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.
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.
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 firstname.lastname@example.org 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: