney General or the Agency of Human Services, to a fiscal agent of the State, or to any audit, review, or investigation that involves alleged Medicaid fraud, Medicaid waste, Medicaid abuse, insurance fraud, or criminal fraud or misrepresentation. (Added 2011, No. 150 (Adj. Sess.),  4.) 
 4023. Bread to be wrapped
A person shall not carry or cart about with intent to sell or offer for sale, or deliver to customers after it has been sold, for human food any kind or quality of bread or cake in loaf form, unless each loaf is wrapped separately in waxed paper, tissue paper, or some similar wrapper or a sanitary container of sufficient thickness and quality to protect the bread and cake from dust and dirt. A person who violates a provision of this section shall be fined $5.00 for each offense. 
 4024. Wood or methyl alcohol; sale for medicinal purposes
(a) A person shall not sell, offer, or expose for sale or have in his or her custody, possession, or control with intent to distribute or sell any commodity, food, drug, preparation, or mixture of any kind whatever intended for internal use, which contains methyl or wood alcohol, or sell, offer, or expose for sale or distribution, or have in his or her custody, possession, or control with intent to distribute, sell, furnish, or use upon or apply to the body of another, any drug, hair tonic, bay rum, or similar preparation intended for external use, which contains methyl or wood alcohol. Nothing in this section shall apply to veterinary remedies containing methyl or wood alcohol when such remedies are plainly and distinctly labeled in such manner as to indicate that they are intended solely for external use on animals. (b) A person who violates a provision of this section shall be imprisoned not more than three months or fined not more than $100.00 nor less than $5.00, or both. (Amended 1981, No. 223 (Adj. Sess.),  23.) 
 4025. Regulation of the sale of poisonous drugs
A person other than a registered pharmacist or physician, who sells or keeps for sale arsenic, corrosive sublimate, chloroform, aconite, strychnine, morphine, opium, cocaine, eucaine, heroin, carbolic acid, prussic acid, paregoric, chloral hydrate, belladonna, cyanide potassium, digitalis, nux vomica, or any salts, solutions, extracts, or tinctures of such drugs, shall keep and offer them for sale only in original and sealed packages or bottles which shall have been prepared by a registered pharmacist or manufacturing chemist, and under a label on which shall be plainly printed the name and nature of the drug therein contained, the proper antidote to be given when taken in dangerous or poisonous quantities, and the name of the pharmacist, manufacturing chemist, or wholesale house that prepared or put up the same, with the name of the place where it was manufactured or prepared for sale. A person who sells any of such drugs shall have affixed to the bottle, box, or wrapper containing the article sold a label of white paper upon which shall be printed in red letters the name and place of business of the vendor, and the words Poison and Antidote. The label shall also contain the name of an antidote, if any, for the poison sold. 
 4026. Sale of drugs; record
When a sale is made by any person of any of such drugs, salts, solutions, extracts, or tinctures, such sale shall be entered and recorded in a book kept for that purpose, giving the name of the article sold, date of sale, to whom sold, residence of purchaser, for whom purchased, the use to be made of the article or drug purchased, and the name of the salesperson or clerk making such sale. Such book shall be in such form as the Board shall prescribe and shall be open to the inspection of health officers, members of the Board, and prosecuting officers who may wish to examine the same. The provisions of this section shall not apply to compounds or preparations labeled according to other provisions of this chapter. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 4027. Penalty
A person who violates a provision of section 4026 of this title shall be fined not more than $100.00. 
 4028. Prescriptions
The provisions of sections 4025-4027 of this title shall not apply to legally qualified practitioners of medicine or to their prescriptions or recipes to their patients. 
 4029. Permit to use preservatives
Nothing in this title shall be so construed as to prevent the Board from issuing to a producer or manufacturer of food or drinks a permit to use such preservatives or coloring matters as the Board may determine are not detrimental to health. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 4030. Embargo, penalty
When it is found or there is probable cause to believe that an article of food or a drug is in violation of the provisions of this title, the Board or its authorized representative may embargo the distribution, sale, use, or transportation of such article until directions for its disposal shall be given by the Board or by action of court. A person, partnership, or corporation who moves, sells, or otherwise disposes of any article so embargoed shall be punished as provided in section 6 of this title. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 4031. Notice of violations of United States statutes
The board or an agent thereof shall notify the proper prosecuting officer of a violation of a federal law for preventing the adulteration or misbranding of food or drugs. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 113 (Adj. Sess.),  70.) 
 4051. Definitions
As used in this chapter:(1) The term Department means the Vermont Department of Health.(2) The term Board means the State Board of Health.(3) The term person includes an individual, partnership, corporation, and association.(4) The term food means:(A) articles used for food or drink for humans or other animals;(B) chewing gum; and(C) articles used for components of any such article.(5) The term drug means:(A) articles recognized in the official United States Pharmacopoeia, official homeopathic pharmacopoeia of the United States, or official national formulary, or any supplement to any of them; (B) articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in humans or other animals; (C) articles (other than food) intended to affect the structure or any function of the body of man or other animals; and (D) articles intended for use as a component of any article specified in subdivision (A), (B), or (C) of this subdivision (5) but does not include devices or their components, parts, or accessories. (6)(A) The term device (except when used in subdivision (18) of this section and in subdivisions 4052(10), 4060(6), 4064(3), and 4067(3) of this title) means instruments, apparatus, and contrivances, including their components, parts, and accessories, intended: (i) for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in humans or other animals; or (ii) to affect the structure of any function of the body of humans or other animals.(B) The term device shall not mean professional diagnostic instruments.(7) The term cosmetic means:(A) articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body or any part thereof for cleansing, beautifying, promoting attractiveness, or altering the appearance; and (B) articles intended for use as a component of any such articles, except that such term shall not include soap. (8) The term hazardous substance means any substance or mixture of substances which:(A) is toxic;(B) is corrosive;(C) is an irritant;(D) is flammable;(E) is radioactive; or(F) generates pressure through decomposition, heat, or other means if such substance or mixture of substances may cause substantial personal injury or illness during any customary or reasonably anticipated handling. (9) The term toxic shall apply to any substance which has the inherent capacity to produce bodily injury to humans through ingestion, inhalation, or absorption through the skin. (10)(A) The term poison means any toxic substance that falls within any of the following categories: (i) produces death within 48 hours in one-half or more than one-half of a group of 10 or more laboratory white rats each weighing between 200 and 300 grams, at a single dose of 50 milligrams or less per kilogram of body weight, when orally administered; or (ii) produces death within 48 hours in one-half or more than one-half of a group of 10 or more laboratory white rats each weighing between 200 and 300 grams, when inhaled continuously for a period of one hour or less at an atmospheric concentration of two milligrams or less per liter of gas, vapor mist, or dust, provided the concentration is likely to be encountered by man when the substance is used in any reasonably foreseeable manner; or (iii) produces death within 48 hours in one-half or more than one-half of a group of 10 or more rabbits tested in a dosage of 200 milligrams or less per kilogram of body weight, when administered by continuous contact with the bare skin for 24 hours or less. (B) If available data on human experience with any substance in the dosages or concentrations described in subdivision (A) of this subdivision (10) indicate results different from those obtained on animals, the human data shall take precedence. (11) The term corrosive means any substance which in contact with living tissue will cause substantial destruction of tissue by chemical action, but shall not refer to action on inanimate surfaces. (12) The term irritant means any substance, not corrosive within the meaning of subdivision (11) of this section, which on immediate, prolonged, or repeated contact with normal living tissue will induce a local inflammatory reaction. (13) The term flammable shall apply to any substance which has a flashpoint of 80 degrees Fahrenheit, or below, as determined by the Tagliabue open cup tester, except that the flammability of the contents of self-pressurized containers shall be determined by methods generally applicable to the containers and established by regulations issued by the Board. (14) The term radioactive shall apply to any substance which as a result of disintegration of unstable atomic nuclei, emits energy. (15) The term label means a display of written, printed, or graphic matter upon the immediate container of any article and a requirement made by or under authority of this chapter that any word, statement, or other information appearing on the label shall not be considered to be complied with unless such word, statement, or other information also appears on the outside container or wrapper, if any there be, of the retail package of the article, or is easily legible through the outside container or wrapper. (16) The term immediate container does not include package liners.(17) The term misbranded package means any retailed package of a hazardous substance, intended for household use, which fails to bear a label: (A) Which states conspicuously:(i) the name or identifying trade name or trademark and place of business of the manufacturer, packer, or distributor; (ii) the common or usual name, or the chemical name (if there be no common or usual name) or the recognized generic name (not trade name only) of the hazardous substance or of each component which contributes substantially to its hazard; (iii) one of the following signal words: danger, warning, or caution; when necessary an affirmative statement of the principal hazard or hazards such as flammable, vapor harmful, causes burns, absorbed through skin, or similar wording descriptive of the hazard; (iv) precautionary measures describing the action to be followed or avoided;(v) instructions, when necessary, for the first aid treatment in case of contact or exposure, if the substance is hazardous through contact or exposure; (vi) the word poison for any substance which is defined as poisonous by subdivision (10)(A) of this section; (vii) instructions for handling or storage; and(viii) the statement keep out of the reach of children, or its practical equivalent; and(B) On which any statement required under subdivision (A) of this subdivision (17) is located prominently and is in English in legible type in contrast by typography, layout, or color with other printed matter on the label: provided that the Board shall, by regulations, provide for minimum information which shall appear on the labels for small packages, which labels need not include all of the information required by this subsection; provided further, that the Board may provide for less than the foregoing statement of the hazard or precautionary measures for labels of hazardous substances presenting only minor hazards; and the term misbranded package shall not apply to packages of economic poisons subject to the federal Insecticide, Fungicide and Rodenticide Act, to packages of substances subject to the federal Food, Drug and Cosmetic Act or to packages of substances intended for use in agriculture, horticulture, industrial, or related uses. Nothing in this chapter shall be construed to be in conflict or interfere with the administration of 6 V.S.A. chapter 81. (18) If an article is alleged to be misbranded because the labeling is misleading, or if an advertisement is alleged to be false because it is misleading, then in determining whether the labeling or advertisement is misleading, there shall be taken into account (among other things) not only representations made or suggested by statement, word, design, device, sound, or in any combination thereof, but also the extent to which the labeling or advertisement fails to reveal facts material in the light of such representations, or material with respect to consequences which may result from the use of the article to which the labeling or advertisement relates under the conditions of use prescribed in the labeling or advertisement thereof or under such conditions of use as are customary or usual. (19) The term advertisement means all representations disseminated in any manner or by any means, other than by labeling, for the purpose of inducing, or which are likely to induce, directly or indirectly, the purchase of food, drugs, devices, or cosmetics. (20) The representation of a drug, in its labeling or advertisement, as an antiseptic shall be considered to be a representation that it is a germicide, except in the case of a drug purporting to be, or represented as, an antiseptic for inhibitory use as a wet dressing, ointment, dusting powder, or such other use as involves prolonged contact with the body. (21) The term new drug means:(A) any drug the composition of which is such that such drug is not generally recognized among experts qualified by scientific training and experience to evaluate the safety of drugs, as safe for use under the conditions prescribed, recommended, or suggested in the labeling thereof; or (B) any drug the composition of which is such that such drug, as a result of investigations to determine its safety for use under such conditions, has become so recognized, but which has not, otherwise than in such investigations, been used to a material extent or for a material time under such conditions. (22) The term contaminated with filth applies to any food, drug, device, or cosmetic not securely protected from dust, dirt, and as far as may be necessary by all reasonable means, from all foreign or injurious contaminations. (23) The provisions of this chapter regarding the selling of food, drugs, devices, or cosmetics shall be considered to include the manufacture, production, processing, packing, offer, possession, and holding of any such article for sale; and the sale, dispensing, and giving of any such article, and the supplying or applying of any such articles in the conduct of any food, drug, or cosmetic establishment. (24) The term federal act means the federal Food, Drug and Cosmetic Act, 21 U.S.C.  301 et seq.; 52 Stat. 1040 et seq. (Added 1959, No. 172,  2, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2015, No. 23,  107; 2017, No. 113 (Adj. Sess.),  71; 2019, No. 131 (Adj. Sess.),  122.)
 4052. Manufacture, sale, delivery; prohibitions
The following acts and the causing thereof within the State of Vermont are hereby prohibited: (1) the manufacture, sale, or delivery, holding, or offering for sale of any food, drug, device, or cosmetic that is adulterated or misbranded; (2) the adulteration or misbranding of any food, drug, device, or cosmetic;(3) the receipt in commerce of any food, drug, device, or cosmetic that is adulterated or misbranded, and the delivery or proffered delivery thereof for pay or otherwise; (4) the sale, delivery for sale, holding for sale, or offering for sale of any article in violation of section 4061 or 4065 of this title; (5) the dissemination of any false advertisement;(6) the refusal to permit entry or inspection, or to permit the taking of a sample, as authorized by section 4070 of this title; (7) the giving of a guaranty or undertaking which guaranty or undertaking is false, except by a person who relied on a guaranty or undertaking to the same effect signed by and containing the name and address of the person residing in the State of Vermont from whom he or she received in good faith the food, drug, device, or cosmetic; (8) the removal or disposal of a detained or embargoed article in violation of section 4055 of this title; (9) the alteration, mutilation, destruction, obliteration, or removal of the whole or any part of the labeling of, or the doing of any other act with respect to a food, drug, device, or cosmetic, if such act is done while such article is held for sale and results in such article being adulterated or misbranded; (10) forging, counterfeiting, simulating, or falsely representing, or without proper authority using any mark, stamp, tag, label, or other identification device authorized or required by regulations promulgated under the provisions of this chapter; (11) the using, on the labeling of any drug or in any advertisement relating to such drug, of any representation or suggestion that any application with respect to such drug is effective under section 4065 of this title, or that such drug complies with the provisions of such section; (12) The sale, offering for sale, distribution, or transportation for sale within this State of any misbranded package of a hazardous substance in a package or container intended for general home and household use. (Added 1959, No. 172,  3, eff. May 12, 1959; amended 2017, No. 113 (Adj. Sess.),  72.) 
 4053. Rules and hearings
(a) The authority to enforce this chapter is vested in the Board. The Board shall from time to time for the efficient enforcement of this chapter adopt rules after public hearing following due notice at least ten days in advance of the hearings to interested persons. (b) In addition to the other remedies provided in this chapter, the Board is hereby authorized through the Attorney General or States Attorneys to apply to the Civil or Criminal Division of any Superior Court, and the court shall have jurisdiction upon hearing and for cause shown, to grant a temporary or permanent injunction restraining any person from violating any provision of this chapter, irrespective of whether or not there exists an adequate remedy at law. (c)(1) Any hazardous substance that is in a misbranded package when introduced into or while in intrastate commerce within this State for sale within this State shall be liable to be proceeded against on libel of information and condemned in any court within this State having jurisdiction over such an action. Any hazardous substance condemned under this section shall, after entry of the decree, be disposed of by destruction or sale as the court may direct and the proceeds thereof, if sold, less the legal costs and charges, shall be paid to the State Treasurer, but the hazardous substance shall not be sold under the decree contrary to the provisions of this chapter or the laws of the jurisdiction in which sold, provided that, upon the payment of costs of the proceeding and the execution and delivery of a good and sufficient bond conditioned that the hazardous substance shall not be sold or disposed of contrary to the provisions of this chapter, the court may direct that the hazardous substance be delivered to the owner thereof to be destroyed or brought into compliance with the provisions of this chapter by relabeling or reprocessing, as the case may be. (2) When a decree of condemnation is entered against the hazardous substance, court costs and fees and storage and other proper expenses shall be awarded against the person, or one intervening as claimant of the hazardous substance. (d) Before any violation of this chapter is reported for institution of a criminal proceeding, the person against whom such proceeding is contemplated may be given appropriate notice and an opportunity to present his or her views to the Board, either orally or in writing, with regard to the contemplated proceeding. Nothing in this chapter shall be construed as requiring the Board to report for prosecution or for the institution of libel proceedings minor violations of the chapter whenever it believes that the public interest will be best served by a suitable notice of warning in writing. (Added 1959, No. 172,  4, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1965, No. 194,  10, eff. July 1, 1965, operative Feb. 1, 1967; 1973, No. 193 (Adj. Sess.),  3, eff. April 9, 1974; 2009, No. 128 (Adj. Sess.),  38a; 2009, No. 154 (Adj. Sess.),  145; 2015, No. 23,  108.) 
 4054. Penalties
(a) A person who violates any of the provisions of section 4052 of this title shall be imprisoned for not more than one year or fined not more than $1,000.00, or both; but if the violation is committed after a conviction of the person under this section has become final, the person shall be imprisoned for not more than one year or fined not more than $2,500.00, or both. (b) A person shall not be subject to the penalties of subsection (a) of this section for having violated subdivision 4052(1) or (3) of this title if he or she establishes a guaranty or undertaking signed by, and containing the name and address of the person residing in the State of Vermont from whom he or she received in good faith the article, to the effect that the article is not adulterated or misbranded within the meaning of this chapter, designating this chapter. (c) No publisher, radio broadcast licensee, or agency or medium for the dissemination of an advertisement, except the manufacturer, packer, distributor, or seller of the article to which a false advertisement relates, shall be liable under this section by reason of the dissemination by him or her of such false advertisement, unless he or she has refused, on the request of the Board, to furnish the Board the name and post office address of the manufacturer, packer, distributor, seller, or advertising agency, residing in the State of Vermont, who causes him or her to disseminate such advertisement. (Added 1959, No. 172,  5, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 4055. Marking; notice
(a) Whenever a duly authorized agent of the Board finds or has probable cause to believe that any food, drug, device, or cosmetic is adulterated, or so misbranded as to be dangerous or fraudulent, within the meaning of this chapter, he or she shall affix to such article a tag or other appropriate marking, giving notice that the article is, or is suspected of being, adulterated or misbranded and has been detained or embargoed, and warning all persons not to remove or dispose of the article by sale or otherwise until permission for removal or disposal is given by the agent or the court. It shall be unlawful for any person to remove or dispose of the detained or embargoed article by sale or otherwise without that permission. (b) When an article detained or embargoed under subsection (a) of this section has been found by the agent to be adulterated or misbranded, he or she shall petition the Civil or Criminal Division of the Superior Court in the unit where the article is detained or embargoed for a libel for condemnation of the article. When the agent has found that an article so detained or embargoed is not adulterated or misbranded, he or she shall remove the tag or other marking. (c) If the court finds that a detained or embargoed article is adulterated or misbranded, the article shall, after entry of the decree, be destroyed at the expense of the claimant thereof, under the supervision of the agent, and all court costs and fees, and storage and other proper expenses, shall be taxed against the claimant of the article or his or her agent; provided that when the adulteration or misbranding can be corrected by proper labeling or processing of the article, the court, after entry of the decree and after the costs, fees, and expenses have been paid and a good and sufficient bond, conditioned that the article shall be so labeled or processed, has been executed, may by order direct that the article be delivered to the claimant thereof for such labeling or processing under the supervision of an agent of the Board. The expense of the supervision shall be paid by the claimant. The bond shall be returned to the claimant of the article on representation to the court by the Board that the article is no longer in violation of this chapter and that the expenses of supervision have been paid. (d) Whenever the Board or any of its authorized agents find in any room, building, vehicle of transportation, or other structure any meat, seafood, poultry, vegetable, fruit, or other perishable articles which are unsound, or contain any filthy, decomposed, or putrid substance, or that may be poisonous or deleterious to health or otherwise unsafe, those articles and substances being hereby declared to be a nuisance, the Board, or its authorized agent, shall forthwith condemn or destroy them, or in any other manner render them unsalable as human food. (Added 1959, No. 172,  6, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1965, No. 194,  10, eff. July 1, 1965, operative Feb. 1, 1967; 1973, No. 193 (Adj. Sess.),  3, eff. April 8, 1974; 2009, No. 128 (Adj. Sess.),  38a; 2009, No. 154 (Adj. Sess.),  146.) 
 4056. Proceedings
(a) Each States Attorney to whom the Board reports any violation of this chapter shall cause appropriate proceedings to be instituted in the proper courts without delay and to be prosecuted in the manner required by law. (b) Before any violation of this chapter is reported to any such attorney for the institution of a criminal proceeding, the person against whom the proceeding is contemplated shall be given appropriate notice and an opportunity to present his or her views before the Board or its designated agent, either orally or in writing, in person, or by attorney, with regard to the contemplated proceedings. (Added 1959, No. 172,  7, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 93 (Adj. Sess.),  16.) 
 4057. Construction
Nothing in this chapter shall require the Board to report for the institution of proceedings under this chapter, minor violations of this chapter, whenever the Board believes that the public interest will be adequately served in the circumstances by a suitable written notice of warning. (1959, No. 172,  8, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 4058. Rules; standards
Whenever in the judgment of the Board such action will promote honesty and fair dealing in the interest of consumers, the Board shall adopt rules fixing and establishing for any food or class of food a reasonable definition and standard of identity, or reasonable standard of quality or fill of container. In prescribing a definition and standard of identity for any food or class of food in which optional ingredients are permitted, the Board shall, for the purpose of promoting honesty and fair dealing in the interest of consumers, designate the optional ingredients which shall be named on the label. The definitions and standard so adopted shall conform so far as practicable to the definitions and standards promulgated under authority of the federal act. (Added 1959, No. 172,  9, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2015, No. 23,  109.) 
 4059. Adulterated food defined
A food shall be deemed to be adulterated:(1)(A) If it bears or contains any poisonous or deleterious substance which may render it injurious to health; but in case the substance is not an added substance, the food shall not be considered adulterated under this clause if the quantity of the substance in the food does not ordinarily render it injurious to health; (B) if it bears or contains any added poisonous or added deleterious substance which is unsafe within the meaning of section 4062 of this title; (C) if it consists in whole or in part of a diseased, contaminated, filthy, putrid, or decomposed substance, or if it is otherwise unfit for food; (D) if it has been produced, prepared, packed, or held under unsanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered diseased, unwholesome, or injurious to health; (E) if it is the product of a diseased animal or an animal which has died otherwise than by slaughter, or that has been fed upon the uncooked offal from a slaughterhouse; or (F) if its container is composed, in whole or in part, of any poisonous or deleterious substance which may render the contents injurious to health. (2)(A) If any valuable constituent has been in whole or in part omitted or abstracted therefrom;(B) if any substance has been substituted wholly or in part therefor;(C) if damage or inferiority has been concealed in any manner; or(D) if any substance has been added thereto or mixed or packed therewith so as to increase its bulk or weight, or reduce its quality or strength or make it appear better or of greater value than it is. (3) If it is confectionery and it bears or contains any alcohol or nonnutritive article or substance except harmless coloring, harmless flavoring, harmless resinous glaze not in excess of four-tenths of one percent, harmless natural wax not in excess of four-tenths of one percent, harmless natural gum and pectin; provided that this subdivision shall not apply to any confectionery by reason of its containing less than one-half of one percent by volume of alcohol derived solely from the use of flavoring, extracts, or to any chewing gum by reason of its containing harmless nonnutritive masticatory substances. (4) If it bears or contains a coal tar color other than one from a batch which has been certified under authority of the federal act. (Added 1959, No. 172,  10, eff. May 12, 1959.) 
 4060. Misbranded food
A food shall be deemed to be misbranded:(1) If its labeling is false or misleading in any particular.(2) If it is offered for sale under the name of another food.(3) If it is an imitation of another food for which a definition and standard of identity have been prescribed by rules adopted pursuant to section 4058 of this title; or if it is an imitation of another food that is not subject to subdivision (7) of this section, unless its label bears in type of uniform size and prominence the word imitation and, immediately thereafter, the name of the food imitated. (4) If its container is so made, formed, or filled as to be misleading.(5) If in package form, unless it bears a label containing:(A) the name and place of business of the manufacturer, packer, or distributor; and(B) an accurate statement of the quantity of the contents in terms of weight, measure, or numerical count; provided that under this subdivision reasonable variations shall be permitted, and exemptions as to small packages shall be established by rules prescribed by the Board. (6) If any word, statement, or other information required by or under authority of this chapter to appear on the label or labeling is not prominently placed thereon with such conspicuousness (as compared with other words, statements, designs, or devices, in the labeling) and in such terms as to render it likely to be read and understood by the ordinary individual under customary conditions of purchase and use. (7) If it purports to be or is represented as a food for which a definition and standard of identity has been prescribed by rules adopted pursuant to section 4058 of this title, unless: (A) it conforms to that definition and standard; and(B) its label bears the name of the food specified in the definition and standard and, insofar as may be required by the rules, the common names of optional ingredients (other than spices, flavoring, and coloring) present in the food. (8) If it purports to be or is represented as:(A) a food for which a standard of quality has been prescribed by rules adopted pursuant to section 4058 of this title, and its quality falls below the standard unless its label bears, in such manner and form as the rules specify, a statement that it falls below those standards; or (B) a food for which a standard or standards of fill of container have been prescribed by rules adopted pursuant to section 4058 of this title, and it falls below the standard of fill of container applicable thereto, unless its label bears, in such manner and form as the rules specify, a statement that it falls below the standard. (9) If it is not subject to the provisions of subdivision (7) of this section, unless it bears labeling clearly giving: (A) the common or usual name of the food, if any there be; and(B) in case it is fabricated from two or more ingredients, the common or usual name of each such ingredient; except that spices, flavorings, and colorings, other than those sold as such, may be designated as spices, flavorings, and colorings, without naming each; provided that, to the extent that compliance with the requirements of this subdivision is impractical or results in deception or unfair competition, exemptions shall be established by rules adopted by the Board. And provided, further, that the requirements of this subdivision shall not apply to food products that are packaged at the direction of purchasers at retail at the time of sale, the ingredients of which are disclosed to the purchasers by other means in accordance with rules adopted by the Board. (10) If it purports to be or is represented for special dietary uses, unless its label bears such information concerning its vitamin, mineral, and other dietary properties as the Board determines to be, and by rules adopted, as necessary in order to inform purchasers fully as to its value for such uses. (11) If it bears or contains any artificial flavoring, artificial coloring, or chemical preservative, unless it bears labeling stating that fact; provided that to the extent that compliance with the requirements of this subsection is impracticable, exemptions shall be established by rules adopted by the Board. (12) If it is a product intended as an ingredient of another food and when used according to the directions of the purveyor will result in the final food product being adulterated or misbranded. (Added 1959, No. 172,  11, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 113 (Adj. Sess.),  73.) 
 4061. Regulations of permits; investigation
(a) Whenever the Board finds after investigation that the distribution in Vermont of any class of food may, by reason of contamination with micro organisms during manufacture, processing, or packing thereof in any locality, be injurious to health, and that the injurious nature cannot be adequately determined after the articles have entered commerce, it then, and in that case only, shall adopt rules providing for the issuance to manufacturers, processors, or packers of that class of food in that locality, of permits to which shall be attached such conditions governing the manufacture, processing, or packing of that class of food and for such temporary period of time, as may be necessary to protect the public health; and after the effective date of the rules and during the temporary period, no person shall introduce or deliver for introduction into commerce any such food manufactured, processed, or packed by any such manufacturer, processor, or packer unless the manufacturer, processor, or packer holds a permit issued by the Board as provided by the rules. (b) The Board is authorized to suspend immediately upon notice any permit issued under authority of this section if it is found that any of the conditions of the permit have been violated. The holder of a permit so suspended shall be privileged at any time to apply for the reinstatement of the permit and the Board shall, immediately after prompt hearing and inspection of the establishment, reinstate the permit if it is found that adequate measures have been taken to comply with and maintain the conditions of the permit, as originally issued, or as amended. (c) Any officer or employee duly designated by the Board shall have access to any factory or establishment, the operator of which holds a permit from the Board, for the purpose of ascertaining whether or not the conditions of the permit are being complied with, and denial of access for the inspection shall be grounds for suspension of the permit until the access is freely given by the operator. (Added 1959, No. 172,  12, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2015, No. 23,  110.) 
 4062. Substances added to food; rules
Any poisonous or deleterious substance added to any food except where the substance is required in the production thereof or cannot be avoided by good manufacturing practice shall be deemed to be unsafe for purposes of the application of subdivision 4059(1)(B) of this title; but when the substance is so required or cannot be so avoided, the Board shall adopt rules limiting the quantity therein or thereon to such extent as the Board finds necessary for the protection of public health, and any quantity exceeding the limits so fixed shall also be deemed to be unsafe for purposes of the application of subdivision 4059(1)(B) of this title. While such a rule is in effect limiting the quantity of any such substance in the case of any food, the food shall not, by reason of bearing or containing any added amount of the substance, be considered to be adulterated within the meaning of subdivision 4059(1)(A) of this title. In determining the quantity of the added substance to be tolerated in or on different articles of food, the Board shall take into account the extent to which the use of the substance is required or cannot be avoided in the production of each such article and the other ways in which the consumer may be affected by the same or other poisonous or deleterious substances. (Added 1959, No. 172,  13, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2015, No. 23,  111.) 
 4063. Adulterated drug or device defined
A drug or device shall be deemed to be adulterated:(1)(A) If it consists in whole or in part of any filthy, putrid, or decomposed substance;(B) if it has been produced, prepared, packed, or held under unsanitary conditions whereby it may have been contaminated with filth, or whereby it may have been rendered injurious to health; (C) if it is a drug and its container is composed, in whole or in part, of any poisonous or deleterious substance which may render the contents injurious to health; or (D) if it is a drug and it bears or contains, for purposes of coloring only, a coal tar color other than one from a batch certified under the authority of the federal act. (2) If it purports to be or is represented as a drug the name of which is recognized in an official compendium, and its strength differs from, or its quality or purity falls below, the standard set forth in the compendium. The determination as to strength, quality, or purity shall be made in accordance with the tests or methods of assay set forth in the compendium, or in the absence of or inadequacy of the tests or methods of assay, those prescribed under authority of the federal act. No drug defined in an official compendium shall be deemed to be adulterated under this subdivision because it differs from the standard of strength, quality, or purity therefor set forth in the compendium, if its difference in strength, quality, or purity from the standard is plainly stated on its label. Whenever a drug is recognized in both the United States Pharmacopoeia and the Homeopathic Pharmacopoeia of the United States, it shall be subject to the requirements of the United States Pharmacopoeia unless it is labeled and offered for sale as a homeopathic drug, in which case it shall be subject to the provisions of the Homeopathic Pharmacopoeia of the United States and not to those of the United States Pharmacopoeia. (3) If it is not subject to the provisions of subdivision (2) of this section and its strength differs from, or its purity or quality falls below, that which it purports or is represented to possess. (4) If it is a drug and any substance has been:(A) mixed or packed therewith so as to reduce its quality or strength; or(B) substituted wholly or in part therefor. (Added 1959, No. 172,  14, eff. May 12, 1959.)
 4064. Misbranded drugs or device
A drug or device is misbranded:(1) If its labeling is false or misleading in any particular.(2) If in package form unless it bears a label containing:(A) the name and place of business of the manufacturer, packer, or distributor; and(B) an accurate statement of the quantity of the contents in terms of weight, measure, or numerical count; provided that under this subdivision (B) reasonable variations shall be permitted, and exemptions as to small packages shall be established by rules adopted by the Board. (3) If any word, statement, or other information required by or under authority of this chapter to appear on the labeling is not prominently placed thereon with such conspicuousness (as compared with other words, statements, designs, or devices, in the labeling) and in such terms as to render it likely to be read and understood by the ordinary individual under customary conditions of purchase and use. (4) If it is for use by humans and contains any quantity of the narcotic or hypnotic substance alpha-eucaine, barbituric acid, beta-eucaine, bromal, cannabis, carbromal, chloral, coca, cocaine, codeine, heroin, morphine, opium, paraldehyde, peyote, sulphonmethane, or other recognized narcotic or hypnotic substances or any chemical derivative of those substances, which derivative has been by the Board, after investigation, found to be, and by rules under this chapter, designated as, habit forming, unless its label bears the name and quantity or proportion of the substance or derivative and in juxtaposition therewith the statement warningmay be habit forming. (5) If it is a drug and is not designated solely by a name recognized in an official compendium unless its label bears: (A) the common or usual name of the drug, if such there be; and(B) in case it is fabricated from two or more ingredients, the common or usual name of each active ingredient, including the kind and quantity or proportion of any alcohol, and also including whether active or not the name and quantity or proportion of any bromides, ether, chloroform, acetanilid, acetphenetidin, amidopyrine, antipyrine, atropine, hyoscine, hyoscyamine, arsenic, digitalis, glucosides, mercury, ouabain, strophanthin, strychnine, thyroid, or other synthetic compounds, or any derivative or preparation of any of those substances, contained therein; provided that to the extent that compliance with the requirements of this subdivision (B) is impracticable, exemptions shall be established by rules adopted by the Board. (6) Unless its labeling bears:(A) adequate directions for use; and(B) such adequate warnings against use in those pathological conditions or by children where its use may be dangerous to health, or against unsafe dosage or methods or duration of administration or application, in such manner and form, as are necessary for the protection of users; provided that where any requirement of this subsection, as applied to any drug or device, is not necessary for the protection of the public health, the Board shall adopt rules exempting the drug or device from the requirements. (7) If it purports to be a drug the name of which is recognized in an official compendium, unless it is packaged and labeled as prescribed therein; provided that the method of packing may be modified with consent of the Board. Whenever a drug is recognized in both the United States Pharmacopoeia and the Homeopathic Pharmacopoeia of the United States, it shall be subject to the requirements of the United States Pharmacopoeia with respect to packaging and labeling unless it is labeled and offered for sale as a homeopathic drug, in which case it shall be subject to the provisions of the Homeopathic Pharmacopoeia of the United States, and not to those of the United States Pharmacopoeia. (8) If it has been found by the Board to be a drug liable to deterioration, unless it is packaged in such form and manner, and its label bears a statement of such precautions, as the Board shall by rule require as necessary for the protection of public health. No such rule shall be established for any drug recognized in an official compendium until the Board informs the appropriate body charged with the revision of the compendium of the need for the packaging or labeling requirements and that body fails within a reasonable time to prescribe the requirements. (9)(A) If it is a drug and its container is so made, formed, or filled as to be misleading;(B) if it is an imitation of another drug; or(C) if it is offered for sale under the name of another drug.(10) If it is dangerous to health when used in the dosage, or with the frequency or duration prescribed, recommended, or suggested in the labeling thereof. (11) If it is a drug sold at retail and contains any quantity of aminopyrine, barbituric acid, cinchophen, pituitary, thyroid, or their derivatives; or it is a drug or device sold at retail and its label (as originally packed) directs that it is to be dispensed or sold only on prescription, unless it is dispensed or sold on a written prescription signed by a practitioner who is licensed by law to administer the drug or device and its label (as dispensed) bears the name and place of business of the dispenser or seller, the serial number and date of the prescription, and the name of the licensed practitioner. Those prescriptions shall not be refilled except on the specific authorization of the prescribing practitioner, provided that where any requirement of this subsection, as applied to any drug or device, is not necessary for the protection of the public health, the Board shall adopt rules exempting the drug or device from the requirement. (12) A drug sold on a written prescription signed by a member of the medical, dental, or veterinary profession (except a drug sold in the course of the conduct of a business of selling drugs pursuant to diagnosis by mail) shall be exempt from the requirement of this section if: (A) the member of the medical, dental, or veterinary profession is licensed by law to administer the drug or recognized synthetic compounds; and (B) the drug bears a label containing the name and place of business of the seller, the serial number and date of the prescription, and the name of the member of the medical, dental, or veterinary profession. (Added 1959, No. 172,  15, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2015, No. 23,  112.) 
 4064a. Misbranded drugs or devices sold by prescription
(a) Except as provided in subsections (b), (c), and (d) of this section, a drug or device which is sold or offered for sale by prescription, including those transported or mailed into this State for use in this State although purchased elsewhere, is misbranded: (1) if its labeling is false or misleading in any particular; or(2) unless it is labeled with the following:(A) the name of the patient or if the patient is an animal the name of its owner and the species of the animal; (B) the expiration date of the drug where the date is required by law or has been determined by the manufacturer, Board, or any agency of the State or U.S. government, if this date is less than one year from date of dispensing; (C) the name or place of business of the dispenser;(D) the serial number and the date the prescription was filled;(E) directions for use as may be stated in the prescription and the name of the medical, dental, osteopathic, or veterinary professional prescribing the drug or device; (F) the name and strength of the drug or its generic equivalent, if any, according to the latest official United States Pharmacopoeia, latest official homeopathic pharmacopoeia of the United States, or latest official national formulary, or any supplement to any of them; (G) the name of the drug shall be the same as written by the prescriber, unless the prescription has been filled with a generic equivalent approved by the prescriber and the purchaser has been informed of the change. (b) The labeling requirements of subdivisions (a)(2)(F) and (G) of this section shall not apply to a drug or device if the prescribing physician explicitly requests for medical reasons that such information shall be omitted. (c) The labeling requirements of subsection (a) of this section shall not apply to a drug or device administered under the supervision of a licensed physician to patients within a hospital or nursing home. (d) Nothing in this section shall be construed to limit the ability of a licensed physician to give, administer, or dispense any drug or device to a patient under his or her care. (Added 1971, No. 182 (Adj. Sess.), eff. July 1, 1972; amended 2007, No. 163 (Adj. Sess.),  4.) 
