§ 9472. Pharmacy benefit managers; required practices with respect to health insurers
§ 9472. Pharmacy benefit managers; required practices with respect to health insurers (a) A pharmacy benefit manager that provides pharmacy benefit management for a health plan shall discharge its duties with reasonable care and diligence and be fair and truthful under the circumstances then prevailing that a pharmacy benefit manager acting in like capacity and […]
§ 9472. Pharmacy benefit managers; required practices with respect to health insurers and covered persons
§ 9472. Pharmacy benefit managers; required practices with respect to health insurers and covered persons (a) A pharmacy benefit manager that provides pharmacy benefit management for a health plan has a fiduciary duty to its health insurer client that includes a duty to be fair and truthful toward the health insurer, to act in the […]
§ 9473. Pharmacy benefit managers; required practices with respect to pharmacies
§ 9473. Pharmacy benefit managers; required practices with respect to pharmacies (a) Within 14 calendar days following receipt of a pharmacy claim, a pharmacy benefit manager or other entity paying pharmacy claims shall do one of the following: (1) Pay or reimburse the claim. (2) Notify the pharmacy in writing that the claim is contested […]
§ 9453. Powers and duties
§ 9453. Powers and duties (a) The Board shall: (1) adopt uniform formats that hospitals shall use to report financial, scope-of-services, and utilization data and information; (2) designate a data organization with which hospitals shall file financial, scope-of-services, and utilization data and information; and (3) designate a data organization or organizations to process, analyze, store, […]
§ 9454. Hospitals; duties
§ 9454. Hospitals; duties (a) Hospitals shall file the following information at the time and place and in the manner established by the Board: (1) a budget for the forthcoming fiscal year; (2) financial information, including costs of operation, revenues, assets, liabilities, fund balances, other income, rates, charges, units of services, and wage and salary […]
§ 9456. Budget review
§ 9456. Budget review (a) The Board shall conduct reviews of each hospital’s proposed budget based on the information provided pursuant to this subchapter and in accordance with a schedule established by the Board. [Subsection (b) effective until January 1, 2023; for subsection (b) effective January 1, 2023 see below.] (b) In conjunction with budget […]
§ 9457. Information available to the public
§ 9457. Information available to the public (a) Information required to be filed under this subchapter shall be made available to the public upon request in accordance with 1 V.S.A. chapter 5, subchapter 3 (Public Records Act), except that information that directly or indirectly identifies individual patients or health care practitioners shall be kept confidential. […]
§ 9461. Quality measures
§ 9461. Quality measures (a) The Department of Financial Regulation shall develop performance quality measures to evaluate and ensure that health insurers, including managed care organizations that contract with health insurers to administer the insurers’ mental health benefits, comply with the provisions of 8 V.S.A. § 4089b and related rules. (b) The Departments of Health […]
§ 9443. Expiration of certificates of need
§ 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) No later than 180 days before the expiration date of a certificate of need, an applicant that has not yet implemented the project approved […]
§ 9444. Revocation of certificates; material change
§ 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 granted by the Board. (b)(1) In the event that after […]