Title 18, Title 18: Health

§ 9353. Integration of health care data; reports (a) The Agency of Human Services shall collaborate with the Health Information Exchange Steering Committee in the development of the Unified Health Data Space in order to improve patient and provider access to relevant information,…

§ 9361. Health care providers delivering health care services through telemedicine or by store-and-forward means (a) As used in this section, “distant site,” “health care provider,” “originating site,” “store-and-forward,” and “telemedicine” have the same meanings as in 8 V.S.A. …

§ 9362. Health care providers delivering health care services by audio-only telephone (a) As used in this section: (1) “Health insurance plan” has the same meaning as in 8 V.S.A. § 4011. (2) “Health care provider” has the same meaning as in 8 V.S.A. § 4098b. (3) “Telemedicine” ha…

§ 9371. Principles for health care reform The General Assembly adopts the following principles as a framework for reforming health care in Vermont: (1) The State of Vermont must ensure universal access to and coverage for high-quality, medically necessary health services for all …

§ 9372. Purpose It is the intent of the General Assembly to create an independent board to promote the general good of the State by: (1) improving the health of the population; (2) reducing the per-capita rate of growth in expenditures for health services in Vermont across all pa…

§ 9373. Definitions As used in this chapter: (1) “Board” means the Green Mountain Care Board established in this chapter. (2) “Chronic care” means health services provided by a health care professional for an established clinical condition that is expected to last a year or more …

§ 9374. Board membership; authority (a)(1) On July 1, 2011, the Green Mountain Care Board is created and shall consist of a chair and four members. The Chair and all of the members shall be State employees and shall be exempt from the State classified system. The Chair shall rece…

§ 9375. Duties (a) The Board shall execute its duties consistent with the principles expressed in section 9371 of this title. (b) The Board shall have the following duties: (1) Oversee the development and implementation, and evaluate the effectiveness, of health care payment and …

§ 9376. Payment amounts; methods (a) Intent. It is the intent of the General Assembly to ensure payments to health care professionals that are consistent with efficiency, economy, and quality of care and will permit them to provide, on a solvent basis, effective and efficient hea…

§ 9377. Payment reform; pilots (a) It is the intent of the General Assembly to achieve the principles stated in section 9371 of this title. In order to achieve this goal and to ensure the success of health care reform, it is the intent of the General Assembly that payment reform …

§ 9377a. Prior authorization pilot program (a) The Green Mountain Care Board shall develop and implement a pilot program or programs for the purpose of measuring the change in system costs within primary care associated with eliminating prior authorization requirements for imagin…

§ 9378. Public process The Green Mountain Care Board shall provide a process for soliciting public input. The process may include receiving written comments on proposed new or amended rules or holding public hearings, or both. (Added 2011, No. 48, § 3, eff. May 26, 2011.)

§ 9379. Agency cooperation The Secretary of Administration shall ensure that, in accordance with State and federal privacy laws, the Green Mountain Care Board has access to data and analysis held by any Executive Branch agency that is necessary to carry out the Board’s duties as …

§ 9380. Rules The Board may adopt rules pursuant to 3 V.S.A. chapter 25 as needed to carry out the provisions of this chapter. (Added 2011, No. 48, § 3, eff. May 26, 2011.)

§ 9381. Appeals (a) The Green Mountain Care Board shall adopt procedures for administrative appeals of its actions, orders, or other determinations. Such procedures shall provide for the issuance of a final order and the creation of a record sufficient to serve as the basis for j…

§ 9382. Oversight of accountable care organizations [Subsection (a) effective until January 1, 2027; see also subsection (a) effective January 1, 2027, set out below] (a) In order to be eligible to receive payments from Medicaid or commercial insurance through any payment reform …

§ 9383. Expenditure analysis; health care spending estimate (a) The Board shall develop annually an expenditure analysis and an estimate of future health care spending covering a period of at least two years. These analyses shall contain data and information as set forth in this …

§ 9384. Reduction or reallocation of reimbursement rates; risks to health insurer solvency (a) As used in this section: (1) “Hospital” has the same meaning as in section 9451 of this title. (2) “Hospital network” means a system comprising two or more affiliated hospitals, and may…

§ 9390. Green Mountain Care Board Nominating Committee created; composition (a) The Green Mountain Care Board Nominating Committee is created for the nomination of the Chair and members of the Green Mountain Care Board. (b)(1) The Committee shall consist of nine members who shall…

§ 9391. Nomination and appointment process (a) Candidate selection process. (1) Unless a vacancy is filled by reappointment by the Governor pursuant to subsection (c) of this section, not later than 90 days prior to a known vacancy occurring on the Green Mountain Care Board the G…

§ 9392. Qualifications for nominees The Green Mountain Care Board Nominating Committee shall assess candidates using the following criteria: (1) commitment to the principles expressed in section 9371 of this title; (2) knowledge of or expertise in health care policy, health care …

§ 9401. Policy (a) It is the policy of the State of Vermont that health care is a public good for all Vermonters and to ensure that all residents have access to quality health services at costs that are affordable. To achieve this policy, it is necessary that the State ensure the…

§ 9402. Definitions As used in this chapter, unless otherwise indicated: (1) “Commissioner” means the Commissioner of Financial Regulation or the Commissioner’s designee. (2) “Community report” means the hospital report prepared under section 9405a of this title. (3) “Department”…

§ 9403. Statewide Health Care Delivery Strategic Plan (a) The Agency of Human Services, in collaboration with the Green Mountain Care Board, the Department of Financial Regulation, the Vermont Program for Quality in Health Care, the Office of the Health Care Advocate, the Health …

§ 9403a. Health Care Delivery Advisory Committee (a) There is created the Health Care Delivery Advisory Committee to: (1) establish health care affordability benchmarks; (2) evaluate and monitor the performance of Vermont’s health care system and its impacts on population 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…