Code of Vermont Rules › Agency 21 - DEPARTMENT OF FINANCIAL REGULATION › Sub-Agency 040 - DIVISION OF HEALTH CARE ADMINISTRATION › Chapter 006 - PROVIDER BARGAINING GROUPS - RULE 6.000 › Section 21 040 006 - PROVIDER BARGAINING GROUPS - RULE 6.000

Current through June, 2024
Section 6.100 Authority
This rule is promulgated by the Health Care Authority under
				  the authority of
				  18 V.S.A. §§
											9404(d)(2) and
				  9409(b).
Section 6.200 Scope and Purpose
Section
				  9406 of
				  Title 18 requires the Health Care Authority to establish a unified health care
				  budget on an annual basis. In preparing the budget each year, the Authority
				  will engage in discussions with representatives of many sectors of Vermont's
				  health care system, including but not limited to health care providers, so that
				  the budgeting process is based on as much information as possible. Individual
				  health care providers who wish to negotiate with the Authority may feel
				  constrained, however, from full participation for fear that their activities
				  will be deemed anticompetitive behavior subject to sanctions under applicable
				  antitrust laws. This rule allows health care providers to benefit from the
				  "state action immunity doctrine" under which a state may allow certain
				  anticompetitive behavior, so long as the behavior is clearly articulated and
				  actively supervised. To that end, this rule is designed to implement
				  18 V.S.A. §
											9409(a) by governing the
				  creation of provider bargaining groups, clearly articulating the scope of the
				  matters that groups can negotiate with the Authority and the health care
				  purchasing pool, and providing for active supervision of all approved
				  activities by the state. Once approved under this rule, a provider bargaining
				  group will be able to engage in the types of negotiations authorized herein
				  without the threat of a challenge under the antitrust laws.
6.201 Applicability
This rule shall apply to health care providers negotiating,
				  or desiring to negotiate, with the Health Care Authority or the health care
				  purchasing pool any matters authorized under
				  18 V.S.A. §
												9409(a).
6.202 Purpose
Section
				  9409
				  of Title 18 permits the Health Care Authority Board to approve the creation of
				  one or more provider bargaining groups, consisting of health care providers who
				  choose to participate in such groups. This rule defines the criteria governing
				  the formation and approval of provider bargaining groups and the activities
				  authorized by § 9409(a).
6.203 Definitions
(A) "Authority" means the Health Care
				Authority established under
				18 V.S.A. §
												9403(a).
(B) "Board" means the board of the Authority
				established under
				18 V.S.A. §
												9403(b).
(C) "Health care facility" means all
				facilities and institutions, whether public or private, proprietary or
				nonprofit, that offer diagnosis, treatment, inpatient or ambulatory care to two
				or more unrelated persons. The term shall not apply to any facility operated by
				religious groups relying solely on spiritual means through prayer or healing,
				but includes all facilities and institutions included in
				18 V.S.A. §
												9432(10).
(D) "Health care provider" or "provider"
				means a person, partnership or corporation, other than a facility or
				institution, licensed or certified or authorized by law to provide professional
				health care service in Vermont to an individual during that individual's
				medical care, treatment or confinement.
(E) "Health care purchasing pool" or
				"purchasing pool" means the purchasing pool established by the secretary of
				administration pursuant to
				18 V.S.A.
				§
												9413(a).
(F) "Provider bargaining group" means a group
				of health care providers authorized under this rule to engage in negotiations
				with the Authority and the purchasing pool.
(G) "Sector" means a part of the unified
				health care budget as defined by the Authority.
(H) "Unified health care budget" means the
				annual budget adopted by the Board pursuant to
				18 V.S.A. §
												9406(b).