Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 770 - PHARMACY ADMINISTRATION (7700) › Section 13 170 770 - PHARMACY ADMINISTRATION (7700)

Current through June, 2024
Section 7701
				Pharmaceutical Manufacturer Fee
Act 80, of the 2007 legislative session, an Act relating to
				  increasing transparency of prescription drug pricing and information,
				  established a manufacturer fee under
				  33 V.S.A. §
											2004. A fee shall be collected annually by
				  the Agency of Human Services from each pharmaceutical manufacturer or labeler
				  of prescription drugs that are paid for by the Office of Vermont Health Access
				  for individuals participating in Medicaid, the Vermont Health Access Plan
				  (VHAP), Dr. Dynasaur, VPharm, VHAP-Pharmacy, VScript, or VScript Expanded. The
				  fee shall be 0.5 percent of the previous calendar year's prescription drug
				  spending by the office and shall be assessed based on manufacturer labeler
				  codes as used in the Medicaid rebate program. The fee shall be deposited in the
				  evidence-based education and advertising fund established by
				  33 V.S.A.
				  §
											2004a. This fee shall fund activities,
				  including the evidence-based education program, established by
				  18 V.S.A. §
											4622.
The evidence-based education program will provide
				  information and education on the therapeutic and cost-effective use of
				  prescription drugs, as well as the collection and analysis of information on
				  pharmaceutical marketing activities under sections
				  4632
				  and
				  4633
				  of Title 18, and analysis of drug data needed by the attorney general's office
				  for enforcement activities concerning prescription drugs.
The OVHA shall annually provide the manufacturer or labeler
				  with a written bill in the amount of 0.5 percent of the payments made on claims
				  submitted during the previous calendar year regarding the manufacturer's or
				  labeler's prescription drugs. This amount will be based on paid claims data
				  (data used to reimburse pharmacies) under the state's programs. The
				  manufacturer or labeler shall remit the invoiced amount according to
				  instructions provided by OVHA.
In the event the manufacturer or labeler believes an error
				  in billing has occurred, the manufacturer or labeler must notify the OVHA in
				  writing within thirty days of the receipt of the bill. This notification must
				  be accompanied by written materials setting forth the basis for the requested
				  review. The billing data will be verified and adjusted if appropriate, which
				  may include a credit as to the amount of the bill, or a refund of amounts
				  paid.
The OVHA shall maintain electronic claims records for five
				  quarters after the end of a billing calendar year that will permit the
				  manufacturer labeler to verify through an audit process the billing invoices
				  provided by the OVHA.
Section
				7702 Telemonitoring
(10/29/2014, 14-05P)
Home telemonitoring is a health service that requires
				  scheduled remote monitoring of data related to an individual's health, and
				  transmission of the data from the individual's home to a licensed home health
				  agency. Scheduled periodic reporting of the individual's data to the licensed
				  physician is required, even when there have been no readings outside the
				  parameters established in the physician's orders. Telemonitoring providers must
				  be available 24 hours per day, 7 days a week.
7702.1 Eligibility and Conditions for
				Coverage (10/29/2014, 14-05P)
Home telemonitoring services will be a benefit for
				  individuals with primary Vermont Medicaid or non-homebound individuals with
				  dual Medicare and Medicaid who are served by Vermont Home Health Agencies in
				  accordance with clinical coverage guidelines, as updated annually and described
				  in the Provider Manual.
7702.2 Qualified Providers (10/29/2014,
				14-05P)
Qualified providers are home health agencies enrolled with
				  Vermont Medicaid.
Qualified providers must follow data parameters established
				  by a licensed physician's plan of care.
Qualified providers must use the following licensed health
				  care professionals to review data: registered nurse (RN), nurse practitioner
				  (NP), clinical nurse specialist (CNS), licensed practical nurse (LPN) under the
				  supervision of a RN, or physician assistant (P A). In the event of a
				  measurement outside of the established individual's parameters, the provider
				  shall use the health care professionals noted above to be responsible for
				  reporting the data to a physician.
The data transmission must comply with standards set by the
				  Health Insurance Portability and Accountability Act (HIPAA).
7702.3 Reimbursement (10/29/2014, 14-05P)
Reimbursement for telemonitoring services is described in
				  the Provider Manual and updated annually.