§ 101. Policy.

It is the policy of the State of Vermont that:

1. Its social and child welfare programs shall provide assistance and benefits to persons of the State in proven need thereof and eligible for such assistance and benefits under the provisions of this title.
2. It is the purpose of its social and child welfare laws to establish and support programs which contribute to the prevention of dependency and social maladjustment and contribute to the rehabilitation and protection of persons of the State.
3. Assistance and benefits shall be administered promptly, with due regard for the preservation of family life, and without restriction of individual rights or discrimination on account of race, religion, political affiliation, or place of residence within the State.
4. Assistance and benefits shall be so administered as to maintain and encourage dignity, self-respect, and self-reliance. It is the legislative intent that assistance granted shall be adequate to maintain a reasonable standard of health and decency based on current cost of living indices. Notwithstanding this subdivision, the Department will amend rules that establish new maximum Reach Up grant amounts only when the General Assembly has taken affirmative action to increase or decrease the Reach Up financial assistance appropriation.
5. The programs of the Department for Children and Families shall be designed to strengthen family life for the care and protection of children; to assist and encourage the use by any family of all available personal and reasonable community resources to this end; and to provide substitute care of children only when the family, with the use of available resources, is unable to provide the necessary care and protection to ensure the right of any child to sound health and to normal physical, mental, spiritual, and moral development.

   Added 1967, No. 147 , § 1; amended 1973, No. 152 (Adj. Sess.), § 10, eff. April 14, 1974; 1975, No. 132 (Adj. Sess.), § 3, eff. Feb. 5, 1976; 2003, No. 122 (Adj. Sess.), § 139a; 2013, No. 131 (Adj. Sess.), § 2, eff. May 20, 2014.

§ 102. Definitions and construction.

1. As used in this chapter:
   1. "Aid" means financial assistance.
   2. "Assistance," when not modified by an adjective, means general assistance or public assistance, or both.
   3. "Benefits" means aid or commodities furnished under chapter 17 of this title.
   4. "Commissioner" means the Commissioner for Children and Families.
   5. "Department" means the Department for Children and Families.
   6. "Federal department" or "federal agency" means a department or agency of the United States of America.
   7. "Guardian" means a legal guardian appointed by a Probate Division of the Superior Court or by a court in a divorce or other proceeding or action.
   8. "Public assistance" means aid provided by the Department under Title IV, XVI, or XIX of the Social Security Act.
   9. "Regulation" means a rule or regulation.
   10. [Repealed.]
   11. "Social Security Act" means the federal Social Security Act and regulations promulgated under the Act, as amended at any time.
2. The laws relating to the Department for Children and Families and its programs shall be construed liberally to carry out the policies stated in this chapter.

   Added 1967, No. 147 , § 1; amended 1973, No. 101 , § 6; 1973, No. 152 (Adj. Sess.), § 11, eff. April 14, 1974; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 68; 2009, No. 154 (Adj. Sess.), § 238a, eff. Feb. 1, 2011; 2009, No. 156 (Adj. Sess.), § I.36; 2013, No. 131 (Adj. Sess.), § 3, eff. May 20, 2014; 2015, No. 23 , § 152; 2021, No. 20 , § 271.

§ 103. Composition of Department.

The Department for Children and Families, created pursuant to 3 V.S.A. §§ 212 and 3084, shall consist of the Commissioner for Children and Families and all divisions, councils, boards, committees, and offices within the Department.

Added 1967, No. 147 , § 1; amended 1973, No. 101 , § 2; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 69; 2013, No. 131 (Adj. Sess.), § 4, eff. May 20, 2014.

§ 104. Function and powers of Department.

1. The Department shall administer all laws specifically assigned to it for administration.
2. In addition to other powers vested in it by law, the Department may do all of the following:
   1. Provide for the administration of the following programs and services:
      1. Aid to the aged, blind, and disabled.
      2. Reach Up financial assistance and support services.
      3. [Repealed.]
      4. Federal Supplemental Nutrition Assistance Program benefits.
      5. General Assistance.
      6. Medical assistance.
      7. Public assistance programs funded with State general funds or the Temporary Assistance to Needy Families (TANF) block grant.
   2. Cooperate with the appropriate federal agencies in receiving, to the extent available, federal funds in support of programs which the Department administers.
   3. Submit plans and reports, adopt rules, and in other respects comply with the provisions of the Social Security Act that pertain to programs administered by the Department.
   4. Receive and disburse funds which are assigned, donated, or bequeathed to it for charitable purposes or for the benefit of recipients of assistance, benefits, or social services. This subdivision shall not be construed to require the Department to accept funds or trusts when the Commissioner, with the approval of the Governor, considers it in the best interests of the State to refuse them.
   5. Receive in trust and expend, in accordance with the provisions of the trust, funds and property assigned, donated, devised, or bequeathed to it for charitable purposes or for the benefit of recipients of assistance, benefits, or social services. Trust funds accepted by the Department shall be safely invested by the State Treasurer. Real property received in trust may, at the discretion of the Commissioner, be administered by the Department of Buildings and General Services of the Agency of Administration. This subdivision shall not be construed to require the Department to accept funds or trusts when the Commissioner, with the approval of the Governor, considers it in the best interests of the State to refuse them.
   6. Aid and assist in charitable work as in the judgment of the Commissioner will best promote the general welfare of the State.
   7. Visit all institutions, homes, places, and establishments soliciting public support and located in the State which are devoted to or used for the care of needy persons.
   8. Visit all institutions, homes, places, and establishments providing room, board, or care to persons receiving social services or benefits from the Department.
   9. Supervise and control children under its care and custody and provide for their care, maintenance, and education.
3. The Department for Children and Families, in cooperation with the Department of Corrections, shall have the responsibility to administer a comprehensive program for youthful offenders and children who commit delinquent acts, including utilization of probation services; of a range of community-based and other treatment, training, and rehabilitation programs; and of secure detention and treatment programs when necessary in the interests of public safety, designed with the objective of preparing those children to live in their communities as productive and mature adults.

