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Resource Use (Cost/Utilization) Measurement and Reporting in Vermont

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Health insurers must report financial and utilization of health care information to the Department of Financial Regulation.1

The Department of Mental Health must annually report to the state legislature on the utilization of mental health services.2

The Department of Vermont Health Access must establish a pharmacy best practices and cost control program to reduce the cost of providing prescription drugs, which must include utilization procedures.3  The department must report to the state legislature the progress of the pharmacy best practices and cost control program.4 The department must also create a clinical utilization review board to make recommendations on the utilization of health care services in the State’s Medicaid programs.5

 

 

Footnotes

  • 1. 8 Vermont Statutes §§3314, 4096, 4516, 4588, 5102, 9440; 18 Vermont Statutes §9410; 9411, 9414
  • 2. 18 Vermont Statutes §7256
  • 3. 33 Vermont Statutes §1998
  • 4. 33 Vermont Statutes §2001
  • 5. 33 Vermont Statutes §§2031, 2032

 

Resource Use (Cost/Utilization) Measurement and Reporting in Vermont

Subtopic Statute/Regulation Description
Resource Use (Cost/Utilization) Measurement and Reporting 4-5 Vt. Code R. 19:7 - Requirements for a mental health review agent service review under the Department of Financial Regulation regulations “Requirements for service review under the Department of Financial Regulation regulations” A mental health review agent must adopt...
4-5 Vt. Code R. 19:8 - Disclosure of essential information by mental health review agent under the Department of Financial Regulation regulations “Disclosing essential information under the Department of Financial Regulation regulations” The mental health review agent must comply...
4-5 Vt. Code R. 3:10.100 - General provisions under the Department of Financial Regulation regulations “General provisions under the Department of Financial Regulation regulations” (1.1) Managed care organizations must comply with consumer...
4-5 Vt. Code R. 3:10.300 - Additional requirements if utilization management mechanisms are used under the Department of Financial Regulation regulations “Additional requirements if utilization management mechanisms are used under the Department of Financial Regulation regulations”  (3...
Vt. Stat. Ann. tit. 18, § 7256 - Reporting requirements for the Department of Mental Health under the health law “Reporting requirements board under the health law” The Department of Mental Health must annually report to the state legislature on the...
Vt. Stat. Ann. tit. 18, § 9410 - Health care database “Health care database under the health law” The commissioner of Vermont health access must establish a unified health care database to...
Vt. Stat. Ann. tit. 33, § 1998 - Pharmacy best practices and cost control program for Medicaid established under the human services law “Pharmacy best practices and cost control program established under the human services law” The commissioner of Vermont health access...
Vt. Stat. Ann. tit. 33, § 2001 - Legislative oversight under the human services law “Legislative oversight under the human services law” The pharmacy best practices and cost control program is subject to legislative...
Vt. Stat. Ann. tit. 33, § 2031 - Creation of clinical utilization review board for Medicaid purposes under the human services law “Creation of clinical utilization review board under the human services law” The Department of Vermont Health Access must create a...
Vt. Stat. Ann. tit. 33, § 2032 - Role of department of Vermont health access under the human services law “Role of department of Vermont health access under the human services law” The Department of Vermont Health Access must provide the...
Vt. Stat. Ann. tit. 8, § 3314 - Health insurer annual financial statements; reports; filing fee under the banking and insurance law “Annual financial statements; reports; filing fee under the banking and insurance law” Health insurers must file an annual financial...
Vt. Stat. Ann. tit. 8, § 3561 - Health insurer annual statement under the banking and insurance law “Annual statement under the banking and insurance law” Every health insurer must annually submit to the commissioner of financial...
Vt. Stat. Ann. tit. 8, § 4062 - Filing and approval of policy forms and premiums under the banking and insurance law “Filing and approval of policy forms and premiums under the banking and insurance law” Every policy of health insurance offered by a...
Vt. Stat. Ann. tit. 8, § 4516 - Hospital service corporation annual report to commissioner under the banking and insurance law “Annual report to commissioner under the banking and insurance law” A hospital service corporation must annually file with the...
Vt. Stat. Ann. tit. 8, § 4588 - Medical service organization annual report to commissioner under the banking and insurance law “Annual report to commissioner under the banking and insurance law” Every medical service corporation must file a financial statement...
Vt. Stat. Ann. tit. 8, § 5106 - Health maintenance annual report to the commissioner under the banking and insurance law “Annual report to the commissioner under the banking and insurance law” A health maintenance organization must annually file a financial...
Vt. Stat. Ann. tit. § 18, 9414 - Quality assurance for managed care organizations under the health law “Quality assurance for managed care organizations under the health law” The commissioner of financial regulation must review a managed...
Click on the individual state law in the table above to see our summary of the individual law.


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