Title 18, Title 18: Health

§ 9403b. Vermont Steering Committee for Comprehensive Primary Health Care (a) There is created the Vermont Steering Committee for Comprehensive Primary Health Care to inform the work of State government, including the Blueprint for Health and the Office of Health Care Reform in t…

§ 9404. Administration (a) The Commissioner and the Green Mountain Care Board shall supervise and direct the execution of all laws vested in the Department and the Board, respectively, by this chapter, and shall formulate and carry out all policies relating to this chapter. (b) T…

§ 9405. State Health Improvement Plan; Health Resource Allocation Plan (a) The Secretary of Human Services or designee, in consultation with the Chair of the Green Mountain Care Board and health care professionals and after receipt of public comment, shall adopt a State Health Im…

§ 9405a. Public participation and strategic planning (a) Each hospital shall have a protocol for meaningful public participation in its strategic planning process for identifying and addressing health care needs that the hospital provides or could provide in its service area. Nee…

§ 9405b. Hospital community reports and ambulatory surgical center quality reports (a) The Commissioner of Health, in consultation with representatives from hospitals, other groups of health care professionals, and members of the public representing patient interests, shall adopt…

§ 9405c. Notice of acquisition (a) As used in this section: (1) “Acquire” means a purchase or transfer through which a hospital will own or control the business of a medical practice. (2) “Hospital” means a general hospital or hospital facility licensed under chapter 43 of this t…

§ 9406. Reporting on participation in 340B drug pricing program [Repealed effective January 1, 2031] (a) Annually on or before January 31, each hospital participating in the federal 340B drug pricing program established by 42 U.S.C. § 256b shall submit to the Green Mountain Care …

§ 9407. Outpatient prescription drugs; limitations on hospital charges [Effective January 1, 2026] (a)(1) A hospital shall not submit a claim to a health insurer for reimbursement of a prescription drug administered in an outpatient or office setting in an amount that exceeds 120…

§ 9408. Common claims forms and procedures Not later than January 15, 1993, the Commissioner shall adopt by rule uniform health insurance claims forms and uniform standards and procedures for the processing of claims, including electronic claims forms submission. (Added 1991, No.…

§ 9408a. Uniform provider credentialing (a) Definitions. As used in this section: (1) “Credentialing” means a process through which an insurer or hospital makes a determination, based on criteria established by the insurer or hospital, concerning whether a provider is eligible to…

§ 9409. Health care provider bargaining groups (a) The Green Mountain Care Board may approve the creation of one or more health care provider bargaining groups, consisting of health care providers who choose to participate. A bargaining group is authorized to negotiate on behalf …

§ 9410. Health care database (a)(1) The Board shall establish and maintain a unified health care database to enable the Board to carry out its duties under this chapter, chapter 220 of this title, and Title 8, including: (A) determining the capacity and distribution of existing r…

§ 9411. Interactive price transparency dashboard (a) The Green Mountain Care Board shall develop and maintain a public, interactive, Internet-based price transparency dashboard that allows consumers to compare health care prices for certain health care services across the State. …

§ 9412. Enforcement (a) In order to carry out the duties under this chapter, in addition to the powers provided in this chapter, in chapter 220 of this title, and in Title 8, the Commissioner and the Board may examine the books, accounts, and papers of health insurers, health car…

§ 9413. Health care quality and price comparison Each health insurer with more than 200 covered lives in this State shall establish an Internet-based tool to enable its members to compare the price of health care in Vermont by service or procedure, including office visits, emerge…

§ 9414. Quality assurance for managed care (a) The Commissioner shall have the power and responsibility to ensure that each managed care organization provides quality health care to its members, in accordance with the provisions of this section. (1) In determining whether a manag…

§ 9414a. Annual reporting by health insurers (a) As used in this section: (1) “Adverse benefit determination” means a denial, reduction, modification, or termination of, or a failure to provide or make payment in whole or in part for, a benefit, including: (A) a denial, reduction…

§ 9416. Vermont Program for Quality in Health Care (a) The Commissioner of Health shall contract with the Vermont Program for Quality in Health Care, Inc. to implement and maintain a statewide quality assurance system to evaluate and improve the quality of health care services re…

§ 9417. Tax-advantaged accounts for health-related expenses; administration; rulemaking (a) As used in this section: (1) “Flexible spending account” or “FSA” has the same meaning as in 26 U.S.C. § 106(c)(2). (2) “Health reimbursement arrangement” or “HRA” means any account-based …

§ 9418. Payment for health care services (a) Except as otherwise specified, as used in this subchapter: (1) “Claim” means any claim, bill, or request for payment for all or any portion of provided health care services that is submitted by: (A) a health care provider or a health c…

§ 9418a. Processing claims, downcoding, and adherence to coding rules [Effective January 1, 2026; see also section 9418a effective until January 1, 2026 set out above] (a) Health plans, contracting entities, covered entities, and payers shall accept and initiate the processing of…

§ 9418b. Prior authorization (a) Health plans shall pay claims for health care services for which prior authorization was required by and received from the health plan, unless: (1) the insured was not a covered individual at the time the service was rendered; (2) the insured’s be…