   Added 1967, No. 147 , § 1; amended 1973, No. 152 (Adj. Sess.), § 12, eff. April 14, 1974; 1983, No. 147 (Adj. Sess.), § 4(a), eff. April 11, 1984; 2013, No. 131 (Adj. Sess.), § 5, eff. May 20, 2014; 2019, No. 128 (Adj. Sess.), § 3; 2021, No. 20 , § 272.

§ 105. Commissioner; appointment, term, duties, and powers.

1. The Commissioner may exercise the powers and perform duties required for effective administration of the Department, and he or she shall determine the policies of the Department.
2. In addition to other duties imposed by law, the Commissioner shall:
   1. administer the laws assigned to the Department;
   2. fix standards and adopt rules necessary to administer those laws and for the custody and preservation of records of the Department;
   3. appoint all necessary assistants, prescribe their duties, and adopt rules necessary to ensure that the assistants shall hold merit system status while in the employ of the Department, unless otherwise specifically provided by law.
3. The Commissioner or the Governor, whenever the federal law so provides, may cooperate with the federal government in providing relief and work relief and community work and training programs in the State.
4. The Commissioner, with the approval of the Attorney General, may enter into reciprocal agreements with social and child welfare agencies in other states in matters relating to social welfare, children, and families.
5. The Commissioner shall ensure the provision of services to children and adolescents with a severe emotional disturbance in coordination with the Secretary of Education and the Commissioners of Mental Health and of Disabilities, Aging, and Independent Living in accordance with the provisions of chapter 43 of this title.
6. Notwithstanding any other provision of law, the Commissioner may delegate to any appropriate employee of the Department any of the administrative duties and powers imposed on him or her by law, with the exception of the duties and powers enumerated in this section. The delegation of authority and responsibility shall not relieve the Commissioner of accountability for the proper administration of the Department.
7. The Commissioner may publicly disclose findings or information about any case of child abuse or neglect that has resulted in the fatality or near fatality of a child, including information obtained under chapter 49 of this title, unless the State's Attorney or Attorney General who is investigating or prosecuting any matter related to the fatality requests the Commissioner to withhold disclosure, in which case the Commissioner shall not disclose any information until completion of any criminal proceedings related to the fatality or until the State's Attorney or Attorney General consents to disclosure, whichever occurs earlier.

   Added 1967, No. 147 , § 1; amended 1973, No. 101 , § 6; 1983, No. 175 (Adj. Sess.); 2013, No. 131 (Adj. Sess.), § 6, eff. May 20, 2014; 2015, No. 29 , § 11; 2021, No. 20 , § 273.

§ 111. Records; restrictions; penalties.

1. 1. The names of or information pertaining to applicants for or recipients of assistance or benefits, including information obtained under section 112 of this title, shall not be disclosed to anyone, except for the purposes directly connected with the administration of the Department or when required by law. (a) (1)  The names of or information pertaining to applicants for or recipients of assistance or benefits, including information obtained under section 112 of this title, shall not be disclosed to anyone, except for the purposes directly connected with the administration of the Department or when required by law.
   2. Names of or information pertaining to applicants for or recipients of Medicaid shall be subject to the confidentiality provisions set forth in section 1902a of this title.
2. A person shall not publish, use, disclose, or divulge any of those records for purposes not directly connected with the administration of programs of the Department or contrary to rules adopted by the Commissioner.

   Added 1967, No. 147 , § 1; amended 1969, No. 99 ; 1973, No. 152 (Adj. Sess.), § 13, eff. April 14, 1974; 1975, No. 244 (Adj. Sess.), § 1; 2013, No. 131 (Adj. Sess.), § 7, eff. May 20, 2014; 2015, No. 29 , § 12; 2015, No. 172 (Adj. Sess.), § E.306.8; 2021, No. 20 , § 274.

§ 112. Banks and agencies to furnish information.

1. An officer of a financial institution, as described in 8 V.S.A. § 11101(32) , a credit union, or an independent trust company in this State, when requested by the Commissioner, shall furnish the Commissioner information in the possession of the bank or company with reference to any person or his or her spouse who is applying for or is receiving assistance or benefits from the Department.
2. Any governmental official or agency in the State, when requested by the Commissioner, shall furnish him or her information in the official's or agency's possession with reference to aid given or money paid or to be paid to any person or person's spouse who is applying for or is receiving assistance or benefits from the Department.
3. The Commissioner of Taxes, when requested by the Commissioner for Children and Families, and unless otherwise prohibited by federal law, shall compare the information furnished by an applicant or recipient of assistance with the State income tax returns filed by such person and shall report his or her findings to the Commissioner for Children and Families. Each application for assistance shall contain a form of consent, executed by the applicant, granting permission to the Commissioner of Taxes to disclose such information to the Commissioner for Children and Families.

   Added 1967, No. 147 , § 1; amended 1975, No. 244 (Adj. Sess.), § 3; 1999, No. 147 (Adj. Sess.), § 4; 2001, No. 73 (Adj. Sess.), § 6, eff. Feb. 2, 2002; 2005, No. 174 (Adj. Sess.), § 70.

§ 113. Repealed. 2013, No. 131 (Adj. Sess.), § 8, eff. May 20, 2014.

§ 114. Allocation of payments when appropriation insufficient.

Should the funds available for assistance be insufficient to provide assistance to all those eligible, the amounts of assistance granted in any program or portion thereof shall be reduced equitably, in the discretion of the Commissioner for Children and Families or the Commissioner of Vermont Health Access by rule.

Added 1967, No. 147 , § 1; amended 1971, No. 247 (Adj. Sess.), § 1, eff. April 7, 1972; 2005, No. 174 (Adj. Sess.), § 71; 2009, No. 156 (Adj. Sess.), § I.37.

§ 115. Repealed. 2013, No. 131 (Adj. Sess.), § 9, eff. May 20, 2014.

§ 116. State-placed students.

