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2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1912. Findings and purpose

§ 1912. Findings and purpose
(a) Cigarette smoking presents serious public health concerns to the State of Vermont and to the citizens of Vermont. The Surgeon General has determined that smoking causes lung cancer, heart disease, and other serious diseases, and that there are hundreds of thousands of tobacco-related deaths in the United States each year. These diseases most often do not appear until many years after a person begins smoking.
(b) Cigarette smoking also presents serious financial concerns for the State. Under certain health care programs, the State may have a legal obligation to provide medical assistance to eligible persons for health conditions associated with cigarette smoking, and those persons may have a legal entitlement to receive such medical assistance. Under these programs, the State pays millions of dollars each year to provide medical assistance to these persons for health conditions associated with cigarette smoking.
(c) It is the policy of the State that financial burdens imposed on the State by cigarette smoking be borne by tobacco product manufacturers rather than by the State to the extent that such manufacturers either determine to enter into a settlement with the State or are found culpable by the courts.
(d) On November 23, 1998, leading U.S. tobacco product manufacturers entered into a settlement agreement, entitled the “Master Settlement Agreement,” with the State. In return for a release of past, present, and certain future claims against these manufacturers as described therein, the Master Settlement Agreement obligates these manufacturers to:
(1) pay substantial sums to the State, tied in part to their volume of sales;
(2) fund a national foundation devoted to the interests of public health; and
(3) make substantial changes in their advertising and marketing practices and corporate culture, with the intention of reducing underage smoking.
(e) It would be contrary to the policy of the State if tobacco product manufacturers who determine not to enter into such a settlement could use a resulting cost advantage to derive large, short-term profits in the years before liability may arise, without ensuring that the State will have an eventual source of recovery from them if they are proven to have acted culpably. Consequently, it is in the interest of the State to require that such manufacturers establish a reserve fund to guarantee a source of compensation, and to prevent such manufacturers from deriving large, short-term profits and then becoming judgment-proof before liability may arise. (Added 1999, No. 130 (Adj. Sess.), § 1, eff. May 12, 2000.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1915. Findings and purpose

§ 1915. Findings and purpose
(a) The General Assembly finds that the provisions of this subchapter will enhance compliance with subchapter 1A of this chapter and further the policies and purposes of that subchapter.
(b) The provisions of this subchapter are not intended to amend and shall not be interpreted as amending subchapter 1A of this chapter. (Added 2003, No. 14, § 1.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1916. Definitions

§ 1916. Definitions
As used in this subchapter:
(1) “Brand family” means all styles of cigarettes sold under the same trademark and differentiated from one another by means of additional modifiers or descriptors, including “menthol,” “lights,” “kings,” and “100s,” and includes a brand name (alone or in conjunction with any other word), trademark, logo, symbol, motto, selling message, recognizable pattern of colors, or any other indicia of product identification identical or similar to, or identifiable with, a previously known brand of cigarettes.
(2) “Cigarette” has the same meaning as in subdivision 1913(4) of this title.
(3) “Commissioner” means the Commissioner of Taxes.
(4) “Wholesale dealer” has the same meaning as in 32 V.S.A. § 7702(16).
(5) “Master Settlement Agreement” has the same meaning as in subdivision 1913(5) of this title.
(6) “Nonparticipating manufacturer” means any tobacco product manufacturer that is not a participating manufacturer.
(7) “Participating manufacturer” has the same meaning as in section II(jj) of the Master Settlement Agreement and all amendments to the Agreement.
(8) “Qualified escrow fund” has the same meaning as in subdivision 1913(6) of this title.
(9) “Retail dealer” has the same meaning as in 32 V.S.A. § 7702(10).
(10) [Repealed.]
(11) “Tobacco product manufacturer” has the same meaning as in subdivision 1913(9) of this title.
(12) “Units sold” has the same meaning as in subdivision 1913(10) of this title. (Added 2003, No. 14, § 1; amended 2015, No. 57, § 83, eff. June 11, 2015; 2021, No. 20, § 301.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1919. Prohibition against the stamping and sale of cigarettes not included in the directory

§ 1919. Prohibition against the stamping and sale of cigarettes not included in the directory
No person shall affix a tax stamp to or sell or offer for sale in this State any package or container of cigarettes manufactured by a tobacco product manufacturer or belonging to a brand family that is not included in the directory, or sell, offer, or possess for sale, in this State, cigarettes of a tobacco product manufacturer or brand family not included in the directory. (Added 2003, No. 14, § 1.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1920. Agent for service of process

