§ 9482. Financial assistance policies for large health care facilities
§ 9482. Financial assistance policies for large health care facilities (a) Each large health care facility in this State shall develop a written financial assistance policy that, at a minimum, complies with the provisions of this subchapter and any applicable federal requirements. (b) The financial assistance policy shall: (1) apply, at a minimum, to all […]
§ 9483. Implementation of financial assistance policy
§ 9483. Implementation of financial assistance policy (a) In addition to any other actions required by applicable State or federal law, a large health care facility shall take the following steps before seeking payment for any emergency or medically necessary health care services: (1) determine whether the patient has health insurance or other coverage for […]
§ 9474. Enforcement
§ 9474. Enforcement (a) Except as provided in subsection (d) of this section, in addition to any remedy available to the Commissioner under this title and any other remedy provided by law, a violation of this subchapter shall be considered a violation of the Vermont Consumer Protection Act in 9 V.S.A. chapter 63, subchapter 1. […]
§ 9481. Definitions
§ 9481. Definitions As used in this subchapter: (1) “Amount generally billed” means the amount a large health care facility generally bills to individuals for emergency or other medically necessary health care services, determined using the “look-back method” set forth in 26 C.F.R. § 1.501(r)-5(b)(3). (2) “Credit reporting agency” means a person who, for fees, […]
§ 9462. Quality improvement projects
§ 9462. Quality improvement projects In addition to reviewing mental health and substance abuse treatment data pursuant to subdivision 9375(b)(12) of this title, the Green Mountain Care Board shall consider the results of any quality improvement projects not otherwise confidential or privileged undertaken by managed care organizations for mental health and substance abuse care and […]
§ 9471. Definitions
§ 9471. Definitions As used in this subchapter: (1) “Beneficiary” means an individual enrolled in a health plan in which coverage of prescription drugs is administered by a pharmacy benefit manager and includes his or her dependent or other person provided health coverage through that health plan. [Subdivision (2) effective until January 1, 2023; for […]
§ 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, […]