To enable a school district to determine if a student is a State-placed student, as defined in 16 V.S.A. § 11(a)(28) , the Commissioner for Children and Families shall immediately notify the superintendent of schools for the school district educating the student if the parent or parents of a student under the care and custody of the Commissioner move from or into that school district.

Added 2013, No. 131 (Adj. Sess.), § 10, eff. May 20, 2014.

§ 121. Cancellation of assistance or benefits.

If at any time the Commissioner for Children and Families or the Commissioner of Vermont Health Access has reason to believe that assistance or benefits have been improperly obtained, he or she shall cause an investigation to be made and may suspend assistance or benefits pending the investigation. If on investigation the Commissioner for Children and Families or the Commissioner of Vermont Health Access is satisfied that the assistance or benefits were illegally obtained, he or she shall immediately cancel them. A person having illegally obtained assistance or benefits shall not be eligible for reinstatement until his or her need has been reestablished.

Added 1967, No. 147 , § 1; amended 2005, No. 174 (Adj. Sess.), § 72; 2009, No. 156 (Adj. Sess.), § I.38.

§ 122. Recovery of payments.

1. The amount of assistance or benefits may be changed or cancelled at any time if the Commissioner for Children and Families or the Commissioner of Vermont Health Access finds that the recipient's circumstances have changed. Upon granting assistance or benefits the Department for Children and Families or the Department of Vermont Health Access shall inform the recipient that changes in his or her circumstances must be promptly reported to the Department.
2. When on the death of a person receiving assistance it is found that the recipient possessed income or property in excess of that reported to the Department for Children and Families or the Department of Vermont Health Access, up to double the total amount of assistance in excess of that to which the recipient was lawfully entitled may be recovered by the Commissioner for Children and Families or the Commissioner of Vermont Health Access as a preferred claim from the estate of the recipient. The Commissioner for Children and Families or the Commissioner of Vermont Health Access shall calculate the amount of the recovery by applying the legal interest rate to the amount of excess recovery paid, except that the recovery shall be capped at double the excess assistance paid.
3. When the Commissioner for Children and Families or the Commissioner of Vermont Health Access finds that a recipient of benefits received assistance in excess of that to which the recipient was lawfully entitled, because the recipient possessed income or property in excess of Department standards, the Commissioner for Children and Families or the Commissioner of Vermont Health Access may take actions to recover the overpayment.
4. In the event of recovery, an amount may be retained by the Commissioner for Children and Families or the Commissioner of Vermont Health Access in a special fund for use in offsetting program expenses and an amount equivalent to the pro rata share to which the United States of America is equitably entitled shall be paid promptly to the appropriate federal agency.

   Added 1967, No. 147 , § 1; 1997, No. 155 (Adj. Sess.), § 20; amended 2005, No. 174 (Adj. Sess.), § 73; 2009, No. 156 (Adj. Sess.), § I.39.

§ 123. Guardian or legal representative.

1. If the Commissioner finds that an applicant for or recipient of assistance is incapable of taking care of himself or herself or his or her business affairs, the Commissioner may direct the payment of the assistance to a guardian appointed by the Probate Division of the Superior Court.
2. If the Commissioner finds that an applicant for or recipient of assistance is incapable of prudently attending to his or her business affairs, the Commissioner may direct the payment of the assistance to the legal representative of the person appointed by the Probate Division of the Superior Court.

   Added 1967, No. 147 , § 1; amended 2009, No. 154 (Adj. Sess.), § 238a, eff. Feb. 1, 2011.

§ 124. Inalienability of assistance payments.

All rights to, and all monies or orders granted to persons as assistance shall be inalienable by assignment, transfer, attachment, trustee process, execution, or otherwise. In case of bankruptcy the assistance shall not pass to or through a trustee or other person acting on behalf of creditors.

Added 1967, No. 147 , § 1.

§ 131. Repealed. 1995, No. 158 (Adj. Sess.), § 4, eff. May 10, 1996.

§ 132. Repealed. 2013, No. 131 (Adj. Sess.), § 11, eff. May 20, 2014.

§ 141. Fraud.

1. A person who knowingly fails, by false statement, misrepresentation, impersonation, or other fraudulent means, to disclose a material fact used to determine whether that person is qualified to receive aid or benefits under a State or federally funded assistance program; or who knowingly fails to disclose a change in circumstances in order to obtain or continue to receive aid or benefits to which he or she is not entitled or in an amount larger than that to which he or she is entitled; or who knowingly aids and abets another person in the commission of any such act shall be punished as provided in section 143 of this title.
2. A person who knowingly uses, transfers, acquires, traffics, alters, forges, or possesses; or who knowingly attempts to use, transfer, acquire, traffic, alter, forge, or possess; or who knowingly aids and abets another person in the use, transfer, acquisition, traffic, alteration, forgery, or possession of a Supplemental Nutrition Assistance Program benefit card, authorization for the purchase of Supplemental Nutrition Assistance Program benefits, certificate of eligibility for medical services, or State health care program identification card in a manner not authorized by law shall be punished as provided in section 143 of this title.
3. A person who administers a State or federally funded assistance program who fraudulently misappropriates, attempts to misappropriate, or aids and abets in the misappropriation of a Supplemental Nutrition Assistance Program benefit, authorization for Supplemental Nutrition Assistance Program benefits, a Supplemental Nutrition Assistance Program benefit identification card, certificate of eligibility for prescribed medicine, State health care program identification card, or assistance from any other State or federally funded program with which he or she has been entrusted or of which he or she has gained possession by virtue of his or her position; or who knowingly misappropriates, attempts to misappropriate, or aids or abets in the misappropriation of funds given in exchange for Supplemental Nutrition Assistance Program benefits shall be punished as provided in section 143 of this title.
4. A person who knowingly files, attempts to file, or aids and abets in the filing of a claim for services to a recipient of benefits under a State or federally funded assistance program for services which were not rendered; or who knowingly files a false claim or a claim for unauthorized items or services under such a program; or who knowingly bills the recipient of benefits under such a program or his or her family for an amount in excess of that provided for by law or regulation; or who knowingly fails to credit the State or its agent for payments received from Social Security, insurance, or other sources; or who in any way knowingly receives, attempts to receive, or aids and abets in the receipt of unauthorized payment as provided herein shall be punished as provided in section 143 of this title.
5. A person providing service for which compensation is paid under a State or federally funded assistance program who requests, and receives, either actually or constructively, any payment or contribution through a payment, assessment, gift, devise, bequest, or other means, whether directly or indirectly, from either a recipient of assistance from the assistance program or from the family of the recipient shall notify the Commissioner for Children and Families or the Commissioner of Vermont Health Access, on a form provided by him or her, of the amount of the payment or contribution and of such other information as specified by the Commissioner for Children and Families or the Commissioner of Vermont Health Access within 10 days after the receipt of the payment or contribution or, if the payment or contribution is to become effective at some time in the future, within 10 days of the consummation of the agreement to make the payment or contribution. Failure to notify the Commissioner for Children and Families or the Commissioner of Vermont Health Access within the time prescribed is punishable as provided in section 143 of this title.
6. Repayment of assistance or services wrongfully obtained shall not constitute a defense to or ground for dismissal of criminal charges brought under this section.