 4065. New drugs; sale regulations
(a) No person shall sell, deliver, offer for sale, hold for sale, or give away any new drug unless: (1) an application with respect thereto has become effective under section 505 of the federal act; or (2) when not subject to the federal act, unless the drug has been tested and has not been found to be unsafe for use under the conditions prescribed, recommended, or suggested in the labeling thereof and before selling or offering the drug for sale, there has been filed with the Board an application setting forth: (i) full reports of investigations which have been made to show whether or not the drug is safe for use; (ii) a full list of the articles used as components of the drug;(iii) a full statement of the composition of the drug;(iv) a full description of the methods used in and the facilities and controls used for the manufacture, processing, and packing of the drug; (v) such samples of the drug and of the articles used as components thereof as the Board may require; and (vi) specimens of the labeling proposed to be used for the drug.(b) An application provided for in subdivision (a)(2) of this section shall become effective on the 60th day after the filing thereof, except that if the Board finds, after due notice to the applicant and giving him or her an opportunity for a hearing, that the drug is not safe for use under the conditions prescribed, recommended, or suggested in the proposed labeling thereof, he or she shall, before the effective date of the application, issue an order refusing to permit the application to become effective. (c) This section shall not apply:(1) to a drug intended solely for investigational use by experts qualified by scientific training and experience to investigate the safety in drugs, provided the drug is plainly labeled for investigational use only; (2) to a drug sold in this State at any time before the enactment of this chapter or introduced into interstate commerce at any time before the enactment of the federal act; or (3) to any drug which is licensed under the Virus, Serum and Toxin Act of July 1, 1902 (U.S.C. 1934 ed. title 42, chap. 4). (d) An order refusing to permit an application under this section to become effective may be revoked by the Board. (Added 1959, No. 172,  16, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 4066. Adulterated cosmetic
A cosmetic shall be deemed to be adulterated:(1) If it bears or contains any poisonous or deleterious substance which may render it injurious to users under the conditions of use prescribed in the labeling or advertisement thereof, or under such conditions of use as are customary or usual. Provided, that this provision shall not apply to coal tar hair dye the label of which bears the following legend conspicuously displayed thereon: cautionthis product contains ingredients which may cause skin irritation on certain individuals and a preliminary test according to accompanying directions should first be made. This product must not be used for dyeing the eyelashes or eyebrows, to do so may cause blindness, and the labeling of which bears adequate directions for the preliminary testing. For the purpose of this subdivision and subdivision (5) of this section, the term hair dye shall not include eyelash dyes or eyebrow dyes. (2) If it consists in whole or in part of any filthy, putrid, or decomposed substance.(3) If it has been produced, prepared, packed, or held under unsanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered injurious to health. (4) If its container is composed, in whole or in part, of any poisonous or deleterious substance which may render the contents injurious to health. (5) If it is not a hair dye and it bears or contains a coal tar color other than one from a batch which has been certified under authority of the federal act. (Added 1959, No. 172,  17, eff. May 12, 1959.) 
 4067. Misbranded cosmetic
A cosmetic shall be deemed to be misbranded:(1) if its labeling is false or misleading in any particular;(2) if in package form unless it bears a label containing:(A) the name and place of business of the manufacturer, packer, or distributor; and(B) an accurate statement of the quantity of the contents in terms of weight, measure, or numerical count: provided that under this subdivision (B) reasonable variations shall be permitted and exemptions as to small packages shall be established by regulations prescribed by the Board; (3) if any word, statement, or other information required by or under authority of this chapter to appear on the label or labeling is not prominently placed thereon with such conspicuousness (as compared with other words, statements, designs, or devices in the labeling) and in such terms as to render it likely to be read and understood by the ordinary individual under customary conditions of purchase and use; (4) if its container is so made, formed, or filled as to be misleading. (Added 1959, No. 172,  18, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.)
 4068. Advertising regulations
(a) An advertisement of a food, drug, device, or cosmetic shall be deemed to be false if it is false or misleading in any particular. (b) For the purpose of this chapter, the advertisement of a drug or device representing it to have any effect in albuminuria, appendicitis, arteriosclerosis, blood poison, bone disease, Brights disease, cancer, carbuncles, cholecystitis, diabetes, diphtheria, dropsy, erysipelas, gallstones, heart and vascular diseases, high blood pressure, mastoiditis, measles, meningitis, mumps, nephritis, otitis media, paralysis, pneumonia, poliomyelitis (infantile paralysis), prostate gland disorders, pyelitis, scarlet fever, sexual impotence, sinus infection, smallpox, tuberculosis, tumors, typhoid, uremia, or venereal disease shall also be deemed to be false, except that no advertisement, not in violation of subsection (a) of this section, shall be deemed to be false under this subsection if it is disseminated only to members of the medical, dental, or veterinary professions, or appears only in the scientific periodicals of these professions, or is disseminated only for the purpose of public health education by persons not commercially interested, directly or indirectly, in the sale of the drugs or devices; provided that whenever the Board determines that an advance in medical science has made any type of self-medication safe as to any of the diseases named in this subsection, the Board shall by regulation authorize the advertisement of drugs having curative or therapeutic effect for the disease, subject to such conditions and restrictions as the Board may deem necessary in the interests of public health; provided that this subsection shall not be construed as indicating that self-medication for diseases other than those named herein is safe or efficacious. (Added 1959, No. 172,  19, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 4069. Rules; authority
(a) The authority to adopt rules for the efficient enforcement of this chapter is hereby vested in the Board. The Board may make the rules adopted under this chapter conform, insofar as practicable, with those promulgated under the federal act. (b) Hearings authorized or required by this chapter shall be conducted by the Board or such officer, agent, or employee as the Board may designate for the purpose. (c) Before adopting any rules contemplated by section 4058; subdivision 4060(10); section 4061; subdivisions 4064(4), (6), (7), (8), and (11); or subsection 4068(b) of this title, the Board shall give appropriate notice of the proposal and of the time and place for a hearing. The rule so adopted shall take effect on a date fixed by the Board, which date shall not be earlier than 60 days after its adoption. The rule may be amended or repealed in the same manner as is provided for its adoption, except that in the case of a rule amending or repealing any such rule, the Board, to such extent as it deems necessary in order to prevent undue hardship, may disregard the foregoing provisions regarding notice, hearing, or effective date. (Added 1959, No. 172,  20, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2015, No. 23,  113.) 
 4070. Inspection; examination of samples
(a) The Board or its duly authorized agent shall have free access at all reasonable hours to any factory, warehouse, or establishment in which food, drugs, devices, or cosmetics are manufactured, processed, packed, or held for introduction into commerce, or to enter any vehicle being used to transport or hold such food, drugs, devices, or cosmetics in commerce, for the purpose: (1) of inspecting the factory, warehouse, establishment, or vehicle to determine if any of the provisions of this chapter are being violated; and (2) to secure samples or specimens of any food, drug, device, or cosmetic after paying or offering to pay for the sample. (b) It shall be the duty of the Board to make or cause to be made examinations of samples secured under the provisions of this section to determine whether any provision of this chapter is being violated. (Added 1959, No. 172,  21, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 113 (Adj. Sess.),  74.) 
 4071. Reports
(a) The Board may cause to be published, from time to time, reports summarizing all judgments, decrees, and court orders which have been rendered under this chapter, including the nature of the charge and the disposition thereof. (b) The Board may also cause to be disseminated such information regarding food, drugs, devices, and cosmetics as the Board deems necessary in the interest of public health and the protection of the consumer against fraud. Nothing in this section shall be construed to prohibit the Board from collecting, reporting, and illustrating the results of the investigations of the Board. (Added 1959, No. 172,  22, eff. May 12, 1959; amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 4086. Menus and menu boards
(a) Restaurants and similar food establishments that are part of a chain with 20 or more locations doing business under the same name and offering for sale substantially the same menu items shall disclose on the menu and on the menu board: (1) adjacent to the name of each standard menu item the number of calories contained in the item; and (2) a succinct statement concerning suggested daily caloric intake.(b) This section shall not apply to alcoholic beverages or to grocery stores except for separately owned food facilities to which this section otherwise applies that are located in a grocery store. For purposes of this section, grocery stores include convenience stores. (c) If at any time subsection (a) or (b) of this section, or both, are preempted by federal law, then restaurants and similar food establishments that are part of a chain with 20 or more locations doing business under the same name and offering for sale substantially the same menu items shall comply with the menu labeling provisions of the applicable federal statutes and regulations. (d) A violation of this section shall be deemed a violation of the Consumer Protection Act, 9 V.S.A. chapter 63, provided that no private right of action shall arise from the provisions of this section. The Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance, and bring civil actions as provided under 9 V.S.A. chapter 63, subchapter 1. (Added 2009, No. 128 (Adj. Sess.),  38b, eff. Jan. 1, 2011; amended 2011, No. 109 (Adj. Sess.),  3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.),  1b, eff. May 18, 2012.) 
 4201. Definitions
As used in this chapter, unless the context otherwise requires:(1) Professional board means:(A) in the case of a dentist, the State Board of Dental Examiners so designated under 26 V.S.A. chapter 12; (B) in the case of a physician or surgeon, the State Board of Medical Practice so designated under 26 V.S.A. chapter 23; (C) in the case of an osteopath, the State Board of Osteopathic Examination and Registration so designated under 26 V.S.A. chapter 33; (D) in the case of a nurse, the Vermont State Board of Nursing so designated under 26 V.S.A. chapter 28; (E) in the case of a pharmacist or pharmacy, the State Board of Pharmacy so designated under 26 V.S.A. chapter 36; (F) in the case of a veterinarian, the State Veterinary Board so designated under 26 V.S.A. chapter 44; (G) in the case of a hospital, laboratory, or nursing home, the State Board of Health so designated under chapter 3 of this title. (2) Board of Health means the State Board of Health so designated under chapter 3 of this title. (3) Board of Pharmacy means the State Board of Pharmacy so designated under 26 V.S.A. chapter 36. (4) Certificate means a certificate of approval issued to a hospital, laboratory, or nursing home under section 4207 of this title. (5) Dentist means a person authorized by law to practice dentistry in this State and who has a license issued to the person under this chapter authorizing him or her to use regulated drugs in connection with his or her professional practice. (6) Depressant or stimulant drug means:(A) any drug that contains any quantity of barbituric acid or any of the salts of barbituric acid, or any derivative of barbituric acid, that is designated as habit-forming because of its effect on the central nervous system in the rules adopted by the Board of Health under section 4202 of this title; (B) any drug, other than methamphetamine, that contains any quantity of amphetamine or any of its optical isomers, any salt or amphetamine or any salt of an optical isomer of amphetamine, that the Board of Health so designates by such rule as habit-forming because of its effect on the central nervous system; (C) gamma hydroxybutyric acid, including its salts, isomers, or salts of isomers;(D) gamma butyrolactone, including 4-butyrolactone and gamma hydroxybutyric acid lactone, including its salts, isomers, or salts of isomers, when packaged, marketed, manufactured, or intended for human consumption; (E) ketamine, including its salts, isomers, or salts of isomers;(F) flunitrazepam, including its salts, isomers, or salts of isomers; and(G) any drug, other than methamphetamine, that contains any quantity of a substance that the Board of Health so designates by such rule as having a serious potential for abuse arising out of its effect on the central nervous system. (7) Dispense includes distribute, leave with, give away, dispose of, or deliver.(8) Exempt officials includes officials of the United States, insular possessions, territories, the District of Columbia, state, and political subdivisions. (9) Federal drug laws means the laws of the United States relating to one or more of those drugs which are defined in this chapter as regulated drugs. (10) Hallucinogenic drugs means stramonium, mescaline or peyote, lysergic acid diethylamide, and psilocybin, and all synthetic equivalents of chemicals contained in resinous extractives of Cannabis sativa, or any salts or derivatives or compounds of any preparations or mixtures thereof, and any other substance that is designated as habit-forming or as having a serious potential for abuse arising out of its effect on the central nervous system or its hallucinogenic effect in the rules adopted by the Board of Health under section 4202 of this title. (11) Hospital means an institution for the care and treatment of the sick and injured licensed as a hospital under chapter 43 of this title and a hospital conducted, maintained, and operated by the United States or the State of Vermont, approved under this chapter as proper to be entrusted with the custody and use of regulated drugs under the direction of a physician or dentist, confirmed by an official written order signed by a person authorized to prescribe such drugs. (12) Laboratory means a laboratory approved under this chapter as proper to be entrusted with the custody and use of regulated drugs for scientific and medical purposes and for purposes of instruction. (13) License means a license to practice their profession issued to one of those persons listed in subdivisions (1)(A) through (F) of this section by his or her respective professional board under the applicable laws of this State, or a license issued by the Board of Health under section 4206 of this title to a person not subject to the jurisdiction of any such professional board. (14) Manufacturer means a person authorized by law to manufacture, bottle, or pack drugs in this State and who has a license issued to the person under this chapter to compound, mix, cultivate, produce, or prepare regulated drugs, but does not include a pharmacy that compounds such drugs to be sold or dispensed on prescriptions at retail. (15)(A) Cannabis means all parts of the plant Cannabis sativa L., except as provided by subdivision (B) of this subdivision (15), whether growing or harvested, and includes: (i) the seeds of the plant;(ii) the resin extracted from any part of the plant; and(iii) any compound, manufacture, salt, derivative, mixture, or preparation of the plant, its seeds, or resin. (B) Cannabis does not include:(i) the mature stalks of the plant and fiber produced from the stalks;(ii) oil or cake made from the seeds of the plant;(iii) any compound, manufacture, salt, derivative, mixture, or preparation of the mature stalks, fiber, oil, or cake; (iv) the sterilized seed of the plant that is incapable of germination; or(v) hemp or hemp products, as defined in 6 V.S.A.  562.(16) Narcotic, narcotics, or narcotic drugs means opium, coca leaves, pethidine (isonipecaine, meperidine), and opiates or their compound, manufacture, salt, alkaloid, or derivative, and every substance neither chemically nor physically distinguishable from them, and preparations containing such drugs or their derivatives, by whatever trade name identified and whether produced directly or indirectly by extraction from substances of vegetable origin, or independently by means of chemical synthesis or by a combination of extraction and chemical synthesis, as the same are so designated in the rules adopted by the Board of Health under section 4202 of this title. (17) Nurse means any person authorized by law to practice nursing in this State.(18) Nursing home means a facility, other than a hospital, operated for the purpose of providing lodging, board, and nursing care to persons who are sick, have an infirmity or disability, or are convalescing, approved under this chapter as proper to be entrusted with the custody and use of regulated drugs prescribed for such individual patients under its care under the direction of a physician or dentist, confirmed by an official written order signed by a person authorized to prescribe such drugs. No nursing home shall be granted a certificate of approval for the possession and use of such drugs unless such nursing home has a registered nurse or a licensed practical nurse on duty or on call 24 hours daily who will have sole responsibility for those drugs. Nothing in this chapter shall be construed as conferring on any nursing home, convalescent home, or home for the aged any authority, right, or privilege beyond that granted to it by the law under which it is licensed or otherwise authorized to function. (19) Official written order means an order written on a form prescribed for that purpose by the U.S. Commissioner of Narcotics and issued by the U.S. Commissioner of Internal Revenue, under any laws of the United States making provision therefor, if such order forms are authorized and required by federal law, and if no such order form is provided, then on an official form provided for that purpose by the Board of Health. (20) Person includes an individual, partnership, corporation, association, trust, or other institution or entity. (21) Pharmacist means any person authorized by law to practice pharmacy in this State; but nothing in this chapter shall be construed as conferring on a person any authority, right, or privilege that is not granted to him or her by the pharmacy laws of his or her state. (22) Pharmacy means any place registered as such by the Board of Pharmacy in which drugs, prescriptions, or poisons are possessed for the purpose of compounding, dispensing, or retailing, or in which drugs, prescriptions, or poisons are compounded, dispensed, or retailed, or in which such drugs, prescriptions, or poisons are by advertising or otherwise offered for sale at retail and which has a license issued to it under this chapter authorizing the retail dealing of regulated drugs. (23) Physician means a person authorized by law to practice medicine in this State and who has a license issued to the person under this chapter authorizing him or her to use regulated drugs in connection with his or her professional practice. (24) Practitioner includes a physician, dentist, veterinarian, surgeon, or any other person who may be lawfully entitled under this chapter to distribute, dispense, prescribe, or administer regulated drugs to patients. (25) Prescribe means an order for a patient made or given by a practitioner.(26) Prescription means an order for a regulated drug made by a physician, physician assistant, advanced practice registered nurse, dentist, or veterinarian licensed under this chapter to prescribe such a drug which shall be in writing except as otherwise specified in this subdivision. Prescriptions for such drugs shall be made to the order of an individual patient, dated as of the day of issue and signed by the prescriber. The prescription shall bear the full name, address, and date of birth of the patient, or if the patient is an animal, the name and address of the owner of the animal and the species of the animal. Such prescription shall also bear the full name, address, and registry number of the prescriber and, unless electronically prescribed, shall be written with ink, indelible pencil, or typewriter; if typewritten, it shall be signed by the prescriber. A written or typewritten prescription for a controlled substance, as defined in 21 C.F.R. Part 1308, shall contain the quantity of the drug written both in numeric and word form. If a prescription is communicated orally, it shall be reduced promptly to writing by the pharmacist. Nothing in this subdivision is meant to authorize the oral communication of a prescription when a written prescription is otherwise required. (27) Registration means the annual registration of licenses and certificates under this chapter. (28) Registry number means the number assigned under rules adopted by the Board of Health to each person authorized under this chapter to use, prescribe, dispense, possess, or administer a regulated drug in connection with his or her professional practice. (29) Regulated drug means:(A) a narcotic drug;(B) a depressant or stimulant drug, other than methamphetamine;(C) a hallucinogenic drug;(D) Ecstasy;(E) cannabis; or(F) methamphetamine.(30) Sale means transfer for a consideration or barter or exchange or an offer or express or implied promise to transfer for a consideration or barter or exchange, and each such transaction made by any person, whether as principal, proprietor, agent, servant, or employee. (31) Veterinarian means a person authorized by law to practice veterinary medicine in this State and who has a license issued to the person under this chapter authorizing him or her to use regulated drugs in connection with his or her professional practice. (32) Veterinary hospital means an institution equipped with the technical facilities and professional and technical personnel necessary for diagnosis and treatment of animals suffering from sickness or injury and which hospital is further approved under this chapter as proper to be entrusted with the custody and use of regulated drugs which may be used only by veterinarians in their professional practice at that hospital. (33) Wholesaler means a person authorized by law, when so required, to sell at wholesale drugs in this State and further has a license issued to the person under this chapter to supply others than consumers with drugs or preparations containing a regulated drug that the person has not produced or prepared. (34) Deliver means the actual, constructive, or attempted transfer or prescription of a regulated drug, whether or not there exists an agency relationship. (35) Cocaine means coca leaves except coca leaves and extracts of coca leaves from which cocaine, ecgonine, and derivatives of ecgonine or their salts have been removed; cocaine, its salts, optical and geometric isomers, and salts of isomers; ecgonine, its derivatives, their salts, isomers, and salts of isomers; or any compound, mixture, or preparation which contains any quantity of any of the substances referred to in this subdivision. (36) Heroin includes every substance not chemically or physically distinguishable from it and preparations containing heroin or its derivatives, by whatever name identified and whether produced directly or indirectly by extraction from substances of vegetable origin, or independently by means of chemical synthesis or by a combination of extraction and chemical synthesis, as designated by the Board of Health by rule. (37) Lysergic acid diethylamide includes any salts or derivatives or compounds of any preparations or mixtures of lysergic acid diethylamide or any preparation, mixture, or compound containing any lysergic acid diethylamide. (38) Ecstasy means 3,4-methylenedioxymethamphetamine, including its salts, isomers, or salts of isomers. (39) Methamphetamine includes any quantity of the substance, its salt, isomers, salts of isomers, optical isomers, and salts of its optical isomers. (40) Crack cocaine means the free-base form of cocaine.(41) Prescription drug means any human drug required by federal law or regulation to be dispensed only by a prescription, including finished dosage forms and active ingredients subject to Section 503(b) of the federal Food, Drug and Cosmetic Act. (42) Ultimate user means a patient who uses a prescription drug.(43) Immature cannabis plant means a female cannabis plant that has not flowered and that does not have buds that may be observed by visual examination. (44) Mature cannabis plant means a female cannabis plant that has flowered and that has buds that may be observed by visual examination. (Added 1967, No. 343 (Adj. Sess.),  1, eff. March 23, 1968; amended 1975, No. 10,  1, eff. 30 days from March 10, 1975; 1989, No. 100,  10, 11; 2001, No. 52,  2; 2003, No. 54,  3; 2011, No. 27,  1; 2013, No. 75,  2; 2013, No. 84,  2, eff. June 10, 2013; 2013, No. 96 (Adj. Sess.),  97; 2013, No. 138 (Adj. Sess.),  9; 2017, No. 86 (Adj. Sess.),  2; 2017, No. 113 (Adj. Sess.),  75.) 
 4202. Powers and duties of the Board of Health
(a) The Board of Health is authorized and empowered to adopt such rules that in its judgment may be necessary or proper to supplement the provisions of this chapter to effectuate the purposes and intent thereof or to clarify its provisions so as to provide the procedure or details to secure effective and proper enforcement of its provisions. (b) These rules and determinations, when adopted, shall, until modified or rescinded, have the force and effect of law. (c) The Board of Health and any representative specifically authorized by it shall have the power to administer oaths, compel the attendance of witnesses and the production of books, papers, and records, and to take proof and testimony concerning all matters with which this chapter is concerned. (d) The rules adopted by the Board of Health under section 4201 of this title for the purpose of determining those drugs defined under that section may be adopted only after prior written notice to the Board of Pharmacy and the Board of Medical Practice and after the Board of Pharmacy and the Board of Medical Practice have had an opportunity to advise the Board of Health with respect to the form and substance of those rules or amendments and to recommend revisions thereof, except with respect to emergency rules adopted pursuant to 3 V.S.A.  844, which may be adopted without notice by the Commissioner of Health. (Added 1967, No. 343 (Adj. Sess.),  2, eff. March 23, 1968; amended 1971, No. 14,  24, eff. March 11, 1971; 2013, No. 75,  2a, eff. June 5, 2013; 2017, No. 113 (Adj. Sess.),  76.) 
 4203. Persons exempted
The provisions of this chapter, restricting the possession and control of regulated drugs, shall not apply to common carriers or to warehousemen while engaged solely in lawfully transporting or storing such drugs while in their original containers, nor to any employee of the same acting within the scope of his or her employment, nor to public officers or their employees in the performance of their official duties requiring possession or control of regulated drugs, nor to temporary incidental possession by employees or agents of persons lawfully entitled to possession, including a medical or dental assistant, nurse, intern, resident, and a member of a patients family dispensing or administering regulated drugs under a licensed physicians or dentists orders, nor by authorized persons whose possession is for the purpose of aiding public officers in performing their official duties. (Added 1967, No. 343 (Adj. Sess.),  3, eff. March 23, 1968.) 
 4204. Preparations excepted
(a) The Board of Health may provide, by rule, for the exception from all provisions of this chapter (except as provided in section 4223 of this title) of the administration, dispensation, or sale at retail of a medicinal preparation containing such amounts of one or more regulated drugs that the Board considers not subject to abuse. (b) The exemption authorized by this section shall be subject to the condition that the medicinal preparation administered, dispensed, or sold, shall contain, in addition to the regulated drug in it, some drug or drugs conferring upon it medicinal qualities other than those possessed by the regulated drug alone, and that such preparation shall be administered, dispensed, and sold in good faith as a medicine, and not for the purpose of evading the provisions of this chapter. (Added 1967, No. 343 (Adj. Sess.),  4, eff. March 23, 1968; amended 2017, No. 113 (Adj. Sess.),  77.) 
 4205. Acts prohibited
It shall be unlawful for any person to manufacture, possess, have under his or her control, sell, prescribe, administer, dispense, or compound any regulated drug, except as authorized in this chapter. (Added 1967, No. 343 (Adj. Sess.),  5, eff. March 23, 1968.) 
 4206. Licenses
(a) No person shall manufacture, compound, mix, cultivate, grow, or by any other process produce, prepare, prescribe, dispense, or compound any regulated drug, and no person as a wholesaler, manufacturer, pharmacist, or pharmacy shall possess or supply the same, without having first obtained a license from the respective professional board having jurisdiction over that person as so designated in subdivision 4201(1) of this title, or, in the event no professional board has such jurisdiction over a person, from the Board of Health under terms adopted by that Board corresponding to those respecting professional licenses. (b) The sales of regulated drugs by manufacturers or wholesalers to persons in this State are restricted to those persons qualified by law to possess the same in connection with a business or profession defined in this chapter. Such sales shall be made only to those persons presenting to the vendor or his or her representative proof in writing that the vendee is authorized under this chapter to possess, use, dispense, sell, compound, or administer that regulated drug. (c) The ultimate user of a prescription drug who has lawfully obtained such prescription drug or other persons authorized by federal law may deliver, without being registered pursuant to 26 V.S.A.  2061, the prescription drug to another person for the purpose of disposal of the prescription drug if the person receiving the prescription drug for purposes of disposal is authorized under a state or federal law or regulation to engage in such activity. (Added 1967, No. 343 (Adj. Sess.),  6, eff. March 23, 1968; amended 2011, No. 27,  2.) 
 4207. Certificates of approval
(a) No hospital, laboratory, or nursing home, or any other person not provided for under section 4206 of this title, shall possess, administer, compound, use, or supply any regulated drug, without having first obtained a certificate of approval from the Board of Health. (b) The certificate of approval issued by the Board of Health in accordance with this section shall be effective only for the person and address and the type of regulated drug designated therein and shall be conspicuously displayed at the indicated place of business. (c) The fee for a certificate of approval shall be $1.00, and for each renewal thereof, $1.00. (d) Persons to whom certificates of approval have been issued shall thereafter apply annually to renew that certificate with the Board of Health. Application for renewal shall be made July 1 of each year. Failure to apply for renewal within 30 days after such date will subject the applicant to a penalty of $25.00 in addition to the renewal fee, to be collected by that Board upon any subsequent application for renewal. (e) The State and a municipal corporation therein shall be exempted from payment of the fees required by this section. (Added 1967, No. 343 (Adj. Sess.),  7, eff. March 23, 1968.) 
 4208. Qualifications for issuance of licenses and certificates
Notwithstanding or in addition to any other provision of law, no license or certificate of approval shall be issued unless and until the applicant therefor has furnished proof satisfactory to the respective board, in the exercise of its discretion: (1) that the applicant is of good moral character or, if the applicant be an association or corporation, that the managing officers are of good moral character, and does not or do not use a regulated drug without medical justification; (2) that the applicant possesses the means to carry on properly the business or profession described in his or her, or its application; (3) in the case of an applicant for a certificate of approval, that the applicant is licensed under the applicable laws of this State, if any, to carry on within this State the business or profession described in his, her , or its application; and (4) that the applicant or any of its managing officers has never been convicted of a violation of any of the criminal provisions of this chapter, or of a similar law of another state, or of the federal drug laws. (Added 1967, No. 343 (Adj. Sess.),  8, eff. March 23, 1968.) 
 4209. Supervision, revocation, and reinstatement of licenses and certificates
(a) A board may, after notice and opportunity for hearing, revoke or suspend for a period of time or amend the terms of any license or certificate issued by that board under section 4207 of this title or under any provision of the laws of this State in the event that any one of the qualifications for issuance of a license or certificate listed in section 4208 of this title were at the time of such issuance or are subsequently thereto not met by the holder thereof or in the event that it is shown to that boards satisfaction that the holder or his or her employee or agent has violated any of the provisions of this chapter. (b) Notwithstanding the foregoing, a board may, upon application of such person, at any time, after notice and opportunity for hearing, and upon good cause shown satisfactory to that board in the exercise of its discretion, reinstate the license or certificate of a person previously suspended or revoked by that board under subsection (a) of this section. (Added 1967, No. 343 (Adj. Sess.),  9, eff. March 23, 1968.) 
 4210. Authorized sales on written orders, records
(a) Every physician, dentist, veterinarian, or other person who is licensed to administer, sell, dispense, or professionally use regulated drugs shall keep a record of such drugs received by him or her and a record of all such drugs administered, dispensed, or professionally used by him or her otherwise than by prescription, in accordance with subsection (d) of this section. It shall, however, be deemed a sufficient compliance with this subsection if any such person using small quantities of solutions or other preparations of such drugs for local application shall keep a record of the quantity, character, and potency of such solutions or other preparations purchased or made up by him or her, and of the dates when purchased or made up, without keeping a record of the amount of such solution or other preparation applied by him or her to individual patients. (b) Manufacturers and wholesalers shall keep records of all regulated drugs compounded, mixed, cultivated, grown, or by any other process produced or prepared, and of all such drugs received and disposed of by them in accordance with the provisions of subsection (d) of this section. (c) Every person who purchases for resale, or who sells preparations or regulated drugs exempted by regulation adopted under section 4204 of this title, shall keep a record showing the quantities and kinds thereof received and sold, or disposed of otherwise, in accordance with the provisions of subsection (d) of this section. (d) The form and content of the records to be maintained under this section shall be prescribed by regulation adopted by the Board of Health, after prior written notice to the Board of Pharmacy and after the Board of Pharmacy has had an opportunity to advise the Board of Health with respect to the form and substance of that regulation and to recommend revisions thereof. The record of regulated drugs received shall in every case show the date of receipt, the name and address of the person from whom received, and the kind and quantity of drugs received, the kind and quantity of such drugs produced or removed from process of manufacture, and the date of such production or removal from process of manufacturer, and such other facts as the Board of Health may require. The record of all such drugs sold, administered, dispensed, or otherwise disposed of shall show the date of selling, administering, or dispensing, the name and address of the person to whom, or for whose use, or the owner and species of animal for which the drugs were sold, administered, or dispensed, and the kind and quantity of drugs and shall be signed by the person giving such order or his or her duly authorized agent. Every such record shall be kept for a period of three years from the date of the transaction recorded, and shall be subject to inspection by a federal officer or an officer of this State or an agent thereof specifically authorized engaged in the enforcement of the federal drug laws or of this chapter. The keeping of a record required by or under the federal drug laws, containing substantially the same information as is specified above, shall constitute compliance with this section, except that every such record shall contain a detailed list of such drugs lost, destroyed, or stolen, if any, the kind and quantity of such drugs, and the date of the discovery of such loss, destruction, or theft. (Added 1967, No. 343 (Adj. Sess.),  10, eff. March 23, 1968.) 
 4211. Records confidential
Prescriptions, orders, and records required by this chapter, and stocks of regulated drugs, shall be open for inspection only to federal or State officers or their specifically authorized agent whose duty it is to enforce the federal drug laws or this chapter; authorized agents of professional licensing boards, as that term is defined under 3 V.S.A. chapter 5; or authorized agents of the Board of Medical Practice. No person having knowledge by virtue of his or her office of any such prescription, order, or record shall divulge such knowledge, except in connection with a prosecution, or proceeding before the Board of Health, Board of Pharmacy, Board of Medical Practice, or another licensing or registration board, to which prosecution or proceeding the person to whom such prescriptions, orders, or records relate is a party. (Added 1967, No. 343 (Adj. Sess.),  11, eff. March 23, 1968; amended 1991, No. 167 (Adj. Sess.),  65; 2019, No. 126 (Adj. Sess.),  6.) 
 4212. Labels
(a) Whenever a manufacturer sells or dispenses a regulated drug and whenever a wholesaler sells or dispenses a regulated drug in a package prepared by him or her, he or she shall securely affix to each package in which that drug is contained a label showing in legible English the name and address of the vendor and the quantity, kind, and form of regulated drug contained therein. No person, except a pharmacist or dispensing physician for the purpose of filling a prescription under this chapter, shall alter, deface, or remove any label so affixed. (b) Whenever a pharmacist or an employee of a hospital, infirmary, school, first aid station, or nursing home sells or dispenses any regulated drug, he or she shall affix to the container in which such drug is sold or dispensed a label showing his or her own name, address, and registry number, or the name, address, and registry number of the pharmacist or hospital or nursing home for whom he or she is lawfully acting, the name and address of the patient, or if the patient is an animal the name and address of the owner of the animal and the species of the animal, the name, address and registry number of the physician, dentist, or veterinarian by whom the prescription was written, the kind and form of the drug contained therein unless the practitioner has specifically ordered in that prescription that such information not be specified on the label, such directions as may be stated on the prescription, and the date of the issuance of the prescription. No person shall alter, deface, or remove any label so affixed. This subsection shall not apply to regulated drugs sold or dispensed for use exclusively within a hospital. (c) Physicians, dentists, or veterinarians dispensing regulated drugs shall affix to the container a label showing the dispensing practitioners name, address, and registry number, the name and address of the patient, or if the patient is an animal the name and address of the owner of the animal and the species of the animal, the kind and form of the drug contained therein unless the dispensing practitioner considers that such information should not be so specified for medical reasons, such directions necessary for use, and the date of the issuance of the prescription and the dispensing of the drug. This subsection shall not apply to an amount of regulated drugs equivalent to three days dosage dispensed to a patient for his or her immediate use without charge by a physician on house call. (Added 1967, No. 343 (Adj. Sess.),  12, eff. March 23, 1968.) 
 4213. Authorized sales of regulated drugs
(a) A duly licensed manufacturer or wholesaler may sell and dispense regulated drugs to any of the following persons, but only on official written orders: (1) To a manufacturer, wholesaler, or pharmacy.(2) To a physician, dentist, or veterinarian, except that an official written order shall not be required when regulated drugs are provided in person by a representative of a duly licensed manufacturer or wholesaler in quantities as samples for which there is no charge, either direct or indirect, and do not exceed ten times the manufacturers recommended maximum individual dose and are clearly marked Sample or Not For Sale on each individual tablet or capsule. (3) To a person in charge of a hospital having in effect a certificate of approval but only for use by or in that hospital for scientific or medical purposes. (4) To a person in charge of a laboratory having in effect a certificate of approval but only for use in that laboratory for scientific or medical purposes. (b) A duly licensed manufacturer or wholesaler may sell regulated drugs to any of the following persons: (1) On an official written order, accompanied by a certificate of exemption, as and if required by the federal drug laws, and in compliance with regulations adopted by the Board of Health to a person in the employ of the government of the United States or of any state, territory, district, county, municipality, or insular government, purchasing, receiving, possessing, or dispensing regulated drugs by reason of his or her official duties. (2) To a master of a ship or a person in charge of any aircraft upon which no physician is regularly employed or to a physician or surgeon duly licensed in some state, territory, or the District of Columbia to practice his or her profession, or to a retired commissioned medical officer of the U.S. Army, Navy, or Public Health Service employed upon such ship or aircraft, for the actual medical needs of persons on board such ship or aircraft, when not in port. However, such regulated drugs shall be sold to the master of such ship or person in charge of such aircraft or to a physician, surgeon, or retired commissioned medical officer of the U.S. Army, Navy, or Public Health Service employed upon such ship or aircraft only in pursuance of an order form approved by a commissioned medical officer or acting assistant surgeon of the U.S. Public Health Service. (3) To a person in a foreign country if the provisions of the federal drug laws and the regulations adopted by the Board of Health are complied with. (c) An official written order for any regulated drug shall be signed in triplicate by the person giving such order or by his or her duly authorized agent. The original shall be presented to the person who sells or dispenses the drug named therein. In event of the acceptance of such order, by such person, each party to the transaction shall preserve his or her copy of such order for a period of three years in such a way as to be readily accessible for inspection by any federal or state officer or their specifically authorized agent whose duty it is to enforce the federal drug laws or this chapter. Notwithstanding the other provisions of this chapter, a duly licensed manufacturer or wholesaler may sell and dispense depressant or stimulant drugs to a person referred to in subdivisions (a)(1), (2), (3), and (4) of this section pursuant to telephone order, provided, however, that an official written order shall be presented to the person selling or dispensing that drug within seven days of the making of that telephone order, and all the provisions of this chapter after the expiration of that period of time apply. (d) Possession of or control of regulated drugs even though obtained as authorized by this section shall not be lawful if not in the regular course of business, occupation, profession, employment, or duty of the possessor. (e) A person in charge of a hospital or of a laboratory, or in the employ of this State or of any other state, or of any political subdivision thereof, or a master of a ship or a person in charge of any aircraft upon which no physician is regularly employed, or a physician or surgeon duly licensed in some state, territory, or the District of Columbia, to practice his or her profession, or a retired commissioned medical officer of the U.S. Army, Navy, or Public Health Service employed upon such ship or aircraft, who obtains regulated drugs under the provisions of this section or otherwise, shall not possess, nor administer, nor dispense, nor otherwise use such drugs, within this State, except within the scope of his or her employment or official duty, and then only for scientific or medicinal purposes and subject to the provisions of this chapter. (Added 1967, No. 343 (Adj. Sess.),  13, eff. March 23, 1968; amended 1969, No. 256 (Adj. Sess.),  8, eff. April 6, 1970.) 