§ 1920. Agent for service of process
(a) Any nonresident or foreign nonparticipating manufacturer that has not registered to do business in the State as a foreign corporation or other business entity shall, as a condition precedent to having its brand families included or retained in the directory, appoint and continually engage without interruption the services of an agent in this State to act as agent for the service of process on whom all process, and any action or proceeding against it concerning or arising out of the enforcement of this subchapter or subchapter 1A of this chapter, or both, may be served in any manner authorized by law. Such service shall constitute legal and valid service of process on the nonparticipating manufacturer. The nonparticipating manufacturer shall provide the name, address, telephone number, and satisfactory proof of the appointment and availability of such agent to the Attorney General. The Secretary of State shall be designated as agent for service of process for importers of nonparticipating manufacturers located outside the United States. Service shall be made upon the Secretary of State in accordance with the provisions of 12 V.S.A. §§ 851 and 852.
(b) The nonparticipating manufacturer shall provide notice to the Attorney General 30 calendar days prior to termination of the authority of any such agent and shall further provide proof to the satisfaction of the Attorney General of the appointment of a new agent no less than five calendar days prior to the termination of an existing agent appointment. In the event an agent terminates an agent appointment, the nonparticipating manufacturer shall notify the Attorney General of said termination within five calendar days and shall include proof to the satisfaction of the Attorney General of the appointment of a new agent.
(c) Any nonparticipating manufacturer whose cigarettes are sold in this State who has not appointed and engaged an agent as required by this section shall be deemed to have appointed the Secretary of State as such agent and may be proceeded against in courts of this State by service of process upon the Secretary of State; provided, however, that the appointment of the Secretary of State as such agent shall not satisfy the condition precedent, required by subsection (a) of this section, for having the individual styles or brands of cigarettes or, if applicable, brand families of the nonparticipating manufacturer included or retained in the directory. (Added 2003, No. 14, § 1; amended 2011, No. 166 (Adj. Sess.), § 5; 2021, No. 20, § 304.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1922. Quarterly escrow deposits

§ 1922. Quarterly escrow deposits
To promote compliance with the provisions of this subchapter, the Attorney General may adopt rules requiring a nonparticipating manufacturer to make the escrow deposits required by subchapter 1A of this chapter in quarterly installments during the year in which the sales covered by such deposits are made. (Added 2003, No. 14, § 1; amended 2015, No. 23, § 137.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1923. Penalties and other remedies

§ 1923. Penalties and other remedies
(a) In addition to or in lieu of any other civil or criminal remedy provided by law, upon a determination that a stamping agent has violated this subchapter or any rule adopted pursuant to this subchapter, the Attorney General may, for each violation of this subchapter, also impose a civil penalty in an amount not to exceed the greater of 500 percent of the retail value of the cigarettes sold, offered for sale, or possessed for sale in violation of this subchapter or $5,000.00. Each stamp affixed and each sale or offer to sell cigarettes in violation of section 1919 of this subchapter shall constitute a separate violation.
(b) The Attorney General may seek an injunction to restrain a threatened or actual violation of this subchapter by a stamping agent and to compel the stamping agent to comply with the provisions of this subchapter. In any action brought pursuant to this section, the State shall be entitled to recover the costs of investigation, expert witness fees, costs of the action, and reasonable attorney’s fees.
(c) It shall be unlawful for a person to:
(1) Sell or distribute cigarettes that the person knows or should know are intended for distribution or sale in the State in violation of this subchapter.
(2) Acquire, hold, own, possess, transport, import, or cause to be imported cigarettes that the person knows or should know are intended for distribution or sale in the State in violation of this subchapter. A violation of this section shall be a misdemeanor punishable by imprisonment for not more than one year and a fine of not more than $5,000.00, or both.
(d) A person who violates section 1919 of this title engages in an unfair and deceptive trade practice in violation of the State’s Consumer Protection Act, 9 V.S.A. § 2451 et seq.
(e) If a court determines that a person has violated the provisions of this subchapter, the court shall order any profits, gain, gross receipts, or other benefit from the violation to be disgorged and paid to the State Treasurer for deposit in the Tobacco Litigation Settlement Fund established pursuant to 32 V.S.A. § 435a.
(f) Unless otherwise expressly provided, the penalties or remedies, or both, provided by this subchapter are cumulative to each other and to the penalties or remedies, or both, available under all other laws of this State. (Added 2003, No. 14, § 1; amended 2011, No. 109 (Adj. Sess.), § 3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.), § 1b, eff. May 18, 2012; 2021, No. 20, § 305.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1924. Miscellaneous provisions

§ 1924. Miscellaneous provisions
(a) The first report of stamping agents required by section 1921 of this title shall be due 30 days after the effective date of this subchapter; the initial certification of a tobacco product manufacturer required by section 1917 of this title shall be due 45 days after the effective date of this subchapter; and the directory described in section 1918 of this title shall be published or made available within 120 days after the effective date of this subchapter.
(b) Both the Attorney General and the Commissioner may adopt rules necessary to effect the purposes of this subchapter.
(c) In any action brought by the State to enforce the provisions of this subchapter, the State shall be entitled to recover the costs of investigation, expert witness fees, costs of the action, and reasonable attorney’s fees.
(d) If a court of competent jurisdiction finds that the provisions of this subchapter and subchapter 1A of this chapter conflict and cannot be harmonized, then such provisions of subchapter 1A shall control. If any section, subsection, subdivision, sentence, or phrase of this subchapter causes subchapter 1A of this chapter to no longer constitute a qualifying act or model statute, as those terms are defined in the Master Settlement Agreement, then that portion of this subchapter shall not apply. If any section, subsection, subdivision, sentence, or phrase of this subchapter is for any reason held to be invalid, unlawful, or unconstitutional, such decision shall not affect the validity of the remaining portions of this subchapter or any part thereof. (Added 2003, No. 14, § 1; amended 2021, No. 20, § 306.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1925. Joint and several liability of importers on nonparticipating manufacturer’s brand families