   Added 1967, No. 147 , § 1; amended 1973, No. 49 ; 1977, No. 206 (Adj. Sess.), § 1; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 74; 2009, No. 156 (Adj. Sess.), § I.40; 2013, No. 131 (Adj. Sess.), § 12, eff. May 20, 2014.

§ 142. Bringing needy person into the State.

1. Any person who knowingly brings or causes to be brought, a needy person from out of the state into this State for the purpose of securing assistance for the needy person or making him or her a public charge, shall be obligated to support the needy person at his or her own expense as long as the needy person or persons dependent on the needy person remain in the State.
2. The Commissioner may bring a civil action on this statute to enforce support of the needy person and his or her dependents.  In the action the court may make an order, which shall be subject to change by the court from time to time as the circumstances require, directing the defendant to pay a certain sum periodically to the Department for the benefit of the needy person and his or her dependents residing in the State.  The court may punish for violation of the order as for contempt.

   Added 1967, No. 147 , § 1.

§ 143. General penalty.

1. A person who knowingly violates a provision of this title for which no penalty is specifically provided shall:
   1. if the assistance or benefits obtained pursuant to a single fraudulent scheme or a course of conduct are in violation of subsection 141(a) or (b) of this title involving $1,000.00 or less, be fined not more than the amount of assistance or benefits wrongfully obtained or be imprisoned not more than one year, or both;
   2. if the assistance or benefits obtained pursuant to a single fraudulent scheme or course of conduct are in violation of subsection (a) or (b) of section 141 of this title and involve more than $1,000.00, be fined not more than an amount equal to the assistance or benefits wrongfully obtained or be imprisoned not more than three years, or both; or
   3. if the violation is under subsection (c), (d), or (e) of section 141 of this title, be fined up to $1,000.00 or up to an amount equal to twice the amount of assistance, benefits, or payments wrongfully obtained or be imprisoned for not more than 10 years, or both.
2. If the person convicted is receiving assistance, benefits, or payments, the Commissioner for Children and Families or the Commissioner of Vermont Health Access may recoup the amount of assistance or benefits wrongfully obtained by reducing the assistance, benefits, or payments periodically paid to the recipient, as limited by federal law, until the amount is fully recovered.
3. If a provider of services is convicted of a violation of subsection 141(d) or (e) of this title, the Commissioner of Vermont Health Access shall, within 90 days of the conviction, suspend the provider from further participation in the medical assistance program administered under Title XIX of the Social Security Act for a period of four years. The suspension required by this subsection may be waived by the Secretary of Human Services only upon a finding that the recipients served by the convicted provider would suffer substantial hardship through a denial of medical services that could not reasonably be obtained through another provider.

   Added 1967, No. 147 , § 1; amended 1977, No. 206 (Adj. Sess.), § 2; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 75; 2009, No. 156 (Adj. Sess.), § I.41; 2021, No. 20 , § 275.

§ 143a. Civil remedies.

1. A person who violates subsection 141(c), (d), or (e) of this title with actual knowledge may be subject to a civil suit by the Attorney General for:
   1. restitution of the amount of assistance, benefits, or payments wrongfully obtained;
   2. interest; and
   3. a civil penalty of up to three times the amount of the wrongfully obtained assistance, benefits, or payments; or $500.00 per false claim; or $500.00 for each false document submitted in support of a false claim, whichever is greatest.
2. The remedies provided in this section shall be in addition to any other remedies provided by law.
3. The right to a jury trial shall attach to actions under this section.

   Added 2003, No. 147 (Adj. Sess.), § 1.

§ 143b. Education and information.

Within six months of the effective date of section 143a of this title, the Department of Vermont Health Access shall issue rules establishing a procedure for health care providers enrolled in State and federally funded medical assistance programs to obtain advisory opinions regarding coverage and reimbursement under those programs. Each advisory opinion issued by the Department of Vermont Health Access shall be binding on that Department and the party or parties requesting the opinion only with regard to the specific questions posed in the opinion, the facts and information set forth in it, and the statutes and rules specifically noted in the opinion.

Added 2003, No. 147 (Adj. Sess.), § 2; amended 2005, No. 174 (Adj. Sess.), § 76; 2009, No. 33 , § 65; 2009, No. 156 (Adj. Sess.), § I.42.

§ 144. Statutory construction.

1. Section 143 of this title shall not preclude prosecution under 13 V.S.A. § 1801 , 1802, or 2002 when the alleged violation involves forging an economic assistance check or where duplicate economic assistance checks have been wrongfully negotiated during any one welfare period.
2. Section 143 of this title shall not preclude prosecution under any other title or sections of this title when the alleged violation is under subsection 141(c) or (d) of this title.

   Added 1977, No. 206 (Adj. Sess.), § 3; amended 2021, No. 20 , § 276.

§ 151. Licensing and registration; violations.