 4214. Authorized professional use of regulated drugs
(a) A physician or dentist licensed under this chapter, in good faith and in the course of his or her professional practice only, may prescribe, administer, and dispense regulated drugs and he or she may cause the same to be administered for medical purposes only by a nurse licensed under this chapter, or an intern, medical or dental assistant, or resident, or in his or her absence by a responsible member of the family of the patient, under his or her direction and supervision. (b) A duly licensed veterinarian, in good faith and in the course of his or her professional practice only and not for use by a human being, may prescribe, administer, and dispense regulated drugs and he or she may cause them to be administered for medical purposes only by an assistant or orderly or by the owner of the animal, under his or her direction and supervision. (c) Any person who has obtained from a physician, dentist, or veterinarian any regulated drug for administration to a patient during the absence of such physician, dentist, or veterinarian under this section shall return to such physician, dentist, or veterinarian any unused portion of such drug, or shall take such action as may be specified by regulation adopted by the Board of Health, when such drug is no longer required by the patient. (Added 1967, No. 343 (Adj. Sess.),  14, eff. March 23, 1968.) 
 4215. Authorized sales by pharmacists
(a) A duly licensed pharmacist, in good faith and in the course of professional practice, may sell and dispense regulated drugs to any person upon a written prescription or oral prescription which is reduced promptly to writing by the pharmacist by an individual authorized by law to prescribe and administer prescription drugs in the course of professional practice. The written prescription shall be dated and signed by the person prescribing or, if an oral prescription, by the pharmacist on the day when written, and bearing the full name and date of birth of the patient for whom the drug is prescribed, and the full name of the person prescribing. If the prescription is for an animal, the prescription shall state the species of animal for which the drug is prescribed and the full name and address of the owner of the animal. A prescription shall not be refilled unless refilling is authorized by the practitioner on the original prescription or by the original oral order. (b)(1) The pharmacist filling a schedule II prescription shall write the date of filling and the pharmacists own signature on the face of the prescription, or if an electronic prescription, shall enter the date of filling and the pharmacists name into the electronic record. (2) Pharmacists shall be subject to the requirements of 21 U.S.C. chapter 13.(3) Notwithstanding the provisions of subdivision (1) or (2) of this subsection, a prescription for a schedule II drug written without a future fill date shall not be filled more than 30 days after the date the prescription was issued. A prescription for a schedule II drug written to be filled at a future date shall not be filled more than 90 days after the date the prescription was issued. (4) A physician who dispenses regulated drugs as part of his or her regular fee or for an additional fee shall be subject to the same requirements as a pharmacist for the purposes of this section. (c) The legal owner of any stock of regulated drugs, upon discontinuance of dealing in such drugs, shall promptly sell such drugs to a manufacturer, wholesaler, or pharmacist, but only on an official written order. (Added 1967, No. 343 (Adj. Sess.),  15, eff. March 23, 1968; amended 2007, No. 163 (Adj. Sess.),  5; 2017, No. 48,  7.) 
 4215a. Sale of schedule V drugs
(a) A duly licensed pharmacist may sell and dispense schedule V drugs only upon written prescription or oral prescription which is promptly reduced to writing by a pharmacist, of a licensed physician, dentist, or veterinarian, dated and signed by the person prescribing or, if an oral prescription, by the pharmacist on the date when written. (b) Schedule V drugs shall include:Any compound, mixture, or preparation containing any of the following limited quantities of narcotic drugs, which shall include one or more nonnarcotic active medicinal ingredients in sufficient proportion to confer upon the compound, mixture, or preparation valuable medicinal qualities other than those possessed by the narcotic drug alone; (1) Not more than 200 milligrams of codeine per 100 milliliters or per 100 grams;(2) Not more than 100 milligrams of dihydrocodeine per 100 milliliters or per 100 grams;(3) Not more than 100 milligrams of ethylmorphine per 100 milliliters or per 100 grams;(4) Not more than 2.5 milligrams of diphenoxylate and not less than 25 micrograms of atropine sulfate per dosage unit. (c) The schedule V drugs as listed in subsection (b) shall be deemed regulated drugs as defined in section 4201(29) of this title. (d) For a first offense, a person knowingly and unlawfully violating the provisions of this section may be imprisoned for not more than six months or fined not more than $500.00, or both. For a second or subsequent offense, a person knowingly and unlawfully violating the provisions of this section may be imprisoned for not more than two years or fined not more than $2,000.00, or both. (Added 1975, No. 58.) 
 4215b. Identification
Only a patient for whom a prescription was written, the owner of an animal for which a prescription was written, or a bona fide representative of the patient or animal owner, as defined by the Board of Pharmacy by rule after consultation with the Commissioner of Health, may pick up a prescription for a Schedule II, III, or IV controlled substance. Prior to dispensing a prescription for a Schedule II, III, or IV controlled substance to a patient not personally known to the pharmacist, the pharmacist shall require the individual receiving the drug to provide a signature and show valid and current government-issued photographic identification as evidence that the individual is the patient for whom the prescription was written, the owner of the animal for which the prescription was written, or the bona fide representative of the patient or animal owner. If the individual does not have valid, current government-issued photographic identification, the pharmacist may request alternative evidence of the individuals identity, as appropriate. (Added 2013, No. 75,  3; amended 2013, No. 138 (Adj. Sess.),  10.) 
 4216. Authorized possession by individuals
(a) A person to whom or for whose use any regulated drug has been prescribed, sold, or dispensed, and the owner of any animal for which any such drug has been prescribed, sold, or dispensed, may lawfully possess the same on the condition that such drug was prescribed, sold, or dispensed by a physician, dentist, pharmacist, or veterinarian licensed to practice in this State or under the laws of another state or country wherein such person has his or her practice, and further that all amounts of the drug are retained in the lawful container in which it was delivered to him or her by the person selling or dispensing the same. (b) Notwithstanding the requirement in subsection (a) of this section that a regulated drug be retained in its original container, the individual to whom a regulated drug was prescribed, dispensed, or sold by a physician, dentist, or pharmacist licensed in Vermont or in another state or country may maintain up to a 14-day supply of the regulated drug outside the original container for his or her own personal use if the following conditions are met: (1) the drug was prescribed for the individual;(2) the individual is in possession of the original or a copy of the prescription label;(3) at all times, the individual intends and has intended to use the drug only for legitimate medical use in conformity with instructions from the prescriber and dispenser; and (4) the individual maintains the limited supply of the drug in a receptacle that reasonably constitutes a more convenient or portable format to enable the individuals legitimate medical use. (Added 1967, No. 343 (Adj. Sess.),  16, eff. March 23, 1968; amended 2015, No. 141 (Adj. Sess.),  1.) 
 4217. Reports by physicians and hospitals
It shall be the duty of every physician and every hospital to report to the Board of Health, promptly, all cases wherein a person has been or is being treated for the use of, or for problems arising from the use of, regulated drugs. The reports shall include the type of problem being treated, the class of regulated drug that was used, and such further information as is required by rules of the Board of Health as adopted under section 4202 of this title, except that the rules shall not require the listing or other identification of the names of the persons being so treated. (Added 1967, No. 343 (Adj. Sess.),  17, eff. March 23, 1968; amended 1969, No. 203 (Adj. Sess.),  1; 2017, No. 113 (Adj. Sess.),  78.) 
 4218. Enforcement
(a) It is hereby made the duty of the Department of Public Safety, its officers, agents, inspectors, and representatives, and pursuant to its specific authorization any other peace officer within the State, and of all States Attorneys, to enforce all provisions of this chapter and of the rules of the Board of Health adopted under this chapter, except those otherwise specifically delegated, and to cooperate with all agencies charged with the enforcement of the federal drug laws, this chapter, and the laws of other states relating to regulated drugs. (b) Such authorities and their specifically authorized agents shall have, at all times, access to all orders, prescriptions, and records kept or maintained under this chapter, as provided herein. (c) A person who gives information to law enforcement officers, the Drug Rehabilitation Commission, or professional boards as defined in section 4201 of this title and their specifically authorized agents, concerning the use of regulated drugs or the misuse by other persons of regulated drugs, shall not be subject to any civil, criminal, or administrative liability or penalty for giving such information. (d) Nothing in this section shall authorize the Department of Public Safety and other authorities described in subsection (a) of this section to have access to VPMS (Vermont Prescription Monitoring System) created pursuant to chapter 84A of this title, except as provided in that chapter. (e) The Department of Public Safety, in consultation with representatives of licensed Vermont pharmacies, shall adopt standard operating guidelines for accessing pharmacy records through the authority granted in this section. Any person authorized to access pharmacy records pursuant to subsection (a) of this section shall follow the Department of Public Safetys guidelines. These guidelines shall be a public record. (Added 1967, No. 343 (Adj. Sess.),  18, eff. March 23, 1968; amended 1969, No. 203 (Adj. Sess.),  2; 1991, No. 167 (Adj. Sess.),  64; 2005, No. 205 (Adj. Sess.),  2; 2013, No. 75,  4; 2017, No. 113 (Adj. Sess.),  79.) 
 4220. Violations; proceedings
(a) In any complaint, information, or indictment, and in any action or proceeding brought for the enforcement of any provision of this chapter, it shall not be necessary to negate any exception, excuse, proviso, or exemption contained in this chapter and the burden of proof of any such exception, excuse, proviso, or exemption shall be upon the defendant. (b) No person shall be convicted of a violation of any provision of this chapter if such person shall have been acquitted or convicted under the criminal provisions of the federal drug laws for the same act or omission which, it is alleged, constitutes a violation of this chapter. (c) On the conviction of any person of the violation of any provision of this chapter, a copy of the judgment and sentence and of the opinion of the court or magistrate, if any opinion be filed, shall be sent by the clerk of the court or by the magistrate to the commission or officer, if any, by whom the convicted defendant has been licensed or registered to practice his or her profession or to carry on his or her business, and to the Board of Health, who shall immediately transmit a copy thereof to the professional board, if any, having such person within its jurisdiction. (Added 1967, No. 343 (Adj. Sess.),  20, eff. March 23, 1968; amended 1971, No. 14,  23, eff. March 11, 1971.) 
 4221. Violations; presumptions
(a) Possession of a false or forged prescription for a regulated drug by any person other than a pharmacist in the pursuance of his or her profession shall be presumptive evidence of his or her intent to use the same for the purpose of illegally obtaining a regulated drug. (b) The presence of a regulated drug in an automobile, other than a public omnibus, is presumptive evidence of knowing possession thereof by each and every person in the automobile at the time such drug was found; except that such presumption does not apply: (1) to a duly licensed operator of an automobile who is at the time operating it for hire in the lawful and proper pursuit of his or her trade; (2) to any person in the automobile if one of them, having obtained the drug and not being under duress, is authorized to possess it and such drug is in the same container as when he or she received possession thereof; or (3) when the drug is concealed upon the person of one of the occupants. (Added 1967, No. 343 (Adj. Sess.),  21, eff. March 23, 1968.)
 4222. Common nuisances
Any store, shop, warehouse, dwelling house, building, vehicle, boat, aircraft, or any place whatever, which is resorted to by persons for the purpose of using regulated drugs or which is used for the illegal keeping or selling of the same, shall be deemed a common nuisance. No person shall keep or maintain such a common nuisance. (Added 1967, No. 343 (Adj. Sess.),  22, eff. March 23, 1968.) 
 4223. Fraud or deceit
(a) No person shall obtain or attempt to obtain a regulated drug, or procure or attempt to procure the administration of a regulated drug: (1) by fraud, deceit, misrepresentation, or subterfuge;(2) by the forgery or alteration of a prescription or of any written order;(3) by the concealment of a material fact; or(4) by the use of a false name or the giving of a false address.(b) Information communicated to a physician in an effort unlawfully to procure a regulated drug or unlawfully to procure the administration of any such drug shall not be deemed a privileged communication. (c) No person shall willfully make a false statement in, or fail to prepare or obtain or keep, or refuse the inspection or copying under this chapter of, any prescription, order, report, or record required by this chapter. (d) No person shall, for the purpose of obtaining a regulated drug, falsely assume the title of, or represent himself or herself to be a manufacturer, wholesaler, pharmacist, physician, dentist, veterinarian, or other authorized person. (e) No person shall make or utter any false or forged prescription or false or forged written order. (f) No person shall affix any false or forged label to a package or receptacle containing regulated drugs. (g) The provisions of this section shall apply to all transactions relating to amounts or types of drugs excepted from the provisions of this chapter by regulation of the Board of Health under section 4204 of this title, in the same way as they apply to transactions relating to any other regulated drug. (h) Any person who, in the course of treatment, is supplied with regulated drugs or a prescription therefor by one physician and who, without disclosing the fact, is knowingly supplied during such treatment with regulated drugs or a prescription therefor by another physician, shall be guilty of a violation of this section. (i) A person who violates this section shall be imprisoned not more than two years and one day or fined not more than $5,000.00, or both. (Added 1967, No. 343 (Adj. Sess.),  23, eff. March 23, 1968; amended 1989, No. 100,  12.) 
 4224. Unused Prescription Drug Disposal Program
(a) The Department of Health shall establish and maintain the statewide Unused Prescription Drug Disposal Program to provide for the safe disposal of Vermont residents unused and unwanted prescription drugs. The Program may include establishing secure collection and disposal sites and providing medication envelopes for sending unused prescription drugs to an authorized collection facility for destruction. (b) Pharmacies that operate 10 or more establishments in the United States, while concurrently conducting business in Vermont, shall enroll in a drug disposal kiosk program on or before July 1, 2023. If the physical dimensions of a pharmacy make an on-site collection receptacle impossible under State and federal law, a pharmacy shall provide a mail-back option for consumers. (Added 2015, No. 173 (Adj. Sess.),  14a, eff. June 8, 2016; amended 2021, No. 115 (Adj. Sess.),  9, eff. July 1, 2022.) 
 4226. Minors; treatment; consent
(a)(1) If a minor 12 years of age or older is suspected to be dependent upon regulated drugs as defined in section 4201 of this title, to have venereal disease, or to be an alcoholic as defined in section 8401 of this title, and the finding of such dependency, disease, or alcoholism is verified by a licensed physician, the minor may give: (A) his or her consent to medical treatment and hospitalization; and(B) in the case of a drug dependent or alcoholic person, consent to nonmedical inpatient or outpatient treatment at a program approved by the Agency of Human Services to provide treatment for drug dependency or alcoholism if deemed necessary by the examining physician for diagnosis or treatment of such dependency or disease or alcoholism. (2) Consent under this section shall not be subject to disaffirmance due to minority of the person consenting. The consent of the parent or legal guardian of a minor consenting under this section shall not be necessary to authorize care as described in this subsection. (b) The parent, parents, or legal guardian shall be notified by the physician if the condition of a minor child requires immediate hospitalization as the result of drug usage, alcoholism, or for the treatment of a venereal disease. (Added 1971, No. 76; amended 1975, No. 143 (Adj. Sess.); 2017, No. 113 (Adj. Sess.),  80.) 
 4228. Unlawful manufacture, distribution, dispensing, or sale of a noncontrolled drug or substance
(a) It is unlawful for any person to knowingly dispense, manufacture, process, package, distribute, or sell or attempt to dispense, manufacture, process, package, distribute, or sell a noncontrolled drug or substance upon either: (1) the express or implied representation that the drug or substance is a controlled drug; or (2) the express or implied representation that the drug or substance is of such nature or appearance that the dispensee or purchaser will be able to dispense or sell the drug or substance as a controlled drug. (b) For the purposes of this section, a controlled drug or substance shall mean those drugs or substances listed under schedules I through V in the federal Controlled Substances Act, 21 U.S.C.  801 et seq. as amended. (c) In determining whether there has been a violation of subsection (a), the following factors shall be considered: (1) whether the physical appearance of the package or container containing the noncontrolled drug or substance is substantially similar to the physical appearance of packages and containers regularly used in the dispensing or sale of controlled drugs or substances; (2) whether the dispensing or sale or attempted dispensing or sale included an exchange or demand for money or other valuable property as consideration for the noncontrolled drug or substance and the amount of such consideration was substantially in excess of the reasonable value of the noncontrolled drug or substance; (3) whether the overall physical appearance of the capsule, tablet, or other finished product containing the noncontrolled drug or substance is substantially similar in size, shape, color, and markings to the physical appearance of a capsule, tablet, or other finished product containing a specific controlled drug or substance. (d) The provisions of this section shall not be applicable to:(1) law enforcement officers acting in the course and legitimate scope of their employment;(2) persons who dispense, manufacture, process, package, distribute, or sell noncontrolled substances to licensed medical practitioners for use as placebos in the course of professional practice or research or for use in FDA-approved investigational new drug trials; (3) licensed medical practitioners, pharmacists, and other persons authorized to dispense or administer controlled substances and acting in the legitimate performance of their professional license. (e) In any prosecution under this section, it is no defense that the accused believed the noncontrolled drug or substance to actually be a controlled drug or substance. (f) A person convicted of violating this section shall be subject to imprisonment for a term of up to one year or a fine of up to $5,000.00, or both. If the violation of this section involves dispensing, distributing, or selling to a person under the age of 21, the person shall be subject to a term of imprisonment of not more than two years or fined up to $10,000.00, or both. (Added 1981, No. 177 (Adj. Sess.),  1; amended 1989, No. 100,  16.) 
 4229. Maintenance of records
Notwithstanding the provisions of sections 4202, 4210, 4213, and 4215 relating to the maintenance of records, all rules adopted by the Board of Health and the Board of Pharmacy governing the records for the manufacturing, distribution, and dispensation of regulated drugs shall be in accordance with the similar requirements set by the federal government under the Controlled Substances Act so that compliance with Board of Health and Board of Pharmacy rules will result in compliance with federal laws and regulations. (Added 1981, No. 244 (Adj. Sess.),  19; amended 2017, No. 113 (Adj. Sess.),  81.) 
 4230. Cannabis
(a) Possession and cultivation. (1) No person shall knowingly and unlawfully possess more than one ounce of cannabis or more than five grams of hashish or cultivate more than two mature cannabis plants or four immature cannabis plants. A person who violates this subdivision shall be assessed a civil penalty as follows: (A) not more than $100.00 for a first offense;(B) not more than $200.00 for a second offense; and(C) not more than $500.00 for a third or subsequent offense.(2)(A) No person shall knowingly and unlawfully possess two ounces or more of cannabis or ten grams or more of hashish or more than three mature cannabis plants or six immature cannabis plants. For a first offense under this subdivision (2), a person shall be provided the opportunity to participate in the Court Diversion Program unless the prosecutor states on the record why a referral to the Court Diversion Program would not serve the ends of justice. A person convicted of a first offense under this subdivision shall be imprisoned not more than six months or fined not more than $500.00, or both. (B) A person convicted of a second or subsequent offense of violating subdivision (A) of this subdivision (2) shall be imprisoned not more than two years or fined not more than $2,000.00, or both. (C) Upon an adjudication of guilt for a first or second offense under this subdivision, the court may defer sentencing as provided in 13 V.S.A.  7041, except that the court may in its discretion defer sentence without the filing of a presentence investigation report and except that sentence may be imposed at any time within two years from and after the date of entry of deferment. The court may, prior to sentencing, order that the defendant submit to a drug assessment screening, which may be considered at sentencing in the same manner as a presentence report. (3) A person knowingly and unlawfully possessing eight ounces of cannabis or 1.4 ounces of hashish or knowingly and unlawfully cultivating more than four mature cannabis plants or eight immature cannabis plants shall be imprisoned not more than three years or fined not more than $10,000.00, or both. (4) A person knowingly and unlawfully possessing more than one pound of cannabis or more than 2.8 ounces of hashish or knowingly and unlawfully cultivating more than six mature cannabis plants or 12 immature cannabis plants shall be imprisoned not more than five years or fined not more than $10,000.00, or both. (5) A person knowingly and unlawfully possessing more than 10 pounds of cannabis or more than one pound of hashish or knowingly and unlawfully cultivating more than 12 mature cannabis plants or 24 immature cannabis plants shall be imprisoned not more than 15 years or fined not more than $500,000.00, or both. (6) If a court fails to provide the defendant with notice of collateral consequences in accordance with 13 V.S.A.  8005(b) and the defendant later at any time shows that the plea and conviction for a violation of this subsection may have or has had a negative consequence, the court, upon the defendants motion, shall vacate the judgment and permit the defendant to withdraw the plea or admission and enter a plea of not guilty. Failure of the court to advise the defendant of a particular collateral consequence shall not support a motion to vacate. (7) The amounts of cannabis in this subsection shall not include cannabis cultivated, harvested, and stored in accordance with section 4230e of this title. (b) Selling or dispensing. (1) A person knowingly and unlawfully selling cannabis or hashish shall be imprisoned not more than two years or fined not more than $10,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing more than one ounce of cannabis or five grams or more of hashish shall be imprisoned not more than five years or fined not more than $100,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing one pound or more of cannabis or 2.8 ounces or more of hashish shall be imprisoned not more than 15 years or fined not more than $500,000.00, or both. (4) A person 21 years of age or older may dispense one ounce or less of cannabis or five grams or less of hashish to another person who is 21 years of age or older, provided that the dispensing is not advertised or promoted to the public. (c) Trafficking. A person knowingly and unlawfully possessing 50 pounds or more of cannabis or five pounds or more of hashish with the intent to sell or dispense the cannabis or hashish shall be imprisoned not more than 30 years or fined not more than $1,000,000.00, or both. There shall be a permissive inference that a person who possesses 50 pounds or more of cannabis or five pounds or more of hashish intends to sell or dispense the cannabis or hashish. (d) Canabis-infused products. Only the portion of a cannabis-infused product that is attributable to cannabis shall count toward the possession limits of this section. The weight of cannabis that is attributable to cannabis-infused products shall be determined according to methods set forth in rule by the Department of Public Safety in accordance with chapter 86 of this title (therapeutic use of cannabis). (Added 1989, No. 100,  1; amended 2001, No. 52,  3; 2003, No. 54,  4; 2013, No. 75,  22d, 22e, eff. July 2, 2013; 2013, No. 76,  1; 2015, No. 133 (Adj. Sess.),  7, eff. May 25, 2016; 2017, No. 74,  27; 2017, No. 86 (Adj. Sess.),  3; 2019, No. 164 (Adj. Sess.),  31, eff. Oct. 7, 2020; 2019, No. 167 (Adj. Sess.),  32, eff. Jan. 1, 2021; 2021, No. 20,  72.) 
 4230a. Cannabis possession by a person 21 years of age or older
(a)(1) Except as otherwise provided in this section, a person 21 years of age or older who possesses one ounce or less of cannabis or five grams or less of hashish and two mature cannabis plants or fewer or four immature cannabis plants or fewer or who possesses paraphernalia for cannabis use shall not be penalized or sanctioned in any manner by the State or any of its political subdivisions or denied any right or privilege under State law. The one-ounce limit of cannabis or five grams of hashish that may be possessed by a person 21 years of age or older shall not include cannabis cultivated, harvested, and stored in accordance with section 4230e of this title. (2)(A) A person shall not consume cannabis in a public place. As used in this section, public place has the same meaning as provided by 7 V.S.A.  831. (B) A person who violates this subdivision (a)(2) shall be assessed a civil penalty as follows: (i) not more than $100.00 for a first offense;(ii) not more than $200.00 for a second offense; and(iii) not more than $500.00 for a third or subsequent offense.(b)(1) Cannabis possessed or consumed in violation of State law is contraband pursuant to subsection 4242(d) of this title and subject to seizure and forfeiture. (2) This section does not:(A) exempt a person from arrest, citation, or prosecution for being under the influence of cannabis while operating a vehicle of any kind or for consuming cannabis while operating a motor vehicle; (B) repeal or modify existing laws or policies concerning the operation of vehicles of any kind while under the influence of cannabis or for consuming cannabis while operating a motor vehicle; (C) limit the authority of primary and secondary schools to impose administrative penalties for the possession of cannabis on school property; (D) prohibit a municipality from adopting a civil ordinance to provide additional penalties for consumption of cannabis in a public place; (E) prohibit a landlord from banning possession or use of cannabis in a lease agreement; or (F) allow an inmate of a correctional facility to possess or use cannabis or to limit the authority of law enforcement, the courts, the Department of Corrections, or the Parole Board to impose penalties on offenders who use cannabis in violation of a court order, conditions of furlough, parole, or rules of a correctional facility. (c)(1) A law enforcement officer is authorized to detain a person if:(A) the officer has reasonable grounds to believe the person has violated subsection (a) of this section; and (B) the person refuses to identify himself or herself satisfactorily to the officer when requested by the officer. (2) The person may be detained only until the person identifies himself or herself satisfactorily to the officer or is properly identified. If the officer is unable to obtain the identification information, the person shall forthwith be brought before a judge in the Criminal Division of the Superior Court for that purpose. A person who refuses to identify himself or herself to the court on request shall immediately and without service of an order on the person be subject to civil contempt proceedings pursuant to 12 V.S.A.  122. (d) Fifty percent of the civil penalties imposed by the Judicial Bureau for violations of this section shall be deposited in the Drug Task Force Special Fund, hereby created to be managed pursuant to 32 V.S.A. chapter 7, subchapter 5, and available to the Department of Public Safety for the funding of law enforcement officers on the Drug Task Force, except for a $12.50 administrative charge for each violation, which shall be deposited in the Court Technology Special Fund, in accordance with 13 V.S.A.  7252. The remaining 50 percent shall be deposited in the Youth Substance Awareness Safety Program Special Fund, hereby created to be managed pursuant to 32 V.S.A. chapter 7, subchapter 5, and available to the Court Diversion Program for funding of the Youth Substance Awareness Safety Program as required by section 4230b of this title. (e) Nothing in this section shall be construed to do any of the following:(1) require an employer to permit or accommodate the use, consumption, possession, transfer, display, transportation, sale, or growing of cannabis in the workplace; (2) prevent an employer from adopting a policy that prohibits the use of cannabis in the workplace; (3) create a cause of action against an employer that discharges an employee for violating a policy that restricts or prohibits the use of cannabis by employees; or (4) prevent an employer from prohibiting or otherwise regulating the use, consumption, possession, transfer, display, transportation, sale, or growing of cannabis on the employers premises. (Added 2013, No. 76,  2; amended 2013, No. 95 (Adj. Sess.),  81, eff. Feb. 25, 2014; 2013, No. 194 (Adj. Sess.),  13; 2017, No. 86 (Adj. Sess.),  4; 2019, No. 164 (Adj. Sess.),  30, eff. Oct. 7, 2020; 2019, No. 167 (Adj. Sess.),  3, eff. Oct. 7, 2020; 2021, No. 20,  73.) 
 4230b. Cannabis possession by a person 16 years of age or older and under 21 years of age; civil violation
(a) Offense. A person 16 years of age or older and under 21 years of age who knowingly and unlawfully possesses one ounce or less of cannabis or five grams or less of hashish or two mature cannabis plants or fewer or four immature cannabis plants or fewer commits a civil violation and shall be referred to the Court Diversion Program for the purpose of enrollment in the Youth Substance Abuse Safety Program. A person who fails to complete the program successfully shall be subject to: (1) a civil penalty of $300.00 and suspension of the persons operators license and privilege to operate a motor vehicle for a period of 30 days, for a first offense; and (2) a civil penalty of not more than $600.00 and suspension of the persons operators license and privilege to operate a motor vehicle for a period of 90 days, for a second or subsequent offense. (b) Issuance of notice of violation. A law enforcement officer shall issue a person who violates this section with a notice of violation, in a form approved by the Court Administrator. The notice of violation shall require the person to provide his or her name and address and shall explain procedures under this section, including that: (1) the person shall contact the Diversion Program in the county where the offense occurred within 15 days; (2) failure to contact the Diversion Program within 15 days will result in the case being referred to the Judicial Bureau, where the person, if found liable for the violation, will be subject to a civil penalty and a suspension of the persons operators license and may face substantially increased insurance rates; (3) no money should be submitted to pay any penalty until after adjudication; and(4) the person shall notify the Diversion Program if the persons address changes.(c) Summons and complaint. When a person is issued a notice of violation under this section, the law enforcement officer shall complete a summons and complaint for the offense and send it to the Diversion Program in the county where the offense occurred. The summons and complaint shall not be filed with the Judicial Bureau at that time. (d) Registration in Youth Substance Awareness Safety Program. Within 15 days after receiving a notice of violation, the person shall contact the Diversion Program in the county where the offense occurred and register for the Youth Substance Awareness Safety Program. If the person fails to do so, the Diversion Program shall file the summons and complaint with the Judicial Bureau for adjudication under 4 V.S.A. chapter 29. The Diversion Program shall provide a copy of the summons and complaint to the law enforcement officer who issued the notice of violation and shall provide two copies to the person charged with the violation. (e) Notice to report to Diversion. Upon receipt from a law enforcement officer of a summons and complaint completed under this section, the Diversion Program shall send the person a notice to report to the Diversion Program. The notice to report shall provide that: (1) The person is required to complete all conditions related to the offense imposed by the Diversion Program, including substance abuse screening and, if deemed appropriate following the screening, substance abuse assessment or substance abuse counseling, or both. (2) If the person does not satisfactorily complete the substance abuse screening, any required substance abuse assessment or substance abuse counseling, or any other condition related to the offense imposed by the Diversion Program, the case will be referred to the Judicial Bureau, where the person, if found liable for the violation, shall be assessed a civil penalty, the persons drivers license will be suspended, and the persons automobile insurance rates may increase substantially. (3) If the person satisfactorily completes the substance abuse screening, any required substance abuse assessment or substance abuse counseling, and any other condition related to the offense imposed by the Diversion Program, no penalty shall be imposed and the persons operators license shall not be suspended. (f) Diversion Program requirements. (1) Upon being contacted by a person who has been issued a notice of violation, the Diversion Program shall register the person in the Youth Substance Awareness Safety Program. Pursuant to the Youth Substance Awareness Safety Program, the Diversion Program shall impose conditions on the person. The conditions imposed shall include only conditions related to the offense and in every case shall include a condition requiring satisfactory completion of substance abuse screening using an evidence-based tool and, if deemed appropriate following the screening, substance abuse assessment and substance abuse education or substance abuse counseling, or both. If the screener recommends substance abuse counseling, the person shall choose a State-certified or State-licensed substance abuse counselor or substance abuse treatment provider to provide the services. (2) Substance abuse screening required under this subsection shall be completed within 60 days after the Diversion Program receives a summons and complaint. The person shall complete all conditions at his or her own expense. (3) When a person has satisfactorily completed substance abuse screening, any required substance abuse education or substance abuse counseling, and any other condition related to the offense which the Diversion Program has imposed, the Diversion Program shall: (A) Void the summons and complaint with no penalty due.(B) Send copies of the voided summons and complaint to the Judicial Bureau and to the law enforcement officer who completed them. Before sending copies of the voided summons and complaint to the Judicial Bureau under this subdivision, the Diversion Program shall redact all language containing the persons name, address, Social Security number, and any other information which identifies the person. (4) If a person does not satisfactorily complete substance abuse screening, any required substance abuse education or substance abuse counseling, or any other condition related to the offense imposed by the Diversion Program or if the person fails to pay the Diversion Program any required Program fees, the Diversion Program shall file the summons and complaint with the Judicial Bureau for adjudication under 4 V.S.A. chapter 29. The Diversion Program shall provide a copy of the summons and complaint to the law enforcement officer who issued the notice of violation and shall provide two copies to the person charged with the violation. (5) A person aggrieved by a decision of the Diversion Program or alcohol counselor may seek review of that decision pursuant to Rule 75 of the Vermont Rules of Civil Procedure. (g) [Repealed.](h) Record of adjudications. Upon adjudicating a person in violation of this section, the Judicial Bureau shall notify the Commissioner of Motor Vehicles, who shall maintain a record of all such adjudications, which shall be separate from the registry maintained by the Department for motor vehicle driving records. The identity of a person in the registry shall be revealed only to a law enforcement officer determining whether the person has previously violated this section. (Added 2013, No. 76,  2; amended 2015, No. 147 (Adj. Sess.),  12, eff. May 31, 2016; 2017, No. 86 (Adj. Sess.),  5; 2019, No. 167 (Adj. Sess.),  6, eff. Oct. 7, 2020.) 
 4230e. Cultivation of cannabis by a person 21 years of age or older
(a)(1) Except as otherwise provided in this section, a person 21 years of age or older who cultivates not more than two mature cannabis plants and four immature cannabis plants shall not be penalized or sanctioned in any manner by the State or any of its political subdivisions or denied any right or privilege under State law. (2) Each dwelling unit shall be limited to two mature cannabis plants and four immature cannabis plants regardless of how many persons 21 years of age or older reside in the dwelling unit. As used in this section, dwelling unit means a building or the part of a building that is used as a primary home, residence, or sleeping place by one or more persons who maintain a household. (3) Any cannabis harvested from the plants allowed pursuant to this subsection shall not count toward the one-ounce possession limit in section 4230a of this title, provided it is stored in an indoor facility on the property where the cannabis was cultivated and reasonable precautions are taken to prevent unauthorized access to the cannabis. (4) Cultivation in excess of the limits provided in this subsection shall be punished in accordance with section 4230 of this title. (b)(1) Personal cultivation of cannabis only shall occur:(A) on property lawfully in possession of the cultivator or with the written consent of the person in lawful possession of the property; and (B) in an area that is screened from public view and access is limited to the cultivator and persons 21 years of age or older who have permission from the cultivator. (2) A person who violates this subsection shall be assessed a civil penalty as follows:(A) not more than $100.00 for a first offense;(B) not more than $200.00 for a second offense; and(C) not more than $500.00 for a third or subsequent offense. (Added 2017, No. 86 (Adj. Sess.),  7; amended 2021, No. 158 (Adj. Sess.),  8, eff. May 31, 2022.)
 4230f. Dispensing cannabis to a person under 21 years of age; criminal offense
(a) No person shall:(1) dispense cannabis to a person under 21 years of age; or(2) knowingly enable the consumption of cannabis by a person under 21 years of age.(b) As used in this section, enable the consumption of cannabis means creating a direct and immediate opportunity for a person to consume cannabis. (c) Except as provided in subsection (d) of this section, a person who violates subsection (a) of this section shall be imprisoned not more than two years or fined not more than $2,000.00, or both. (d) A person who violates subsection (a) of this section, where the person under 21 years of age while operating a motor vehicle on a public highway causes death or serious bodily injury to himself or herself or to another person as a result of the violation, shall be imprisoned not more than five years or fined not more than $10,000.00, or both. (e)(1) Subsections (a)-(d) of this section shall not apply to a person under 21 years of age who dispenses cannabis to a person under 21 years of age or who knowingly enables the consumption of cannabis by a person under 21 years of age. (2) A person who is 18, 19, or 20 years of age who knowingly dispenses cannabis to a person who is 18, 19, or 20 years of age commits a civil violation and shall be referred to the Court Diversion Program for the purpose of enrollment in the Youth Substance Awareness Safety Program in accordance with the provisions of section 4230b of this title and shall be subject to the penalties in that section for failure to complete the program successfully. (3) A person 18, 19, or 20 years of age who knowingly dispenses to a person under 18 years of age who is at least three years that persons junior shall be sentenced to a term of imprisonment of not more than five years in accordance with section 4237 of this title. (4) A person who is 19 years of age who knowingly dispenses to a person 17 years of age or a person who is 18 years of age who knowingly dispenses cannabis to a person who is 16 or 17 years of age commits a misdemeanor crime and shall be fined not more than $500.00. (5) A person who is under 18 years of age who knowingly dispenses cannabis to another person who is under 18 years of age commits a delinquent act and shall be subject to 33 V.S.A. chapter 52. (f) This section shall not apply to a dispensary that lawfully provides cannabis to a registered patient or caregiver or to a registered caregiver who provides cannabis to a registered patient pursuant to chapter 86 of this title. (g) The provisions of this section do not limit or restrict the prosecution for other offenses arising out of the same conduct, nor shall they limit or restrict defenses under common law. (Added 2017, No. 86 (Adj. Sess.),  8; amended 2018, No. 8 (Sp. Sess.),  14, eff. July 2, 2018; 2019, No. 167 (Adj. Sess.),  4, eff. Oct. 7, 2020.) 