§ 9418c. Fair contract standards (a) Required information. (1) Each contracting entity shall provide and each health care contract shall obligate the contracting entity to provide participating health care providers information sufficient for the participating provider to determi…

§ 9418d. Contract amendments (a) A health care contract may be amended by mutual agreement of the parties. (b) Absent mutual agreement of the parties, a health care contract may be amended only as follows: (1) The contracting entity shall provide to the participating provider not…

§ 9418e. Most favored nation clauses prohibited Not later than 180 days after the effective date of this section, no contracting entity shall do any of the following: (1) offer to a provider, hospital, pharmacist, or pharmacy a health care contract that includes a most favored na…

§ 9418f. Rental network contracts (a) Definitions. As used in this section: (1) “Health care services” means services for the diagnosis, prevention, treatment, or cure of a health condition, illness, injury, or disease. (2)(A) “Provider” means a physician, a physician organizatio…

§ 9418g. Enforcement In addition to any other remedy provided by law, the Commissioner may, in the Commissioner’s sole discretion, enforce the provisions of this subchapter as specified in this section. In determining whether to undertake an enforcement action, the Commissioner m…

§ 9419. Charges for access to medical records (a) A custodian may impose a charge that is no more than a flat $5.00 fee or no more than $0.50 per page, whichever is greater, for providing copies of an individual’s health care record. A custodian shall provide an individual or the…

§ 9420. Conversion of nonprofit hospitals (a) Policy and purpose. The State has a responsibility to ensure that the assets of nonprofit entities, which are impressed with a charitable trust, are managed prudently and are preserved for their proper charitable purposes. (b) Definit…

§ 9422. Credit card payments optional for providers (a) As used in this section: (1) “Credit card payment” means a type of electronic funds transfer in which a health insurer or its contracted vendor issues a single-use series of numbers associated with payment for health care se…

§ 9431. Policy and purpose (a) It is declared to be the public policy of this State that the general welfare and protection of the lives, health, and property of the people of this State require that all new health care projects be offered or developed in a manner that avoids unn…

§ 9432. Definitions As used in this subchapter: (1) “Ambulatory surgical center” means a facility or portion of a facility that provides surgical care not requiring an overnight stay. The office of a dentist in which activities are limited to dentistry and oral or maxillofacial s…

§ 9433. Administration (a) The Green Mountain Care Board shall exercise such duties and powers as necessary for the implementation of the certificate of need program as provided by and consistent with this subchapter. The Board shall issue or deny certificates of need and adminis…

§ 9434. Certificate of need; general rules (a) A health care facility shall not develop or have developed on its behalf a new health care project without issuance of a certificate of need by the Board. For purposes of this subsection, a “new health care project” means any of the …

§ 9435. Exclusions (a) Excluded from this subchapter are offices of physicians, dentists, or other practitioners of the healing arts, meaning the physical places that are occupied by such providers on a regular basis in which such providers perform the range of diagnostic and tre…

§ 9437. Criteria A certificate of need shall be granted if the applicant demonstrates that the project serves the public good and the Board finds: (1) The proposed project aligns with statewide health care reform goals and principles because the project: (A) takes into considerat…

§ 9439. Competing applications (a) The Board shall provide by rule a process by which any person wishing to offer or develop a new health care project may submit a competing application when a substantially similar application is pending. The competing application must be filed a…

§ 9440. Procedures (a) Notwithstanding 3 V.S.A. chapter 25, a certificate of need application shall be in accordance with the procedures of this section. (b)(1) The application shall be in such form and contain such information as the Board establishes. In addition, the Board may…

§ 9440a. Applications, information, and testimony; oath required (a) Each application filed under this subchapter, any written information required or permitted to be submitted in connection with an application or with the monitoring of an order, decision, or certificate issued b…

§ 9440b. Information technology; review procedures Notwithstanding the procedures in section 9440 of this title, the Board shall establish by rule standards and expedited procedures for reviewing applications for the purchase or lease of health care information technology that ot…

§ 9441. Fees (a) The Board shall charge a fee for the filing of certificate of need applications. The fee shall be calculated at the rate of 0.125 percent of project costs. (b) The maximum fee shall not exceed $20,000.00 and the minimum filing fee is $250.00 regardless of project…

§ 9442. Bonds In any circumstance in which bonds are to be or may be issued in connection with a new health care project subject to the provisions of this subchapter, the certificate of need shall include the requirement that all information required to be provided to the bonding…

§ 9443. Expiration of certificates of need (a) Unless otherwise specified in the certificate of need, a project shall be implemented within five years or the certificate shall be invalid. (b) Not later than 180 days before the expiration date of a certificate of need, an applican…

§ 9444. Revocation of certificates; material change (a) The Board may revoke a certificate of need for substantial noncompliance with the scope of the project as designated in the application, or for failure to comply with the conditions set forth in the certificate of need grant…

§ 9445. Enforcement (a) Any person who offers or develops any new health care project within the meaning of this subchapter without first obtaining a certificate of need as required by this subchapter, or who otherwise violates any of the provisions of this subchapter or any rule…

§ 9446. Home health agencies; geographic service areas The terms of a certificate of need relating to the boundaries of the geographic service area of a home health agency may be modified by the Board, in consultation with the Commissioner of Disabilities, Aging, and Independent …