Title 33, Human Services

§ 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 …

§ 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…

§ 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 structur…

§ 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 servi…

§ 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…

§ 1998. Pharmacy Best Practices and Cost Control Program established (a) The Commissioner of Vermont Health Access shall establish and maintain a Pharmacy Best Practices and Cost Control Program designed to reduce the cost of providing prescription drugs, while maintaining high q…

§ 1998a. Pharmacy mail order The Pharmacy Best Practices and Cost Control Program shall require consumers to purchase prescription drugs using mail order for selected pharmacy products. (Added 2005, No. 71, § 307.)

§ 1999. Consumer protection rules; prior authorization (a)(1) The Pharmacy Best Practices and Cost Control Program shall authorize pharmacy benefit coverage when a patient’s health care provider prescribes a prescription drug not on the preferred drug list, or a prescription drug…

§ 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. Ju…

§ 2001. Legislative oversight (a) Notwithstanding the provisions of 2 V.S.A. § 20(d), the Commissioner of Vermont Health Access shall report annually on or before October 30 to the House Committees on Appropriations, on Health Care, and on Human Services and the Senate Committees…

§ 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 …

§ 2003. Pharmacy discount plans (a) The Commissioner of Vermont Health Access shall implement pharmacy discount plans, to be known as the Healthy Vermonters Program, for Vermonters without adequate coverage for prescription drugs. The provisions of subchapter 8 of this chapter sh…

§ 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…

§ 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…

§ 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…

§ 2031. Creation of Clinical Utilization Review Board (a) The Department of Vermont Health Access shall maintain the Clinical Utilization Review Board to examine existing medical services, emerging technologies, and relevant evidence-based clinical practice guidelines and make re…

§ 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 prac…

§ 2071. Definitions As used in this subchapter: (1) “Individual with disabilities” means an individual who is under age 65 and is entitled, under the Social Security Act, to disability insurance benefits or is eligible for Medicare. (2) “Maintenance drug” means a drug approved by…

§ 2072. General eligibility (a) An individual shall be eligible for assistance under this subchapter if the individual: (1) is a resident of Vermont at the time of application for benefits; (2) is at least 65 years of age or is an individual with disabilities as defined in subdiv…

§ 2073. VPharm assistance program (a) Effective January 1, 2006, the VPharm program is established as a State pharmaceutical assistance program to provide supplemental pharmaceutical coverage to Medicare beneficiaries. The supplemental coverage under subsection (c) of this sectio…

§ 2075. Assistance in enrolling in Medicare Part D The Agency of Human Services may act, if permissible under federal law, as an individual’s agent to enroll the individual in a Medicare Part D prescription drug plan and a low-income subsidy if the individual has not enrolled pri…

§ 2076. Over-the-counter and generic medications (a) All public pharmaceutical assistance programs shall provide coverage for those over-the-counter pharmaceuticals on the preferred drug list developed under section 1998 of this title, provided the pharmaceuticals are authorized …

§ 2077. Administration (a) The programs established under this subchapter shall be designed to provide maximum access to program participants, to incorporate mechanisms that are easily understood and require minimum effort for applicants and health care providers, and to promote …

§ 2078. Education and outreach The Department of Disabilities, Aging, and Independent Living shall conduct ongoing education and outreach to inform Vermonters who are elders and Vermonters with disabilities of the benefits they may be entitled to pursuant to this subchapter, make…

§ 2079. Construction The benefits provided by the pharmaceutical assistance programs established under this subchapter constitute medical services for purposes of section 141 of this title. (Added 2005, No. 71, § 314.)

§ 2080. Vermont Prescription Drug Pricing and Consumer Protection Program The Secretary of Human Services shall administer this subchapter in conformity with the Pharmacy Best Practices and Cost Control Program established under subchapter 5 of this chapter to enable the citizens…

§ 2081. Rulemaking The Agency of Human Services shall adopt rules necessary to implement and administer the provisions of this subchapter, including standards and schedules establishing coverage and exclusion of pharmaceuticals and maximum quantities of pharmaceuticals to be disp…

§ 2091. Dr. Dynasaur-like coverage; legislative intent In establishing Dr. Dynasaur-like coverage for children and pregnant individuals who are not eligible for the Dr. Dynasaur program because of their immigration status, it is the intent of the General Assembly that the hospita…

§ 2092. Dr. Dynasaur-like coverage for certain Vermont residents (a) As used in this section, the term “Vermont residents who have an immigration status for which Medicaid coverage is not available” includes migrant workers who are employed in seasonal occupations in this State. …