 4230g. Dispensing cannabis to a person under 21 years of age; civil action for damages
(a) A spouse, child, guardian, employer, or other person who is injured in person, property, or means of support by a person under 21 years of age who is impaired by cannabis, or in consequence of the impairment by cannabis of any person under 21 years of age, shall have a right of action in his or her own name, jointly or severally, against any person or persons who have caused in whole or in part such impairment by knowingly dispensing cannabis to a person under 21 years of age or enabling the consumption of cannabis by a person under 21 years of age. (b) Upon the death of either party, the action and right of action shall survive to or against the partys executor or administrator. The party injured or his or her legal representatives may bring either a joint action against the impaired person under 21 years of age and the person or persons who knowingly dispensed the cannabis or enabled the consumption of the cannabis, or a separate action against either or any of them. (c) An action to recover for damages under this section shall be commenced within two years after the cause of action accrues, and not after. (d) In an action brought under this section, evidence of responsible actions taken or not taken is admissible if otherwise relevant. (e) A defendant in an action brought under this section has a right of contribution from any other responsible person or persons, which may be enforced in a separate action brought for that purpose. (f) A person who knowingly dispenses cannabis to a person under 21 years of age or who enables consumption of cannabis by a person under 21 years of age may be held liable under this section if the person knew, or a reasonable person in the same circumstances would have known, that the person who received the cannabis was under 21 years of age. (Added 2017, No. 86 (Adj. Sess.),  9.) 
 4230h. Chemical extraction via butane or hexane prohibited
(a) No person shall manufacture concentrated cannabis by chemical extraction or chemical synthesis using butane or hexane. (b) A person who violates subsection (a) of this section shall be imprisoned not more than two years or fined not more than $2,000.00, or both. A person who violates subsection (a) of this section and causes serious bodily injury to another person shall be imprisoned not more than five years or fined not more than $5,000.00, or both. (Added 2017, No. 86 (Adj. Sess.),  10; amended 2021, No. 158 (Adj. Sess.),  20, eff. May 31, 2022.) 
 4230i. Exceptions
(a) A person who is convicted of a felony for selling cannabis in violation of section 4230 of this title or selling a regulated drug to minors or on school grounds in violation of section 4237 of this title for an offense that occurred on or after July 1, 2018 and who possesses one ounce or less of cannabis or five grams or less of hashish commits a civil violation and shall be assessed a civil penalty as follows: (1) not more than $200.00 for a first offense;(2) not more than $300.00 for a second offense; and(3) not more than $500.00 for a third or subsequent offense.(b) A person who is convicted of a felony for selling cannabis in violation of section 4230 of this title or selling a regulated drug to minors or on school grounds in violation of section 4237 of this title for an offense that occurred on or after July 1, 2018 and who possesses any of the following commits a misdemeanor and is subject to imprisonment of not more than one year or a fine of not more than $1,000.00, or both: (1) more than one ounce, but not more than two ounces of cannabis;(2) more than five grams, but not more than 10 grams of hashish; or(3) not more than six mature cannabis plants and 12 immature cannabis plants. (Added 2017, No. 86 (Adj. Sess.),  11.)
 4230j. Cannabis possession by a person under 16 years of age; delinquency
A person under 16 years of age who engages in conduct in violation of subdivision 4230b of this title commits a delinquent act and shall be subject to 33 V.S.A. chapter 52. The person shall be provided the opportunity to participate in the Court Diversion Program. (Added 2019, No. 167 (Adj. Sess.),  7, eff. Oct. 7, 2020.) 
 4231. Cocaine
(a) Possession. (1) A person knowingly and unlawfully possessing cocaine shall be imprisoned not more than one year or fined not more than $2,000.00, or both. (2) A person knowingly and unlawfully possessing cocaine in an amount consisting of 2.5 grams or more of one or more preparations, compounds, mixtures, or substances containing cocaine shall be imprisoned not more than five years or fined not more than $100,000.00, or both. (3) A person knowingly and unlawfully possessing cocaine in an amount consisting of one ounce or more of one or more preparations, compounds, mixtures, or substances containing cocaine shall be imprisoned not more than 10 years or fined not more than $250,000.00, or both. (4) [Deleted.](b) Selling or dispensing. (1) A person knowingly and unlawfully dispensing cocaine shall be imprisoned not more than three years or fined not more than $75,000.00, or both. A person knowingly and unlawfully selling cocaine shall be imprisoned not more than five years or fined not more than $100,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing cocaine in an amount consisting of 2.5 grams or more of one or more preparations, compounds, mixtures, or substances containing cocaine shall be imprisoned not more than 10 years or fined not more than $250,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing cocaine in an amount consisting of one ounce or more of one or more preparations, compounds, mixtures, or substances containing cocaine shall be imprisoned not more than 20 years or fined not more than $1,000,000.00, or both. (c)(1) Trafficking. A person knowingly and unlawfully possessing cocaine in an amount consisting of 150 grams or more of one or more preparations, compounds, mixtures, or substances containing cocaine with the intent to sell or dispense the cocaine shall be imprisoned not more than 30 years or fined not more than $1,000,000.00, or both. There shall be a permissive inference that a person who possesses cocaine in an amount consisting of 150 grams or more of one or more preparations, compounds, mixtures, or substances containing cocaine intends to sell or dispense the cocaine. The amount of possessed cocaine under this subdivision to sustain a charge of conspiracy under 13 V.S.A.  1404 shall be no less than 400 grams in the aggregate. (2) A person knowingly and unlawfully possessing crack cocaine in an amount consisting of 60 grams or more of one or more preparations, compounds, mixtures, or substances containing crack cocaine with the intent to sell or dispense the crack cocaine shall be imprisoned not more than 30 years or fined not more than $1,000,000.00, or both. There shall be a permissive inference that a person who possesses crack cocaine in an amount consisting of 60 grams or more of one or more preparations, compounds, mixtures, or substances containing crack cocaine intends to sell or dispense the crack cocaine. (Added 1989, No. 100,  2; amended 2001, No. 52,  4; 2003, No. 54,  5; 2007, No. 187 (Adj. Sess.),  1.) 
 4232. LSD
(a) Possession. (1) A person knowingly and unlawfully possessing lysergic acid diethylamide shall be imprisoned not more than one year or fined not more than $2,000.00, or both. (2) A person knowingly and unlawfully possessing lysergic acid diethylamide in an amount consisting of 100 milligrams or more of one or more preparations, compounds, mixtures, or substances containing lysergic acid diethylamide shall be imprisoned not more than five years or fined not more than $25,000.00, or both. (3) A person knowingly and unlawfully possessing lysergic acid diethylamide in an amount consisting of one gram or more of one or more preparations, compounds, mixtures, or substances containing lysergic acid diethylamide shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (4) A person knowingly and unlawfully possessing lysergic acid diethylamide in an amount consisting of 10 grams or more of one or more preparations, compounds, mixtures, or substances containing lysergic acid diethylamide shall be imprisoned not more than 20 years or fined not more than $500,000.00, or both. (b) Selling or dispensing. (1) A person knowingly and unlawfully dispensing lysergic acid diethylamide shall be imprisoned not more than three years or fined not more than $25,000.00, or both. A person knowingly and unlawfully selling lysergic acid diethylamide shall be imprisoned not more than five years or fined not more than $25,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing lysergic acid diethylamide in an amount consisting of 100 milligrams or more of one or more preparations, compounds, mixtures, or substances containing lysergic acid diethylamide shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing lysergic acid diethylamide in an amount consisting of one gram or more of one or more preparations, compounds, mixtures, or substances containing lysergic acid diethylamide shall be imprisoned not more than 20 years or fined not more than $500,000.00, or both. (Added 1989, No. 100,  3; amended 2001, No. 52,  5.) 
 4233. Heroin
(a) Possession. (1) A person knowingly and unlawfully possessing heroin shall be imprisoned not more than one year or fined not more than $2,000.00, or both. (2) A person knowingly and unlawfully possessing heroin in an amount consisting of 200 milligrams or more of one or more preparations, compounds, mixtures, or substances containing heroin shall be imprisoned not more than five years or fined not more than $100,000.00, or both. (3) A person knowingly and unlawfully possessing heroin in an amount consisting of one gram or more of one or more preparations, compounds, mixtures, or substances containing heroin shall be imprisoned not more than 10 years or fined not more than $250,000.00, or both. (4) A person knowingly and unlawfully possessing heroin in an amount consisting of two grams or more of one or more preparations, compounds, mixtures, or substances containing heroin shall be imprisoned not more than 20 years or fined not more than $1,000,000.00, or both. (b) Selling or dispensing. (1) A person knowingly and unlawfully dispensing heroin shall be imprisoned not more than three years or fined not more than $75,000.00, or both. A person knowingly and unlawfully selling heroin shall be imprisoned not more than five years or fined not more than $100,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing heroin in an amount consisting of 200 milligrams or more of one or more preparations, compounds, mixtures, or substances containing heroin shall be imprisoned not more than 10 years or fined not more than $250,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing heroin in an amount consisting of one gram or more of one or more preparations, compounds, mixtures, or substances containing heroin shall be imprisoned not more than 20 years or fined not more than $1,000,000.00, or both. (c) Trafficking. A person knowingly and unlawfully possessing heroin in an amount consisting of 3.5 grams or more of one or more preparations, compounds, mixtures, or substances containing heroin with the intent to sell or dispense the heroin shall be imprisoned not more than 30 years or fined not more than $1,000,000.00, or both. There shall be a permissive inference that a person who possesses heroin in an amount of 3.5 grams or more of one or more preparations, compounds, mixtures, or substances containing heroin intends to sell or dispense the heroin. The amount of possessed heroin under this subsection to sustain a charge of conspiracy under 13 V.S.A.  1404 shall be no less than 10 grams in the aggregate. (d) Transportation into the State. In addition to any other penalties provided by law, a person knowingly and unlawfully transporting one gram or more of heroin into Vermont with the intent to sell or dispense the heroin shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (Added 1989, No. 100,  4; amended 2001, No. 52,  6; 2003, No. 54,  6; 2007, No. 187 (Adj. Sess.),  2; 2013, No. 195 (Adj. Sess.),  8.) 
 4233a. Fentanyl
(a) Selling or dispensing. (1) A person knowingly and unlawfully dispensing fentanyl shall be imprisoned not more than three years or fined not more than $75,000.00, or both. A person knowingly and unlawfully selling fentanyl shall be imprisoned not more than five years or fined not more than $100,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing fentanyl in an amount consisting of four milligrams or more of one or more preparations, compounds, mixtures, or substances containing fentanyl shall be imprisoned not more than 10 years or fined not more than $250,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing fentanyl in an amount consisting of 20 milligrams or more of one or more preparations, compounds, mixtures, or substances containing fentanyl shall be imprisoned not more than 20 years or fined not more than $1,000,000.00, or both. (4) In lieu of a charge under this subsection, but in addition to any other penalties provided by law, a person knowingly and unlawfully selling or dispensing any regulated drug containing a detectable amount of fentanyl shall be imprisoned not more than five years or fined not more than $250,000.00, or both. (b) Trafficking. A person knowingly and unlawfully possessing fentanyl in an amount consisting of 70 milligrams or more of one or more preparations, compounds, mixtures, or substances containing fentanyl with the intent to sell or dispense the fentanyl shall be imprisoned not more than 30 years or fined not more than $1,000,000.00, or both. There shall be a permissive inference that a person who possesses fentanyl in an amount of 70 milligrams or more of one or more preparations, compounds, mixtures, or substances containing fentanyl intends to sell or dispense the fentanyl. The amount of possessed fentanyl under this subsection to sustain a charge of conspiracy under 13 V.S.A.  1404 shall be not less than 70 milligrams in the aggregate. (c) Transportation into the State. In addition to any other penalties provided by law, a person knowingly and unlawfully transporting more than 20 milligrams of fentanyl into Vermont with the intent to sell or dispense the fentanyl shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (Added 2017, No. 62,  4.) 
 4234. Depressant, stimulant, and narcotic drugs
 [Subsection (a) effective until July 1, 2023; see also subsection (a) effective July 1, 2023 set out below.] (a) Possession. (1)(A) Except as provided by subdivision (B) of this subdivision (1), a person knowingly and unlawfully possessing a depressant, stimulant, or narcotic drug, other than heroin or cocaine, shall be imprisoned not more than one year or fined not more than $2,000.00, or both. (B) A person knowingly and unlawfully possessing 224 milligrams or less of buprenorphine shall not be punished in accordance with subdivision (A) of this subdivision (1).  [Subsection (a) effective July 1, 2023; see also subsection (a) effective until July 1, 2023 set out above.] (a) Possession. (1) A person knowingly and unlawfully possessing a depressant, stimulant, or narcotic drug, other than heroin or cocaine, shall be imprisoned not more than one year or fined not more than $2,000.00, or both. (2) A person knowingly and unlawfully possessing a depressant, stimulant, or narcotic drug, other than heroin or cocaine, consisting of 100 times a benchmark unlawful dosage or its equivalent as determined by the Board of Health by rule shall be imprisoned not more than five years or fined not more than $25,000.00, or both. (3) A person knowingly and unlawfully possessing a depressant, stimulant, or narcotic drug, other than heroin or cocaine, consisting of 1,000 times a benchmark unlawful dosage or its equivalent as determined by the Board of Health by rule shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (4) A person knowingly and unlawfully possessing a depressant, stimulant, or narcotic drug, other than heroin or cocaine, consisting of 10,000 times a benchmark unlawful dosage or its equivalent as determined by the Board of Health by rule shall be imprisoned not more than 20 years or fined not more than $500,000.00, or both. (b) Selling or dispensing. (1) A person knowingly and unlawfully dispensing a depressant, stimulant, or narcotic drug, other than fentanyl, heroin, or cocaine, shall be imprisoned not more than three years or fined not more than $75,000.00, or both. A person knowingly and unlawfully selling a depressant, stimulant, or narcotic drug, other than fentanyl, cocaine, or heroin, shall be imprisoned not more than five years or fined not more than $25,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing a depressant, stimulant, or narcotic drug, other than fentanyl, heroin, or cocaine, consisting of 100 times a benchmark unlawful dosage or its equivalent as determined by the Board of Health by rule shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing a depressant, stimulant, or narcotic drug, other than fentanyl, heroin, or cocaine, consisting of 1,000 times a benchmark unlawful dosage or its equivalent as determined by the Board of Health by rule shall be imprisoned not more than 20 years or fined not more than $500,000.00, or both.  [Subsection (c) repealed effective July 1, 2023.] (c) Possession of buprenorphine by a person under 21 years of age. (1) Except as provided in subdivision (2) of this subsection, a person under 21 years of age who knowingly and unlawfully possesses 224 milligrams or less of buprenorphine commits a civil violation and shall be subject to the provisions of section 4230b of this title. (2) A person under 16 years of age who knowingly and unlawfully possesses 224 milligrams or less of buprenorphine commits a delinquent act and shall be subject to the provisions of section 4230j of this title. (Added 1989, No. 100,  5; amended 2001, No. 52,  7; 2009, No. 25,  14; 2017, No. 62,  5; 2021, No. 46,  2, eff. June 1, 2021; 2021, No. 46,  3, eff. July 1, 2023.) 
 4234a. Methamphetamine
(a) Possession. (1) A person knowingly and unlawfully possessing methamphetamine shall be imprisoned not more than one year or fined not more than $2,000.00, or both. (2) A person knowingly and unlawfully possessing methamphetamine in an amount consisting of 2.5 grams or more of one or more preparations, compounds, mixtures, or substances containing methamphetamine shall be imprisoned not more than five years or fined not more than $100,000.00, or both. (3) A person knowingly and unlawfully possessing methamphetamine in an amount consisting of 25 grams or more of one or more preparations, compounds, mixtures, or substances containing methamphetamine shall be imprisoned not more than 10 years or fined not more than $250,000.00, or both. (b) Selling and dispensing. (1) A person knowingly and unlawfully dispensing methamphetamine shall be imprisoned not more than three years or fined not more than $75,000.00, or both. A person knowingly and unlawfully selling methamphetamine shall be imprisoned not more than five years or fined not more than $100,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing methamphetamine in an amount consisting of 2.5 grams or more of one or more preparations, compounds, mixtures, or substances containing methamphetamine shall be imprisoned not more than 10 years or fined not more than $250,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing methamphetamine in an amount consisting of 25 grams or more of one or more preparations, compounds, mixtures, or substances containing methamphetamine shall be imprisoned not more than 20 years or fined not more than $1,000,000.00, or both. (c) Trafficking. A person knowingly and unlawfully possessing methamphetamine in an amount consisting of 300 grams or more of one or more preparations, compounds, mixtures, or substances containing methamphetamine with the intent to sell or dispense the methamphetamine shall be imprisoned not more than 30 years or fined not more than $1,000,000.00, or both. There shall be a permissive inference that a person who possesses methamphetamine in an amount consisting of 300 grams or more of one or more preparations, compounds, mixtures, or substances containing methamphetamine intends to sell or dispense the methamphetamine. The amount of possessed methamphetamine under this subsection to sustain a charge of conspiracy under 13 V.S.A.  1404 shall be no less than 800 grams in the aggregate. (Added 2003, No. 54,  7.) 
 4234b. Ephedrine and pseudoephedrine
(a) Possession. (1) No person shall knowingly and unlawfully possess a drug product containing ephedrine base, pseudoephedrine base, or phenylpropanolamine base with the intent to use the product as a precursor to manufacture methamphetamine or another controlled substance. (2) A person who violates this subsection shall:(A) if the offense involves possession of less than nine grams of ephedrine base, pseudoephedrine base, or phenylpropanolamine base, be imprisoned not more than one year or fined not more than $2,000.00, or both; (B) if the offense involves possession of nine or more grams of ephedrine base, pseudoephedrine base, or phenylpropanolamine base, be imprisoned not more than five years or fined not more than $100,000.00, or both. (b) Sale. (1) A drug product containing ephedrine base, pseudoephedrine base, or phenylpropanolamine base shall not be distributed at retail to the general public unless it is maintained in a locked display case or behind the counter out of the publics reach. (2)(A) A retail establishment shall not knowingly complete a sale to a person if the drug product or combination of drug products purchased would surpass a total of more than 3.6 grams within a 24-hour period or nine grams within a 30-day period of ephedrine base, pseudoephedrine base, or phenylpropanolamine base or their isomers. (B) This subdivision shall not apply to drug products dispensed pursuant to a valid prescription.(3) A person or business which violates this subdivision shall:(A) for a first violation be assessed a civil penalty of not more than $100.00; and(B) for a second and subsequent violation be assessed a civil penalty of not more than $500.00. (c) Electronic registry system. (1)(A) Retail establishments shall use an electronic registry system to record the sale of products made pursuant to subsection (b) of this section. The electronic registry system shall have the capacity to block a sale of nonprescription drug products containing ephedrine base, pseudoephedrine base, or phenylpropanolamine base that would result in a purchaser exceeding the lawful daily or monthly amount. The system shall contain an override function that may be used by an agent of a retail establishment who is dispensing the drug product and who has a reasonable fear of imminent bodily harm to his or her person or to another person if the transaction is not completed. The system shall create a record of each use of the override mechanism. (B) The electronic registry system shall be available free of charge to the State of Vermont, retail establishments, and local law enforcement agencies. (C) The electronic registry system shall operate in real time to enable communication among in-state users and users of similar systems in neighboring states. (D) The State shall use the National Precursor Log Exchange (NPLEx) online portal or its equivalent to host Vermonts electronic registry system. (2)(A) Prior to completing a sale under subsection (b) of this section, a retail establishment shall require the person purchasing the drug product to present a current, valid, government-issued identification document. The retail establishment shall record in the electronic registry system: (i) the name and address of the purchaser;(ii) the name of the drug product and quantity of ephedrine, pseudoephedrine, and phenylpropanolamine base sold in grams; (iii) the date and time of purchase;(iv) the form of identification presented, the issuing government entity, and the corresponding identification number; and (v) the name of the person selling or furnishing the drug product.(B)(i) If the retail establishment experiences an electronic or mechanical failure of the electronic registry system and is unable to comply with the electronic recording requirement, the retail establishment shall maintain a written log or an alternative electronic record-keeping mechanism until the retail establishment is able to comply fully with this subsection (c). (ii) If the region of the State where the retail establishment is located does not have broadband Internet access, the retail establishment shall maintain a written log or an alternative electronic record-keeping mechanism until broadband Internet access becomes accessible in that region. At that time, the retail establishment shall come into compliance with this subsection (c). (C) A retail establishment shall maintain all records of drug product purchases made pursuant to this subsection (c) for a minimum of two years. (3) A retail establishment shall display a sign at the register provided by NPLEx or its equivalent to notify purchasers of drug products containing ephedrine, pseudoephedrine, or phenylpropanolamine base that: (A) the purchase of the drug product or products shall result in the purchasers identity being listed on a national database; and (B) the purchaser has the right to request the transaction number for any purchase that was denied pursuant to this subsection (c). (4) A person or retail establishment that violates this subsection shall:(A) for a first violation be assessed a civil penalty of not more than $100.00; and(B) for a second or subsequent violation be assessed a civil penalty of not more than $500.00. (d) This section shall not apply to a manufacturer that has obtained an exemption from the Attorney General of the United States under Section 711(d) of the federal Combat Methamphetamine Epidemic Act of 2005. (e) As used in this section:(1) Distributor means a person, other than a manufacturer or wholesaler, that sells, delivers, transfers, or in any manner furnishes a drug product to any person that is not the ultimate user or consumer of the product. (2) Knowingly means having actual knowledge of the relevant facts.(3) Manufacturer means a person that produces, compounds, packages, or in any manner initially prepares a drug product for sale or use. (4) Wholesaler means a person, other than a manufacturer, that sells, transfers, or in any manner furnishes a drug product to any other person for the purpose of being resold. (Added 2005, No. 164 (Adj. Sess.),  2, eff. Sept. 30, 2006; amended 2013, No. 75,  19, eff. Oct. 1, 2013; 2013, No. 75,  19a, eff. Sept. 30, 2016; 2017, No. 62,  7, eff. June 7, 2017; 2017, No. 113 (Adj. Sess.),  82.) 
 4235. Hallucinogenic drugs
(a) Dose of a hallucinogenic drug means that minimum amount of a hallucinogenic drug, not commonly used for therapeutic purposes, which causes a substantial hallucinogenic effect. The Board of Health shall adopt rules which establish doses for hallucinogenic drugs. The Board may incorporate, where applicable, dosage calculations or schedules, whether described as dosage equivalencies or otherwise, established by the federal government. (b) Possession. (1) A person knowingly and unlawfully possessing a hallucinogenic drug, other than lysergic acid diethylamide, shall be imprisoned not more than one year or fined not more than $2,000.00, or both. (2) A person knowingly and unlawfully possessing 10 or more doses of a hallucinogenic drug, other than lysergic acid diethylamide, shall be imprisoned not more than five years or fined not more than $25,000.00, or both. (3) A person knowingly and unlawfully possessing 100 or more doses of a hallucinogenic drug, other than lysergic acid diethylamide, shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (4) A person knowingly and unlawfully possessing 1,000 or more doses of a hallucinogenic drug, other than lysergic acid diethylamide, shall be imprisoned not more than 15 years or fined not more than $500,000.00, or both. (c) Selling or dispensing. (1) A person knowingly and unlawfully dispensing a hallucinogenic drug, other than lysergic acid diethylamide, shall be imprisoned not more than three years or fined not more than $25,000.00, or both. A person knowingly and unlawfully selling a hallucinogenic drug, other than lysergic acid diethylamide, shall be imprisoned not more than five years or fined not more than $25,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing 10 or more doses of a hallucinogenic drug, other than lysergic acid diethylamide, shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing 100 or more doses of a hallucinogenic drug, other than lysergic acid diethylamide, shall be imprisoned not more than 15 years or fined not more than $500,000.00, or both. (Added 1989, No. 100,  6; amended 2001, No. 52,  8.) 
 4235a. Ecstasy
(a) Possession. (1) A person knowingly and unlawfully possessing Ecstasy shall be imprisoned not more than one year or fined not more than $2,000.00, or both. (2) A person knowingly and unlawfully possessing Ecstasy in an amount consisting of two grams or more of one or more preparations, compounds, mixtures, or substances containing Ecstasy shall be imprisoned not more than five years or fined not more than $25,000.00, or both. (3) A person knowingly and unlawfully possessing Ecstasy in an amount consisting of 20 grams or more of one or more preparations, compounds, mixtures, or substances containing Ecstasy shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (4) A person knowingly and unlawfully possessing Ecstasy in an amount consisting of seven ounces or more of one or more preparations, compounds, mixtures, or substances containing Ecstasy shall be imprisoned not more than 20 years or fined not more than $500,000.00, or both. (b) Selling or dispensing. (1) A person knowingly and unlawfully dispensing Ecstasy shall be imprisoned not more than three years or fined not more than $25,000.00, or both. A person knowingly and unlawfully selling Ecstasy shall be imprisoned not more than five years or fined not more than $25,000.00, or both. (2) A person knowingly and unlawfully selling or dispensing Ecstasy in an amount consisting of two grams or more of one or more preparations, compounds, mixtures, or substances containing Ecstasy shall be imprisoned not more than 10 years or fined not more than $100,000.00, or both. (3) A person knowingly and unlawfully selling or dispensing Ecstasy in an amount consisting of 20 grams or more of one or more preparations, compounds, mixtures, or substances containing Ecstasy shall be imprisoned not more than 20 years or fined not more than $500,000.00, or both. (Added 2001, No. 52,  9.) 
 4236. Manufacture or cultivation
(a) A person knowingly and unlawfully manufacturing or cultivating a regulated drug shall be imprisoned not more than 20 years or fined not more than $1,000,000.00, or both. (b) This section shall not apply to the cultivation of cannabis. (Added 1989, No. 100,  7.)
 4237. Selling or dispensing to minors; selling on school grounds
(a) Dispensing regulated drugs to minors. A person knowingly and unlawfully dispensing any regulated drug to a minor who is at least three years that persons junior shall be sentenced to a term of imprisonment of not more than five years. (b) Sale of regulated drugs. A person knowingly and unlawfully selling any regulated drug to a minor shall, in addition to any other penalty, be sentenced to a term of imprisonment of not more than 10 years. (c) Selling on school grounds. No person shall knowingly and unlawfully:(1) dispense or sell a regulated drug to any person on a school bus or on real property owned by a public or private elementary, secondary, or vocational school; (2) sell a regulated drug to any person on real property abutting real property owned by a public or private elementary, secondary, or vocational school; or (3) dispense a regulated drug to any person in public view on real property abutting real property owned by a school. (d) Abutting school property. The selling or dispensing of a regulated drug to a person on property abutting school property is a violation under this section only if it occurs within 500 feet of the school property. Property shall be considered abutting school property if: (1) it shares a boundary with school property; or(2) it is adjacent to school property and is separated only by a river, stream, or public highway. (e) Penalty. A person who violates subsection (c) of this section shall, in addition to any other penalty, be sentenced to a term of imprisonment of not more than 10 years. (f) Definitions. As used in this section:(1) Minor means a person under the age of 18.(2) Owned by a school means owned, leased, controlled, or subcontracted by a school and used frequently by students for educational or recreational activities. (Added 1989, No. 100,  8; amended 2001, No. 52,  10; 2003, No. 54,  8; 2017, No. 113 (Adj. Sess.),  83.) 
 4238. Second and subsequent offenses
A person convicted of a second or subsequent offense of violating section 4228, 4230, 4231, 4232, 4233, 4234, 4235, 4236 or 4237 of this title, except a violation of subdivision 4230(a)(1), shall be subject to a term of imprisonment or fined up to twice that authorized by those sections, or both. (Added 1989, No. 100,  9.) 
 4239. Collection of fines
Fines imposed for violation of this chapter shall be considered as a judgment and may be collected and executed upon by the State, through the States Attorneys office or the Attorney Generals office, according to the Rules of Civil Procedure. The State may use the discovery provisions of the civil rules in connection with collection of an execution upon the judgment. Such procedure for collection of a fine shall not be exclusive. (Added 1989, No. 100,  15.) 
 4240. Prevention and treatment of opioid-related overdoses
(a) As used in this section:(1) Health care professional means a physician licensed pursuant to 26 V.S.A. chapter 23 or 33, a physician assistant licensed to prescribe and dispense prescription drugs pursuant to 26 V.S.A. chapter 31, an advanced practice registered nurse authorized to prescribe and dispense prescription drugs pursuant to 26 V.S.A. chapter 28, or a pharmacist licensed pursuant to 26 V.S.A. chapter 36. (2) Opioid antagonist means a drug that, when administered, negates or neutralizes in whole or part the pharmacological effects of an opioid in the body. (3) Victim means the person who has overdosed on an opioid drug or who is believed to have overdosed on an opiate drug. (b) For the purpose of addressing prescription and nonprescription opioid overdoses in Vermont, the Department shall develop and implement a prevention, intervention, and response strategy, depending on available resources, that shall: (1) provide educational materials on opioid overdose prevention to the public free of charge, including to substance abuse treatment providers, health care providers, opioid users, and family members of opioid users; (2) increase community-based prevention programs aimed at reducing risk factors that lead to opioid overdoses; (3) increase timely access to treatment services for opioid users, including medication-assisted treatment; (4)(A) educate substance abuse treatment providers on methods to prevent opioid overdoses;(B) provide education and training on overdose prevention, intervention, and response to individuals living with addiction and participating in opioid treatment programs, syringe exchange programs, residential drug treatment programs, or correctional services; (5) facilitate overdose prevention, drug treatment, and addiction recovery services by implementing and expanding hospital referral services for individuals treated for an opioid overdose; and (6) develop a statewide opioid antagonist pilot program that emphasizes access to opioid antagonists to and for the benefit of individuals with a history of opioid use. (c)(1) A health care professional acting in good faith and within his or her scope of practice may directly or by standing order prescribe, dispense, and distribute an opioid antagonist to the following persons, provided the person has been educated about opioid-related overdose prevention and treatment in a manner approved by the Department: (A) a person at risk of experiencing an opioid-related overdose; or(B) a family member, friend, or other person in a position to assist a person at risk of experiencing an opioid-related overdose. (2) A health care professional who prescribes, dispenses, or distributes an opioid antagonist in accordance with subdivision (1) of this subsection shall be immune from civil or criminal liability with regard to the subsequent use of the opioid antagonist, unless the health professionals actions with regard to prescribing, dispensing, or distributing the opioid antagonist constituted recklessness, gross negligence, or intentional misconduct. The immunity granted in this subdivision shall apply whether or not the opioid antagonist is administered by or to a person other than the person for whom it was prescribed. (d)(1) A person may administer an opioid antagonist to a victim if he or she believes, in good faith, that the victim is experiencing an opioid-related overdose. (2) After a person has administered an opioid antagonist pursuant to subdivision (1) of this subsection (d), he or she shall immediately call for emergency medical services if medical assistance has not yet been sought or is not yet present. (3) A person shall be immune from civil or criminal liability for administering an opioid antagonist to a victim pursuant to subdivision (1) of this subsection unless the persons actions constituted recklessness, gross negligence, or intentional misconduct. The immunity granted in this subdivision shall apply whether or not the opioid antagonist is administered by or to a person other than the person for whom it was prescribed. (e) A person acting on behalf of a community-based overdose prevention program or a licensed pharmacist shall be immune from civil or criminal liability for providing education on opioid-related overdose prevention or for purchasing, acquiring, distributing, or possessing an opioid antagonist unless the persons actions constituted recklessness, gross negligence, or intentional misconduct. (f) Any health care professional who treats a victim and who has knowledge that the victim has been administered an opioid antagonist within the preceding 30 days shall refer the victim to professional substance abuse treatment services. (Added 2013, No. 75,  17; amended 2015, No. 38,  25, eff. May 28, 2015.) 
 4241. Scope
(a) The following property shall be subject to this subchapter:(1) All regulated drugs which have been cultivated, manufactured, distributed, compounded, possessed, sold, prescribed, dispensed, or delivered in violation of subchapter 1 of this chapter. (2) All raw materials, products, and equipment of any kind, which are used or intended for use in cultivating, manufacturing, compounding, dispensing, delivering, processing, importing, or exporting any regulated drug in violation of subchapter 1 of this chapter. (3) All property which is used or intended for use as a container for property described in subdivision (1) or (2) of this subsection. (4) All books, records, and research, including formulas, microfilm, tapes, computers, software, and data, which are used or intended for use in violation of subchapter 1 of this chapter. (5) Any consideration, including monies, negotiable instruments, and securities, used or intended for use in the cultivation, manufacture, compounding, distribution, or delivery of any regulated drug in violation of subchapter 1 of this chapter and any proceeds or derivative proceeds of any dispensing or sale of any regulated drug in violation of subchapter 1 of this chapter, including monies, negotiable instruments, and securities. Such consideration, proceeds, or derivative proceeds shall be forfeited to the extent of the interest of an owner, only by reason of an action or omission committed or omitted with the knowledge or consent of the owner. As used herein, derivative proceeds shall not include real property which is occupied as the primary residence of a person involved in the violation and a member or members of that persons family. (6) All conveyances, including aircraft, vehicles, or vessels, which are used or are intended for use to transport, conceal, or in any manner facilitate the cultivation, manufacture, compounding, dispensing, delivering, sale, or possession of a regulated drug in violation of subchapter 1 of this chapter. No conveyance shall be forfeited: (A) which is used by any person as a common carrier in the transaction of business as a common carrier unless the owner or other person in charge of such conveyance was a consenting party or privy to a violation of subchapter 1 of this chapter; (B) by reason of any act or omission of any person other than the owner while the conveyance was unlawfully in the possession of a person other than the owner in violation of the criminal laws of the United States, this State, or any other state; or (C) by reason of the use or intended use of the conveyance in violation of subchapter 1 of this chapter by a person other than the owner, unless the owner knew or had reason to believe that the conveyance was used in that manner. (7) Any property seized pursuant to 13 V.S.A.  364.(b) This subchapter shall apply to property for which forfeiture is sought in connection with: (1) a violation under chapter 84, subchapter 1 of this title that carries by law a maximum penalty of ten years incarceration or greater; or (2) a violation of 13 V.S.A.  364. (Added 1985, No. 174 (Adj. Sess.),  2; amended 1989, No. 100,  13; 2013, No. 84,  3, eff. June 10, 2013; 2015, No. 53,  3.)
 4242. Seizure
(a) The court may issue at the request of the State ex parte a preliminary order or process to seize or secure property for which forfeiture is sought and to provide for its custody. Process for seizure of such property shall issue only upon a showing of probable cause that the property is subject to forfeiture. Application therefor and issuance, execution, and return shall be subject to provisions of applicable law. (b) Any property subject to forfeiture under this subchapter may be seized upon process. Seizure without process may be made when: (1) the seizure is incident to an arrest with probable cause or a search under a valid search warrant; (2) the property subject to seizure has been the subject of a prior judgment in favor of the State in a forfeiture proceeding under this subchapter; or (3) the seizure is incident to a valid warrantless search.(c) If property is seized without process under subdivision (b)(1) or (3) of this section, the State shall forthwith petition the court for a preliminary order or process under subsection (a) of this section. (d) Notwithstanding subsection 4241(b) of this title, all regulated drugs the possession of which is prohibited under this chapter are contraband and shall be automatically forfeited to the State and destroyed. (Added 1985, No. 174 (Adj. Sess.),  2; amended 1987, No. 42; 2015, No. 53,  4.) 
 4243. Judicial forfeiture procedure
(a) Conviction or agreement required. An asset is subject to forfeiture by judicial determination under section 4241 of this title and 13 V.S.A.  364 if: (1) a person is convicted of the criminal offense related to the action for forfeiture; or (2) a person enters into an agreement with the prosecutor under which he or she is not charged with a criminal offense related to the action for forfeiture. (b) Evidence. The State may introduce into evidence in the judicial forfeiture case the fact of a conviction in the Criminal Division. (c) Burden of proof. The State bears the burden of proving by clear and convincing evidence that the property is an instrument of or represents the proceeds of the underlying offense. (d) Notice. Within 60 days from when the seizure occurs, the State shall notify any owners, possessors, and lienholders of the property of the action, if known or readily ascertainable. Upon motion by the State, a court may extend the time period for sending notice for a period not to exceed 90 days for good cause shown. (e) Return of property. If notice is not sent in accordance with subsection (d) of this section, and no time extension is granted or the extension period has expired, the law enforcement agency shall return the property to the person from whom the property was seized. An agencys return of property due to lack of proper notice does not restrict the agencys authority to commence a forfeiture proceeding at a later time. Nothing in this subsection shall require the agency to return contraband, evidence, or other property that the person from whom the property was seized is not entitled to lawfully possess. (f) Filing of petition. The State shall file a petition for forfeiture of any property seized under section 4242 of this title promptly, but not more than 14 days from the date the preliminary order or process is issued. The petition shall be filed in the Superior Court of the county in which the property is located or in any court with jurisdiction over a criminal proceeding related to the property. (g) Service of petition. A copy of the petition shall be served on all persons named in the petition as provided for in Rule 4 of the Vermont Rules of Civil Procedure. In addition, the State shall cause notice of the petition to be published in a newspaper of general circulation in the State, as ordered by the court. The petition shall state: (1) the facts upon which the forfeiture is requested, including a description of the property subject to forfeiture, and the type and quantity of regulated drug involved; (2) the names of the apparent owner or owners, lienholders who have properly recorded their interests, and any other person appearing to have an interest; and, in the case of a conveyance, the name of the person holding title, the registered owner, and the make, model, and year of the conveyance. (Added 1985, No. 174 (Adj. Sess.),  2; amended 2015, No. 53,  5; 2015, No. 97 (Adj. Sess.),  50.) 