§ 1925. Joint and several liability of importers on nonparticipating manufacturer’s brand families
Each nonparticipating manufacturer located outside the United States and each importer of any nonparticipating manufacturer’s brand families that are sold in the State shall bear joint and several liability for the deposit of all escrow due and payment of all penalties, costs, and attorney’s fees imposed under this subchapter. The nonparticipating manufacturer, as a condition to being listed on the directory, shall provide a declaration on a form prescribed by the Attorney General from each of its importers of any of its brand families to be sold in the State that the importer accepts joint and several liability for all escrow deposits due pursuant to section 1914 of this title and for all penalties, costs, and attorney’s fees assessed under section 1914 of this title. (Added 2011, No. 166 (Adj. Sess.), § 4, eff. May 16, 2012.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1950. Purpose

§ 1950. Purpose
(a) The purpose of this subchapter is to establish assessments on health care providers, which funds shall be used in the State’s health care program in such a way as to be eligible for federal financial participation.
(b) The Secretary and the Commissioner shall interpret and administer the provisions of this subchapter so as to maximize federal financial participation and avoid disallowances of federal financial participation.
(c) If the purpose of this subchapter can no longer be accomplished, the Secretary of Human Services shall so notify the General Assembly on or before the following February 15. (Added 1991, No. 253 (Adj. Sess.), § 1; amended 1993, No. 56, § 1, eff. June 3, 1993; 2005, No. 71, § 282; 2009, No. 156 (Adj. Sess.), § I.51.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1952. General provisions

§ 1952. General provisions
(a) The Secretary of Human Services shall adopt rules necessary for the implementation of this subchapter.
(b) The Department may use not more than one percent of the assessments received under the provisions of this subchapter for necessary administrative expenses associated with this subchapter.
(c) The budget of any hospital assessed under the provisions of this subchapter that includes a nursing home, home health agency, or physician’s office practice shall have its assessment based only on the hospital portion of its budget. The nursing home and home health agency components of the budget shall be assessed separately as provided for in this subchapter.
(d) No health care provider conducted, maintained, or operated by the U.S. government shall be subject to an assessment levied under the provisions of this subchapter.
(e) Each assessment imposed pursuant to this subchapter is the liability of the health care provider and no portion thereof shall be charged directly to any patient or resident, but may be treated as a cost of doing business for the purpose of determining rates and charges.
(f) If a health care provider fails to pay its assessments under this subchapter according to the schedule or a variation thereof adopted by the Commissioner, the Commissioner may, after notice and opportunity for hearing, deduct these assessment arrears and any late-payment penalties from Medicaid payments otherwise due to the provider. The deduction of these assessment arrears may be made in one or more installments on a schedule to be determined by the Commissioner. (Added 1991, No. 94, § 1; amended 1991, No. 253 (Adj. Sess.), § 3; 1993, No. 56 § 1, eff. June 3, 1993; 1999, No. 49, § 201; 2005, No. 71, § 284; 2007, No. 190 (Adj. Sess.), § 49, eff. June 6, 2008; 2009, No. 156 (Adj. Sess.), § I.53.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1953. Hospital assessment

§ 1953. Hospital assessment
(a) Hospitals shall be subject to an annual assessment as follows:
(1) Beginning July 1, 2012, each hospital’s annual assessment, except for hospitals assessed under subdivision (2) of this subsection, shall be six percent of its net patient revenues (less chronic, skilled, and swing bed revenues).
(2) Beginning July 1, 2004, each mental hospital or psychiatric facility’s annual assessment shall be 4.21 percent, provided that the U.S. Department of Health and Human Services grants a waiver to the uniform assessment rate pursuant to 42 C.F.R. § 433.68(e). If the U.S. Department of Health and Human Services fails to grant a waiver, mental hospitals and psychiatric facilities shall be assessed under subdivision (1) of this subsection.
(b) Each hospital shall be notified in writing by the Department of the assessment made pursuant to this section. If no hospital submits a request for reconsideration under section 1958 of this title, the assessment shall be considered final.
(c) Each hospital shall submit its assessment to the Department according to a payment schedule adopted by the Commissioner. Variations in payment schedules shall be permitted as deemed necessary by the Commissioner.
(d) Any hospital that fails to make a payment to the Department on or before the specified schedule, or under any schedule for delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive this late payment assessment provided for in this subsection for good cause shown by the hospital. (Added 1991, No. 94, § 1; amended 1993, No. 56, § 1, eff. June 3, 1993; 1995, No. 5, § 26, eff. March 3, 1995; 1995, No. 14, § 2, eff. April 12, 1995; 1997, No. 59, §§ 69, 70, eff. June 30, 1997; 1999, No. 49, § 199; 2001, No. 65, § 13; 2003, No. 66, § 306, see effective date note set out below; 2003, No. 163 (Adj. Sess.), § 7; 2005, No. 71, § 285; 2007, No. 190 (Adj. Sess.), § 47, eff. June 6, 2008; 2009, No. 156 (Adj. Sess.), § E.309.4; 2011, No. 45, § 24, eff. May 24, 2011; 2011, No. 128 (Adj. Sess.), § 36.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1954. Nursing home assessment