This subchapter shall apply to all licenses, registrations, and applications for licenses and registrations which the Commissioner or the Department may issue or grant, unless otherwise specifically provided.

1. The Commissioner shall adopt rules governing applications for and issuance, revocation, term, and renewal of licenses and registrations. In the rules, the Commissioner may prescribe standards and conditions to be met, records to be kept, and reports to be filed. Licenses and registration shall be for a term of one year from issuance unless otherwise prescribed by rule.
2. Premises covered by a license or registration may be visited and inspected by the Department at reasonable hours. A person who accepts a license or registration shall permit visits and inspections and examinations of the records he or she is required to keep.
3. A license or registration may be revoked for cause after hearing and may be suspended in situations which immediately imperil the health, safety, or well-being of persons in the care of the licensee or registrant.
4. Before a license is granted, the Department shall visit and inspect the premises for which the license is requested and make further inquiry and investigation as the Commissioner may direct. Before a family child care home registration is granted, the Department shall make inquiry and investigation. Inquiry and investigation may include a visit to and inspection of the premises for which the registration is requested. Further inquiry and investigation may be made as the Commissioner may direct.
5. Whenever the Attorney General has reason to believe that a facility required by the Commissioner to be licensed or registered is being operated without such license or registration, the Attorney General may bring an action for equitable relief in the name of the State against the operator of such facility to restrain such operation. The action may be brought in the Superior Court of the county in which the facility is located. The Court is authorized to grant equitable relief to restrain and prevent such operation.
6. Any person who violates the terms of an injunction or restraining order issued under subdivision (5) of this section shall forfeit and pay to the State a civil penalty of not more than $100.00 for each violation. In such cases, the Attorney General acting in the name of the State may petition for recovery of such civil penalty.
7. Whenever the Department determines that a licensed child care facility or registered family child care home has violated a health or safety rule, the facility or home shall post the Department's notice of violation in a conspicuous place in the facility or home. In the case of a serious violation, as defined by the Department by rule, the facility or home shall also notify by mail a person responsible for the welfare of each child attending that facility or home. A serious violation shall include violation of group size and staffing requirements and any violation involving a situation which immediately imperils the health, safety, or well-being of persons in the care of the licensee or registrant.

   Added 2013, No. 131 (Adj. Sess.), § 13, eff. May 20, 2014; amended 2021, No. 20 , § 277.

§ 152. Access to records.

1. The Commissioner may obtain from the Vermont Crime Information Center the record of convictions of any person to the extent required by law or the Commissioner has determined by rule that such information is necessary to regulate a facility or individual subject to regulation by the Department or to carry out the Department's child protection obligations under chapters 49-59 of this title. The Commissioner shall first notify the person whose record is being requested.
2. The owner or operator of a facility licensed or registered by the Department may ask the Commissioner for the record of convictions and the record of substantiated reports of child abuse of a current employee or a person to whom the owner or operator has given a conditional offer of employment. The request shall be in writing and shall be accompanied by a release signed by the current or prospective employee. The owner or operator shall inform the current or prospective employee that he or she has the right to appeal the accuracy and completeness of the record. Upon receiving a request under this subsection, the Commissioner shall ask the Vermont Crime Information Center for the record of convictions of the current or prospective employee.
3. If the person has a record of convictions, the Commissioner shall provide the owner or operator with a copy of the record. If the person has a record of substantiated reports of child abuse, the Commissioner shall inform the requesting owner or operator that such record exists.
4. Information released to an owner or operator under this section shall not be released or disclosed by the owner or operator to any other person. Release or disclosure of such information by an owner or operator may result in the loss of the license or registration.
5. As used in this section:
   1. "Commissioner" means the Commissioner for Children and Families or the Commissioner's designee.
   2. "Employee" shall include volunteers.
   3. "Substantiated reports of child abuse" means reports of child abuse substantiated under section 4915 of this title.
   4. "Volunteer" means an individual who, without compensation, provides services through a public or private organization.

      Added 2013, No. 131 (Adj. Sess.), § 13, eff. May 20, 2014; amended 2015, No. 60 , § 12.

§§ 301-307. Repealed. 2013, No. 131 (Adj. Sess.), § 14, eff. May 20, 2014.

§ 308. Repealed. 2009, No. 135 (Adj. Sess.), § 26(17)(A).

§§ 309-311. Repealed. 2013, No. 131 (Adj. Sess.), § 14, eff. May 20, 2014.

§§ 321-324. Repealed. 2013, No. 131 (Adj. Sess.), § 14, eff. May 20, 2014.

§ 401. Composition of Department.

The Department of Vermont Health Access, created under 3 V.S.A. § 3088 , shall consist of the Commissioner of Vermont Health Access, the Medical Director, and all divisions within the Department, including the Divisions of Managed Care; Health Reform; the Vermont Health Benefit Exchange; and Medicaid Policy, Fiscal, and Support Services.

Added 2009, No. 156 (Adj. Sess.), § I.79; amended 2011, No. 48 , § 5; 2011, No. 171 (Adj. Sess.), § 36, eff. May 16, 2012.

§ 402. Medicaid and Exchange Advisory Committee.