 4244. Forfeiture hearing
(a) Within 60 days following service of notice of seizure and forfeiture under section 4243 of this title, a claimant may file a demand for judicial determination of the forfeiture. The demand must be in the form of a civil complaint accompanied by a sworn affidavit setting forth the facts upon which the claimant intends to rely, including, if relevant, the noncriminal source of the asset or currency at issue. The demand must be filed with the court administrator in the county in which the seizure occurred. (b) The court shall hold a hearing on the petition as soon as practicable after, and in any event no later than 90 days following, the conclusion of the criminal prosecution. (c) A lienholder who has received notice of a forfeiture proceeding may intervene as a party. If the court finds that the lienholder has a valid, good faith interest in the subject property which is not held through a straw purchase, trust, or otherwise for the actual benefit of another and that the lienholder did not at any time have knowledge or reason to believe that the property was being or would be used in violation of the law, the court upon forfeiture shall order compensation to the lienholder to the extent of the lienholders interest. (d) The court shall not order the forfeiture of property if an owner, co-owner, or person who regularly uses the property, other than the defendant, shows by a preponderance of the evidence that the owner, co-owner, or regular user did not consent to or have any express or implied knowledge that the property was being or was intended to be used in a manner that would subject the property to forfeiture, or that the owner, co-owner, or regular user had no reasonable opportunity or capacity to prevent the defendant from using the property. (e) The proceeding shall be against the property and shall be deemed civil in nature. The State shall have the burden of proving all material facts by clear and convincing evidence. (f) The court shall make findings of fact and conclusions of law and shall issue a final order. If the petition is granted, the court shall order the property held for evidentiary purposes, delivered to the State Treasurer, or, in the case of regulated drugs or property which is harmful to the public, destroyed. (Added 1985, No. 174 (Adj. Sess.),  2; amended 2015, No. 53,  6.) 
 4245. Remission or mitigation of forfeiture
(a) On petition filed within 90 days after completion of a forfeiture proceeding, a court that issued a forfeiture order pursuant to section 4244 of this title may order that the forfeiture be remitted or mitigated. The petition shall be sworn and shall include all information necessary for its resolution or shall describe where such information can be obtained. Upon receiving a petition, the court shall investigate and may conduct a hearing if in its judgment it would be helpful to the resolution of the petition. The court shall either grant or deny the petition within 90 days. (b) The court may remit or mitigate a forfeiture upon finding that relief should be granted to avoid extreme hardship or upon finding that the petitioner has a valid, good faith interest in the property which is not held through a straw purchase, trust, or otherwise for the benefit of another and that the petitioner did not at any time have knowledge or reason to believe that the property was being or would be used in violation of the law. (Added 1985, No. 174 (Adj. Sess.),  2; amended 2018, No. 8 (Sp. Sess.),  7, eff. June 28, 2018.) 
 4246. Maintenance
Law enforcement agencies seizing property under this subchapter shall ensure that the property is properly maintained. Equipment and conveyances seized shall be removed to an appropriate place for storage. Any monies, negotiable instruments, or securities seized shall if practicable be deposited in an interest-bearing account pending final disposition by the court unless the seizing agency determines the properties to be of an evidentiary nature and provides for their security in another manner. Any such deposit in an interest-bearing account shall only be accomplished pursuant to a court order directing the same, and the court shall have jurisdiction to enter such order or any other order directing interim disposition of the properties pending final disposition by the court. (Added 1985, No. 174 (Adj. Sess.),  2.) 
 4247. Disposition of property
(a) Whenever property is forfeited and delivered to the State Treasurer under this subchapter, the State Treasurer shall, not sooner than 90 days after the date the property is delivered, sell the property at a public sale held under 27 V.S.A. chapter 18, subchapter 7. (b) The proceeds from the sale of forfeited property shall be used first to offset any costs of selling the property and then, after any liens on the property have been paid in full, applied to payment of seizure, storage, and forfeiture expenses, including animal care expenses related to the underlying violation. Remaining proceeds shall be distributed as follows: (1)(A) 45 percent shall be distributed among:(i) the Office of the Attorney General;(ii) the Department of States Attorneys and Sheriffs; and(iii) State and local law enforcement agencies. [Subsection (b)(1)(B) repealed effective July 1, 2024.] (B) The Agency of Administration is authorized to determine the allocations among the groups listed in subdivision (A) of this subdivision (1) and may only reimburse the prosecutor and law enforcement agencies that participated in the enforcement effort resulting in the forfeiture for expenses incurred, including actual expenses for involved personnel. The proceeds shall be held by the Treasurer until the Agency notifies the Treasurer of the allocation determinations, at which time the Treasurer shall forward the allocated amounts to the appropriate agencys operating funds. (2) The remaining 55 percent shall be deposited in the General Fund. (Added 1985, No. 174 (Adj. Sess.),  2; amended 2015, No. 53,  7; 2021, No. 141 (Adj. Sess.),  2, eff. July 1, 2022; 2021, No. 141 (Adj. Sess.),  3.)
 4248. Records
(a) Law enforcement departments and agencies, and other state departments and agencies which have custody of any property subject to forfeiture under this subchapter, or which dispose of such property, shall keep and maintain full and complete records including the following: (1) from whom the property was received;(2) description of the property, including the exact kinds, quantities, and forms of the property; (3) value of the property;(4) if the property is deposited in an interest-bearing account, the location of the account and the amount of interest; (5) under what authority the property was held or received or disposed;(6) to whom the property was delivered;(7) the date and manner of destruction or disposition of the property.(b) Those records shall be submitted to the State Treasurer and shall be open to inspection by all federal and State departments and agencies charged with enforcement of federal and State drug control laws. Persons making final disposition or destruction of the property under court order shall report, under oath, to the court the exact circumstances of that disposition or destruction and a copy of that report shall be sent to the State Treasurer. (Added 1985, No. 174 (Adj. Sess.),  2.) 
 4249. Transportation of alcohol, tobacco, or regulated drugs into places of detention
(a) No person shall knowingly carry or introduce or cause to be carried or introduced into a lockup, jail, prison, or correctional facility: (1) alcohol or alcoholic beverages;(2) cannabis;(3) a regulated drug, other than cannabis, as defined in section 4201 of this title, except upon the prescription or direction of a practitioner as that term is defined in 26 V.S.A. chapter 36; or (4) tobacco or tobacco products, except that an employee may possess or store tobacco or tobacco products in a locked automobile parked on the correctional facility grounds, store tobacco or tobacco products in a secure place within the correctional facility which is designated for storage of employee tobacco, and possess tobacco or tobacco products in a designated smoking area. (b) A person who violates subdivision (a)(1) of this section shall be imprisoned not more than three months or fined not more than $300.00, or both. (c) A person who violates subdivision (a)(2) of this section shall be imprisoned not more than six months or fined not more than $500.00, or both. (d) A person who violates subdivision (a)(3) of this section shall be imprisoned not more than one year or fined not more than $1,000.00, or both. (e) A person who violates subdivision (a)(4) of this section shall be subject to a civil penalty of not more than $450.00 for the first offense and $900.00 for any subsequent offense. An action under this subsection shall be brought in the same manner as for a traffic violation pursuant to 23 V.S.A. chapter 24. (f) As used in this section, correctional facility means any secure or staff-secure building, enclosure, space, or structure of or supported by the Department and used for the confinement of persons committed to the custody of the Commissioner of Corrections, or for any other matter related to such confinement. (Added 2003, No. 54,  9; amended 2007, No. 64,  2; 2017, No. 83,  147.) 
 4250. Selling or dispensing a regulated drug with death resulting
(a) If the death of a person results from the selling or dispensing of a regulated drug to the person in violation of this chapter, the person convicted of the violation shall be imprisoned not less than two years nor more than 20 years. (b) This section shall apply only if the persons use of the regulated drug is the proximate cause of his or her death. (Added 2003, No. 54,  10.) 
 4252. Penalties for dispensing or selling regulated drugs in a dwelling
(a) No person shall knowingly permit a dwelling, building, or structure owned by or under the control of the person to be used for the purpose of illegally dispensing or selling a regulated drug. (b) A landlord shall be in violation of subsection (a) of this section only if the landlord knew at the time he or she signed the lease agreement that the tenant intended to use the dwelling, building, or structure for the purpose of illegally dispensing or selling a regulated drug. (c) A person who violates this section shall be imprisoned not more than two years or fined not more than $1,000.00 or both. (Added 2007, No. 187 (Adj. Sess.),  3.) 
 4253. Use of a firearm while selling or dispensing a drug
(a) A person who uses a firearm during and in relation to selling or dispensing a regulated drug in violation of subdivision 4230(b)(3), 4231(b)(3), 4232(b)(3), 4233(b)(3), 4234(b)(3), 4234a(b)(3), 4235(c)(3), or 4235a(b)(3) of this title shall be imprisoned not more than three years or fined not more than $5,000.00, or both, in addition to the penalty for the underlying crime. (b) A person who uses a firearm during and in relation to trafficking a regulated drug in violation of subsection 4230(c), 4231(c), 4233(c), or 4234a(c) of this title shall be imprisoned not more than five years or fined not more than $10,000.00, or both, in addition to the penalty for the underlying crime. (c) For purposes of this section, use of a firearm shall include the exchange of firearms for drugs, and this section shall apply to the person who trades a firearm for a drug and the person who trades a drug for a firearm. (Added 2011, No. 121 (Adj. Sess.),  5.) 
 4254. Immunity from liability
(a) As used in this section:(1) Drug overdose means an acute condition resulting from or believed to be resulting from the use of a regulated drug that a layperson would reasonably believe requires medical assistance. For purposes of this section, regulated drug shall include alcohol. (2) Medical assistance means professional services provided to a person experiencing a drug overdose by a health care professional licensed, registered, or certified under State law who, acting within his or her lawful scope of practice, may provide diagnosis, treatment, or emergency services for a person experiencing a drug overdose. (3) Seeks medical assistance shall include providing care to someone who is experiencing a drug overdose while awaiting the arrival of medical assistance to aid the overdose victim. (b) A person who, in good faith and in a timely manner, seeks medical assistance for someone who is experiencing a drug overdose shall not be cited, arrested, or prosecuted for a violation of this chapter or cited, arrested, or prosecuted for procuring, possessing, or consuming alcohol by someone under 21 years of age pursuant to 7 V.S.A.  656 or for providing to or enabling consumption of alcohol by someone under 21 years of age pursuant to 7 V.S.A.  658(a)-(c). (c) A person who is experiencing a drug overdose and, in good faith, seeks medical assistance for himself or herself or is the subject of a good faith request for medical assistance shall not be cited, arrested, or prosecuted for a violation of this chapter or cited, arrested, or prosecuted for procuring, possessing, or consuming alcohol by someone under 21 years of age pursuant to 7 V.S.A.  656 or for providing to or enabling consumption of alcohol by someone under 21 years of age pursuant to 7 V.S.A.  658(a)-(c). (d) A person who seeks medical assistance for a drug overdose or is the subject of a good faith request for medical assistance pursuant to subsection (b) or (c) of this section shall not be subject to any of the penalties for violation of 13 V.S.A.  1030 (violation of a protection order), for a violation of this chapter or 7 V.S.A.  656, for being at the scene of the drug overdose or for being within close proximity to any person at the scene of the drug overdose. (e) A person who seeks medical assistance for a drug overdose or is the subject of a good faith request for medical assistance pursuant to subsection (b) or (c) of this section shall not be subject to any sanction for a violation of a condition of pretrial release, probation, furlough, or parole for a violation of this chapter or 7 V.S.A.  656 for being at the scene of the drug overdose or for being within close proximity to any person at the scene of the drug overdose. (f) The act of seeking medical assistance for or by someone who is experiencing a drug overdose shall be considered a mitigating circumstance at sentencing for a violation of any other offense. (g) The immunity provisions of this section apply only to the use and derivative use of evidence gained as a proximate result of the persons seeking medical assistance for a drug overdose, being the subject of a good faith request for medical assistance, being at the scene, or being within close proximity to any person at the scene of the drug overdose for which medical assistance was sought and do not preclude prosecution of the person on the basis of evidence obtained from an independent source. (h) A person who seeks medical assistance for a drug overdose pursuant to subsection (b) or (c) of this section shall not be subject to the provisions of subchapter 2 of this chapter concerning property subject to forfeiture, except that prima facie contraband shall be subject to forfeiture. (i) Except in cases of reckless or intentional misconduct, law enforcement shall be immune from liability for citing or arresting a person who is later determined to qualify for immunity under this section. (Added 2013, No. 71,  2, eff. June 5, 2013; amended 2013, No. 195 (Adj. Sess.),  17; 2017, No. 83,  148.) 
 4255. Vermont Prescription Drug Advisory Council
(a) There is hereby created the Vermont Prescription Drug Advisory Council for the purpose of advising the Commissioner of Health on matters related to the Vermont Prescription Monitoring System and to the appropriate use of controlled substances in treating acute and chronic pain and in preventing prescription drug abuse, misuse, and diversion. (b)(1) The Advisory Council shall consist of the following members:(A) the Commissioner of Health or designee, who shall serve as chair;(B) a designee of the Division of Substance Use Programs;(C) the Commissioner of Mental Health or designee;(D) the Commissioner of Public Safety or designee;(E) the Commissioner of Labor or designee;(F) the Vermont Attorney General or designee;(G) the Director of the Blueprint for Health or designee;(H) the Medical Director of the Department of Vermont Health Access;(I) the Chair of the Board of Medical Practice or designee, who shall be a clinician;(J) a representative of the Vermont State Dental Society, who shall be a dentist;(K) a representative of the Vermont Board of Pharmacy, who shall be a pharmacist;(L) a faculty member of the academic detailing program at the University of Vermonts College of Medicine; (M) a faculty member of the University of Vermonts College of Medicine with expertise in the treatment of addiction or chronic pain management; (N) a representative of the Vermont Medical Society, who shall be a primary care clinician;(O) a representative of the American Academy of Family Physicians, Vermont chapter, who shall be a primary care clinician; (P) a representative from the Vermont Board of Osteopathic Physicians, who shall be an osteopath; (Q) a representative from the Vermont Association of Naturopathic Physicians, who shall be a naturopathic physician; (R) a representative of the Federally Qualified Health Centers, who shall be a primary care clinician selected by the Bi-State Primary Care Association; (S) a representative of the Vermont Ethics Network;(T) a representative of the Hospice and Palliative Care Council of Vermont;(U) a representative of the Office of the Health Care Advocate;(V) a representative of health insurers, to be selected by the three health insurers with the most covered lives in Vermont; (W) a clinician who works in the emergency department of a hospital, to be selected by the Vermont Association of Hospitals and Health Systems in consultation with any nonmember hospitals; (X) a clinician who specializes in occupational medicine, to be selected by the Commissioner of Health; (Y) a clinician who specializes in physical medicine and rehabilitation, to be selected by the Commissioner of Health; (Z) a member of the Vermont Board of Nursing Subcommittee on APRN Practice, who shall be an advanced practice registered nurse who has clinical experience that includes working with patients who are experiencing acute or chronic pain; (AA) a representative from the Vermont Assembly of Home Health and Hospice Agencies;(BB) a psychologist licensed pursuant to 26 V.S.A. chapter 55 who has experience in treating chronic pain, to be selected by the Board of Psychological Examiners; (CC) a drug and alcohol abuse counselor licensed pursuant to 26 V.S.A. chapter 62, to be selected by the Commissioner of Health; (DD) a retail pharmacist, to be selected by the Vermont Pharmacists Association;(EE) an advanced practice registered nurse full-time faculty member from the University of Vermonts College of Nursing and Health Sciences with a current clinical practice that includes caring for patients with acute or chronic pain; (FF) a licensed acupuncturist with experience in pain management, to be selected by the Vermont Acupuncture Association; (GG) a representative of the Vermont Substance Abuse Treatment Providers Association;(HH) a consumer representative who is either a consumer in recovery from prescription drug abuse or a consumer receiving medical treatment for chronic noncancer-related pain; and (II) a consumer representative who is or has been an injured worker and has been prescribed opioids. (2) In addition to the members appointed pursuant to subdivision (1) of this subsection (b), the Council shall consult with the Opioid Prescribing Task Force, specialists, and other individuals as appropriate to the topic under consideration. (c) Advisory Council members who are not employed by the State or whose participation is not supported through their employment or association shall be entitled to a per diem and expenses as provided by 32 V.S.A.  1010. (d)(1) The Advisory Council shall provide advice to the Commissioner concerning rules for the appropriate use of controlled substances in treating acute pain and chronic noncancer pain; the appropriate use of the Vermont Prescription Monitoring System; and the prevention of prescription drug abuse, misuse, and diversion. (2) The Advisory Council shall evaluate the use of nonpharmacological approaches to treatment for pain, including the appropriateness, efficacy, and cost-effectiveness of using complementary and alternative therapies, such as chiropractic, acupuncture, and massage. (e) The Commissioner of Health may adopt rules pursuant to 3 V.S.A. chapter 25 regarding the appropriate use of controlled substances in treating acute pain and chronic noncancer pain; the appropriate use of the Vermont Prescription Monitoring System; and the prevention of prescription drug abuse, misuse, and diversion, after seeking the advice of the Council. (Added 2015, No. 173 (Adj. Sess.),  14; amended 2017, No. 113 (Adj. Sess.),  84; 2019, No. 82,  6; 2021, No. 115 (Adj. Sess.),  2, eff. July 1, 2022.) 
 4281. Legislative intent
The General Assembly recognizes the important public health benefits of the legal medical use of controlled substances and also the significant risk to public health that can arise due to the abuse of those substances. It is the intent of this chapter to create the Vermont Prescription Monitoring System, which will provide an electronic database and reporting system for electronic monitoring of prescriptions for Schedules II, III, and IV controlled substances, as defined in 21 C.F.R. Part 1308, as amended and as may be amended, to promote the public health through enhanced opportunities for treatment for and prevention of abuse of controlled substances, without interfering with the legal medical use of those substances. (Added 2005, No. 205 (Adj. Sess.),  1.) 
 4282. Definitions
As used in this chapter:(1) Dispenser means any person who dispenses or engages in dispensing as those terms are defined in 26 V.S.A.  2022(5). (2) Health care provider means an individual licensed, certified, or authorized by law to provide professional health care service in this State to an individual during that individuals medical or dental care, treatment, or confinement. (3) VPMS means the Vermont Prescription Monitoring System established under this chapter.(4) Delegate means an individual employed by a health care provider or pharmacy or in the Office of the Chief Medical Examiner and authorized by a health care provider or dispenser or by the Chief Medical Examiner to request information from the VPMS relating to a bona fide current patient of the health care provider or dispenser or to a bona fide investigation or inquiry into an individuals death. (5) Department means the Department of Health.(6) Drug diversion investigator means an employee of the Department of Public Safety whose primary duties include investigations involving violations of laws regarding prescription drugs or the diversion of prescribed controlled substances, and who has completed a training program established by the Department of Health by rule that is designed to ensure that officers have the training necessary to use responsibly and properly any information that they receive from the VPMS. (7) Evidence-based means based on criteria and guidelines that reflect high-quality, cost-effective care. The methodology used to determine such guidelines shall meet recognized standards for systematic evaluation of all available research and shall be free from conflicts of interest. Consideration of the best available scientific evidence does not preclude consideration of experimental or investigational treatment or services under a clinical investigation approved by an institutional review board. (Added 2005, No. 205 (Adj. Sess.),  1; amended 2013, No. 75,  6; 2017, No. 113 (Adj. Sess.),  85.) 
 4283. Creation; implementation
(a) The Department shall maintain an electronic database and reporting system for monitoring Schedules II, III, and IV controlled substances, as defined in 21 C.F.R. Part 1308, as amended and as may be amended, that are dispensed within the State of Vermont by a health care provider or dispenser or dispensed to an address within the State by a pharmacy licensed by the Vermont Board of Pharmacy. (b) As required by the Department, every dispenser who is licensed by the Vermont Board of Pharmacy shall report to the Department in a timely manner data for each controlled substance in Schedules II, III, and IV, as amended and as may be amended, dispensed to a patient within Vermont. Reporting shall not be required for: (1) a drug administered directly to a patient; or(2) a drug dispensed by a health care provider at a facility licensed by the Department, provided that the quantity dispensed is limited to an amount adequate to treat the patient for a maximum of 48 hours. (c) Data for each controlled substance that is dispensed shall include the following:(1) patient identifier, which may include the patients name and date of birth;(2) drug dispensed;(3) date of dispensing;(4) quantity and dosage dispensed;(5) the number of days supply;(6) health care provider; and(7) dispenser.(d) The data shall be provided in the electronic format defined by the Department. To the extent possible, the format shall not require data entry in excess of that required in the regular course of business. Electronic transmission is not required if a waiver has been granted by the Department to an individual dispenser. The Department shall strive to create VPMS in a manner that will enable real-time transmittal to VPMS and real-time retrieval of information stored in VPMS. (e) It is not the intention of the Department that a health care provider or a dispenser shall have to pay a fee or tax or purchase hardware or proprietary software required by the Department specifically for the use, establishment, maintenance, or transmission of the data. The Department shall seek grant funds and take any other action within its financial capability to minimize any cost impact to health care providers and dispensers. (f) The Department shall purge from VPMS all data that are more than six years old.(g) The Commissioner shall develop and provide advisory notices, which shall make clear that all prescriptions for controlled drugs in Schedules II, III, and IV are entered into a statewide database in order to protect the public. The notices shall be distributed at no cost to dispensers and health care providers who are subject to this chapter. (h) A dispenser shall be subject to discipline by the Board of Pharmacy or by the applicable licensing entity if the dispenser intentionally fails to comply with the requirements of subsection (b), (c), or (d) of this section. (Added 2005, No. 205 (Adj. Sess.),  1; amended 2013, No. 75,  7.) 
 4284. Protection and disclosure of information
(a) The data collected pursuant to this chapter and all related information and records shall be confidential, except as provided in this chapter, and shall not be subject to the Public Records Act. The Department shall maintain procedures to protect patient privacy, ensure the confidentiality of patient information collected, recorded, transmitted, and maintained, and ensure that information is not disclosed to any person except as provided in this section. (b)(1) The Department shall provide only the following persons with access to query the VPMS:(A) a health care provider, dispenser, or delegate who is registered with the VPMS and certifies that the requested information is for the purpose of providing medical or pharmaceutical treatment to a bona fide current patient; (B) personnel or contractors, as necessary for establishing and maintaining the VPMS;(C) the Medical Director of the Department of Vermont Health Access, for the purposes of Medicaid quality assurance, utilization, and federal monitoring requirements with respect to Medicaid recipients for whom a Medicaid claim for a Schedule II, III, or IV controlled substance has been submitted; (D) a medical examiner or delegate from the Office of the Chief Medical Examiner, for the purpose of conducting an investigation or inquiry into the cause, manner, and circumstances of an individuals death; (E) a health care provider or medical examiner licensed to practice in another state, to the extent necessary to provide appropriate medical care to a Vermont resident or to investigate the death of a Vermont resident. (2) The Department shall provide reports of data available to the Department through the VPMS only to the following persons: (A) A patient or that persons health care provider, or both, when VPMS reveals that a patient may be receiving more than a therapeutic amount of one or more regulated substances. (B) A designated representative of a board responsible for the licensure, regulation, or discipline of health care providers or dispensers pursuant to a bona fide specific investigation. (C) A patient for whom a prescription is written, insofar as the information relates to that patient. (D) The relevant occupational licensing or certification authority if the Commissioner reasonably suspects fraudulent or illegal activity by a health care provider. The licensing or certification authority may report the data that are the evidence for the suspected fraudulent or illegal activity to a drug diversion investigator. (E)(i) The Commissioner of Public Safety, personally, or the Deputy Commissioner of Public Safety, personally, if the Commissioner of Health, personally, or a Deputy Commissioner of Health, personally, makes the disclosure and has consulted with at least one of the patients health care providers, when the disclosure is necessary to avert a serious and imminent threat to a person or the public. (ii) The Commissioner of Public Safety, personally, or the Deputy Commissioner of Public Safety, personally, when he or she requests data from the Commissioner of Health, and the Commissioner of Health believes, after consultation with at least one of the patients health care providers, that disclosure is necessary to avert a serious and imminent threat to a person or the public. (iii) The Commissioner or Deputy Commissioner of Public Safety may disclose such data received pursuant to this subdivision (E) as is necessary, in his or her discretion, to avert the serious and imminent threat. (F) A prescription monitoring system or similar entity in another state pursuant to a reciprocal agreement to share prescription monitoring information with the Vermont Department of Health as described in section 4288 of this title. (G) The Commissioner of Health or the Commissioners designee in order to identify patients who filled prescriptions written pursuant to chapter 113 of this title. (c) A person who receives data or a report from VPMS or from the Department shall not share that data or report with any other person or entity not eligible to receive that data pursuant to subsection (b) of this section, except as necessary and consistent with the purpose of the disclosure and in the normal course of business. Nothing shall restrict the right of a patient to share his or her own data. (d) The Commissioner shall offer health care providers and dispensers training in the proper use of information they may receive from VPMS. Training may be provided in collaboration with professional associations representing health care providers and dispensers. (e) A drug diversion investigator who may receive information pursuant to this section shall not have access to VPMS except for information provided to the officer by the licensing or certification authority. (f) The Department is authorized to use information from VPMS for research, trend analysis, and other public health promotion purposes, provided that data are aggregated or otherwise de-identified. The Department shall post the results of trend analyses on its website for use by health care providers, dispensers, and the general public. When appropriate, the Department shall send alerts relating to identified trends to health care providers and dispensers by electronic mail. (g) Following consultation with the Vermont Prescription Drug Advisory Council and an opportunity for input from stakeholders, the Department shall develop a policy that will enable it to use information from VPMS to determine if individual prescribers and dispensers are using VPMS appropriately. (h) Following consultation with the Vermont Prescription Drug Advisory Council and an opportunity for input from stakeholders, the Department shall develop a policy that will enable it to evaluate the prescription of regulated drugs by prescribers. (i) Knowing disclosure of transmitted data to a person not authorized by subsection (b) of this section, or obtaining information under this section not relating to a bona fide specific investigation, shall be punishable by imprisonment for not more than one year or a fine of not more than $1,000.00, or both, in addition to any penalties under federal law. (j) All information and correspondence relating to the disclosure of information by the Commissioner to a patients health care provider pursuant to subdivision (b)(2)(A) of this section shall be confidential and privileged, exempt from public inspection and copying under the Public Records Act, immune from subpoena or other disclosure, and not subject to discovery or introduction into evidence. (k) Each request for disclosure of data pursuant to subdivision (b)(2)(B) of this section shall document a bona fide specific investigation and shall specify the case number of the investigation. (Added 2005, No. 205 (Adj. Sess.),  1; amended 2013, No. 75,  8, eff. Oct. 1, 2013; 2015, No. 27,  3, eff. May 20, 2015; 2015, No. 173 (Adj. Sess.),  1; 2019, No. 82,  7.) 
 4285. Immunity
A dispenser or health care provider shall be immune from civil, criminal, or administrative liability as a result of any action made in good faith pursuant to and in accordance with this chapter, but nothing in this section shall be construed to establish immunity for the failure to follow standards of professional conduct or the failure to exercise due care in the provision of services. (Added 2005, No. 205 (Adj. Sess.),  1.) 
 4287. Rulemaking
The Department shall adopt rules for the implementation of VPMS as defined in this chapter consistent with 45 C.F.R. Part 164, as amended and as may be amended, that limit the disclosure to the minimum information necessary for purposes of this chapter. (Added 2005, No. 205 (Adj. Sess.),  1; amended 2013, No. 75,  9.) 
 4288. Reciprocal agreements
The Department of Health may enter into reciprocal agreements with other states that have prescription monitoring programs so long as access under such agreement is consistent with the privacy, security, and disclosure protections in this chapter. (Added 2013, No. 75,  10, eff. Oct. 1, 2013.) 
 4289. Standards and guidelines for health care providers and dispensers
(a) Each professional licensing authority for health care providers shall develop evidence-based standards to guide health care providers in the appropriate prescription of Schedules II, III, and IV controlled substances for treatment of acute pain, chronic pain, and for other medical conditions to be determined by the licensing authority. The standards developed by the licensing authorities shall be consistent with rules adopted by the Department of Health. The licensing authorities shall submit their standards to the Commissioner of Health, who shall review for consistency across health care providers and notify the applicable licensing authority of any inconsistencies identified. (b)(1) Each health care provider who prescribes any Schedule II, III, or IV controlled substances shall register with the VPMS by November 15, 2013. (2) If the VPMS shows that a patient has filled a prescription for a controlled substance written by a health care provider who is not a registered user of VPMS, the Commissioner of Health shall notify the applicable licensing authority and the provider by mail of the providers registration requirement pursuant to subdivision (1) of this subsection. (3) The Commissioner of Health shall develop additional procedures to ensure that all health care providers who prescribe controlled substances are registered in compliance with subdivision (1) of this subsection. (c) Except in the event of electronic or technological failure, health care providers shall query the VPMS with respect to an individual patient in the following circumstances: (1) at least annually for patients who are receiving ongoing treatment with an opioid Schedule II, III, or IV controlled substance; (2) when starting a patient on a Schedule II, III, or IV controlled substance for nonpalliative long-term pain therapy of 90 days or more; (3) the first time the provider prescribes an opioid Schedule II, III, or IV controlled substance written to treat chronic pain; and (4) prior to writing a replacement prescription for a Schedule II, III, or IV controlled substance pursuant to section 4290 of this title. (d)(1) Each dispenser who dispenses any Schedule II, III, or IV controlled substances shall register with the VPMS. (2) Except in the event of electronic or technological failure, dispensers shall query the VPMS in accordance with rules adopted by the Commissioner of Health. (3) Pharmacies and other dispensers shall report each dispensed prescription for a Schedule II, III, or IV controlled substance to the VPMS within 24 hours or one business day after dispensing. (e) The Commissioner of Health shall, after consultation with the Vermont Prescription Drug Advisory Council, adopt rules necessary to effect the purposes of this section. The Commissioner and the Council shall consider additional circumstances under which health care providers should be required to query the VPMS, including whether health care providers should be required to query the VPMS prior to writing a prescription for any opioid Schedule II, III, or IV controlled substance or when a patient requests renewal of a prescription for an opioid Schedule II, III, or IV controlled substance written to treat acute pain, and the Commissioner may adopt rules accordingly. (f) Each professional licensing authority for health care providers and dispensers shall consider the statutory requirements, rules, and standards adopted pursuant to this section in disciplinary proceedings when determining whether a licensee has complied with the applicable standard of care. (Added 2013, No. 75,  11; amended 2015, No. 173 (Adj. Sess.),  2; 2019, No. 82,  8.) 
 4290. Replacement prescriptions and medications
(a) As used in this section, replacement prescription means an unscheduled prescription request in the event that the document on which a patients prescription was written or the patients prescribed medication is reported to the prescriber as having been lost or stolen. (b) When a patient or a patients parent or guardian requests a replacement prescription for a Schedule II, III, or IV controlled substance, the patients health care provider shall query the VPMS prior to writing the replacement prescription to determine whether the patient may be receiving more than a therapeutic dosage of the controlled substance. (c) When a health care provider writes a replacement prescription pursuant to this section, the provider shall clearly indicate as much by writing the word REPLACEMENT on the face of the prescription. The health care provider shall document the writing of the replacement prescription in the patients medical record. (Added 2013, No. 75,  12, eff. Oct. 1, 2013.) 
 4301. Definitions
(a) As used in this chapter:(1) Bakery means all buildings, rooms, basements, cellars, lofts, or other premises or part thereof used, occupied, or maintained for the purpose of producing for sale bread, cakes, pies, or other food products made either wholly or partially with flour. (2) Childrens camp means any residential camp for children that:(A) offers a combination of programs and facilities established for the primary purpose of providing an experience to children; (B) is operated for five or more consecutive days during one or more seasons of the year; and (C) provides 24-hours-a-day supervision of children.(3) Commissioner means the Commissioner of Health.(4) Department means the Department of Health.(5) Establishment means food manufacturing establishments, food service establishments, lodging establishments, childrens camps, seafood vending facilities, and shellfish reshippers and repackers. (6) Food means articles of food, drink, confectionery, or condiment for human consumption, whether simple, mixed, or compound, and all substances and ingredients used in the preparation thereof. (7) Food manufacturing establishment or food processor means all buildings, rooms, basements, cellars, lofts, or other premises or part thereof used, occupied, or maintained for the purpose of manufacturing, preparing, packing, canning, bottling, keeping, storing, handling, serving, or distributing food for sale. A food manufacturing establishment shall include food processors, bakeries, distributers, and warehouses. A food manufacturing establishment shall not include a place where only maple syrup or maple products, as defined in 6 V.S.A.  481, are prepared for human consumption. (8) Food service establishment means entities that prepare, serve, and sell food to the public, including restaurants, temporary food vendors, caterers, mobile food units, and limited operations as defined in rule. (9) Lodging establishment means a place where overnight accommodations are regularly provided to the transient, traveling, or vacationing public, including hotels, motels, inns, and bed and breakfasts. Lodging establishment shall not include short-term rentals. (10) Salvage food means any food product from which the label on the packaging has been lost or destroyed or which has been subjected to possible damage as the result of an accident, fire, flood, or other cause that prevents the product from meeting the specifications of the manufacturer or the packer, but is otherwise suitable for human consumption. (11) Salvage food facility means any food vendor for which salvage food comprises 50 percent or more of gross sales. (12) Seafood vending facility means a store, motor vehicle, retail stand, or similar place from which a person sells seafood for human consumption. (13) Shellfish reshipper and repacker means an establishment engaging in interstate commerce of molluskan shellfish. (14) Short-term rental means a furnished house, condominium, or other dwelling room or self-contained dwelling unit rented to the transient, traveling, or vacationing public for a period of fewer than 30 consecutive days and for more than 14 days per calendar year. (b) Nothing in this chapter shall be construed to modify or affect laws or rules of the Agency of Agriculture, Food and Markets. (Amended 1989, No. 256 (Adj. Sess.),  10(a), eff. Jan 1, 1991; 2003, No. 42,  2, eff. May 27, 2003; 2017, No. 76,  5; 2018, No. 10 (Sp. Sess.),  1.) 
 4302. General Requirements
(a) A person shall not manufacture, prepare, pack, can, bottle, keep, store, handle, serve, or distribute in any manner food for the purpose of sale, in an unclean, unsanitary, or unhealthful establishment or under unclean, unsanitary, or unhealthful conditions. (b) A person shall not engage in the business of conducting a lodging establishment, short-term rental, or childrens camp under unclean, unsanitary, or unhealthful conditions. (Amended 2017, No. 76,  5; 2018, No. 10 (Sp. Sess.),  1.) 
 4303. Rulemaking
(a) The Commissioner shall adopt rules pursuant to 3 V.S.A. chapter 25 to establish minimum standards for the safe and sanitary operation of food or lodging establishments or childrens camps or any combination thereof and for their administration and enforcement. The rules shall require that an establishment be constructed, maintained, and operated with strict regard for the health of the employees and the public pursuant to the following general requirements: (1) The entire establishment and its immediate appertaining premises, including the fixtures and furnishings, the machinery, apparatus, implements, utensils, receptacles, vehicles, and other devices used in the production, keeping, storing, handling, serving, or distributing of the food, or the materials used in the food, shall be constructed, maintained, and operated in a clean, sanitary, and healthful manner. (2) The food and the materials used in the food shall be protected from any foreign or injurious contamination that may render them unfit for human consumption. (3) The clothing, habits, and conduct of the employees shall be conducive to and promote cleanliness, sanitation, and healthfulness. (4) There shall be proper, suitable, and adequate toilets and lavatories constructed, maintained, and operated in a clean, sanitary, and healthful manner. (5) There shall be proper, suitable, and adequate water supply, heating, lighting, ventilation, drainage, sewage disposal, and plumbing. (6) There shall be proper operation and maintenance of pools, recreation water facilities, spas, and related facilities within lodging establishments. (7) The Commissioner may adopt any other minimum conditions deemed necessary for the operation and maintenance of a food or lodging establishment in a safe and sanitary manner. (b)(1) The rules adopted by the Commissioner shall provide that a service member or veteran who is designated by the U.S. Armed Forces as a 92G Culinary Specialist or equivalent and is certified as a culinarian by the American Culinary Federation shall be deemed to: (A) have knowledge of the prevention of food-borne disease;(B) be able to apply the Hazard Analysis Critical Control Point principles; and(C) have met the criteria for demonstration of knowledge requirements set forth by the Department of Health in rule for the purposes of obtaining a food establishment license. (2) As used in this subsection:(A) Service member means an individual who is an active member of:(i) the U.S. Armed Forces;(ii) a reserve component of the U.S. Armed Forces;(iii) the U.S. Coast Guard; or(iv) the National Guard of any state.(B) Veteran means a former service member who received an honorable discharge or a general discharge under honorable conditions from active duty not more than two years prior to submitting an application for a food establishment license under this chapter. (Amended 2017, No. 76,  5; 2017, No. 119 (Adj. Sess.),  7.) 