§ 1954. Nursing home assessment
(a) Beginning July 1, 2011, each nursing home’s annual assessment shall be $4,509.57, and beginning October 1, 2011, $4,919.53 per bed licensed pursuant to section 7105 of this title on June 30 of the immediately preceding fiscal year. The annual assessment for each bed licensed as of the beginning of the fiscal year shall be prorated for the number of days during which the bed was actually licensed and any overpayment shall be refunded to the facility. To receive the refund, a facility shall notify the Commissioner in writing of the size of the decrease in the number of its licensed beds and dates on which the beds ceased to be licensed.
(b) The Department shall provide written notification of the assessment amount to each nursing home. The assessment amount determined shall be considered final unless the home requests a reconsideration. Requests for reconsideration shall be subject to the provisions of section 1958 of this title.
(c) Each nursing home shall submit its assessment to the Department according to a schedule adopted by the Commissioner. The Commissioner may permit variations in the schedule of payment as deemed necessary.
(d) Any nursing home that fails to make a payment to the Department on or before the specified schedule, or under any schedule of delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive the late-payment assessment provided for in this subsection for good cause shown by the nursing home. (Added 1991, No. 94, § 1; amended 1991, No. 253 (Adj. Sess.), § 4; 1993, No. 56, § 1, eff. June 3, 1993; 1995, No. 5, § 27, eff. March 9, 1995; 1995, No. 14, § 3, eff. April 12, 1995; 1999, No. 49, § 202; 2001, No. 65, § 14; 2001, No. 142 (Adj. Sess.), § 120a; 2001, No. 143 (Adj. Sess.), § 49, eff. June 21, 2002; 2003, No. 66, § 307; 2003, No. 163 (Adj. Sess.), § 8; 2005, No. 71, § 286; 2007, No. 76, § 9, eff. June 7, 2007; 2007, No. 190 (Adj. Sess.), § 50, eff. June 6, 2008; 2009, No. 156 (Adj. Sess.), § I.54; 2011, No. 45, § 25, eff. May 24, 2011.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1955. ICF/DD assessment

§ 1955. ICF/DD assessment
(a) Beginning October 1, 2011, each ICF/DD’s annual assessment shall be 5.9 percent of the ICF/DD’s total annual direct and indirect expenses for the most recently settled ICF/DD audit.
(b) The Department shall provide written notification of the assessment amount to each ICF/DD. The assessment amount determined shall be considered final unless the facility requests a reconsideration. Requests for reconsideration shall be subject to the provisions of section 1958 of this title.
(c) Each ICF/DD shall remit its assessment to the Department according to a schedule adopted by the Commissioner. The Commissioner may permit variations in the schedule of payment as deemed necessary.
(d) Any ICF/DD that fails to make a payment to the Department on or before the specified schedule, or under any schedule of delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive the late-payment assessment provided for in this subsection for good cause shown by the ICF/DD. (Added 1991, No. 94, § 1; amended 1993, No. 56, § 1, eff. June 3, 1993; 2005, No. 71, § 287; 2007, No. 190 (Adj. Sess.), § 48, eff. June 6, 2008; 2009, No. 156 (Adj. Sess.), § I.55; 2011, No. 45, § 26, eff. May 24, 2011; 2013, No. 96 (Adj. Sess.), § 208.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1955a. Home health agency assessment

