Code of Vermont Rules › Agency 80 - ADMINISTRATIVE AND ADVISORY AGENCIES › Sub-Agency 280 - GREEN MOUNTAIN CARE BOARD › Chapter 006 - RULE 8.000: DATA SUBMISSION › Section 80 280 006 - RULE 8.000: DATA SUBMISSION

Current through June, 2024
8.100 GENERAL PROVISIONS
8.101 Authority.
The Board adopts this rule pursuant to   18 V.S.A. §§
											9375,  9380,  9404,  9410,  9453, and  9454.
8.102 Purpose.
The Green Mountain Care Board ("Board" or "GMCB") stewards two data sets (collectively "the health care database"). The Vermont Health Care Uniform Reporting and Evaluation System ("VHCURES") data set contains information related to health care utilization, costs, and resources provided to Vermont residents. The Vermont Uniform Hospital Discharge Data Set ("VUHDDS") contains information related to health care provided to patients at health care facilities in Vermont and health care provided to Vermont residents at health care facilities in other states.
Health insurers, health care providers, hospitals and other health care facilities, and governmental agencies must submit reports, data, schedules, statistics, and other information specified by the Board for inclusion in the health care database. This rule sets forth the Board's requirements for reporting health care claims and eligibility data, inpatient discharge data, outpatient procedure and service data, emergency department data, and other information relating to health care provided in Vermont and to Vermont residents outside the state. Green Mountain Care Board Rule  9.000   sets forth the processes by which the Board makes data available to support legitimate and beneficial research and analysis.
8.103 Definitions.
For purposes of this rule:
(1) "Ambulatory surgery center" has the same meaning as in   18 V.S.A. §
											2141(1).
(2) "Board" or "GMCB" means the Green Mountain Care Board established in Title 18, Chapter 220 of the Vermont Statutes Annotated, the Board's staff, or other designee of the Board.
(3) "Claims data" means service-level remittance and other related administrative information generated from the interaction of patients and the health care delivery system. Examples of claims data include provider information; charge and payment information; clinical diagnosis, procedure, and service codes; and national drug codes. Claims data also include information intended to represent payments made under an accountable care organization- based payment reform model.
(4) "Council chair" means the chair of the Data Governance Council.
(5) "Data Governance Council" or "Council" means the committee established by the Board and given responsibilities for the Board's data governance program.
(6) "Data set" means a collection of logical individual data records, regardless of format.
(7) "Data collection vendor" means a vendor with whom the Board contracts to manage data collection, cleansing, validation, integration, and consolidation related to the health care database.
(8) "Days" means calendar days unless otherwise indicated.
(9) "Eligibility data" means demographic information for each individual member enrolled for medical or pharmacy benefits for one or more days of coverage at any time during a reporting period.
(10) "General hospital" has the same meaning as in   18 V.S.A. §
											1902(1)(A).
(11) "Health care" has the same meaning as in 45 C.F.R. §
											160.103.
(12) "Health care database" means the VHCURES and VUHDDS data sets, collectively.
(13) "Health care facility" has the same meaning as in   18 V.S.A. §
											9432(8).
(14) "Health care provider" has the same meaning as in   18 V.S.A. §
											9432(9).
(15) "Health insurer" has the same meaning as in   18 V.S.A. §
											9410(j)(1).
(16) "Insured" has the same meaning as in   18 V.S.A. §
											9418(a)(10).
(17) "Mandatory submitter" means any person required to submit data for inclusion in the health care database.
(18) "Member" means the insured subscriber and any other person(s) eligible for health care benefits under the subscriber's policy, such as the subscriber's spouse or dependent.
(19) "Patient" means any person in a data set that is the subject of the activities of the claim performed by the health care provider.
(20) "Person" means any natural person, business entity, municipality, the State of Vermont or any department, agency, or subdivision of the State, and any partnership, unincorporated association, or other legal entity.
(21) "Pharmacy benefit manager" or "PBM" has the same meaning as in   18 V.S.A. §
											9471(5).
(22) "Psychiatric hospital" has the same meaning as in   18 V.S.A. §
											1902(1)(B).
(23) "Reporting manual(s)" means either the VHCURES Reporting Manual or the VUHDDS Reporting Manual or the two documents collectively.
(24) "Submitters" means mandatory submitters and voluntary submitters collectively.
(25) "Subscriber" means the individual responsible for payment of premiums or whose employment, income, or other circumstances is the basis for eligibility for membership in a health benefit plan.
(26) "Third-party administrator" or "TPA" means any person who receives or collects charges, contributions, or premiums for, or adjusts or settles claims on or for residents of Vermont or health insurers.
(27) "Vermont Health Care Uniform Reporting and Evaluation System" or "VHCURES" means the data set containing information related to eligibility, health care claims, and related data submitted by health care insurers to the GMCB.
(28) "Vermont Uniform Hospital Discharge Data Set" or "VUHDDS" means the data set consisting of inpatient discharge data, outpatient procedures and services data, and emergency department data submitted by general hospitals, ambulatory surgery centers, and psychiatric hospitals that is maintained by the Vermont Department of Health.
(29) "VHCURES members" means members who are Vermont residents.
(30) "VHCURES Reporting Manual" means the document created and maintained by the Board or the Data Governance Council that specifies data submission requirements for the VHCURES data set, including the required data submission schedule, required fields, file layouts, file components, edit specifications, instructions, and other technical information.
(31) "Voluntary submitter" includes persons other than mandatory submitters, including any health benefit plan offered or administered by or on behalf of the federal government or a self-insured employer, that voluntarily submits data to the Board for inclusion in the health care database.
(32) "VUHDDS Reporting Manual" means the document created and maintained by the Board or the Data Governance Council that specifies data submission requirements for the VUHDDS data set, including the required data submission schedule, required fields, file layouts, file components, edit specifications, instructions, and other technical information.