 4304. Employees
(a) An employer shall not allow a person affected with any contagious, infectious, or other disease or physical ailment that may render employment detrimental to the public health to work in an establishment, and a person so affected shall not work in an establishment subject to the provisions of this chapter. (b) The Commissioner may require a person employed in an establishment subject to the provisions of this chapter to undergo medical testing or an examination necessary for the purpose of determining whether the person is affected by a contagious, infectious, or other disease or physical ailment that may render his or her employment detrimental to public health. The Commissioner may prohibit a person from working in an establishment pursuant to an emergency health order described in section 127 of this title if the person refuses to submit to medical testing or an examination. (Amended 2017, No. 76,  5.) 
 4306. Inspection
(a) It shall be the duty of the Commissioner to enforce the provisions of this chapter and of 6 V.S.A.  3312(d), and he or she shall be permitted to inspect through his or her duly authorized officers, inspectors, agents, or assistants, at all reasonable times, an establishment, an establishments records, and a salvage food facility subject to the provisions of this chapter. (b) Whenever an inspection demonstrates that the establishment or salvage food facility is not operated in accordance with the provision of this chapter, the officer, inspector, agent, or assistant shall notify the licensee of the conditions found and direct necessary changes. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2007, No. 38,  8a, eff. May 21, 2007; 2017, No. 76,  5.) 
 4307. Hearing; orders
When an inspection demonstrates that any establishment is being maintained or operated in violation of the provisions of this chapter or any related rules, the Commissioner shall provide written notice, together with an order commanding both abatement of the violation and compliance with this chapter within a reasonable period of time to be fixed in the order. Under any related rules adopted by the Commissioner, a person upon whom the notice and order are served shall be given an opportunity to be heard and to show cause as to why the order should be vacated or amended. When, upon a hearing, it appears that the provisions of this chapter have not been violated, the Commissioner shall immediately vacate the order, but without prejudice. When, however, it appears that the provisions have been violated and the person fails to comply with an order issued by the Commissioner under the provisions of this section, the Commissioner shall revoke, modify, or suspend the persons license or enforce a civil penalty. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 76,  5.) 
 4309. Penalty
A person who violates a provision of this chapter or 6 V.S.A.  3312(d), for which no other penalty is provided, shall be fined not more than $300.00 for the first offense and, for each subsequent offense, not more than $500.00. (Amended 2007, No. 38,  8b, eff. May 21, 2007; 2017, No. 76,  5.) 
 4351. License from Department of Health
(a) A person shall not operate or maintain a food manufacturing facility, retail food establishment, lodging establishment, childrens camp, seafood vending facility, or any other place in which food is prepared and served, unless he or she obtains and holds from the Commissioner a license authorizing such operation. All licenses shall be displayed in a manner as to be easily viewed by the public. (b)(1) A person shall not knowingly and willingly sell or offer for sale a bulk product manufactured by a bakery, regardless of whether the bakery is located inside or outside the State, unless the operator of the bakery holds a valid license from the Commissioner. (2) The Commissioner shall not grant a license to a bakery located outside the State unless:(A) the person operating the bakery:(i) has consented in writing to the Departments inspection and paid the required fee; or (ii) has presented to the Department satisfactory evidence of inspection and approval from the proper authority in his or her state and paid the required fee; and (B) inspection of the bakery confirms that it meets the laws and rules of this State.(c) The Commissioner may issue a temporary license for no more than 90 days. The temporary license shall state the conditions under which it is issued. (d) If the Commissioner does not renew a license, he or she shall provide written notice to the licensee. The notice shall specify any changes necessary to conform with State rules and shall state that if compliance is achieved within the time designated in the notice, the license shall be renewed. If the licensee fails to achieve compliance within the prescribed time, the licensee shall have an opportunity for a hearing. (e) Any licensee or applicant aggrieved by a decision or order of the Commissioner may appeal to the Board of Health within 30 days of that decision. Hearings by the Board under this section shall be subject to the provisions of 3 V.S.A. chapter 25 relating to contested cases. The Board shall consider the matter de novo and all persons, parties, and interests may appear and be heard. The Board shall issue an order within 30 days following the conclusion of the hearing. (f) If a licensee fails to renew his or her license within 60 days of its expiration date, a licensee shall apply for a new license and meet all licensure requirements anew. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1969, No. 242 (Adj. Sess.), eff. April 2, 1970; 1973, No. 98,  7, eff. July 1, 1973; 1989, No. 103,  1; 2017, No. 76,  5.) 
 4352. Application
Prior to operating an establishment in which food is prepared and served or in which three or more lodging units are offered to the public, a person shall apply to the Commissioner upon forms supplied by the Department and shall pay a license fee as provided by section 4353 of this title. An application for licensure shall be submitted no fewer than 30 days prior to the opening of a food or lodging establishment. Upon receipt of such license fee and when satisfied that the premises are sanitary and healthful in accordance with the provisions of this chapter and related rules, the Commissioner shall issue a license to the applicant with respect to the premises described in the application. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2017, No. 76,  5.) 
 4353. Fees
(a) The Commissioner may establish by rule any requirement the Department needs to determine the applicable categories or exemptions for licenses. The following license fees shall be paid annually to the Department at the time of making the application according to the following schedules:  I  Seating capacity of 0 to 25; $105.00 II  Seating capacity of 26 to 50; $180.00 III  Seating capacity of 51 to 100; $300.00 IV  Seating capacity of 101 to 200; $385.00 V  Seating capacity of 201 to 599; $450.00 VI  Seating capacity 600 and over; $1,000.00 VII  Home Caterer; $155.00 VIII  Commercial Caterer; $260.00 IX  Limited Operations; $140.00 X  Fair Stand; $125.00; if operating for four or more days per year; $230.00 I  Lodging capacity of 1 to 10; $130.00 II  Lodging capacity of 11 to 20; $185.00 III  Lodging capacity of 21 to 50; $250.00 IV  Lodging capacity of 51 to 200; $390.00 V  Lodging capacity of over 200; $1,000.00 I  Gross receipts of $10,001.00 to $50,000.00; $175.00 II  Gross receipts of over $50,000.00; $275.00 III  Gross receipts of $10,000.00 or less are exempt pursuant to section 4358 of this title I  Home bakery; $100.00 II  Small commercial; $200.00 III  Large commercial; $350.00(b) The Commissioner of Health shall be the final authority on definition of categories contained in this section. (c) All fees received by the Department under this section shall be credited to a special fund and shall be available to the Department to offset the cost of providing the services. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1975, No. 118,  69, eff. April 30, 1975; 1985, No. 166 (Adj. Sess.),  1; 1989, No. 103,  2; 1995, No. 47,  5, eff. April 20, 1995; 1997, No. 155 (Adj. Sess.),  60, eff. July 1, 1999; 2001, No. 65,  7, 7a, eff. July 1, 2002, 7b, eff. July 1, 2003; 2007, No. 76,  12, eff. June 7, 2007; 2011, No. 128 (Adj. Sess.),  5; 2015, No. 57,  9; 2017, No. 76,  5.) 
 4354. Term of license
A license shall expire annually on a date established by the Department and shall be renewed upon the payment of a new license fee if the licensee is in good standing with the Department. (Amended 1973, No. 98,  8, eff. July 1, 1973; 1975, No. 118,  70, eff. April 30, 1975; 2017, No. 76,  5.) 
 4358. Exemptions
(a) The provisions of this subchapter shall apply only to those hotels, inns, restaurants, tourist camps, and other places that solicit the patronage of the public by advertising by means of signs, notices, placards, radio, electronic communications, or printed announcements. (b) The provisions of this subchapter shall not apply to an individual manufacturing and selling bakery products from his or her own home kitchen whose average gross retail sales do not exceed $125.00 per week. (c) Any food manufacturing establishment claiming a licensing exemption shall provide documentation as required by rule. (d) The Commissioner shall not adopt a rule requiring food establishments that operate less than six months of the year and provide outdoor seating for fewer than 16 people at one time to provide toilet and hand washing facilities for patrons. (Amended 2017, No. 76,  5.) 
 4391. Milk to be served in original container
A person, firm, or corporation owning or operating a hotel, restaurant, store, lunch room, fountain, roadside booth or stand, or a boarding house which makes a practice of serving meals to transients, and who purchases milk for resale or to serve to his or her patrons shall not either directly or by an agent, servant, or employee sell or serve milk for drinking purposes to his or her patrons unless such milk is served or sold in the original bottle or like container in which the milk was delivered to such hotel, restaurant, store, lunch room, fountain, roadside lunch booth or stand, or boarding house. 
 4392. Exceptions; dispensing devices
(a) The provisions of section 4391 of this title shall not be construed to prevent or prohibit a person, firm, or corporation from purchasing milk in bulk for uses other than for serving patrons for drinking purposes, nor to prevent the sale or serving of cream, skimmed milk, or buttermilk from bulk, if the same is pure and wholesome and is sold and served as cream, skimmed milk, or buttermilk, nor shall it prevent or prohibit the sale of milk in mixed drinks at soda fountains, or from original bulk containers equipped with a dispensing device, provided the owner of such device has notified the Board and the Agency of Agriculture, Food and Markets of each device installed and its location, and has complied in all other respects with the rules and regulations of the Secretary of Agriculture, Food and Markets as provided in this subchapter. (b) Milk or chocolate milk dispensed from any such device shall be homogenized and pasteurized and flavored skimmed milk shall be pasteurized. The words chocolate milk, as used in this subsection, shall be construed to mean milk of a butterfat content of not less than 3.5 percent butterfat to which chocolate has been added and any flavored milk drink with a content of less than 3.5 percent butterfat shall be labeled Flavored Drink according to the flavor used. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1989, No. 256 (Adj. Sess.),  10(a), eff. Jan. 1, 1991; 2003, No. 42,  2, eff. May 27, 2003; 2017, No. 113 (Adj. Sess.),  86.) 
 4393. Rulemaking
The Secretary of Agriculture, Food and Markets shall, subject to approval by the State Board of Health, make and adopt such rules as the Secretary deems necessary relating to the construction, operation, and use of such dispensing devices. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 2003, No. 42,  2, eff. May 27, 2003; 2017, No. 113 (Adj. Sess.),  87.) 
 4394. Penalty
A person, firm or corporation who violates a provision of section 4391 of this title shall be fined not more than $50.00. 
 4466. Inspection
(a) The Commissioner may inspect through his or her duly authorized officers, inspectors, agents, or assistants, at all reasonable times, a short-term rental and the operators records related to the short-term rental. (b) Whenever an inspection demonstrates that the short-term rental is not operated in accordance with applicable provisions of this chapter, the officer, inspector, agent, or assistant shall notify the operator of the conditions found and shall direct necessary changes. (c) Nothing in this section shall be construed to supersede the authority and responsibilities of the Division of Fire Safety. The Divisions Executive Director shall inform the Commissioner in a timely manner of any enforcement actions that the Division has taken against the operator of a short-term rental. (Added 2018, No. 10 (Sp. Sess.),  1; amended 2019, No. 14,  49, eff. April 30, 2019.) 
 4467. Posting contact information
A short-term rental operator shall post within the unit a telephone number for the person responsible for the unit and the contact information for the Department of Health and the Department of Public Safetys Division of Fire Safety. (Added 2018, No. 10 (Sp. Sess.),  1.) 
 4468. Educational materials
(a) The Department of Health, in collaboration with the Department of Public Safetys Division of Fire Safety, shall prepare a packet of information pertaining to the health, safety, and financial obligations of short-term rental operators, including information regarding the importance of reviewing options for property and liability insurance with the operators insurance company. (b) Included with the information packet set forth in subsection (a) of this section shall be a self-certification form pertaining to health and safety precautions that short-term rental operators must take into consideration prior to renting a unit. The form shall be retained by the operator and need not be filed with the Department. (Added 2018, No. 10 (Sp. Sess.),  1.) 
 4475. Definitions
(a)(1) The term drug paraphernalia means all equipment, products, devices, and materials of any kind that are used, or promoted for use or designed for use, in planting, propagating, cultivating, growing, harvesting, manufacturing, compounding, converting, producing, processing, preparing, testing, analyzing, packaging, repackaging, storing, containing, concealing, injecting, ingesting, inhaling, or otherwise introducing into the human body a regulated drug in violation of chapter 84 of this title. Drug paraphernalia does not include needles and syringes distributed or possessed as part of an organized community-based needle exchange program. (2) Organized community-based needle exchange program means a program approved by the Commissioner of Health under section 4478 of this title, the purpose of which is to provide access to clean needles and syringes, and which is operated by an AIDS service organization, a substance abuse treatment provider, or a licensed health care provider or facility. Such programs shall be operated in a manner that is consistent with the provisions of 10 V.S.A. chapter 159 (waste management; hazardous waste), and any other applicable laws. (b) In determining whether an object is drug paraphernalia, a court or other authority may consider, in addition to all other logically relevant factors, the following: (1) statements by an owner or by anyone in control of the object concerning its use;(2) the proximity of the object to regulated drugs;(3) the existence of any residue of regulated drugs on the object;(4) direct or circumstantial evidence of the intent of an owner, or of anyone in control of the object, to sell to persons intending to use the object in violation of this chapter; (5) instructions, oral or written, provided with the object concerning its use;(6) descriptive materials accompanying the object which explain or depict its use;(7) national and local advertising concerning its use;(8) the manner in which the object is displayed for sale;(9) whether the owner, or anyone in control of the object, is a legitimate supplier of like or related items to the community, such as a licensed distributor or dealer of tobacco products; (10) direct or circumstantial evidence of the ratio of sales of the object to the total sales of the business enterprise; (11) the existence and scope of legitimate uses for the object in the community;(12) expert testimony concerning its use. (Added 1983, No. 186 (Adj. Sess.); amended 1999, No. 28,  2.)
 4476. Offenses and penalties
(a) A person who sells drug paraphernalia to a person under 18 years of age shall be imprisoned for not more than two years or fined not more than $2,000.00, or both. (b) The distribution and possession of needles and syringes as part of an organized community-based needle exchange program shall not be a violation of this section or of chapter 84 of this title. (Added 1983, No. 186 (Adj. Sess.); amended 1999, No. 28,  3; 2017, No. 86 (Adj. Sess.),  12.) 
 4477. Forfeiture
Upon conviction under section 4476 of this title, the defendant shall forfeit to the State all items used, promoted for use, or designed for use as drug paraphernalia. (Added 1983, No. 186 (Adj. Sess.).) 
 4478. Needle exchange programs
The Department of Health, in collaboration with the statewide harm reduction coalition, shall develop operating guidelines for needle exchange programs. If a program complies with such operating guidelines and with existing laws and regulations, it shall be approved by the Commissioner of Health. Such operating guidelines shall be established no later than September 30, 1999. (Added 1999, No. 28,  4.) 
 501. State health laboratory; other laboratories; tests
The Board shall have supervision and management of the Vermont State health laboratory. The Board may provide for approval and registration of laboratories performing examinations or tests of a public health nature. Any laboratory that examines material for any living agent or evidence of living agent of a reportable disease to any person shall send the results of such tests, if positive, forthwith to the State health laboratory. The laboratory shall make chemical and bacteriological examination of water supplies, milk, and food products and examinations for the detection and control of communicable diseases; and shall carry on such work in relation to the health of the residents of the State as the Board shall direct. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; amended 2017, No. 113 (Adj. Sess.),  52.) 
 501a. Specimens submitted by chiropractic physicians
(a) According to the public health laws of this State, the State health laboratory is required to serve the interests of all of the people of the State, and as chiropractic physicians are subject to the laws relating to contagious and infectious diseases, the purpose of this section is to authorize the facilities of the State health laboratory to chiropractic physicians and their patients. (b) All duly licensed chiropractic physicians in this State shall be legally entitled to submit specimens for examination and to receive reports on such specimens submitted to the laboratory. (c) This section shall not be construed to enlarge or restrict the existing legal practice of chiropractors. (Added 1959, No. 241,  1-3; amended 2017, No. 113 (Adj. Sess.),  53.) 
 501b. Certification of laboratories
(a) The Commissioner may certify a laboratory that meets the standards currently in effect of the National Environmental Laboratory Accreditation Conference and is accredited by an approved National Environmental Laboratory Accreditation Program accrediting authority or its equivalent to perform the testing and monitoring: (1) required under 10 V.S.A. chapter 56 and the federal Safe Drinking Water Act; and(2) of water from a potable water supply, as that term is defined in 10 V.S.A.  1972(6).(b)(1) The Commissioner may by order suspend or revoke a certificate granted under this section, after notice and opportunity to be heard, if the Commissioner finds that the certificate holder has: (A) submitted materially false or materially inaccurate information; or(B) violated any material requirement, restriction, or condition of the certificate; or(C) violated any statute, rule, or order relating to this title.(2) The order shall set forth what steps, if any, may be taken by the certificate holder to relieve the holder of the suspension or enable the certificate holder to reapply for certification if a previous certificate has been revoked. (c) A person may appeal the suspension or revocation of the certificate to the Board under section 128 of this title. Drug laboratory approval   $500.00 Drug laboratory alternate approval   $300.00 Drug laboratory approval renewal   $300.00 Safe Drinking Water Act (SDWA) laboratory certificationBacteriology   $500.00 Inorganic chemistry   $500.00 Organic chemistry (volatile organic compounds/pesticides   $500.00 Radiological chemistry   $500.00 Laboratory site visits   Not to exceed cost Clinical laboratory registration fee   $25.00 (e) Fees collected under this section shall be credited to a special fund and shall be available to the Department to offset the costs of providing these services. (f) A laboratory certified to conduct testing of groundwater sources or water supplies for use by a potable water supply, as that term is defined in 10 V.S.A.  1972(6), including under the requirements of 10 V.S.A.  1982, shall submit the results of groundwater analyses to the Department of Health in a format required by the Department of Health. (Added 1991, No. 71,  6; amended 1997, No. 155 (Adj. Sess.),  56; 2003, No. 163 (Adj. Sess.),  1; 2011, No. 163 (Adj. Sess.),  3, eff. Jan. 1, 2013; 2017, No. 161 (Adj. Sess.),  6; 2019, No. 57,  16.) 
 502. School of instruction; periodicals
The Board may conduct a school of instruction for health officers at such times and places as it directs. It may issue a periodical giving the results of the work done at the laboratory and the approved methods for the protection of the public health, and such publications shall be furnished free to health officers and residents of the State. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961.) 
 503. Use of laboratory by people
(a) The use of the laboratory, and all investigations mentioned in this chapter therein made, except as otherwise provided, shall be available to the people of this State. (b) Reasonable fees shall be charged to cover the cost of services provided if the service is not requested under the authority of the Commissioner of Health. (c) Notwithstanding the provisions of 32 V.S.A.  603, the Commissioner shall establish fees reasonably related to the cost of the laboratory services. The Commissioner shall have the discretion to change fee amounts or add new fees to respond to new laboratory testing requirements or improvements, except for fee increases charged to municipalities for testing public water systems and supplies and the fee for total coliform testing which shall be not more than $14.00. In determining whether to exercise such discretion, the Commissioner shall consider such factors as newly identified public health needs, changes in technology or methodology which affect cost, changes in testing supply cost, and changes in sample numbers which affect testing costs. Fees collected under this section shall be credited to a special fund and shall be available to the Department to offset the cost of providing the services, and shall be reported in accordance with 32 V.S.A.  605. (Amended 1985, No. 220 (Adj. Sess.),  1; 1991, No. 71,  5; 1999, No. 49,  187, 188; 2001, No. 143 (Adj. Sess.),  51, eff. June 21, 2002; 2003, No. 61,  2.) 
 504. Investigation in criminal cause; expert witness
When the States Attorney of a county, on the order of a Superior judge or the Attorney General, for use in a criminal cause pending in his or her office, requests an expert investigation, chemical or pathological, of a substance, such investigation shall be made at the laboratory forthwith, without charge to the State; and the expert making or interpreting such investigation shall submit the results of such experts work to such States Attorney, and shall attend court as a witness at any place in the State when required to do so by subpoena, and submit in court the results of such experts investigation; and he or she shall be paid as such witness his or her actual expenses of attendance when summoned by the State. (Amended 1985, No. 267 (Adj. Sess.),  16.) 
 505. Autopsies
When a Superior Judge or the Attorney General orders an autopsy on the body of a person, as provided in section 504 of this title, he or she shall therein direct that such autopsy shall be made by the Chief Medical Examiner, or under his or her direction, unless, for good cause shown, such judge or the Attorney General otherwise directs. (Amended 1971, No. 33,  2, eff. July 1, 1971.) 
 506. Duties and compensation of the Chief Medical Examiner performing autopsy
At such autopsy, the Chief Medical Examiner shall take and preserve under proper seal, such portions of the body and its contents, together with such other articles as he or she judges may require subsequent examination in the investigation of the case. For performing such autopsy, he or she shall be paid his or her actual expenses, including the expenses of his or her assistants. The Commissioner of Finance and Management, upon presentation of the account for such expenses, duly sworn to by the Chief Medical Examiner and approved by the Attorney General, shall issue his or her warrant therefor. (Amended 1959, No. 328 (Adj. Sess.),  8(a), (b); 1971, No. 33,  3, eff. July 1, 1971; 1983, No. 195 (Adj. Sess.),  5.) 
 507. Contract for services of the Chief Medical Examiner
The State Board of Health may contract with any person, institution, or State department for the performance of any or all of the duties of the Chief Medical Examiner. Such services shall be paid for from the biennial budget of the Department of Health. (Amended 1959, No. 329 (Adj. Sess.),  27, eff. March 1, 1961; 1961, No. 20; 1971, No. 33,  4, eff. July 1, 1971.) 
 508. Medical examiners, appointment; term
(a) The Chief Medical Examiner may appoint regional medical examiners, who shall be licensed doctors of medicine or osteopathy geographically distributed throughout the State. A regional medical examiner may be licensed in Vermont or in another state. The regional medical examiners shall serve indefinite terms at the pleasure of the Chief Medical Examiner. (b) The Chief Medical Examiner may appoint assistant medical examiners to assist in performing the duties of the Chief Medical Examiner. An assistant medical examiner shall be an individual with extensive experience in the medical profession which may include medicine, nursing, emergency medical work, or any other medical profession deemed by the Chief Medical Examiner to provide sufficient health care experience, including an individual licensed in a medical profession in another state. An assistant medical examiner shall serve at the pleasure of and be under the direction and supervision of the Chief Medical Examiner. The Chief Medical Examiner may assign assistant medical examiners to work under the supervision of a regional medical examiner. An assistant medical examiner shall not perform autopsies except within his or her defined scope of practice. (c) An assistant medical examiner shall meet the training and certification requirements established by the Chief Medical Examiner and approved by the Commissioner. (Amended 1961, No. 43; 1969, No. 128,  1; 1971, No. 33,  5, eff. July 1, 1971; 1999, No. 45,  1.) 
 509. Autopsy; payment; fees
For performing an autopsy, the Chief Medical Examiner and his or her assistants are entitled to their expenses from the State upon giving the Commissioner of Finance and Management their certified voucher. Regional medical examiners and assistant medical examiners are entitled to receive from the State a fee fixed by the Commissioner of Health and approved by the Attorney General, plus their reasonable and necessary expenses. (Amended 1959, No. 328 (Adj. Sess.),  8; 1961, No. 190; 1963, No. 11, eff. March 19, 1963; 1969, No. 265 (Adj. Sess.),  2, eff. July 1, 1970; 1971, No. 33,  6, eff. July 1, 1971; 1983, No. 195 (Adj. Sess.),  5; 1987, No. 191 (Adj. Sess.); 1999, No. 45,  2.) 
 510. Removal and retention of pituitary glands
In the course of any autopsy performed by the Chief Medical Examiner or his or her designee, the Chief Medical Examiner may remove the pituitary gland from the body for use in manufacturing a hormone necessary for the physical growth of persons who are, or may become, hypopituitary dwarfs. However, the pituitary gland shall not be removed or retained under the authority of this section if the person having the right to control disposition of the decedents remains notifies the examiner prior to the autopsy that removal of the decedents pituitary gland would be contrary to the religious beliefs or personal conviction of such person or of the decedent at the time of death. (Added 1983, No. 140 (Adj. Sess.), eff. April 5, 1984.) 
 511. Actions against medical examiners
Actions taken by any person given authority under this chapter, including an assistant medical examiner, shall be considered to be actions taken by a State employee for the purposes of 3 V.S.A. chapter 29 and 12 V.S.A. chapter 189 if such actions occurred within the scope of such persons duties. (Added 2017, No. 80,  16.) 
 4501. Definitions
As used in this chapter:(1) Health care practitioner means an individual licensed by the Board of Medical Practice or the Office of Professional Regulation to provide professional health care services in this State. (2)(A) Stem cell and stem cell-related products means any articles that contain or consist, or purport to contain or consist, of one or more of the following, when intended for implantation, transplantation, infusion, or transfer into a human recipient and when intended for use in the diagnosis, cure, mitigation, treatment, or prevention of any disease or condition based on or in connection with a proven or purported attribute of stem cells: (i) human cells, including cells from tissues such as bone marrow; adipose tissue; amniotic membrane; umbilical cord blood, when not autologous or in a first- or second-degree relative; placenta; and other tissue or cell sources; (ii) intracellular or extracellular components or vesicles; or(iii) amniotic fluid.(B) For purposes of this chapter, stem cell and stem cell-related products does not include the use of whole blood or blood products for routine transfusions or use of hematopoietic stem cells for reconstitution of bone marrow after treatment of blood-related cancers or diseases such as leukemias or lymphomas. (Added 2021, No. 61,  1.) 
 4502. Unapproved stem cell and stem cell-related products; notice; disclosure
(a) Notice. (1) A health care practitioner who administers one or more stem cell or stem cell-related products that are not approved by the U.S. Food and Drug Administration shall provide each patient with the following written notice prior to administering any such product to the patient for the first time: THIS NOTICE MUST BE PROVIDED TO YOU UNDER VERMONT LAW. This health care practitioner administers one or more stem cell or stem cell-related products that have not been approved by the U.S. Food and Drug Administration. You are encouraged to consult with your primary care provider prior to having an unapproved stem cell or stem cell-related product administered to you. (2)(A) The written notice required by subdivision (1) of this subsection (a) shall:(i) be at least 8.5 by 11 inches and printed in not less than 40-point type; and(ii) include information on methods for filing a complaint with the applicable licensing authority and for making a consumer inquiry, including to the Attorney Generals Consumer Assistance Program. (B) The health care practitioner shall also prominently display the written notice required by subdivision (1) of this subsection (a), along with the information required to be included by subdivision (A)(ii) of this subdivision (2), at the entrance and in an area visible to patients in the health care practitioners office. (b) Disclosure. (1) A health care practitioner who administers stem cell or stem cell-related products that are not approved by the U.S. Food and Drug Administration shall provide a disclosure form to a patient for the patients signature prior to each administration of an unapproved stem cell or stem cell-related product. (2) The disclosure form shall state, in language that the patient could reasonably be expected to understand, the stem cell or stem cell-related products U.S. Food and Drug Administration approval status. (3) The health care practitioner shall retain in the patients medical record a copy of each disclosure form signed and dated by the patient and shall provide a copy of the disclosure form for the patient to take home. (c) Advertisements. A health care practitioner shall include the notice set forth in subdivision (a)(1) of this section in any advertisements relating to the use of stem cell or stem cell-related products that are not approved by the U.S. Food and Drug Administration. In print advertisements, the notice shall be clearly legible and in a font size not smaller than the largest font size used in the advertisement. For all other forms of advertisements, the notice shall either be clearly legible in a font size not smaller than the largest font size used in the advertisement or clearly spoken. (d) Nonapplicability. The provisions of this section shall not apply to the following:(1) a health care practitioner who has obtained approval or clearance for an investigational new drug or device from the U.S. Food and Drug Administration for the use of stem cell or stem cell-related products; (2) a health care practitioner who administers a stem cell or stem cell-related product pursuant to an employment or other contract to administer stem cell or stem cell-related products on behalf of or under the auspices of an institution certified by the Foundation for the Accreditation of Cellular Therapy, the National Institutes of Health Blood and Marrow Transplant Clinical Trials Network, or AABB, formerly known as the American Association of Blood Banks; or (3) a health care practitioner who has personally received a formal or informal determination from the U.S. Food and Drug Administration stating that approval is not necessary for the practitioners specific usage of the stem cell or stem cell-related products. (e) Violations. A violation of this section constitutes unprofessional conduct under 3 V.S.A.  129a and 26 V.S.A.  1354. (Added 2021, No. 61,  1.)
 4601. Definitions
As used in this chapter:(1) Biological product means a virus, therapeutic serum, toxin, antitoxin, vaccine, blood, blood component or derivative, allergenic product, protein (except any chemically synthesized polypeptide), or analogous product, or arsphenamine or derivative of arsphenamine (or any other trivalent organic arsenic compound), applicable to the prevention, treatment, or cure of a disease or condition in human beings. (2) Brand name means the registered trademark name given to a drug product by its manufacturer or distributor. (3) Generic drug means a drug listed by generic name and considered to be chemically and therapeutically equivalent to a drug listed by brand name, as both names are identified in the most recent edition of or supplement to the U.S. Food and Drug Administrations Approved Drug Products with Therapeutic Equivalence Evaluations (the Orange Book). (4) Generic name means the official name of a drug product as established by the U. S. Adopted Names Council (USAN) or its successor, if applicable. (5) Interchangeable biological product means a biological product that the U.S. Food and Drug Administration has: (A) licensed and determined, pursuant to 42 U.S.C.  262(k)(4), to be interchangeable with the reference product against which it was evaluated as may be reflected in the U.S. Food and Drug Administrations Lists of Licensed Biological Products with Reference Product Exclusivity and Biosimilarity or Interchangeability Evaluations (the Purple Book); or (B) determined to be therapeutically equivalent as set forth in the latest edition of or supplement to the U.S. Food and Drug Administrations Approved Drug Products with Therapeutic Equivalence Evaluations (the Orange Book). (6) Pharmacist means a natural person licensed by the State Board of Pharmacy to prepare, compound, dispense, and sell drugs, medicines, chemicals, and poisons. (7) Prescriber means any duly licensed physician, dentist, veterinarian, or other practitioner licensed to write prescriptions for the treatment or prevention of disease in man or animal. (8) Proper name means the nonproprietary name of a biological product.(9) Reference product means the single biological product licensed pursuant to 42 U.S.C.  262(a) against which the interchangeable biological product was evaluated by the U.S. Food and Drug Administration pursuant to 42 U.S.C.  262(k). (Added 1977, No. 127 (Adj. Sess.),  1; amended 2001, No. 63,  124; 2017, No. 193 (Adj. Sess.),  1.) 
 4605. Alternative drug or biological product selection
(a)(1) When a pharmacist receives a prescription for a drug that is listed either by generic name or brand name in the most recent edition of or supplement to the U.S. Department of Health and Human Services publication Approved Drug Products With Therapeutic Equivalence Evaluations (the Orange Book) of approved drug products, the pharmacist shall select the lowest priced drug from the list which is equivalent as defined by the Orange Book, unless otherwise instructed by the prescriber, or by the purchaser if the purchaser agrees to pay any additional cost in excess of the benefits provided by the purchasers health benefit plan if allowed under the legal requirements applicable to the plan, or otherwise to pay the full cost for the higher-priced drug. (2) When a pharmacist receives a prescription for a biological product, the pharmacist shall select the lowest-priced interchangeable biological product unless otherwise instructed by the prescriber, or by the purchaser if the purchaser agrees to pay any additional cost in excess of the benefits provided by the purchasers health benefit plan if allowed under the legal requirements applicable to the plan, or otherwise to pay the full cost for the higher priced biological product. (3) Notwithstanding subdivisions (1) and (2) of this subsection, when a pharmacist receives a prescription from a Medicaid beneficiary, the pharmacist shall select the preferred brand-name or generic drug or biological product from the Department of Vermont Health Accesss preferred drug list. (b) The purchaser shall be informed by the pharmacist or his or her representative that an alternative selection as provided under subsection (a) of this section will be made unless the purchaser agrees to pay any additional cost in excess of the benefits provided by the purchasers health benefit plan if allowed under the legal requirements applicable to the plan, or otherwise to pay the full cost for the higher-priced drug or biological product. (c) When refilling a prescription, pharmacists shall receive the consent of the prescriber to dispense a drug or biological product different from that originally dispensed, and shall inform the purchaser that a substitution shall be made pursuant to this section unless the purchaser agrees to pay any additional cost in excess of the benefits provided by the purchasers health benefit plan if allowed under the legal requirements applicable to the plan, or otherwise to pay the full cost for the higher-priced drug or biological product. (d) Any pharmacist substituting a generically equivalent drug or interchangeable biological product shall charge no more than the usual and customary retail price for that selected drug or biological product. This charge shall not exceed the usual and customary retail price for the prescribed brand. (e)(1) Except as described in subdivision (4) of this subsection, within five business days following the dispensing of a biological product, the dispensing pharmacist or designee shall communicate the specific biological product provided to the patient, including the biological products name and manufacturer, by submitting the information in a format that is accessible to the prescriber electronically through one of the following: (A) an interoperable electronic medical records system;(B) an electronic prescribing technology;(C) a pharmacy benefit management system; or(D) a pharmacy record.(2) Entry into an electronic records system as described in subdivision (1) of this subsection shall be presumed to provide notice to the prescriber. (3)(A) If a pharmacy does not have access to one or more of the electronic systems described in subdivision (1) of this subsection (e), the pharmacist or designee shall communicate to the prescriber the information regarding the biological product dispensed using telephone, facsimile, electronic transmission, or other prevailing means. (B) If a prescription is communicated to the pharmacy by means other than electronic prescribing technology, the pharmacist or designee shall communicate to the prescriber the information regarding the biological product dispensed using the electronic process described in subdivision (1) of this subsection (e) unless the prescriber requests a different means of communication on the prescription. (4) Notwithstanding any provision of this subsection to the contrary, a pharmacist shall not be required to communicate information regarding the biological product dispensed in the following circumstances: (A) the U.S. Food and Drug Administration has not approved any interchangeable biological products for the product prescribed; or (B) the pharmacist dispensed a refill prescription in which the product dispensed was unchanged from the product dispensed at the prior filling of the prescription. (f) The Board of Pharmacy shall maintain a link on its website to the current lists of all biological products that the U.S. Food and Drug Administration has determined to be interchangeable biological products. (Added 1977, No. 127 (Adj. Sess.),  1; amended 2001, No. 63,  124; 2005, No. 71,  306, eff. June 21, 2005; 2009, No. 35,  3; 2017, No. 193 (Adj. Sess.),  2.) 
 4606. Brand certification
If the prescriber has determined that the generic equivalent of a drug or the interchangeable biological product for the biological product being prescribed has not been effective or with reasonable certainty is not expected to be effective in treating the patients medical condition or causes or is reasonably expected to cause adverse or harmful reactions in the patient, the prescriber shall indicate brand necessary, no substitution, dispense as written, or DAW in the prescribers own handwriting on the prescription blank or shall indicate the same using electronic prescribing technology and the pharmacist shall not substitute the generic equivalent or interchangeable biological product. If a prescription is unwritten and the prescriber has determined that the generic equivalent of the drug or the interchangeable biological product for the biological product being prescribed has not been effective or with reasonable certainty is not expected to be effective in treating the patients medical condition or causes or is reasonably expected to cause adverse or harmful reactions in the patient, the prescriber shall expressly indicate to the pharmacist that the brand-name drug or biological product is necessary and substitution is not allowed and the pharmacist shall not substitute the generic equivalent drug or interchangeable biological product. (Added 1977, No. 127 (Adj. Sess.),  1; amended 2001, No. 63,  124; 2009, No. 103 (Adj. Sess.),  4; 2017, No. 193 (Adj. Sess.),  3.) 
 4607. Information; labeling
(a) Every pharmacy in the State shall have posted a sign in a prominent place that is in clear unobstructed view which shall read: Vermont law requires pharmacists in some cases to select a less expensive generic equivalent drug or interchangeable biological product for the drug or biological product prescribed unless you or your physician direct otherwise. Ask your pharmacist. (b) The label of the container of all drugs and biological products dispensed by a pharmacist under this chapter shall indicate the generic or proper name using an abbreviation if necessary, the strength of the drug or biological product, if applicable, and the name or number of the manufacturer or distributor. (Added 1977, No. 127 (Adj. Sess.),  1; amended 2001, No. 63,  124; 2009, No. 103 (Adj. Sess.),  5; 2017, No. 193 (Adj. Sess.),  4.) 
 4608. Liability
(a) Nothing in this chapter shall affect a licensed hospital with the development and maintenance of a hospital formulary system in accordance with that institutions policies and procedures that pertain to its drug distribution system developed by the medical staff in cooperation with the hospitals pharmacist and administration. (b) The substitution of a generic drug or interchangeable biological product by a pharmacist under the provisions of this chapter does not constitute the practice of medicine. (Added 1977, No. 127 (Adj. Sess.),  1; amended 2017, No. 193 (Adj. Sess.),  5.) 