§ 1955a. Home health agency assessment
(a)(1) Each home health agency’s assessment shall be 4.25 percent of its net patient revenues from home health services provided exclusively in Vermont.
(2) On or before May 1 of each year, each home health agency shall provide to the Department a copy of its most recent audited financial statement prepared in accordance with generally accepted accounting principles. The amount of the tax shall be determined by the Commissioner based on the home health net patient revenue attributable to services reported on the agency’s financial statement.
(3) For providers who began operations as a home health agency after January 1, 2005, the tax shall be assessed as follows:
(A) Until such time as the home health agency submits audited financial statements for its first full year of operation as a home health agency, the Commissioner, in consultation with the home health agency, shall annually estimate the amount of tax payable and shall prescribe a schedule for interim payments.
(B) At such time as the full-year audited financial statement is filed, the final assessment shall be determined, and the home health agency shall pay any underpayment or the Department shall refund any overpayment. The assessment for the State fiscal year in which a provider commences operations as a home health agency shall be prorated for the proportion of the State fiscal year in which the new home health agency was in operation.
(b) Each home health agency shall be notified in writing by the Department of the assessment made pursuant to this section. If no home health agency submits a request for reconsideration under section 1958 of this title, the assessment shall be considered final.
(c) Each home health agency shall submit its assessment to the Department according to a payment schedule adopted by the Commissioner. Variations in payment schedules shall be permitted as deemed necessary by the Commissioner.
(d) Any home health agency that fails to make a payment to the Department on or before the specified schedule, or under any schedule for delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive the late-payment assessment provided for in this subsection for good cause shown by the home health agency. (Added 1999, No. 49, § 203; amended 2001, No. 65, § 15; 2003, No. 66, § 309; 2005, No. 71, § 288; 2009, No. 47, § 15; 2009, No. 156 (Adj. Sess.), § I.56; 2011, No. 45, § 23, eff. May 24, 2011; 2013, No. 73, § 55, eff. July 1, 2005, eff. June 5, 2013; 2017, No. 73, § 18a, eff. June 13, 2017; repealed on July 1, 2023 by 2021, No. 73 § 13.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1955b. Pharmacy assessment

§ 1955b. Pharmacy assessment
(a) Beginning July 1, 2005, each pharmacy’s monthly assessment shall be $0.10 for each prescription filled and refilled.
(b) Each pharmacy shall declare and provide supporting documentation to the Commissioner of the total number of prescriptions filled and refilled in the previous month and remit the assessment due for that month. The declaration and payment shall be due by the end of the following month.
(c) Each pharmacy shall submit its assessment payment to the Department monthly. Variations in payment timing shall be permitted as deemed necessary by the Commissioner.
(d) Any pharmacy that fails to pay an assessment to the Department on or before the due date shall be assessed a late payment penalty of two percent of the assessment amount for each month it remains unpaid; but late payment penalties for any one quarter shall not exceed $500.00. The Commissioner may waive a penalty under this subsection for good cause shown by the pharmacy, as determined by the Commissioner in his or her discretion. (Added 2005, No. 71, § 289; amended 2009, No. 156 (Adj. Sess.), § I.57.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1956. Proceeds from assessments

§ 1956. Proceeds from assessments
All assessments, including late-payment assessments, from health care providers under this subchapter shall be deposited in the General Fund. No provision of this subchapter shall permit the State to reduce the level of State funds expended on the nursing home Medicaid program in any fiscal year below the level expended in fiscal year 1991 from the General Fund for the nursing home Medicaid program. (Added 1991, No. 94, § 1; amended 1991, No. 253 (Adj. Sess.), § 6; 1993, No. 56, § 1, eff. June 3, 1993; 1995, No. 14, § 4, eff. April 12, 1995; 1995, No. 174 (Adj. Sess.), § 3; 1999, No. 49, § 204; 1999, No. 147 (Adj. Sess.), § 4; 2001, No. 63, § 99a; 2001, No. 65, § 16; 2001, No. 143 (Adj. Sess.), § 50, eff. June 21, 2002; 2003, No. 66, § 310; 2003, No. 163 (Adj. Sess.), § 9; 2005, No. 71, § 291; 2005, No. 215 (Adj. Sess.), § 313; 2019, No. 6, § 76, eff. April 22, 2019.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1957. Audits

§ 1957. Audits
The Commissioner may require the submission of audited information as needed from health care providers to determine that amounts received from health care providers were correct. If an audit identifies amounts received due to errors by the Department, the Commissioner shall make payments to any health care provider that the audit reveals paid amounts it should not have been required to pay. Payments made under this section shall be made from the Fund. (Added 1991, No. 94, § 1; amended 1991, No. 253 (Adj. Sess.), § 7; 1993, No. 56, § 1, eff. June 3, 1993; 2005, No. 71, § 292; 2009, No. 156 (Adj. Sess.), § I.58.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1958. Appeals

§ 1958. Appeals
(a) Any health care provider may submit a written request to the Department for reconsideration of the determination of the assessment within 20 days of notice of the determination. The request shall be accompanied by written materials setting forth the basis for reconsideration. If requested, the Department shall hold a hearing within 90 days from the date on which the reconsideration request was received. The Department shall mail written notice of the date, time, and place of the hearing to the health care provider at least 30 days before the date of the hearing. On the basis of the evidence submitted to the Department or presented at the hearing, the Department shall reconsider and may adjust the assessment. Within 20 days following the hearing, the Department shall provide notice in writing to the health care provider of the final determination of the amount it is required to pay based on any adjustments made by it. Proceedings under this section are not subject to the requirements of 3 V.S.A. chapter 25.
(b) Upon request, the Commissioner shall enter into nonbinding arbitration with any health care provider dissatisfied with the Department’s decision regarding the amount it is required to pay. The arbitrator shall be selected by mutual consent, and compensation shall be provided jointly.
(c) Any health care provider may appeal the decision of the Department as to the amount it is required to pay either before or after arbitration, to the Superior Court having jurisdiction over the health care provider. (Added 1991, No. 94, § 1; amended 1991, No. 253 (Adj. Sess.), § 8; 1993, No. 56, § 1, eff. June 3, 1993; 2005, No. 71, § 293; 2009, No. 156 (Adj. Sess.), § I.59; 2017, No. 210 (Adj. Sess.), § 4, eff. June 1, 2018.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1959. Ambulance agency assessment

