The Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES)

VHCURES
The Department of Financial Regulation has a statutory mandate to collect eligibility and claims data for Vermont residents from commercial health insurers and the state Medicaid program through the Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES). The purpose of VHCURES is to be a resource for measuring and improving health care system performance. Regulation H-2008-01 for VHCURES was effective as of September 30, 2008. Historical data submissions start with the incurred date of January 1, 2007 and move forward.
 
Under state law, the definition of health insurer includes third party administrators (TPAs), pharmacy benefit managers (PBMs), any entity conducting administrative services for business, and any other similar entity with claims data, eligibility data, provider files and other information relating to health care provided to Vermont residents.
 
State of Vermont Annual Registration Requirements

Under Vermont laws and regulations, health insurers including TPAs and PBMs providing services to even a single Vermont residents are required to register on an annual basis by December 31 with the State of Vermont. This requirement pertains to comprehensive major medical health benefit plans that may be insured or self-insured, Medicare Supplement, and Medicare Parts C and D. The instructions below this narrative will guide registrants to the on-line registration form hosted by the State’s contractor Onpoint Health Data. All entities must register annually.

Pertaining to TPAs, any person who on behalf of a health insurer or purchaser of health benefits receives or collects charges, contributions or premiums for, or adjusts or settles claims on or for residents of Vermont or Vermont health care providers and facilities shall register with the State of Vermont, both before doing business in Vermont and on an annual basis prior to December 31 thereafter. See 18 V.S.A. §9410 and Regulation H-2008-01, Section 3.

Pertaining to PBMs, before doing business in Vermont and on an annual basis prior to December 31 thereafter, any person or entity that performs pharmacy benefit management (a pharmacy benefit manager or “PBM”) is required to register with the State of Vermont. See 18 V.S.A. § 9421. This would include persons or entities in a contractual or employment relationship with a PBM performing pharmacy benefit management for a health plan. See 18 V.S.A § 9471. 

Data Submission Information

VHCURES Reports

Vermont Insurer Assessments

Under separate programs established by the state legislature and administered by the Agency of Administration, health insurers including TPAs and PBMs providing services to Vermont residents are required to contribute to the Vermont Health Care Information Technology Reinvestment Fund and the Health Care Claims Assessment (Act 45 of the 2011 Vermont legislative session). For further information about the assessments, contact Mylinda Trombley, Financial Manager, Mylinda.Trombley@ahs.state.vt.usor 802-879-5950. 

Claims Data Release

Under Section 8 of VHCURES regulation H-2008-01, researchers can apply for limited use healthcare claims research data sets requiring an application and review process, the approval of the department, and execution of a data use agreement. Acquiring a data extract for approved use under a data use agreement with the department includes a cost for files starting with a base rate of $5,200 and may be more depending on the complexity of the extract and need for technical assistance. Review the VHCURES Warehouse Data Dictionary for specific information about the data elements included in the VHCURES consolidated eligibility and medical and pharmacy claims data set.  For additional information about the data release process and requirements, contact Dian Kahn at dian.kahn@state.vt.us or (802) 828-2906.

The following applications for limited use healthcare claims research data sets to support research and studies have been approved to date:

VHCURES Program Staff

Vermont Department of Financial Regulation
89 Main Street
Montpelier, VT  05620-3101
  • Dian Kahn, Director of Analysis and Data Management
    VHCURES Program Director
    (802) 828-2906 dian.kahn@state.vt.us