 4621. Definitions
Except as otherwise specified, for the purposes of this subchapter:(1) Department means the Department of Health.(2) Evidence-based means based on criteria and guidelines that reflect high-quality, cost-effective care. The methodology used to determine such guidelines shall meet recognized standards for systematic evaluation of all available research and shall be free from conflicts of interest. Consideration of the best available scientific evidence does not preclude consideration of experimental or investigational treatment or services under a clinical investigation approved by an institutional review board. (Added 2007, No. 80,  14; amended 2009, No. 156 (Adj. Sess.),  I.21.) 
 4622. Evidence-based education program
(a)(1) The Department of Health, in collaboration with the Attorney General, the University of Vermont area health education centers program, and the Department of Vermont Health Access, shall establish an evidence-based prescription drug education program for health care professionals designed to provide information and education on the therapeutic and cost-effective utilization of prescription drugs to physicians, pharmacists, and other health care professionals authorized to prescribe and dispense prescription drugs. To the extent practicable, the program shall use the evidence-based standards developed by the Blueprint for Health. The Department of Health may collaborate with other states in establishing this program. (2) The program shall notify prescribers about commonly used brand-name drugs for which the patent has expired within the last 12 months or will expire within the next 12 months. The Departments of Health and of Vermont Health Access shall collaborate in issuing the notices. (3) To the extent permitted by funding, the program may include population-based medication management. (b) The Department of Health shall request information and collaboration from physicians, pharmacists, private insurers, hospitals, pharmacy benefit managers, the Drug Utilization Review Board, medical schools, the Attorney General, and any other programs providing an evidence-based education to prescribers on prescription drugs in developing and maintaining the program. (c) The Department of Health may contract for technical and clinical support in the development and the administration of the program from entities conducting independent research into the effectiveness of prescription drugs. (d) The Department of Health and the Attorney General shall collaborate in reviewing the marketing activities of pharmaceutical manufacturing companies in Vermont and determining appropriate funding sources for the program, including awards from suits brought by the Attorney General against pharmaceutical manufacturers. (Added 2007, No. 80,  14; amended 2009, No. 156 (Adj. Sess.),  I.22; 2011, No. 63,  E.311.) 
 4631. Confidentiality of prescription information
(a) It is the intent of the General Assembly to advance the States interest in protecting the public health of Vermonters, protecting the privacy of prescribers and prescribing information, and to ensure costs are contained in the private health care sector, as well as for State purchasers of prescription drugs, through the promotion of less costly drugs and ensuring prescribers receive unbiased information. (b) As used in this section:(1) Electronic transmission intermediary means an entity that provides the infrastructure that connects the computer systems or other electronic devices used by health care professionals, prescribers, pharmacies, health care facilities and pharmacy benefit managers, health insurers, third-party administrators, and agents and contractors of those persons in order to facilitate the secure transmission of an individuals prescription drug order, refill, authorization request, claim, payment, or other prescription drug information. (2) Health care facility shall have the same meaning as in section 9402 of this title.(3) Health care professional shall have the same meaning as health care provider in section 9402 of this title. (4) Health insurer shall have the same meaning as in section 9410 of this title.(5) Marketing shall include advertising, promotion, or any activity that is intended to be used or is used to influence sales or the market share of a prescription drug, influence or evaluate the prescribing behavior of an individual health care professional to promote a prescription drug, market prescription drugs to patients, or evaluate the effectiveness of a professional pharmaceutical detailing sales force. (6) Pharmacy means any individual or entity licensed or registered under 26 V.S.A. chapter 36. (7) Prescriber means an individual allowed by law to prescribe and administer prescription drugs in the course of professional practice. (8) Promotion or promote means any activity or product the intention of which is to advertise or publicize a prescription drug, including a brochure, media advertisement or announcement, poster, free sample, detailing visit, or personal appearance. (9) Regulated records means information or documentation from a prescription dispensed in Vermont and written by a prescriber doing business in Vermont. (c)(1) The Department of Health and the Office of Professional Regulation, in consultation with the appropriate licensing boards, shall establish a prescriber data-sharing program to allow a prescriber to give consent for his or her identifying information to be used for the purposes described under subsection (d) of this section. The Department and Office shall solicit the prescribers consent on licensing applications or renewal forms and shall provide a prescriber a method for revoking his or her consent. The Department and Office may establish rules for this program. (2) The Department or Office shall make available the list of prescribers who have consented to sharing their information. Entities who wish to use the information as provided for in this section shall review the list at minimum every six months. (d) A health insurer, a self-insured employer, an electronic transmission intermediary, a pharmacy, or other similar entity shall not sell, license, or exchange for value regulated records containing prescriber-identifiable information, nor permit the use of regulated records containing prescriber-identifiable information for marketing or promoting a prescription drug, unless the prescriber consents as provided in subsection (c) of this section. Pharmaceutical manufacturers and pharmaceutical marketers shall not use prescriber-identifiable information for marketing or promoting a prescription drug unless the prescriber consents as provided in subsection (c) of this section. (e) The prohibitions set forth in subsection (d) of this section shall not apply to the following: (1) the sale, license, exchange for value, or use of regulated records for the limited purposes of pharmacy reimbursement; prescription drug formulary compliance; patient care management; utilization review by a health care professional, the patients health insurer, or the agent of either; or health care research; (2) the dispensing of prescription medications to a patient or to the patients authorized representative; (3) the transmission of prescription information between an authorized prescriber and a licensed pharmacy, between licensed pharmacies, or that may occur in the event a pharmacys ownership is changed or transferred; (4) care management educational communications provided to a patient about the patients health condition, adherence to a prescribed course of therapy, and other information relating to the drug being dispensed, treatment options, recall or patient safety notices, or clinical trials; (5) the collection, use, or disclosure of prescription information or other regulatory activity as authorized by chapter 84, chapter 84A, or section 9410 of this title, or as otherwise provided by law; (6) the collection and transmission of prescription information to a Vermont or federal law enforcement officer engaged in his or her official duties as otherwise provided by law; and (7) the sale, license, exchange for value, or use of patient and prescriber data for marketing or promoting if the data do not identify a prescriber, and there is no reasonable basis to believe that the data provided could be used to identify a prescriber. (f) In addition to any other remedy provided by law, the Attorney General may file an action in Superior Court for a violation of this section or of any rules adopted under this section by the Attorney General. The Attorney General shall have the same authority to investigate and to obtain remedies as if the action were brought under the Vermont Consumer Protection Act, 9 V.S.A. chapter 63. Each violation of this section or of any rules adopted under this section by the Attorney General constitutes a separate civil violation for which the Attorney General may obtain relief. (Added 2007, No. 80,  17; amended 2007, No. 89 (Adj. Sess.),  3, eff. March 5, 2008; 2009, No. 59,  1; 2011, No. 109 (Adj. Sess.),  3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.),  1b, eff. May 18, 2012.) 
 4631a. Expenditures by manufacturers of prescribed products
(a) As used in this section:(1) Allowable expenditures means:(A) Payment to the sponsor of a significant educational, medical, scientific, or policy-making conference or seminar, provided: (i) the payment is not made directly to a health care professional or pharmacist;(ii) funding is used solely for bona fide educational purposes, except that the sponsor may, in the sponsors discretion, apply some or all of the funding to provide meals and other food for all conference participants; and (iii) all program content is objective, free from industry control, and does not promote specific products. (B) Honoraria and payment of the expenses of a health care professional who serves on the faculty at a bona fide significant educational, medical, scientific, or policy-making conference or seminar, provided: (i) there is an explicit contract with specific deliverables which are restricted to medical issues, not marketing activities; and (ii) consistent with federal law, the content of the presentation, including slides and written materials, is determined by the health care professional. (C) For a bona fide clinical trial:(i) gross compensation for the Vermont location or locations involved;(ii) direct salary support per principal investigator and other health care professionals per year; and (iii) expenses paid on behalf of investigators or other health care professionals paid to review the clinical trial. (D) For a research project that constitutes a systematic investigation, is designed to develop or contribute to general knowledge, and reasonably can be considered to be of significant interest or value to scientists or health care professionals working in the particular field of inquiry: (i) gross compensation;(ii) direct salary support per health care professional; and(iii) expenses paid on behalf of each health care professional.(E) Payment or reimbursement for the reasonable expenses, including travel and lodging-related expenses, necessary for technical training of individual health care professionals on the use of a medical device if the commitment to provide such expenses and the amounts or categories of reasonable expenses to be paid are described in a written agreement between the health care provider and the manufacturer. (F) Royalties and licensing fees paid to health care providers in return for contractual rights to use or purchase a patented or otherwise legally recognized discovery for which the health care provider holds an ownership right. (G) The payment of the reasonable expenses of an individual related to the interview of the individual by a manufacturer of prescribed products in connection with a bona fide employment opportunity or for health care services on behalf of an employee of the manufacturer. (H) Sponsorship of an educational program offered by a medical device manufacturer at a national or regional professional society meeting at which programs accredited by the Accreditation Council for Continuing Medical Education, or a comparable professional accrediting entity, are also offered, provided: (i) no payment is made directly to a health care professional or pharmacist; and(ii) the funding is used solely for bona fide educational purposes, except that the manufacturer may provide meals and other food for program participants. (I) Other reasonable fees, payments, subsidies, or other economic benefits provided by a manufacturer of prescribed products at fair market value. (2) Bona fide clinical trial means an FDA-reviewed clinical trial that constitutes research as that term is defined in 45 C.F.R.  46.102 and reasonably can be considered to be of interest to scientists or health care professionals working in the particular field of inquiry. (3) Clinical trial means any study assessing the safety or efficacy of prescribed products administered alone or in combination with other prescribed products or other therapies, or assessing the relative safety or efficacy of prescribed products in comparison with other prescribed products or other therapies. (4) Free clinic means a health care facility operated by a nonprofit private entity that: (A) in providing health care, does not accept reimbursement from any third-party payor, including reimbursement from any insurance policy, health plan, or federal or state health benefits program that is individually determined; (B) in providing health care, either:(i) does not impose charges on patients to whom service is provided; or(ii) imposes charges on patients according to their ability to pay;(C) may accept patients voluntary donations for health care service provision; and(D) is licensed or certified to provide health services in accordance with Vermont law.(5) Gift means:(A) anything of value provided for free to a health care provider or to a member of the Green Mountain Care Board established in chapter 220 of this title; or (B) except as otherwise provided in subdivisions (1)(A)(ii) and (1)(H)(ii) of this subsection (a), any payment, food, entertainment, travel, subscription, advance, service, or anything else of value provided to a health care provider or to a member of the Green Mountain Care Board established in chapter 220 of this title, unless: (i) it is an allowable expenditure as defined in subdivision (a)(1) of this section; or(ii) the health care provider or Board member reimburses the cost at fair market value.(6) Health benefit plan administrator means the person or entity who sets formularies on behalf of an employer or health insurer. (7)(A) Health care professional means:(i) a person who is authorized by law to prescribe or to recommend prescribed products, who regularly practices in this State, and who either is licensed by this State to provide or is otherwise lawfully providing health care in this State; or (ii) a partnership or corporation made up of the persons described in subdivision (i) of this subdivision (7)(A); or (iii) an officer, employee, agent, or contractor of a person described in subdivision (i) of this subdivision (7)(A) who is acting in the course and scope of employment, of an agency, or of a contract related to or supportive of the provision of health care to individuals. (B) The term shall not include a person described in subdivision (A) of this subdivision (7) who is employed solely by a manufacturer. (C) Regularly practices means to practice at least periodically under contract with, as an employee of, or as the owner of, a medical practice, health care facility, nursing home, hospital, or university located in Vermont. (8) Health care provider means a health care professional, hospital, nursing home, pharmacist, health benefit plan administrator, or any other person authorized to dispense or purchase for distribution prescribed products in this State. The term does not include a hospital foundation that is organized as a nonprofit entity separate from a hospital. (9) Manufacturer means a pharmaceutical, biological product, or medical device manufacturer or any other person who is engaged in the production, preparation, propagation, compounding, processing, marketing, packaging, repacking, distributing, or labeling of prescribed products. The term does not include a wholesale distributor of biological products, a retailer, or a pharmacist licensed under 26 V.S.A. chapter 36. The term also does not include a manufacturer whose only prescribed products are classified as Class I by the U.S. Food and Drug Administration, are exempt from pre-market notification under Section 510(k) of the federal Food, Drug and Cosmetic Act, and are sold over-the-counter without a prescription. (10) Marketing shall include promotion, detailing, or any activity that is intended to be used or is used to influence sales or market share or to evaluate the effectiveness of a professional sales force. (11) Pharmaceutical manufacturer means any entity which is engaged in the production, preparation, propagation, compounding, conversion, or processing of prescription drugs, whether directly or indirectly by extraction from substances of natural origin, independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis, or any entity engaged in the packaging, repackaging, labeling, relabeling, or distribution of prescription drugs. The term does not include a wholesale distributor of prescription drugs, a retailer, or a pharmacist licensed under 26 V.S.A. chapter 36. (12) Prescribed product means a drug as defined in section 201 of the federal Food, Drug and Cosmetic Act, 21 U.S.C.  321, a compound drug or drugs, a medical device as defined in this subsection, a biological product as defined in section 351 of the Public Health Service Act, 42 U.S.C.  262, for human use, or a combination product as defined in 21 C.F.R.  3.2(e), but shall not include prescription eyeglasses, prescription sunglasses, or other prescription eyewear. (13) Sample means a unit of a prescription drug, biological product, or medical device that is not intended to be sold and is intended to promote the sale of the drug, product, or device. The term includes starter packs and coupons or other vouchers that enable an individual to receive a prescribed product free of charge or at a discounted price. The term does not include prescribed products distributed free of charge or at a discounted price pursuant to a manufacturer-sponsored or manufacturer-funded patient assistance program. (14) Significant educational, scientific, or policy-making conference or seminar means an educational, scientific, or policy-making conference or seminar that: (A) is accredited by the Accreditation Council for Continuing Medical Education or a comparable organization or is presented by an approved sponsor of continuing education, provided that the sponsor is not a manufacturer of prescribed products; and (B) offers continuing education credit, features multiple presenters on scientific research, or is authorized by the sponsor to recommend or make policy. (15) Medical device means an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including any component, part, or accessory, that is: (A) recognized in the official National Formulary or the U.S. Pharmacopeia, or any supplement to them; (B) intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease, in humans or other animals; or (C) intended to affect the structure or any function of the body of humans or other animals, and which does not achieve its primary intended purposes through chemical action within or on such body and which is not dependent upon being metabolized for the achievement of its primary intended purposes. (b)(1) It is unlawful for any manufacturer of a prescribed product or any wholesale distributor of medical devices, or any agent thereof, to offer or give any gift to a health care provider or to a member of the Green Mountain Care Board established in chapter 220 of this title. (2) The prohibition set forth in subdivision (1) of this subsection shall not apply to any of the following: (A) Samples of a prescribed product or reasonable quantities of an over-the-counter drug, a nonprescription medical device, an item of nonprescription durable medical equipment, an item of medical food as defined in the federal Orphan Drug Act, as amended, 21 U.S.C.  360ee(b)(3), or infant formula as defined in Section 201(z) of the federal Food, Drug, and Cosmetic Act, 21 U.S.C.  321, provided to a health care provider for free distribution to patients. (B) The loan of a medical device for a short-term trial period, not to exceed 120 days, to permit evaluation of a medical device by a health care provider or patient. (C) The provision of reasonable quantities of medical device demonstration or evaluation units to a health care provider to assess the appropriate use and function of the product and determine whether and when to use or recommend the product in the future. (D) The provision, distribution, dissemination, or receipt of peer-reviewed academic, scientific, or clinical articles or journals and other items that serve a genuine educational function provided to a health care provider for the benefit of patients. (E) Scholarship or other support for medical students, residents, and fellows to attend a significant educational, scientific, or policy-making conference or seminar of a national, regional, or specialty medical or other professional association if the recipient of the scholarship or other support is selected by the association. (F) Rebates and discounts for prescribed products provided in the normal course of business.(G) Labels approved by the federal Food and Drug Administration for prescribed products.(H) The provision to a free clinic of financial donations or of free:(i) prescription drugs;(ii) over-the-counter drugs;(iii) medical devices;(iv) biological products;(v) combination products;(vi) medical food;(vii) infant formula; or(viii) medical equipment or supplies.(I) Prescribed products distributed free of charge or at a discounted price pursuant to a manufacturer-sponsored or manufacturer-funded patient assistance program. (J) Fellowship salary support provided to fellows through grants from manufacturers of prescribed products, provided: (i) such grants are applied for by an academic institution or hospital;(ii) the institution or hospital selects the recipient fellows;(iii) the manufacturer imposes no further demands or limits on the institutions, hospitals, or fellows use of the funds; and (iv) fellowships are not named for a manufacturer and no individual recipients fellowship is attributed to a particular manufacturer of prescribed products. (K) The provision of coffee or other snacks or refreshments at a booth at a conference or seminar. (c) Except as described in subdivisions (a)(1)(C) and (D) of this section, no manufacturer or other entity on behalf of a manufacturer shall provide any fee, payment, subsidy, or other economic benefit to a health care provider in connection with the providers participation in research. (d) The Attorney General may bring an action in the Civil Division of the Washington Unit of the Superior Court for injunctive relief, costs, and attorneys fees and may impose on a manufacturer that violates this section a civil penalty of not more than $10,000.00 per violation. Each unlawful gift shall constitute a separate violation. In any action brought pursuant to this section, the Attorney General shall have the same authority to investigate and to obtain remedies as if the action were brought under the Consumer Protection Act, 9 V.S.A. chapter 63. (Added 2009, No. 59,  3; amended 2009, No. 128 (Adj. Sess.),  32, eff. May 27, 2010; 2011, No. 48,  3d; 2011, No. 51,  1; 2011, No. 109 (Adj. Sess.),  3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.),  1b, eff. May 18, 2012; 2011, No. 171 (Adj. Sess.),  32a; 2013, No. 130 (Adj. Sess.),  5a; 2015, No. 97 (Adj. Sess.),  50a.) 
 4632. Disclosure of allowable expenditures and gifts by manufacturers of prescribed products
(a)(1)(A) Annually on or before April 1 of each year, every manufacturer of prescribed products shall disclose to the Office of the Attorney General for the preceding calendar year the value, nature, purpose, and recipient information of any allowable expenditure or gift permitted under subdivision 4631a(b)(2) of this title to any health care provider or to a member of the Green Mountain Care Board established in chapter 220 of this title, except: (i) Royalties and licensing fees as described in subdivision 4631a(a)(1)(F) of this title.(ii) Rebates and discounts for prescribed products provided to health care providers in the normal course of business as described in subdivision 4631a(b)(2)(F) of this title. (iii) Payments for clinical trials as described in subdivision 4631a(a)(1)(C) of this title, which shall be disclosed after the earlier of the date of the approval or clearance of the prescribed product by the Food and Drug Administration for the use for which the clinical trial is being conducted or four calendar years after the date the payment was made. For a clinical trial for which disclosure is delayed under this subdivision (iii), the manufacturer shall identify to the Attorney General the clinical trial, the start date, and the web link to the clinical trial registration on the national clinical trials registry. (iv) Interview or health care expenses as described in subdivision 4631a(a)(1)(G) of this title. (v) Coffee or other snacks or refreshments at a booth at a conference or seminar.(vi) Loans of medical devices for short-term trial periods pursuant to subdivision 4631a(b)(2)(B) of this title, provided the loan results in the purchase, lease, or other comparable arrangement of the medical device after issuance of a certificate of need pursuant to chapter 221, subchapter 5 of this title. (vii) Prescribed products distributed free of charge or at a discounted price pursuant to a manufacturer-sponsored or manufacturer-funded patient assistance program. (B) Annually on or before April 1 of each year, every manufacturer of prescribed products shall disclose to the Office of the Attorney General for the preceding calendar year, if the manufacturer is reporting other allowable expenditures or permitted gifts pursuant to subdivision (A) of this subdivision (a)(1), the product, dosage, number of units, and recipient information of over-the-counter drugs, nonprescription medical devices, items of nonprescription durable medical equipment, medical food, and infant formula provided to a health care provider for free distribution to patients pursuant to subdivision 4631a(b)(2)(A) of this title, provided that any public reporting of such information shall not include information that allows for the identification of individual recipients of such products or connects individual recipients with the monetary value of the products provided. (C) Annually on or before April 1 of each year, every manufacturer of prescribed products shall disclose to the Office of the Attorney General for the preceding calendar year the value, nature, purpose, and recipient information of any allowable expenditure or gift to an academic institution; to a nonprofit hospital foundation; or to a professional, educational, or patient organization representing or serving health care providers or consumers located in or providing services in Vermont, except: (i) Royalties and licensing fees as described in subdivision 4631a(a)(1)(F) of this title.(ii) Rebates and discounts for prescribed products provided in the normal course of business as described in subdivision 4631a(b)(2)(F) of this title. (iii) Payments for clinical trials as described in subdivision 4631a(a)(1)(C) of this title, which shall be disclosed after the earlier of the date of the approval or clearance of the prescribed product by the Food and Drug Administration for the use for which the clinical trial is being conducted or four calendar years after the date the payment was made. For a clinical trial for which disclosure is delayed under this subdivision (iii), the manufacturer shall identify to the Attorney General the clinical trial, the start date, and the web link to the clinical trial registration on the national clinical trials registry. (D) Any public reporting of the provision of free prescription or over-the-counter drugs, medical devices, biological products, medical equipment, combination products, medical food, infant formula, or supplies to a free clinic shall not include information that allows for the identification of individual recipients of such products or that connects individual recipients with the monetary value of the products provided. (2)(A)(i) Subject to the provisions of subdivision (B) of this subdivision (a)(2) and to the extent allowed under federal law, annually on or before April 1 of each year beginning in 2012, each manufacturer of prescribed products shall disclose to the Office of the Attorney General all samples provided to health care providers during the preceding calendar year, identifying for each sample the product, recipient, number of units, and dosage. (ii) The Office of the Attorney General may contract with academic researchers to release to such researchers data relating to manufacturer distribution of samples, subject to confidentiality provisions and without including the names or license numbers of individual recipients, for analysis and aggregated public reporting. (iii) Any public reporting of manufacturer distribution of samples shall not include information that allows for the identification of individual recipients of samples or connects individual recipients with the monetary value of the samples provided. (B) Subdivision (A) of this subdivision (a)(2) shall not apply to samples of prescription drugs required to be reported under Sec. 6004 of the Patient Protection and Affordable Care Act of 2010, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, if the Office of the Attorney General determines that the U.S. Department of Health and Human Services will collect and report state- and recipient-specific information regarding manufacturer distribution of samples of such prescription drugs. (3) Annually on or before April 1, each manufacturer of prescribed products also shall disclose to the Office of the Attorney General the name and address of the individual responsible for the manufacturers compliance with the provisions of this section. (4) Disclosure shall be made on a form and in a manner prescribed by the Office of the Attorney General and shall require manufacturers of prescribed products to report each allowable expenditure or gift permitted under subdivision 4631a(b)(2) of this title, including: (A) except as otherwise provided in subdivisions (1)(B) and (2) of this subsection (a), the value, nature, and purpose of each allowable expenditure and gift permitted under subdivision 4631a(b)(2) of this title according to specific categories identified by the Office of the Attorney General; (B) the name of the recipient;(C) the recipients address;(D) the recipients institutional affiliation;(E) prescribed product or products being marketed, if any; and(F) the recipients State board number or, in the case of an institution, foundation, or organization, the federal tax identification number or the identification number assigned by the Attorney General. (5) [Repealed.](6) Except as otherwise provided in subdivisions (1)(B) and (2)(A) of this subsection, the Office of the Attorney General shall make all disclosed data publicly available and searchable through an Internet website. (7) [Repealed.](b)(1) Annually on or before April 1, the Office of the Attorney General shall collect a $500.00 fee from each manufacturer of prescribed products filing annual disclosures of expenditures greater than zero described in subsection (a) of this section. (2) Fees collected under this section shall fund collection and analysis of information on activities related to the marketing of prescribed products under section 4631a of this title and under this section. The fees shall be collected in a special fund assigned to the Office. (c) The Attorney General may bring an action in the Civil Division of the Washington Unit of the Superior Court for injunctive relief, costs, and attorneys fees and to impose on a manufacturer of prescribed products that fails to disclose as required by subsection (a) of this section a civil penalty of no more than $10,000.00 per violation. Each unlawful failure to disclose shall constitute a separate violation. In any action brought pursuant to this section, the Attorney General shall have the same authority to investigate and to obtain remedies as if the action were brought under the Consumer Protection Act, 9 V.S.A. chapter 63. (d) The terms used in this section shall have the same meanings as in section 4631a of this title. (Added 2001, No. 127 (Adj. Sess.),  1, eff. June 13, 2002; amended 2003, No. 122 (Adj. Sess.),  128b; 2005, No. 71,  54a; 2005, No. 191 (Adj. Sess.),  45; 2007, No. 80,  3, 4; 2009, No. 59,  4; 2009, No. 128 (Adj. Sess.),  33; 2009, No. 156 (Adj. Sess.),  I.23; 2011, No. 48,  3e; 2011, No. 51,  2, eff. Jan. 1, 2012; 2011, No. 171 (Adj. Sess.),  32b; 2011, No. 109, (Adj. Sess.),  3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.),  1b, eff. May 18, 2012; 2011, No. 171 (Adj. Sess.),  41(f), eff. May 16, 2012; 2015, No. 131 (Adj. Sess.),  12; 2021, No. 73,  15.) 
 4633. Pharmaceutical marketer price disclosure
(a) When a pharmaceutical marketer engages in any form of prescription drug marketing directly to a physician or other person authorized to prescribe prescription drugs, the marketer shall disclose to the physician or other prescriber the average wholesale price (AWP) of the drugs being marketed. Disclosure shall include the AWP per pill and the price relationship between the drug being marketed and other drugs within the same therapeutic class. (b) The disclosures required under this section shall be on a form and in a manner prescribed by the Office of the Attorney General. The Attorney General may adopt rules to implement the provisions of this section. (c) In addition to any other remedy provided by law, the Attorney General after consultation with the Commissioner of Financial Regulation may file an action in Superior Court for a violation of this section or of rules adopted under this section. In any such action, the Attorney General shall have the same authority to investigate and to obtain remedies as if the action were brought under the Consumer Protection Act, 9 V.S.A. chapter 63. Each violation of this section or of rules adopted under this section constitutes a separate civil violation for which the Attorney General may obtain relief. (d) As used in this section:(1) Average wholesale price or AWP means the wholesale price charged on a specific commodity that is assigned by the pharmaceutical manufacturing company and listed in a nationally recognized drug pricing file. (2) Pharmaceutical manufacturing company shall have the same meaning as pharmaceutical manufacturer in section 4631a of this title. (3) Pharmaceutical marketer means a person who, while employed by or under contract to represent a pharmaceutical manufacturing company, engages in marketing, as that term is defined in section 4631a of this title. (Added 2003, No. 122 (Adj. Sess.),  128c; amended 2007, No. 80,  5; 2009, No. 59,  6; 2011, No. 78 (Adj. Sess.),  2, eff. April 2, 2012; 2011, No. 109 (Adj. Sess.),  3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.),  1b, eff. May 18, 2012.) 
 4634. Prescription drug price disclosure
(a) Upon request, a pharmacy shall disclose to any consumer or health care provider the usual and customary retail price of a prescription drug. (b) With each prescription dispensed, a pharmacy shall disclose to the consumer, in writing, the price of the prescription and any payment toward the price required of the consumer. (c) For purposes of this section:(1) Price of the prescription means the amount charged by the pharmacy to the consumer or, if applicable, to the consumers health benefit plan. (2) Usual and customary retail price means the total price charged to a consumer who does not have prescription drug coverage under a health benefit plan. (d) In addition to any other remedy provided by law, the Attorney General may file an action in Superior Court for a violation of this section. In any such action, the Attorney General shall have the same authority to investigate and to obtain remedies as if the action were brought under the Consumer Protection Act, 9 V.S.A. chapter 63. Each violation of this section constitutes a separate civil violation for which the Attorney General may obtain relief. (Added 2003, No. 122 (Adj. Sess.),  128a; amended 2011, No. 109 (Adj. Sess.),  3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.),  1b, eff. May 18, 2012.) 
 4635. Prescription drug cost transparency
(a) As used in this section:(1) Manufacturer shall have the same meaning as pharmaceutical manufacturer in section 4631a of this title. (2) Prescription drug means a drug as defined in 21 U.S.C.  321.(b)(1)(A) The Department of Vermont Health Access shall create annually a list of 10 prescription drugs on which the State spends significant health care dollars and for which the wholesale acquisition cost has increased by 50 percent or more over the past five years or by 15 percent or more during the previous calendar year, creating a substantial public interest in understanding the development of the drugs pricing. The list shall include at least one generic and one brand-name drug and shall indicate each of the drugs on the list that the Department considers to be specialty drugs. The Department shall include the percentage of the wholesale acquisition cost increase for each drug on the list; rank the drugs on the list from those with the largest increase in wholesale acquisition cost to those with the smallest increase; indicate whether each drug was included on the list based on its cost increase over the past five years or during the previous calendar year, or both; and provide the Departments total expenditure for each drug on the list during the most recent calendar year. (B) The Department of Vermont Health Access shall create annually a list of 10 prescription drugs on which the State spends significant health care dollars and for which the cost to the Department of Vermont Health Access, net of rebates and other price concessions, has increased by 50 percent or more over the past five years or by 15 percent or more during the previous calendar year, creating a substantial public interest in understanding the development of the drugs pricing. The list shall include at least one generic and one brand-name drug and shall indicate each of the drugs on the list that the Department considers to be specialty drugs. The Department shall rank the drugs on the list from those with the greatest increase in net cost to those with the smallest increase and indicate whether each drug was included on the list based on its cost increase over the past five years or during the previous calendar year, or both. (C)(i) Each health insurer with more than 5,000 covered lives in this State for major medical health insurance shall create annually a list of 10 prescription drugs on which its health insurance plans spend significant amounts of their premium dollars and for which the cost to the plans, net of rebates and other price concessions, has increased by 50 percent or more over the past five years or by 15 percent or more during the previous calendar year, or both, creating a substantial public interest in understanding the development of the drugs pricing. The list shall include at least one generic and one brand-name drug and shall indicate each of the drugs on the list that the health insurer considers to be specialty drugs. The health insurer shall rank the drugs on the list from those with the greatest increase in net cost to those with the smallest increase and indicate whether each drug was included on the list based on its cost increase over the past five years or during the previous calendar year, or both. (ii) Each health insurer creating a list pursuant to subdivision (i) of this subdivision (b)(1)(C) shall provide to the Office of the Attorney General the percentage by which the net cost to its plans increased over the applicable period or periods for each drug on the list, as well as the insurers total expenditure, net of rebates and other price concessions, for each drug on the list during the most recent calendar year. Information provided to the Office of the Attorney General pursuant to this subdivision (b)(1)(C)(ii) is exempt from public inspection and copying under the Public Records Act and shall not be released. (2) The Department of Vermont Health Access and the health insurers shall provide to the Office of the Attorney General and the Green Mountain Care Board the lists of prescription drugs developed pursuant to subdivisions (1)(A), (B), and (C)(i) of this subsection annually on or before June 1. The Office of the Attorney General and the Green Mountain Care Board shall make all of the information available to the public on their respective websites. (c)(1)(A) Of the prescription drugs listed by the Department of Vermont Health Access and the health insurers pursuant to subdivisions (b)(1)(B) and (C) of this section, the Office of the Attorney General shall identify 15 drugs as follows: (i) of the drugs appearing on more than one payers list, the Office of the Attorney General shall identify the top 15 drugs on which the greatest amount of money was spent across all payers during the previous calendar year, to the extent information is available; and (ii) if fewer than 15 drugs appear on more than one payers list, the Office of the Attorney General shall rank the remaining drugs based on the amount of money spent by any one payer during the previous calendar year, in descending order, and select as many of the drugs at the top of the list as necessary to reach a total of 15 drugs. (B) For the 15 drugs identified by the Office of the Attorney General pursuant to subdivision (A) of this subdivision (1), the Office of the Attorney General shall require the manufacturer of each such drug to provide all of the following: (i) Justification for the increase in the net cost of the drug to the Department of Vermont Health Access, to one or more health insurers, or both, which shall be provided to the Office of the Attorney General in a format that the Office of the Attorney General determines to be understandable and appropriate and shall be provided in accordance with a timeline specified by the Office of the Attorney General. The manufacturer shall submit to the Office of the Attorney General all relevant information and supporting documentation necessary to justify the manufacturers net cost increase to the Department of Vermont Health Access, to one or more health insurers, or both during the identified period of time, including: (I) each factor that specifically caused the net cost increase to the Department of Vermont Health Access, to one or more health insurers, or both during the specified period of time; (II) the percentage of the total cost increase attributable to each factor; and(III) an explanation of the role of each factor in contributing to the cost increase.(ii) A separate version of the information submitted pursuant to subdivision (i) of this subdivision (1)(B), which shall be made available to the public by the Office of the Attorney General and the Green Mountain Care Board pursuant to subsection (d) of this section. In the event that the manufacturer believes it necessary to redact certain information in the public version as proprietary or confidential, the manufacturer shall provide an explanation for each such redaction to the Office of the Attorney General. The information, format, and any redactions shall be subject to approval by the Office of the Attorney General. (iii) Additional information in response to all requests for such information by the Office of the Attorney General. (2) Nothing in this section shall be construed to restrict the legal ability of a prescription drug manufacturer to change prices to the extent permitted under federal law. (d)(1) The Attorney General shall provide a report to the General Assembly on or before December 1 of each year based on the information received from manufacturers pursuant to this section. The Attorney General shall post the report and the public version of each manufacturers information submitted pursuant to subdivision (c)(1)(B)(ii) of this section on the Office of the Attorney Generals website. (2) The Green Mountain Care Board shall post on its website the report prepared by the Attorney General pursuant to subdivision (1) of this subsection and the public version of each manufacturers information submitted pursuant to subdivision (c)(1)(B)(ii) of this section, and may inform the public of the availability of the report and the manufacturers justification information. (e) Information provided to the Office of the Attorney General pursuant to subdivision (c)(1)(B) of this section is exempt from public inspection and copying under the Public Records Act and shall not be released in a manner that allows for the identification of an individual drug or manufacturer or that is likely to compromise the financial, competitive, or proprietary nature of the information, except for the information prepared for release to the public pursuant to subdivision (c)(1)(B)(ii) of this section. (f) The Attorney General may bring an action in the Civil Division of the Superior Court, Washington County for injunctive relief, costs, and attorneys fees, and to impose on a manufacturer that fails to provide any of the information required by subsection (c) of this section, in the format requested by the Office of the Attorney General and in accordance with the timeline specified by the Office of the Attorney General, a civil penalty of not more than $10,000.00 per violation. Each unlawful failure to provide information shall constitute a separate violation. In any action brought pursuant to this section, the Attorney General shall have the same authority to investigate and to obtain remedies as if the action were brought under the Consumer Protection Act, 9 V.S.A. chapter 63. (Added 2015, No. 165 (Adj. Sess.),  2, eff. June 2, 2016; amended 2017, No. 193 (Adj. Sess.),  9, eff. May 30, 2018.) 
 4636. Impact of prescription drug costs on health insurance premiums; report
(a)(1) Each health insurer with more than 1,000 covered lives in this State for major medical health insurance shall report to the Green Mountain Care Board, for all covered prescription drugs, including generic drugs, brand-name drugs, and specialty drugs provided in an outpatient setting or sold in a retail setting: (A) the 25 most frequently prescribed drugs and the average wholesale price for each drug;(B) the 25 most costly drugs by total plan spending and the average wholesale price for each drug; and (C) the 25 drugs with the highest year-over-year price increases and the average wholesale price for each drug. (2) A health insurer shall not be required to provide to the Green Mountain Care Board the actual price paid, net of rebates, for any prescription drug. (b) The Green Mountain Care Board shall compile the information reported pursuant to subsection (a) of this section into a consumer-friendly report that demonstrates the overall impact of drug costs on health insurance premiums. The data in the report shall be aggregated and shall not reveal information as specific to a particular health benefit plan. (c) The Board shall publish the report required pursuant to subsection (b) of this section on its website on or before January 1 of each year. (Added 2017, No. 193 (Adj. Sess.),  8, eff. May 30, 2018.) 