1. A Medicaid and Exchange Advisory Committee is created for the purpose of advising the Commissioner of Vermont Health Access with respect to policy development and program administration for the Vermont Health Benefit Exchange, Medicaid, and Medicaid-funded programs, consistent with the requirements of federal law.
2. 1. The Commissioner of Vermont Health Access shall appoint members of the Advisory Committee established by this section, who shall serve staggered three-year terms. The total membership of the Advisory Committee shall be at least 22 members. The Commissioner may remove members of the Committee who fail to attend three consecutive meetings and may appoint replacements. The Commissioner may reappoint members to serve more than one term. (b) (1)  The Commissioner of Vermont Health Access shall appoint members of the Advisory Committee established by this section, who shall serve staggered three-year terms. The total membership of the Advisory Committee shall be at least 22 members. The Commissioner may remove members of the Committee who fail to attend three consecutive meetings and may appoint replacements. The Commissioner may reappoint members to serve more than one term.
   2. 1. The Commissioner of Vermont Health Access shall appoint one representative of health insurers licensed to do business in Vermont to serve on the Advisory Committee. The Commissioner of Health shall also serve on the Advisory Committee. (2) (A) The Commissioner of Vermont Health Access shall appoint one representative of health insurers licensed to do business in Vermont to serve on the Advisory Committee. The Commissioner of Health shall also serve on the Advisory Committee.
      2. Of the remaining members of the Advisory Committee, one-quarter of the members shall be from each of the following constituencies:
         1. beneficiaries of Medicaid or Medicaid-funded programs;
         2. individuals, self-employed individuals, health insurance brokers and agents, and representatives of businesses eligible for or enrolled in the Vermont Health Benefit Exchange;
         3. advocates for consumer organizations; and
         4. health care professionals and representatives from a broad range of health care professionals.
   3. Members whose participation is not supported through their employment or association shall receive per diem compensation pursuant to 32 V.S.A. § 1010 and reimbursement of travel expenses. In addition, members who are eligible for Medicaid or who are enrolled in a qualified health benefit plan in the Vermont Health Benefit Exchange and whose income does not exceed 300 percent of the federal poverty level shall also receive reimbursement of expenses, including costs of child care, personal assistance services, and any other service necessary for participation in the Advisory Committee and approved by the Commissioner.
3. 1. The Advisory Committee shall have an opportunity to review and comment on Agency policy initiatives pertaining to quality improvement initiatives and to health care benefits and eligibility for individuals receiving services through Medicaid, programs funded with Medicaid funds under a Section 1115 waiver, or the Vermont Health Benefit Exchange. It also shall have the opportunity to comment on proposed rules prior to commencement of the rulemaking process pursuant to 3 V.S.A. chapter 25 and on waiver or waiver amendment applications prior to submission to the Centers for Medicare and Medicaid Services. (c) (1)  The Advisory Committee shall have an opportunity to review and comment on Agency policy initiatives pertaining to quality improvement initiatives and to health care benefits and eligibility for individuals receiving services through Medicaid, programs funded with Medicaid funds under a Section 1115 waiver, or the Vermont Health Benefit Exchange. It also shall have the opportunity to comment on proposed rules prior to commencement of the rulemaking process pursuant to 3 V.S.A. chapter 25 and on waiver or waiver amendment applications prior to submission to the Centers for Medicare and Medicaid Services.
   2. Prior to the annual budget development process, the Department of Vermont Health Access shall engage the Advisory Committee in setting priorities, including consideration of scope of benefits, beneficiary eligibility, health care professional reimbursement rates, funding outlook, financing options, and possible budget recommendations.
4. 1. The Advisory Committee shall make policy recommendations on proposals of the Department of Vermont Health Access to the Department, the Green Mountain Care Board, the Health Reform Oversight Committee, the Senate Committee on Health and Welfare, and the House Committees on Health Care and on Human Services. When the General Assembly is not in session, the Commissioner shall respond in writing to these recommendations, a copy of which shall be provided to the members of each of the legislative committees of jurisdiction and to the Green Mountain Care Board. (d) (1)  The Advisory Committee shall make policy recommendations on proposals of the Department of Vermont Health Access to the Department, the Green Mountain Care Board, the Health Reform Oversight Committee, the Senate Committee on Health and Welfare, and the House Committees on Health Care and on Human Services. When the General Assembly is not in session, the Commissioner shall respond in writing to these recommendations, a copy of which shall be provided to the members of each of the legislative committees of jurisdiction and to the Green Mountain Care Board.
   2. During the legislative session, the Commissioner shall provide the Advisory Committee at regularly scheduled meetings with updates on the status of policy and budget proposals.
5. The Commissioner shall convene the Advisory Committee at least 10 times during each calendar year. If at least one-third of the members of the Advisory Committee so choose, the members may convene up to four additional meetings per calendar year on their own initiative by sending a request to the Commissioner. The Department shall provide the Committee with staffing and independent technical assistance as needed to enable it to make effective recommendations.
6. A majority of the members of the Committee shall constitute a quorum, and all action shall be taken upon a majority vote of the members present and voting.

   Added 2011, No. 48 , § 7, eff. July 1, 2012; amended 2011, No. 171 (Adj. Sess.), §§ 35b, 41c; 2021, No. 20 , § 278.

§ 403. Financial institutions to furnish information.

1. As used in this section:
   1. "Bank" shall have the same meaning as in 8 V.S.A. § 11101 .
   2. "Broker-dealer" shall have the same meaning as in 9 V.S.A. § 5102 .
   3. "Credit union" shall have the same meaning as in 8 V.S.A. § 30101 .
   4. "Financial institution" means any financial services provider, including a bank, credit union, broker-dealer, investment advisor, mutual fund, or investment company.
   5. "Investment advisor" shall have the same meaning as in 9 V.S.A. § 5102 .
   6. "Mutual fund" shall have the same meaning as in 8 V.S.A. § 3461 .
2. A financial institution, when requested by the Commissioner of Vermont Health Access, shall furnish to the Commissioner or to an agent of the Department of Vermont Health Access information in the possession of the financial institution with reference to any person or his or her spouse who is applying for or is receiving assistance or benefits from the Department of Vermont Health Access. The Department of Vermont Health Access shall issue instructions to the financial institution detailing the nature of the request and the information necessary to satisfy the request.
3. A financial institution shall not be subject to criminal or civil liability for actions taken in accordance with subsection (b) of this section.

   Added 2017, No. 210 (Adj. Sess.), § 6, eff. June 1, 2018.

§ 404. State agencies to furnish information.