§ 1959. Ambulance agency assessment
(a)(1) The annual assessment for each ambulance agency shall be 3.3 percent of the ambulance agency’s annual net patient revenues for services delivered to patients in Vermont during the most recent annual fiscal period. As used in this section, “net patient revenues” means the total amount of payments an ambulance agency received during the fiscal period from Medicaid, Medicare, commercial insurance, and all other payers as payment for services rendered. The term does not include municipal appropriations, donations from any source, or any other funding unrelated to the delivery of health care services.
(2) The Department shall determine the appropriate fiscal period as necessary to ensure compliance with federal law.
(3) Ambulance agencies shall remit the assessment amount to the Department annually on or before June 1.
(b) The Department shall provide written notification of the assessment amount to each ambulance agency. The assessment amount determined shall be considered final unless the agency requests reconsideration. Requests for reconsideration shall be subject to the provisions of section 1958 of this title.
(c) Each ambulance agency shall remit its assessment to the Department according to a schedule adopted by the Commissioner. The Commissioner may permit variations in the schedule of payment as deemed necessary.
(d) Any ambulance agency that fails to make a payment to the Department on or before the specified schedule, or under any schedule of delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive the late-payment assessment provided in this subsection for good cause shown by the ambulance agency. (Added 2015, No. 134 (Adj. Sess.), § 30; amended 2017, No. 73, § 9, eff. June 13, 2017; 2017, No. 210 (Adj. Sess.), § 5, eff. June 1, 2018.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1991. Definitions

§ 1991. Definitions
As used in this chapter:
(1) “Dental hygienist” means an individual licensed to practice as a dental hygienist under 26 V.S.A. chapter 12.
(2) “Dental services” means preventive, diagnostic, or corrective procedures related to the teeth and associated structures of the oral cavity.
(3) “Dental therapist” means an individual licensed to practice as a dental therapist under 26 V.S.A. chapter 12.
(4) “Dentist” means an individual licensed to practice dentistry under 26 V.S.A. chapter 12. (Added 2019, No. 72, § E.306.1.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1992. Medicaid coverage for adult dental services

§ 1992. Medicaid coverage for adult dental services
(a) Vermont Medicaid shall provide coverage for medically necessary dental services provided by a dentist, dental therapist, or dental hygienist working within the scope of the provider’s license as follows:
(1) Preventive services, including prophylaxis and fluoride treatment, with no co-payment. These services shall not be counted toward the annual maximum benefit amount set forth in subdivision (2) of this subsection.
(2)(A) Diagnostic, restorative, and endodontic procedures, to a maximum of $1,500.00 per calendar year, provided that the Department of Vermont Health Access may adjust the maximum pursuant to the process outlined in subdivision (B) of this subdivision (2) and may approve expenditures in excess of that amount when exceptional medical circumstances so require. Exceptional medical circumstances include emergency dental services, as defined by the Department by rule.
(B) The Department may set the maximum for coverage of diagnostic, restorative, and endodontic procedures in excess of the amount set forth in subdivision (A) of this subdivision (2) for a calendar year based on the Department’s annual assessment of available funds, provided that the Department submit a report to the House Committee on Health Care, the Senate Committee on Health and Welfare, and the House and Senate Committees on Appropriations, or to the Joint Fiscal Committee if the General Assembly is not in session, each time the Department adjusts the maximum.
(C) The following individuals shall not be subject to the annual maximum benefit amount set forth in this subdivision (2):
(i) individuals served through the Community Rehabilitation and Treatment and Developmental Disability Services programs pursuant to Vermont’s Global Commitment to Health Section 1115 demonstration; and
(ii) Medicaid beneficiaries who are pregnant or in the postpartum eligibility period, as defined by the Department by rule.
(3) Other dental services as determined by the Department by rule.
(b) The Department of Vermont Health Access shall develop a reimbursement structure for dental services in the Vermont Medicaid program that encourages dentists, dental therapists, and dental hygienists to provide preventive care. (Added 2019, No. 72, § E.306.1; amended 2021, No. 130 (Adj. Sess.), § 1, eff. May 24, 2022; 2023, No. 51, § 1, eff. July 1, 2023; 2023, No. 78, § E.307.1, eff. July 1, 2023.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 1997. Definitions

