reglab/statecodes huggingface dataset:
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9376. Payment amounts; methods

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9377a. Prior authorization pilot program

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9378. Public process

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9379. Agency cooperation

§ 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 that is necessary to carry out the Board’s duties as described in this chapter. (Added 2011, No. 48, § 3, eff. May 26, 2011.)
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9381. Appeals

§ 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 Board’s approving, modifying, or disapproving a health insurer’s 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9383. Expenditure analysis; health care spending estimate

§ 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 Board’s review of health insurance rates and the budgets of hospitals and accountable care organizations. The analyses shall:
(1) inform the Board’s 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9390. Green Mountain Care Board Nominating Committee created; composition

§ 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. § 23. 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9391. Nomination and appointment process

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 220 - Green Mountain Care Board › § 9392. Qualifications for nominees

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9401. Policy

§ 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 ensure 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; 2023, No. 6, § 225, eff. July 1, 2023.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9404. Administration

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9405a. Public participation and strategic planning

§ 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 hospital’s 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9405c. Notice of acquisition

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9408. Common claims forms and procedures

§ 9408. Common claims forms and procedures
Not 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; 2023, No. 6, § 226, eff. July 1, 2023.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9408a. Uniform provider credentialing

§ 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 provider’s 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 provider’s 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 after 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; 2023, No. 6, § 227, eff. July 1, 2023.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9409. Health care provider bargaining groups

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9411. Interactive price transparency dashboard

§ 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 member’s 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. (Added 2019, No. 159 (Adj. Sess.), § 2.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9412. Enforcement

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9413. Health care quality and price comparison

§ 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 member’s specific plan, as well as any remaining balance on the member’s deductible for the plan year. (Added 2015, No. 54, § 20, eff. July 1, 2016.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9416. Vermont Program for Quality in Health Care

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9417. Tax-advantaged accounts for health-related expenses; administration; rulemaking

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9418e. Most favored nation clauses prohibited

§ 9418e. Most favored nation clauses prohibited
Not 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; amended 2023, No. 6, § 234, eff. July 1, 2023.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9419. Charges for access to medical records

§ 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 individual’s 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 individual’s 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9422. Credit card payments optional for providers

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9431. Policy and purpose

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9433. Administration

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9439. Competing applications

§ 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 hospital’s 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9440a. Applications, information, and testimony; oath required

§ 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 applicant’s 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9440b. Information technology; review procedures

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9441. Fees

§ 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.)
2023 Vermont Statutes › Title 18 - Health › Chapter 221 - Health Care Administration › § 9442. Bonds

§ 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.)