1. Any governmental official or agency in the State, when requested by the Department of Vermont Health Access, shall furnish to the Department information in the official's or agency's possession with reference to aid given or money paid or to be paid to any person or person's spouse who is applying for or is receiving assistance or benefits from the Department of Vermont Health Access.
2. The Commissioner of Taxes, when requested by the Commissioner of Vermont Health Access, and unless otherwise prohibited by federal law, shall compare the information furnished by an applicant or recipient of assistance with the State income tax returns filed by such person and shall report his or her findings to the Commissioner of Vermont Health Access. Each application for assistance shall contain a form of consent, executed by the applicant, granting permission to the Commissioner of Taxes to disclose such information to the Commissioner of Vermont Health Access.
3. On the first day of each month, each unit of the Superior Court shall provide to the Commissioner of Vermont Health Access a list of all estates, including testate, intestate, and small estates, opened during the previous calendar month within the jurisdiction of that unit's Probate Division. The list shall contain the following information for each estate:
   1. the decedent's full name;
   2. the decedent's date of birth;
   3. the decedent's date of death;
   4. the docket number;
   5. the date on which the estate was opened; and
   6. the full name and contact information for the executor or administrator or his or her legal representative.

      Added 2017, No. 210 (Adj. Sess.), § 8, eff. June 1, 2018.

§ 501. Disabilities, aging, and independent living policy.

1. It is the policy of the State of Vermont that all older Vermonters and Vermonters with disabilities should:
   1. be able to live as independently as they choose and as their personal circumstances permit;
   2. be able to receive services and benefits which they need and to which they are entitled by law;
   3. be able to be full and active participants in the life of their communities, including competitive employment consistent with their abilities and interests; and
   4. be protected against unlawful and unnecessary restriction.
2. The programs of the Department of Disabilities, Aging, and Independent Living shall be administered in a manner consistent with this policy.
3. The laws pertaining to the Department of Disabilities, Aging, and Independent Living and its programs shall be construed liberally to carry out the policies stated in this section.

   Added 1989, No. 219 (Adj. Sess.), § 3; amended 2005, No. 174 (Adj. Sess.), § 79.

§ 502. Definitions.

As used in this chapter:

1. "Adult foster care" means provision of 24-hour home care services for one or two adult persons with a disability in the residence of the person providing the home care services.
2. "Americans with Disabilities Act" means the federal Americans with Disabilities Act of 1990 and regulations promulgated under the Act, as amended at any time.
3. "Commissioner" means the Commissioner of Disabilities, Aging, and Independent Living.
4. "Department" means the Department of Disabilities, Aging, and Independent Living.
5. "Home care services" include room, board, safety services, household services, and any specialized services to meet the unique needs of the individual.
6. "Older Americans Act" means the federal Older Americans Act of 1965 and regulations promulgated under the Act, as amended at any time.
7. "Older persons" means individuals who have attained the age of 60 years.
8. "Persons with disabilities" means individual Vermonters who have functional limitations by virtue of physical, psychiatric, cognitive, or psychological conditions.
9. "Rehabilitation Act" means the federal Rehabilitation Act of 1973 and regulations promulgated under the Act, as amended at any time.
10. "Social Security Act" means the federal Social Security Act and regulations promulgated under the Act, as amended at any time.

    Added 1989, No. 219 (Adj. Sess.), § 3; amended 2005, No. 174 (Adj. Sess.), § 79; 2007, No. 37 , § 1; 2013, No. 131 (Adj. Sess.), § 16, eff. May 20, 2014; 2021, No. 20 , § 279.

§ 503. Composition of Department.

The Department, created pursuant to 3 V.S.A. § 3085a , shall consist of the Commissioner of Disabilities, Aging, and Independent Living, the Advisory Board established under section 505 of this title, and all divisions and units of the Department, including the Division for the Blind and Visually Impaired and the Division of Vocational Rehabilitation.

Added 1989, No. 219 (Adj. Sess.), § 3; amended 2005, No. 174 (Adj. Sess.), § 79.

§ 504. Duties of Department.

1. The Department shall administer all laws and programs specifically assigned to it for administration, including:
   1. Federally funded services for older persons in accordance with the Older Americans Act.
   2. Federally funded vocational rehabilitation and independent living services for persons with disabilities in accordance with the Rehabilitation Act. The Division of Vocational Rehabilitation may contract with clients at up to $51.00 per year per employee, or may charge up to $70.00 per hour, for services rendered by the Employee Assistance Program. The Division shall charge $160.00 for each injured worker screening defined in the Department of Labor rules. For activities outside the scope of services funded by the Federal Assistive Technology Act, the Division may charge up to $100.00 per hour for assistive technology services rendered, including assistive technology consultations, assistive technology evaluations, individual assistive technology training, and assistive technology topic training. The Division may charge fees at the rate of up to $100.00 per month for specialized assistive technology equipment leasing. The Division may charge these fees to service providers, State agencies, schools, and individuals. The Division shall continue to provide the following services at no charge: information and assistance, State financing activities, equipment demonstration, short-term device loans, public outreach, technical assistance, and equipment reutilization. Fees shall be retained by the Division.
   3. Federally required survey and certification of health care facilities participating in Medicare or Medicaid, as provided by Titles XVIII and XIX of the Social Security Act.
   4. Special services, including vocational rehabilitation, for Vermonters who are blind or have a visual impairment, and for Vermonters who are deaf or hard of hearing.
   5. The duties, responsibilities, and authority of the Division of Licensing and Protection pertaining to level IV facilities presently granted under the authority of chapter 71 of this title and any other provision of law.
   6. All of the duties, responsibilities, and authority of the Division of Licensing and Protection to level I and level II nursing homes and level III residential care homes, hospitals, and home health services granted under the authority of chapter 71 of this title and any other provision of law.
   7. The duties, responsibilities, and authority of the former Developmental Services Division of the former Department of Developmental and Mental Health Services, and the personal care and hi-tech programs in the former Department of Prevention, Assistance, Transition, and Health Access.
2. The Department shall ensure coordination of government and private services directed at providing assistance to and analyzing issues affecting older persons and persons with disabilities.
3. In addition to the powers vested in it by law, the Department may:
   1. cooperate with, and contract with, with the approval of the Governor, the federal government and appropriate federal agencies which fund programs which the Department administers;
   2. notwithstanding the provisions of 3 V.S.A. chapter 13, enter into an agreement with the University of Vermont and State Agricultural College to continue the Rural and Farm Family Rehabilitation Program; and
   3. take and hold in trust for the State any grant or devise of land or donation or bequest of money, or other personal property, to be applied to the maintenance of persons with developmental disabilities.