§ 1997. Definitions
As used in this subchapter:
(1) “Board” or “Drug Utilization Review Board” means the Drug Utilization Review Board established in connection with the Medicaid program.
(2) “Commissioner” means the Commissioner of Vermont Health Access.
(3) “Health benefit plan” means a health benefit plan with prescription drug coverage offered or administered by a health insurer, as defined by 18 V.S.A. § 9402, and the out-of-state counterparts to such plans. The term includes:
(A) any State public assistance program with a health benefit plan that provides coverage of prescription drugs;
(B) any health benefit plan offered by or on behalf of the State of Vermont or any instrumentality of the State providing coverage for government employees and their dependents that agrees to participate in the Program; and
(C) any insured or self-insured health benefit plan that agrees to participate in the Program.
(4) “Department” means the Department of Vermont Health Access.
(5) “Participating health benefit plan” means a health benefit plan that has agreed to participate in one or more components of the Pharmacy Best Practices and Cost Control Program.
(6) “Program” or “the Pharmacy Best Practices and Cost Control Program” means the Pharmacy Best Practices and Cost Control Program established by this subchapter.
(7) “State public assistance program” includes the Medicaid program, VPharm, the State Children’s Health Insurance Program, the State of Vermont AIDS Medication Assistance Program, the General Assistance program, the Pharmacy Discount Plan Program, and the out-of-state counterparts to such programs. (Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2005, No. 174 (Adj. Sess.), § 100; 2009, No. 156 (Adj. Sess.), § I.61; 2013, No. 79, § 25, eff. Jan. 1, 2014.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 2000. Pharmacy benefit management

§ 2000. Pharmacy benefit management
The Commissioner may implement all or a portion of the Pharmacy Best Practices and Cost Control Program through a contract with a third party with expertise in the management of pharmacy benefits. (Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2005, No. 174 (Adj. Sess.), § 102; 2009, No. 156 (Adj. Sess.), § I.63.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 2002. Supplemental rebates

§ 2002. Supplemental rebates
(a) The Commissioner of Vermont Health Access, separately or in concert with the authorized representatives of any participating health benefit plan, shall use the preferred drug list authorized by the Pharmacy Best Practices and Cost Control Program to negotiate with pharmaceutical companies for the payment to the Commissioner of supplemental rebates or price discounts for Medicaid and for any other State public assistance health benefit plans designated by the Commissioner, in addition to those required by Title XIX of the Social Security Act. The Commissioner may also use the preferred drug list to negotiate for the payment of rebates or price discounts in connection with drugs covered under any other participating health benefit plan within or outside this State, provided that such negotiations and any subsequent agreement shall comply with the provisions of 42 U.S.C. § 1396r-8. The Program, or such portions of the Program as the Commissioner shall designate, shall constitute a State pharmaceutical assistance program under 42 U.S.C. § 1396r-8(c)(1)(C).
(b) The Commissioner shall negotiate supplemental rebates, price discounts, and other mechanisms to reduce net prescription drug costs by means of any negotiation strategy that the Commissioner determines will result in the maximum economic benefit to the Program and to consumers in this State, while maintaining access to high-quality prescription drug therapies. The Commissioner may negotiate through a purchasing pool or directly with manufacturers. The provisions of this subsection do not authorize agreements with pharmaceutical manufacturers in which financial support for medical services covered by the Medicaid program is accepted as consideration for placement of one or more prescription drugs on the preferred drug list.
(c) The Department of Vermont Health Access shall prohibit the public disclosure of information revealing company-identifiable trade secrets (including rebate and supplemental rebate amounts, and manufacturer’s pricing) obtained by the Department, and by any officer, employee, or contractor of the Department in the course of negotiations conducted pursuant to this section. Such confidential information shall be exempt from public disclosure under 1 V.S.A. chapter 5, subchapter 3 (Public Records Act). (Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2005, No. 71, § 311; 2005, No. 174 (Adj. Sess.), § 104; 2009, No. 156 (Adj. Sess.), § I.65; 2021, No. 20, § 307.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 2004. Manufacturer fee

