Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs)
Annual registration by December 31 with the State of Vermont is required for all TPAs and PBMs providing administrative and benefit management services to any Vermont residents related to health benefit plans. The State of Vermont is transitioning the TPA and PBM registration forms that will be available shortly for the upcoming annual renewal cycle for December 31.
Failure to fully and/or timely submit required health care claims data, eligibility data, provider files and other information relating to health care services provided to Vermont residents, pursuant to the authority in 18 V.S.A. 9410(g) and Regulation H-2008-001 (VHCURES).
Payment of an administrative penalty of Seventy Five Thousand ($75,000) Dollars
Section 9405b of Title 18 requires each hospital licensed pursuant to Chapter 43 of Title 18 to publish and provide to the Commissioner annual hospital community reports in standard format. The purpose of this regulation is to establish the standard format for such reports, as well as the contents.
The purpose of this Bulletin is to clarify the Department's position on the effective dates for specific sections of long-term care regulation H 2009-01. The Commissioner is authorized to issue this Bulletin pursuant to 8 V.S.A. § 15.
Transacting insurance business in Vermont without a certificate of authority or license from the Commissioner of Banking, Insurance, Securities, and Health Care Administration in violation of 8 V.S.A. § 3361 and § 3368. Issuing and delivering certificates of coverage that were not filed with and approved by the Commissioner in violation of 8 V.S.A. § 4062.
Action taken was:
Administrative penalty payment of $100,000.00
Payment of the Department’s costs of $3,663.00
Cease and Desist from entering into any master group policy contract to cover Vermont residents that would require it to have a Vermont certificate of authority or license, unless it holds such license.