 4637. Notice of introduction of new high-cost prescription drugs
(a) As used in this section:(1) Manufacturer shall have the same meaning as pharmaceutical manufacturer in section 4631a of this title. (2) Prescription drug means a drug as defined in 21 U.S.C.  321.(b) A prescription drug manufacturer shall notify the Office of the Attorney General in writing if it is introducing a new prescription drug to market at a wholesale acquisition cost that exceeds the threshold set for a specialty drug under the Medicare Part D program. The manufacturer shall provide the written notice within three calendar days following the release of the drug in the commercial market. A manufacturer may make the notification pending approval by the U.S. Food and Drug Administration (FDA) if commercial availability is expected within three calendar days following the approval. (c) Not later than 30 calendar days following notification pursuant to subsection (b) of this section, the manufacturer shall provide all of the following information to the Office of the Attorney General in a format that the Office prescribes: (1) a description of the marketing and pricing plans used in the launch of the new drug in the United States and internationally; (2) the estimated volume of patients who may be prescribed the drug;(3) whether the drug was granted breakthrough therapy designation or priority review by the FDA prior to final approval; and (4) the date and price of acquisition if the drug was not developed by the manufacturer.(d) The manufacturer may limit the information reported pursuant to subsection (c) of this section to that which is otherwise in the public domain or publicly available. (e) The Office of the Attorney General shall publish on its website at least quarterly the information reported to it pursuant to this section. The information shall be published in a manner that identifies the information that is disclosed on a per-drug basis and shall not be aggregated in a manner that would not allow identification of the drug. (f) The Attorney General may bring an action in the Civil Division of the Superior Court, Washington County for injunctive relief, costs, and attorneys fees and to impose on a manufacturer that fails to provide the information required by subsection (c) of this section a civil penalty of not more than $1,000.00 per day for every day after the notification period described in subsection (b) of this section that the required information is not reported. In any action brought pursuant to this section, the Attorney General shall have the same authority to investigate and to obtain remedies as if the action were brought under the Consumer Protection Act, 9 V.S.A. chapter 63. (Added 2017, No. 193 (Adj. Sess.),  10, eff. May 30, 2018.) 
 4651. Wholesale importation program for prescription drugs; design
(a) The Agency of Human Services, in consultation with interested stakeholders and appropriate federal officials, shall design a wholesale prescription drug importation program that complies with the applicable requirements of 21 U.S.C.  384, including the requirements regarding safety and cost savings. The program design shall: (1) designate a State agency that shall either become a licensed drug wholesaler or contract with a licensed drug wholesaler in order to seek federal certification and approval to import safe prescription drugs and provide significant prescription drug cost savings to Vermont consumers; (2) use Canadian prescription drug suppliers regulated under the laws of Canada or of one or more Canadian provinces, or both; (3) ensure that only prescription drugs meeting the U.S. Food and Drug Administrations safety, effectiveness, and other standards shall be imported by or on behalf of the State; (4) import only those prescription drugs expected to generate substantial savings for Vermont consumers; (5) ensure that the program complies with the tracking and tracing requirements of 21 U.S.C.  360eee and 360eee-1 to the extent feasible and practical prior to imported drugs coming into the possession of the State wholesaler and that it complies fully after imported drugs are in the possession of the State wholesaler; (6) prohibit the distribution, dispensing, or sale of imported products outside Vermonts borders; (7) recommend a charge per prescription or another method of support to ensure that the program is funded adequately in a manner that does not jeopardize significant consumer savings; and (8) include a robust audit function.(b) On or before January 1, 2019, the Secretary of Human Services shall submit the proposed design for a wholesale prescription drug importation program to the House Committees on Health Care and on Ways and Means and the Senate Committees on Health and Welfare and on Finance. (Added 2017, No. 133 (Adj. Sess.),  1, eff. May 21, 2018.) 
 4652. Monitoring for anticompetitive behavior
The Agency of Human Services shall consult with the Office of the Attorney General to identify the potential, and to monitor, for anticompetitive behavior in industries that would be affected by a wholesale prescription drug importation program. (Added 2017, No. 133 (Adj. Sess.),  1, eff. May 21, 2018.) 
 4653. Federal compliance
(a) On or before July 1, 2020, the Agency of Human Services shall submit a formal request to the Secretary of the U.S. Department of Health and Human Services for certification of the States wholesale prescription drug importation program. (b) The Agency of Human Services shall seek the appropriate federal approvals, waivers, exemptions, or agreements, or a combination thereof, as needed to enable all covered entities enrolled in or eligible for the federal 340B Drug Pricing Program to participate in the States wholesale prescription drug importation program to the fullest extent possible without jeopardizing their eligibility for the 340B Program. (Added 2017, No. 133 (Adj. Sess.),  1, eff. May 21, 2018; amended 2019, No. 72,  E.300.5.) 
 4654. Program financing
The Agency of Human Services shall not implement the wholesale prescription drug importation program until the General Assembly enacts legislation establishing a charge per prescription or another method of financial support for the program. (Added 2017, No. 133 (Adj. Sess.),  1, eff. May 21, 2018.) 
 4655. Implementation provisions
Upon the last to occur of the General Assembly enacting a method of financial support pursuant to section 4654 of this chapter and receipt of certification and approval by the Secretary of the U.S. Department of Health and Human Services, the Agency of Human Services shall begin implementation of the wholesale prescription drug importation program and shall begin operating the program within six months. As part of the implementation process, the Agency of Human Services shall, in accordance with State procurement and contract laws, rules, and procedures as appropriate: (1) become licensed as a wholesaler or enter into a contract with a Vermont-licensed wholesaler;(2) contract with one or more Vermont-licensed distributors;(3) contract with one or more licensed and regulated Canadian suppliers;(4) engage with health insurance plans, employers, pharmacies, health care providers, and consumers; (5) develop a registration process for health insurance plans, pharmacies, and prescription drug-administering health care providers who are willing to participate in the program; (6) create a publicly available source for listing the prices of imported prescription drug products that shall be made available to all participating entities and consumers; (7) create an outreach and marketing plan to generate program awareness;(8) starting in the weeks before the program becomes operational, create and staff a hotline to answer questions and address the needs of consumers, employers, health insurance plans, pharmacies, health care providers, and other affected sectors; (9) establish the audit function and a two-year audit work-plan cycle; and(10) conduct any other activities that the Agency determines to be important for successful implementation of the program. (Added 2017, No. 133 (Adj. Sess.),  1, eff. May 21, 2018.) 
 4656. Annual reporting
(a) Annually on or before January 15, the Agency of Human Services shall report to the House Committees on Health Care and on Ways and Means and the Senate Committees on Health and Welfare and on Finance regarding the operation of the wholesale prescription drug importation program during the previous calendar year, including: (1) which prescription drugs were included in the wholesale importation program;(2) the number of participating pharmacies, health care providers, and health insurance plans; (3) the number of prescriptions dispensed through the program;(4) the estimated savings to consumers, health plans, employers, and the State during the previous calendar year and to date; (5) information regarding implementation of the audit plan and audit findings; and(6) any other information the Secretary of Human Services deems relevant.(b) The provisions of 2 V.S.A.  20(d) (expiration of required reports) shall not apply to the report to be made under this section. (Added 2017, No. 133 (Adj. Sess.),  1, eff. May 21, 2018.) 
 4750. Definitions
As used in this chapter:(1) Health insurance plan has the same meaning as in 8 V.S.A.  4089b.(2) Medication-assisted treatment means the use of U.S. Food and Drug Administration-approved medications, in combination with counseling and behavioral therapies, to provide a whole patient approach to the treatment of substance use disorders. (Added 2017, No. 153 (Adj. Sess.),  1a, eff. May 21, 2018; amended 2017, No. 176 (Adj. Sess.),  2; 2019, No. 14,  51, eff. April 30, 2019; 2019, No. 43,  2.) 
 4751. Purpose
It is the purpose of this chapter to authorize the Departments of Health and of Vermont Health Access to establish a regional system of opioid addiction treatment. (Added 2011, No. 135 (Adj. Sess.),  1, eff. May 14, 2012; amended 2015, No. 173 (Adj. Sess.),  3.) 
 4752. Opioid addiction treatment system
(a) The Departments of Health and of Vermont Health Access shall establish by rule a regional system of opioid addiction treatment. (b) The rules shall include the following requirements:(1) Patients shall receive appropriate, comprehensive assessment and therapy from a physician or advanced practice registered nurse and from a licensed clinical professional with clinical experience in addiction treatment, including a psychiatrist, masters- or doctorate-level psychologist, mental health counselor, clinical social worker, or drug and alcohol abuse counselor. (2) A medical assessment shall be conducted to determine whether pharmacological treatment, which may include methadone, buprenorphine, and other federally approved medications to treat opioid addiction, is medically appropriate. (3) A routine medical assessment of the appropriateness for the patient of continued pharmacological treatment based on protocols designed to encourage cessation of pharmacological treatment as medically appropriate for the individual treatment needs of the patient. (4) Controlled substances for use in federally approved pharmacological treatments for opioid addiction shall be dispensed only by: (A) a treatment program authorized by the Department of Health; or(B) a physician or advanced practice registered nurse who is not affiliated with an authorized treatment program but who meets federal requirements for use of controlled substances in the pharmacological treatment of opioid addiction. (5) Comprehensive education and training requirements shall apply for health care providers, pharmacists, and the licensed clinical professionals listed in subdivision (1) of this subsection, including relevant aspects of therapy and pharmacological treatment. (6) Patients shall abide by rules of conduct, violation of which may result in discharge from the treatment program, including: (A) provisions requiring urinalysis at such times as the program may direct;(B) restrictions on medication dispensing designed to prevent diversion of medications and to diminish the potential for patient relapse; and (C) such other rules of conduct as a provider authorized to provide treatment under subdivision (4) of this subsection (b) may require. (c) [Repealed.] (Added 2011, No. 135 (Adj. Sess.),  1, eff. May 14, 2012; amended 2015, No. 173 (Adj. Sess.),  3.)
 4753. Care coordination
Prescribing physicians and collaborating health care and addictions professionals may coordinate care for patients receiving medication-assisted treatment for substance use disorder, which may include monitoring adherence to treatment, coordinating access to recovery supports, and providing counseling, contingency management, and case management services. (Added 2015, No. 173 (Adj. Sess.),  3.) 
 4754. Limitation on prior authorization requirements
(a) A health insurance plan shall not require prior authorization for prescription drugs for a patient who is receiving medication-assisted treatment if the dosage prescribed is within the U.S. Food and Drug Administrations dosing recommendations. (b) A health insurance plan shall not require prior authorization for all counseling and behavioral therapies associated with medication-assisted treatment for a patient who is receiving medication-assisted treatment. (Added 2019, No. 43,  3, eff. Jan. 1, 2020.) 
 4771. Purpose
It is the purpose of this subchapter to comply with any opioid litigation settlements to which the State or municipalities within the State were a party regarding the management and expenditure of monies received by the State. While an opioid litigation settlement may designate a portion of the monies for local or State use, this subchapter applies to only monies from abatement accounts funds. (Added 2021, No. 118 (Adj. Sess.),  1, eff. May 16, 2022.) 
 4772. Opioid Settlement Advisory Committee
(a) Creation. There is created the Opioid Settlement Advisory Committee to provide advice and recommendations regarding remediation spending from the Opioid Abatement Special Fund established pursuant to this subchapter. (b) Membership. (1) The Advisory Committee shall be composed of the following members and shall reflect the diversity of Vermont in terms of gender, race, age, ethnicity, sexual orientation, gender identity, disability status, and socioeconomic status and ensure inclusion of individuals with lived experience of opioid use disorder and their family members whenever possible: (A) the Commissioner of Health or designee, who shall serve as a nonvoting chair;(B) the Chief Prevention Officer established pursuant to 3 V.S.A.  2321;(C) one current member of the House of Representatives, appointed by the Speaker of the House; (D) one current member of the Senate, appointed by the Committee on Committees;(E) a primary care prescriber with experience providing medication- assisted treatment within the Blueprint for Health hub and spoke model, appointed by the Executive Director of the Blueprint for Health, to provide a statewide perspective on the provision of medication-assisted treatment services; (F) a provider with academic research credentials, appointed by the University of Vermont, to provide a statewide perspective on academic research relating to opioid use disorder; (G) two individuals with lived experience of opioid use disorder, including at least one of whom is in recovery, one member appointed by the Howard Centers Safe Recovery program and one member appointed by the Vermont Association of Mental Health and Addiction Recovery, to provide a statewide perspective on the experience of living with opioid use disorder; (H) an assistant judge, appointed by the Vermont Association of County Judges; and(I) seven individuals, each employed by or an agent of a different city or town that collectively reflect Vermonts diverse population and geography, appointed by the Vermont League of Cities and Towns. (2)(A) The term of office of each appointed member shall be four years. Of the members first appointed, eight shall be appointed for a term of three years and eight shall be appointed for a term of four years. Members shall hold office for the term of their appointments and until their successors have been appointed. All vacancies shall be filled for the balance of the unexpired term in the same manner as the original appointment. Members are eligible for reappointment. (B) A member may be removed from the Advisory Committee by the members appointing entity for cause, which includes only neglect of duty, gross misconduct, conviction of a crime, or inability to perform the responsibilities of the office. The Chair of the Advisory Committee shall simultaneously notify the Governor, the Speaker of the House, and the President Pro Tempore that the member has been removed from the Advisory Committee. (c) Powers and duties. The Advisory Committee shall demonstrate broad ongoing consultation with individuals living with opioid use disorder about their direct experience with related systems, including medication-assisted treatment, residential treatment, recovery services, harm reduction services, overdose, supervision by the Department of Corrections, and involvement with the Department for Children and Families Family Services Division. To that end, the Advisory Committee shall demonstrate consultation with individuals with direct lived experience of opioid use disorder, frontline support professionals, the Substance Misuse Oversight Prevention and Advisory Council, and other stakeholders to identify spending priorities as related to opioid use disorder prevention, intervention, treatment, and recovery services and harm reduction strategies for the purpose of providing recommendations to the Governor, the Department of Health, and the General Assembly on prioritizing spending from the Opioid Abatement Special Fund. The Advisory Committee shall consider: (1) the impact of the opioid crisis on communities throughout Vermont, including communities abatement needs and proposals for abatement strategies and responses; (2) the perspectives of and proposals from opioid use disorder prevention coalitions, recovery centers, and medication-assisted treatment providers; and (3) the ongoing challenges of the opioid crisis on marginalized populations, including individuals who have a lived experience of opioid use disorder. (d) Assistance. The Advisory Committee shall have the administrative, technical, and legal assistance of the Department of Health. (e) Presentation. Annually, the Advisory Committee shall present its recommendations for expenditures from the Opioid Abatement Special Fund established pursuant to this subchapter to the Department of Health and concurrently submit its recommendations in writing to the House Committees on Appropriations and on Humans Services and the Senate Committees on Appropriations and on Health and Welfare. (f) Meetings. (1) The Commissioner of Health shall call the first meeting of the Advisory Committee to occur on or before June 30, 2022. (2) The Advisory Committee shall meet at least quarterly but not more than six times per calendar year. (3) The Advisory Committee shall adopt procedures to govern its proceedings and organization, including voting procedures and how the staggered terms shall be apportioned among members. (4) All meetings of the Advisory Committee shall be consistent with Vermonts Open Meeting Law pursuant to 1 V.S.A. chapter 5, subchapter 2. (g) Compensation and reimbursement. (1) For attendance at meetings during adjournment of the General Assembly, a legislative member of the Advisory Committee serving in the members capacity as a legislator shall be entitled to per diem compensation and reimbursement of expenses pursuant to 2 V.S.A.  23 for not more than six meetings per year. These payments shall be appropriated from the Opioid Abatement Special Fund. (2) Other members of the Advisory Committee shall be entitled to per diem compensation and reimbursement of expenses as permitted under 32 V.S.A.  1010 for not more than six meetings per year. These payments shall be appropriated from the Opioid Abatement Special Fund. (Added 2021, No. 118 (Adj. Sess.),  1, eff. May 16, 2022.) 
 4773. Designation of lead State agency
The Department of Health shall serve as the lead State agency and single point of contact for submitting requests for funding to the national settlement fund administrator. Approved requests shall be disbursed to the Department for deposit into the Opioid Abatement Special Fund established in section 4774 of this subchapter. (Added 2021, No. 118 (Adj. Sess.),  1, eff. May 16, 2022.) 
 4774. Opioid Abatement Special Fund
(a)(1) There is created the Opioid Abatement Special Fund, a special fund established and managed pursuant to 32 V.S.A. chapter 7, subchapter 5 and administered by the Department of Health. The Opioid Abatement Special Fund shall consist of all abatement account fund monies disbursed to the Department from the national abatement account fund, the national opioid abatement trust, the supplemental opioid abatement fund, or any other settlement funds that must be utilized exclusively for opioid prevention, intervention, treatment, recovery, and harm reduction services. (2) The Department shall include a spending plan, informed by the recommendations of the Opioid Settlement Advisory Committee established pursuant to section 4772 of this subchapter, as part of its annual budget submission, and once approved, the Department shall request to have the funds formally released from the national abatement account fund, the national opioid abatement trust, the supplemental opioid abatement fund, or any other settlement funds that must be utilized exclusively for opioid prevention, intervention, treatment, recovery, and harm reduction services. The Department shall disburse monies from the Opioid Abatement Special Fund pursuant to 32 V.S.A. chapter 7, subchapter 3. (3) Disbursements from the Opioid Abatement Special Fund shall supplement and not supplant or replace any existing or future local, State, or federal government funding for infrastructure, programs, supports, and resources, including health insurance benefits, federal grant funding, and Medicaid and Medicare funds. (b) Expenditures from the Opioid Abatement Special Fund shall be used for the following opioid prevention, intervention, treatment, recovery, harm reduction, and evaluation activities: (1) preventing overdose deaths and other harms;(2) treatment of opioid use disorder;(3) support for individuals in treatment and recovery and their families;(4) connecting individuals who need help to the help needed;(5) addressing the needs of criminal justice-involved persons;(6) addressing the needs of pregnant or parenting individuals and their families, including babies with neonatal abstinence syndrome; (7) preventing overprescribing and ensuring appropriate prescribing and dispensing of opioids; (8) preventing the misuse of opioids;(9) educating law enforcement and other first responders regarding appropriate practices and precautions when dealing with fentanyl or other drugs and providing wellness and support services for first responders and others who experience secondary trauma associated with opioid-related emergency events; (10) supporting efforts to provide leadership, planning, coordination, facilitation, training, and technical assistance to abate the opioid epidemic; (11) researching opioid abatement;(12) implementing other evidence-based or evidence-informed programs or strategies that support prevention, harm reduction, treatment, or recovery of opioid use disorder and any co-occurring substance use or mental health disorder; and (13) the cost of the administrative, technical, and legal assistance provided to the Advisory Committee by the Department of Health. (c) Priority for expenditures from the Opioid Abatement Special Fund shall be aimed at reducing overdose deaths, including the following: (1) promoting the appropriate use of naloxone and other U.S. Food and Drug Administration-approved drugs to reverse opioid overdoses, specifically: (A) expanding training for first responders, schools, community support groups, families; and (B) increasing distribution to individuals who are uninsured or whose health insurance does not cover the needed goods and services; (2) increasing access to medication-assisted treatment and other opioid-related treatment, specifically: (A) increasing distribution of medication-assisted treatment to individuals who are uninsured or whose health insurance does not cover the needed goods and services; (B) providing education to school-based and youth-focused programs that discourage or prevent misuse, including how to access opioid use disorder treatment; (C) providing medication-assisted education and awareness training to health care providers, emergency medical technicians, law enforcement, and other first responders; and (D) providing treatment and recovery support services, such as residential and inpatient treatment, intensive outpatient treatment, outpatient therapy or counseling, and recovery housing that allows or integrates medication and other support services; (3) assisting pregnant and postpartum individuals, specifically:(A) enhancing services for expanding screening, brief intervention, and referral to treatment (SBIRT) services to non-Medicaid eligible or uninsured pregnant individuals; (B) expanding comprehensive evidence-based or evidence-informed treatment and recovery services, including medication-assisted treatment, for individuals with co-occurring opioid use disorder and other substance or mental health disorders for up to 12 months postpartum; and (C) providing comprehensive wraparound services to pregnant and postpartum individuals with opioid use disorder, including housing, transportation, job placement, training, and child care; (4) expanding treatment for neonatal abstinence syndrome (NAS), specifically:(A) expanding comprehensive evidence-based or evidence-informed recovery support for babies with NAS; (B) expanding services for better continuum of care to address infant needs and support the parent-child relationship; and (C) expanding long-term treatment and services for medical monitoring of babies with NAS and their families; (5) expanding the availability of warm handoff programs and recovery services, specifically:(A) expanding services such as navigators and on-call teams to begin medication-assisted treatment in hospital emergency departments; (B) expanding warm handoff services to transition to recovery services;(C) broadening the scope of recovery services to include co-occurring substance use disorder or mental health conditions; (D) providing comprehensive wraparound services to individuals in recovery, including housing, transportation, job placement, training, and child care; and (E) hiring additional workers to facilitate the expansions listed in this subdivision (5); (6) treating incarcerated populations, specifically:(A) providing evidence-based or evidence-informed treatment and recovery support, including medication-assisted treatment for individuals with opioid use disorder or co-occurring substance use or mental health disorders while transitioning out of the criminal justice system; and (B) increasing funding for correctional facilities to provide treatment and recovery support to inmates with opioid use disorder; (7) supporting prevention programs, specifically:(A) funding for media campaigns to prevent opioid misuse;(B) funding for evidence-based or evidence-informed prevention in schools;(C) funding for health care provider education and outreach regarding best prescribing practices for opioids consistent with current Department of Health and U.S. Centers for Disease Control and Prevention guidelines, including providers at hospitals; (D) funding for community drug disposal programs; and(E) funding and training for first responders to participate in pre- arrest diversion programs, post-overdose response teams, or similar strategies that connect at-risk individuals to mental health services and supports; (8) expanding syringe service programs, specifically providing comprehensive syringe services programs with more wraparound services, including linkages to opioid use disorder treatment, access to sterile syringes, and linkages to care and treatment of infectious diseases; and (9) facilitating evidence-based or evidence-informed data collection and research analyzing and evaluating the effectiveness of the abatement strategies within Vermont. (Added 2021, No. 118 (Adj. Sess.),  1, eff. May 16, 2022.) 
 4801. Declaration of policy
(a) It is the policy of the State of Vermont that alcoholism and alcohol abuse are correctly perceived as health and social problems rather than criminal transgressions against the welfare and morals of the public. (b) The General Assembly therefore declares that:(1) alcoholics and alcohol abusers shall no longer be subjected to criminal prosecution solely because of their consumption of alcoholic beverages or other behavior related to consumption that is not directly injurious to the welfare or property of the public; and (2) alcoholics and alcohol abusers shall be treated as persons with the condition of alcoholism and shall be provided adequate and appropriate medical and other humane rehabilitative services congruent with their needs. (Added 2013, No. 131 (Adj. Sess.),  118, eff. May 20, 2014; amended 2017, No. 113 (Adj. Sess.),  89.) 
 4802. Definitions
As used in this chapter:(1) Alcoholic means a person with the condition of alcoholism.(2) Alcoholism means addiction to the drug alcohol. It is characterized by:(A) chronic absence of control by the drug user over the frequency or the volume of his or her alcohol intake; and (B) inability of the drug user to moderate consistently his or her drinking practices in spite of the onset of a variety of consequences deleterious to his or her health. (3) Approved substance abuse treatment program means a treatment program which is approved by the Secretary as qualified to provide treatment for substance abuse. (4) Client means a person who is provided treatment services by an approved substance abuse treatment program, substance abuse crisis team, or designated substance abuse counselor. (5) Designated substance abuse counselor means a person approved by the Secretary to evaluate and treat substance abusers, pursuant to the provisions of this chapter. (6) Detoxification means the planned withdrawal of an individual from a state of acute or chronic intoxication under qualified supervision and with or without the use of medication. Detoxification is monitoring and management of the physical and psychological effects of withdrawal, for the purpose of assuring safe and rapid return of the individual to normal bodily and mental functioning. (7) Incapacitated means that a person, as a result of his or her use of alcohol or other drugs, is in a state of intoxication or of mental confusion resulting from withdrawal such that the person: (A) appears to need medical care or supervision by approved substance abuse treatment personnel, as defined in this section, to assure his or her safety; or (B) appears to present a direct active or passive threat to the safety of others.(8) Intoxicated means a condition in which the mental or physical functioning of an individual is substantially impaired as a result of the presence of alcohol or other drugs in his or her system. (9) Law enforcement officer means a law enforcement officer certified by the Vermont Criminal Justice Council as provided in 20 V.S.A.  2355-2358 or appointed by the Commissioner of Public Safety as provided in 20 V.S.A.  1911. (10) Licensed hospital means a hospital licensed under chapter 43 of this title.(11) Protective custody means a civil status in which an incapacitated person is detained by a law enforcement officer for the purposes of: (A) assuring the safety of the individual or the public, or both; and(B) assisting the individual to return to a functional condition.(12) Secretary means the Secretary of Human Services or designee.(13) Substance abuse crisis team means an organization approved by the Secretary to provide emergency treatment and transportation services to substance abusers pursuant to the provisions of this chapter. (14) Substance abuser means anyone who drinks alcohol or consumes other drugs to an extent or with a frequency that impairs or endangers his or her health or the health and welfare of others. (15) Treatment means the broad range of medical, detoxification, residential, outpatient, aftercare, and follow-up services which are needed by substance abusers and may include a variety of other medical, social, vocational, and educational services relevant to the rehabilitation of these persons. (Added 2013, No. 131 (Adj. Sess.),  118, eff. May 20, 2014; amended 2017, No. 113 (Adj. Sess.),  90.) 
 4803. Substance Misuse Prevention Oversight and Advisory Council
(a) Creation. There is created the Substance Misuse Prevention Oversight and Advisory Council within the Department of Health to improve the health outcomes of all Vermonters through a consolidated and holistic approach to substance misuse prevention that addresses all categories of substances. The Council shall provide advice to the Governor and General Assembly for improving prevention policies and programming throughout the State and to ensure that population prevention measures are at the forefront of all policy determinations. The Advisory Councils prevention initiatives shall encompass all substances at risk of misuse, including: (1) alcohol;(2) cannabis;(3) controlled substances, such as opioids, cocaine, and methamphetamines; and(4) tobacco products and tobacco substitutes as defined in 7 V.S.A.  1001 and substances containing nicotine or that are otherwise intended for use with a tobacco substitute. (b) Membership. (1) The agenda of the Council shall be determined by an executive committee composed of the following members: (A) the Commissioner of Health or designee, who shall serve as chair;(B) a community leader in the field of substance misuse prevention, appointed by the Governor, who shall serve as vice chair; (C) the Secretary of Education or designee;(D) the Commissioner of Public Safety or designee; and(E) the Chief Prevention Officer established pursuant to 3 V.S.A.  2321.(2) The members of the executive committee jointly shall appoint members to the Council with demographic and regional diversity. Members of the Council shall collectively offer expertise and experience in the categories listed below with the understanding that a single member may offer expertise and experience in multiple categories: (A) at least two people with lived substance use disorder experience, including a person in recovery and a family member of a person in recovery; (B) one or more youth less than 18 years of age;(C) one or more young adults between 18 and 25 years of age;(D) the Director of Trauma Prevention and Resilience Development established pursuant to 33 V.S.A.  3403; and (E) persons with expertise in the following disciplines:(i) substance misuse prevention in a professional setting;(ii) pediatric care specific to substance misuse prevention or substance use disorder;(iii) academic research pertaining to substance misuse prevention or behavioral addiction treatment; (iv) education in a public school setting specific to substance misuse prevention;(v) law enforcement with expertise in drug enforcement, addressing impaired driving, and community policing; (vi) community outreach or collaboration in the field of substance misuse prevention;(vii) the criminal justice system;(viii) treatment of substance use disorder;(ix) recovery from substance use disorder in a community setting;(x) municipalities;(xi) community-based, nonprofit youth services;(xii) substance use disorder or substance misuse prevention within the older Vermonter population; and (xiii) comprehensive communications and media campaigns.(c) Powers and duties. The Council shall strengthen the States response to the substance use disorder crisis by advancing evidence-based and evidence-informed substance misuse prevention initiatives. The Councils duties shall include: (1) reviewing and making recommendations on best practices to assist communities and schools to significantly reduce the demand for substances through prevention and education; (2) reviewing substance misuse prevention program evaluations and making specific recommendations for modification based on the results, including recommendations to address gaps in both services and populations served; (3) reviewing existing State laws, rules, policies, and programs and proposing changes to eliminate redundancy and to eliminate barriers experienced by communities and schools in coordinating preventative action with State government; (4) reviewing existing community-based youth programming, including recreation, municipal programs, parent-child center programs, and afterschool and year-round programs, to determine a foundation of connection and support for all Vermont children and youth; (5) reviewing community-based programs for older Vermonters for the purpose of identifying gaps in services, including geographic disparities, eliminating barriers, and coordinating prevention services; (6) recommending strategies to integrate substance misuse prevention programming across the State, including between State agencies and in public-private partnerships; (7) development of a statewide media campaign for substance misuse prevention; and(8) holding a minimum of two public meetings to receive public input and advice for setting program priorities for substances at risk of misuse. (d) Committees. The Council shall have the ability to create issue-specific committees for the purpose of carrying out its duties, such as a youth committee. Any committees created may draw on the expertise of any individual regardless of whether that individual is a member of the Council. (e) Assistance. The Council shall have administrative, technical, and communications assistance from the Manager of Substance Misuse Prevention established pursuant to section 4804 of this title. (f) Report. Annually on or before January 1, the Council shall submit a written report to the Governor, the House Committees on Appropriations and on Human Services, and the Senate Committees on Appropriations and on Health and Welfare with its findings and any recommendations for legislative action. The report shall also include the following: (1) measurable goals for the effectiveness of prevention programming statewide;(2) three to five performance measures for all substances at risk of misuse that demonstrate the systems results; (3) the results of evaluations of State-funded programs; and(4) an explanation of State-funded program budgets.(g) Organization. (1) Members of the Council shall serve two-year terms and may be reappointed. Any vacancy on the Council shall be filled in the same manner as the original appointment. The replacement member shall serve for the remainder of the unexpired term. Any individual interested in serving on the Council may submit a letter of interest or resume to the Manager of Substance Misuse Prevention. (2) A majority of the membership shall constitute a quorum.(h) Compensation and reimbursement. Members of the Council who are not employed by the State or whose participation is not supported through their employment or association shall be entitled to per diem compensation and reimbursement of expenses as permitted under 32 V.S.A.  1010 for not more than six meetings per year, unless further authorized by the Commissioner of Health. Payments to members of the Council authorized under this subsection shall be made from monies appropriated to the Department of Health. (Added 2013, No. 131 (Adj. Sess.),  118, eff. May 20, 2014; amended 2015, No. 58,  E.313.1; 2017, No. 154 (Adj. Sess.),  4a, eff. May 21, 2018; 2019, No. 82,  3; 2021, No. 105 (Adj. Sess.),  347, eff. July 1, 2022.) 
 4804. Manager of Substance Misuse Prevention
There is created the permanent position of the Manager of Substance Misuse Prevention within the Department of Health for the purpose of: (1) coordinating the work of the Substance Misuse Prevention Oversight and Advisory Council established pursuant to section 4803 of this title; and (2) coordinating regional planning. (Added 2013, No. 131 (Adj. Sess.),  118, eff. May 20, 2014; amended 2019, No. 82,  3.)
 4806. Division of Substance Use Programs
(a) The Division of Substance Use Programs shall plan, operate, and evaluate a consistent, effective program of substance use programs. All duties, responsibilities, and authority of the Division shall be carried out and exercised by and within the Department of Health. (b) The Division shall be responsible for the following services:(1) prevention and intervention;(2) [Repealed.](3) project CRASH schools; and(4) alcohol and drug treatment.(c) Under the direction of the Commissioner of Health, the Division shall review and approve all alcohol and drug programs developed or administered by any State agency or department. (d) Any federal or private funds received by the State for purposes of subdivision (b)(4) of this section shall be in the budget of and administered by the Department of Health. (e) [Repealed.] (Added 2013, No. 131 (Adj. Sess.),  118, eff. May 20, 2014; amended 2015, No. 156 (Adj. Sess.),  3, eff. Sept. 1, 2016; 2021, No. 115 (Adj. Sess.),  3, eff. July 1, 2022.)
 4807. Authority and accountability for alcoholism services; rules for acceptance into treatment
(a) The Secretary shall have the authority and accountability for providing or arranging for the provision of a comprehensive system of alcoholism prevention and treatment services. (b) All State funds appropriated specifically for the prevention and treatment of alcoholism and any federal or private funds which are received by the State for these purposes shall be in the budget of and be administered by a single governmental unit designated by the Secretary. This provision does not apply to the programs of the Department of Corrections. (c) The Secretary shall adopt rules and standards under 3 V.S.A. chapter 25 for the implementation of the provisions of this chapter. In establishing rules regarding admissions to alcohol treatment programs, the Secretary shall adhere to the following guidelines: (1) A client shall be initially assigned or transferred to outpatient treatment, unless he or she is found to require medical treatment, detoxification, or residential treatment. (2) A person shall not be denied treatment solely because he or she has withdrawn from treatment against medical advice on a prior occasion or because he or she has relapsed after earlier treatment. (3) An individualized treatment plan shall be prepared and maintained on a current basis for each client. (4) Provision shall be made for a continuum of coordinated treatment services so that a person who leaves a program or a form of treatment shall have available and use other appropriate treatment. (Added 2013, No. 131 (Adj. Sess.),  118, eff. May 20, 2014.) 
 4810. Treatment and services
(a) When a law enforcement officer encounters a person who, in the judgment of the officer, is intoxicated as defined in section 4802 of this title, the officer may assist the person, if he or she consents, to his or her home, to an approved substance abuse treatment program, or to some other mutually agreeable location. (b) When a law enforcement officer encounters a person who, in the judgment of the officer, is incapacitated as defined in section 4802 of this title, the person shall be taken into protective custody by the officer. The officer shall transport the incapacitated person directly to an approved substance abuse treatment program with detoxification capabilities or to the emergency room of a licensed general hospital for treatment, except that if a substance abuse crisis team or a designated substance abuse counselor exists in the vicinity and is available, the person may be released to the team or counselor at any location mutually agreeable between the officer and the team or counselor. The period of protective custody shall end when the person is released to a substance abuse crisis team, a designated substance abuse counselor, a clinical staff person of an approved substance abuse treatment program with detoxification capabilities, or a professional medical staff person at a licensed general hospital emergency room. The person may be released to his or her own devices if, at any time, the officer judges him or her to be no longer incapacitated. Protective custody shall in no event exceed 24 hours. (c) If an incapacitated person is taken to an approved substance abuse treatment program with detoxification capabilities and the program is at capacity, the person shall be taken to the nearest licensed general hospital emergency room for treatment. (d) A person judged by a law enforcement officer to be incapacitated and who has not been charged with a crime may be lodged in protective custody in a lockup or community correctional center for up to 24 hours or until judged by the person in charge of the facility to be no longer incapacitated, if and only if: (1) the person refuses to be transported to an appropriate facility for treatment or, if once there, refuses treatment or leaves the facility before he or she is considered by the responsible staff of that facility to be no longer incapacitated; or (2) no approved substance abuse treatment program with detoxification capabilities and no staff physician or other medical professional at the nearest licensed general hospital can be found who will accept the person for treatment. (e) No person shall be lodged in a lockup or community correctional center under subsection (d) of this section without first being evaluated and found to be indeed incapacitated by a substance abuse crisis team, a designated substance abuse counselor, a clinical staff person of an approved substance abuse treatment program with detoxification capabilities, or a professional medical staff person at a licensed general hospital emergency room. (f) No lockup or community correctional center shall refuse to admit an incapacitated person in protective custody whose admission is requested by a law enforcement officer, in compliance with the conditions of this section. (g) Notwithstanding subsection (d) of this section, a person under 18 years of age who is judged by a law enforcement officer to be incapacitated and who has not been charged with a crime shall not be held at a lockup or community correctional center. If needed treatment is not readily available, the person shall be released to his or her parent or guardian. If the person has no parent or guardian in the area, arrangements shall be made to house him or her according to the provisions of 33 V.S.A. chapter 53. The official in charge of an adult jail or lockup shall notify the Director of the Office of Drug and Alcohol Abuse Programs of any person under 18 years of age brought to an adult jail or lockup pursuant to this chapter. (h) If an incapacitated person in protective custody is lodged in a lockup or community correctional center, his or her family or next of kin shall be notified as promptly as possible. If the person is an adult and requests that there be no notification, his or her request shall be respected. (i) A taking into protective custody under this section is not an arrest.(j) Law enforcement officers or persons responsible for supervision in a lockup or community correctional center or members of a substance abuse crisis team or designated substance abuse counselors who act under the authority of this section are acting in the course of their official duty and are not criminally or civilly liable therefor, unless for gross negligence or willful or wanton injury. (Added 2019, No. 6,  98, amended 2019, No. 6,  99, eff. July 1, 2025.) 
 4811. Incarceration for intoxication prohibited
A person who has not been charged with a crime shall not be incarcerated in a secure facility operated by the Department of Corrections on account of the persons intoxication. (Added 2019, No. 6,  100, eff. July 1, 2025.)