§ 2004. Manufacturer fee
(a) Annually, each pharmaceutical manufacturer or labeler of prescription drugs that are paid for by the Department of Vermont Health Access for individuals participating in Medicaid, Dr. Dynasaur, or VPharm shall pay a fee to the Agency of Human Services. The fee shall be 1.75 percent of the previous calendar year’s prescription drug spending by the Department and shall be assessed based on manufacturer labeler codes as used in the Medicaid rebate program.
(b) Fees collected under this section shall fund collection and analysis of information on pharmaceutical marketing activities under 18 V.S.A. §§ 4632 and 4633; analysis of prescription drug data needed by the Office of the Attorney General for enforcement activities; the Vermont Prescription Monitoring System established in 18 V.S.A. chapter 84A; the evidence-based education program established in 18 V.S.A. chapter 91, subchapter 2; statewide unused prescription drug disposal initiatives; prevention of prescription drug misuse, abuse, and diversion; the Substance Misuse Prevention Oversight and Advisory Council established in 18 V.S.A. § 4803; treatment of substance use disorder; exploration of nonpharmacological approaches to pain management; a hospital antimicrobial program for the purpose of reducing hospital-acquired infections; the purchase and distribution of fentanyl testing strips; the purchase and distribution of naloxone to emergency medical services personnel; and any opioid-antagonist education, training, and distribution program operated by the Department of Health or its agents. The fees shall be collected in the Evidence-Based Education and Advertising Fund established in section 2004a of this title.
(c) The Secretary of Human Services or designee shall make rules for the implementation of this section.
(d) The Department shall maintain on its website a list of the manufacturers who have failed to provide timely payment as required under this section. (Added 2007, No. 80, § 20; amended 2007, No. 89 (Adj. Sess.), § 4; 2009, No. 156 (Adj. Sess.), § I.67; 2011, No. 162 (Adj. Sess.), § E.311; 2013, No. 50, § E.312.1; 2013, No. 79, § 27, eff. Jan. 1, 2014; 2013, No. 95 (Adj. Sess.), § 84, eff. Feb. 25, 2014; 2015, No. 173 (Adj. Sess.), § 12, eff. Jan. 1, 2016; 2019, No. 70, § 29; 2019, No. 72, § E.313.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 2004a. Evidence-Based Education and Advertising Fund

§ 2004a. Evidence-Based Education and Advertising Fund
(a) The Evidence-Based Education and Advertising Fund is established in the State Treasury as a special fund to be a source of financing for activities relating to fund collection and analysis of information on pharmaceutical marketing activities under 18 V.S.A. §§ 4632 and 4633; for analysis of prescription drug data needed by the Office of the Attorney General for enforcement activities; for the Vermont Prescription Monitoring System established in 18 V.S.A. chapter 84A; for the evidence-based education program established in 18 V.S.A. chapter 91, subchapter 2; for statewide unused prescription drug disposal initiatives; for the prevention of prescription drug misuse, abuse, and diversion; for the Substance Misuse Prevention Oversight and Advisory Council established in 18 V.S.A. § 4803; for treatment of substance use disorder; for exploration of nonpharmacological approaches to pain management; for a hospital antimicrobial program for the purpose of reducing hospital-acquired infections; for the purchase and distribution of fentanyl testing strips; for the purchase and distribution of naloxone to emergency medical services personnel; and for the support of any opioid-antagonist education, training, and distribution program operated by the Department of Health or its agents. Monies deposited into the Fund shall be used for the purposes described in this section.
(b) Into the Fund shall be deposited:
(1) revenue from the manufacturer fee established under section 2004 of this title; and
(2) the proceeds from grants, donations, contributions, taxes, and any other sources of revenue as may be provided by statute, rule, or act of the General Assembly.
(c) The Fund shall be administered pursuant to 32 V.S.A. chapter 7, subchapter 5, except that interest earned on the Fund and any remaining balance shall be retained in the Fund. (Added 2007, No. 80, § 20a; amended 2011, No. 162 (Adj. Sess.), § E.311.1, eff. May 17, 2012; 2013, No. 50, § E.312.2; 2013, No. 95 (Adj. Sess.), § 85, eff. Feb. 25, 2014; 2015, No. 173 (Adj. Sess.), § 13; 2019, No. 72, § E.313.1.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 2007. Canadian Prescription Drug Information Program

§ 2007. Canadian Prescription Drug Information Program
The Department of Vermont Health Access shall establish a website and prepare written information to offer guidance to Vermont residents seeking information about ordering prescription drugs through the mail or otherwise from a participating Canadian pharmacy. (Added 2003, No. 122 (Adj. Sess.), § 128m; amended 2005, No. 174 (Adj. Sess.), § 106; 2009, No. 156 (Adj. Sess.), § I.68.)
2023 Vermont Statutes › Title 33 - Human Services › Chapter 19 - Medical Assistance › § 2032. Role of Department of Vermont Health Access

§ 2032. Role of Department of Vermont Health Access
(a) The Department of Vermont Health Access shall provide the Clinical Utilization Review Board with data support to enable the Board to conduct reviews.
(b) The Department’s Program Integrity Unit shall inform the Board of practices the Unit has identified through its reviews in order to avoid duplication of efforts.
(c) The Department shall provide members of the Board with per diem compensation.
(d) The Department shall have the final authority to evaluate and implement the Board’s recommendations.
(e) The Department shall conduct comprehensive evaluations of the Board’s success in improving clinical and utilization results using claims data and a survey of health care professional satisfaction. The Department shall report annually by January 15 to the House Committee on Health Care and the Senate Committee on Health and Welfare regarding the results of the most recent evaluation or evaluations and a summary of the Board’s activities and recommendations since the last report. 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) The Department shall adopt rules pursuant to 3 V.S.A. chapter 25 as needed to implement specific recommendations. (Added 2009, No. 146 (Adj. Sess.), § C34; amended 2013, No. 142 (Adj. Sess.), § 70; 2015, No. 11, § 36.)