      Added 1989, No. 219 (Adj. Sess.), § 3; amended 1995, No. 47 , § 16, eff. April 20, 1995; 2005, No. 174 (Adj. Sess.), §§ 79, 79a; 2007, No. 76 , § 22a; 2011, No. 128 (Adj. Sess.), § 8; 2013, No. 96 (Adj. Sess.), § 200.

§ 505. Advisory Board.

1. An advisory board to the Department is created for the purpose of advising the Commissioner with respect to programs and issues affecting older persons and persons with disabilities.
2. The Board shall be composed of no fewer than 19 and no more than 24 members appointed by the Governor for terms of three years.  Of these members, no fewer than 14 shall be individuals who are older persons or persons with disabilities, of which at least seven shall be selected for their familiarity with and interest in programs and issues affecting the interests of older persons, and seven shall be selected for their familiarity with and interest in programs and issues affecting the interests of persons with disabilities.  Five members shall be selected to represent the interests of each of the five regions of the State.  Persons who are paid providers of services to older persons and persons with disabilities shall not be appointed except as representatives of one of the five regions of the State or because they otherwise qualify for membership.  The Advisory Board and Commissioner shall seek the advice and recommendations of paid service providers on an organized and regular basis.
3. The Governor shall designate the chair of the Board.
4. Members shall not be entitled to compensation but shall be reimbursed for actual and necessary expenses incurred in connection with their duties as members of the Board.
5. A vacancy shall be filled in the manner provided for the original appointment for the unexpired portion of that term.
6. The Board shall advise the Commissioner on matters related to the interests of older persons and persons with disabilities. It shall be guided generally by reference to the statements of objectives and policy found in the Older Americans Act and the Americans with Disabilities Act.
7. The Board may establish committees to facilitate its work and to ensure it pays adequate and appropriate attention to the range of issues for which the Department is responsible.  The Board may also create ad hoc committees to address discrete issues as they arise.
8. The Commissioner shall ensure that the Advisory Board and its committees receive sufficient staff support to meet their responsibilities.

   Added 1989, No. 219 (Adj. Sess.), § 3.

§ 601. Center for the Prevention and Treatment of Sexual Abuse.

1. There is established within the Agency of Human Services the Vermont Center for the Prevention and Treatment of Sexual Abuse (the Center).  The Center shall be jointly overseen by the Commissioner of Corrections and the Commissioner for Children and Families.
2. The purpose of the Center shall be to protect Vermont's citizens from sexual assault and child sexual abuse.  The Center shall oversee Vermont's systematic response to sexual assault and child sexual abuse, while recognizing that many agencies, organizations, and individuals have their own independent roles and responsibilities within this system.
3. The responsibilities of the Center shall include:
   1. coordinating sex offender treatment programs in correctional and juvenile institutions and in the community;
   2. coordinating victim and family treatment programs;
   3. providing support to sexual abuse prevention programs statewide and in local communities;
   4. providing training to recognize and prevent sexual abuse in consultation with the Department of Corrections, the Department for Children and Families, the Department of Mental Health, the Department of State's Attorneys and Sheriffs, and other agencies, organizations, and individuals as are desirable and necessary;
   5. providing a central organization for the acquisition and dissemination of information regarding best practices for the prevention of sexual violence; the treatment and supervision of adult and juvenile offenders; the provision of victims services; judicial practices conducive to public protection and the supervision of offenders; protocols for coordinated investigations of allegations of child sexual abuse; and any other information that may be beneficial in aiding Vermont's response to sexual abuse;
   6. making available an array of services to sexually abused children and their family members; and
   7. providing grants to community agencies to further the Center's purpose of protecting Vermont's citizens from sexual assault and child sexual abuse.
4. The Commissioner of Corrections and the Commissioner for Children and Families shall be responsible for maintaining and providing staffing for the center.

   Added 2009, No. 1 , § 12, eff. March 4, 2009; amended 2011, No. 139 (Adj. Sess.), § 37, eff. May 14, 2012.

§§ 701-708a. Repealed. 2013, No. 131 (Adj. Sess.), § 17, eff. May 20, 2014.

§§ 801-805. Repealed. 2013, No. 131 (Adj. Sess.), § 17, eff. May 20, 2014.

§ 806. Repealed. 2009, No. 135 (Adj.. Sess.), § 26(17)(B).

§§ 807-812. Repealed. 2013, No. 131 (Adj. Sess.), § 17, eff. May 20, 2014.

§ 900. Definitions.

Unless otherwise required by the context, the words and phrases in this chapter shall be defined as follows:

1. "Agency" means the Agency of Human Services.
2. "Director" means the Director of Rate Setting.
3. "Division" means the Division of Rate Setting.
4. "Provider" means any entity, excluding a hospital or a physician, providing services to State-assisted persons pursuant to a contract or other form of agreement with the State.
5. "Secretary" means the Secretary of Human Services.
6. "State-assisted" means a person eligible for or receiving benefits administered by or in coordination with the Agency.

   Added 1995, No. 160 (Adj. Sess.), § 9; amended 1997, No. 61 , § 268; 2007, No. 172 (Adj. Sess.), § 9; 2013, No. 131 (Adj. Sess.), § 18, eff. May 20, 2014.

§ 901. Reimbursement objectives.

Reimbursement rates for nursing homes shall reflect the following objectives:

1. maintain an equitable and fair balance between cost containment and quality care in nursing homes;
2. encourage nursing homes to admit persons without regard to their source of payment;
3. provide an incentive to nursing homes to admit and provide care to persons in need of comparatively greater care;
4. be manageable administratively for both the State and nursing homes; and
5. prevent unnecessary cost increases.

   Added 1989, No. 267 (Adj. Sess.), § 1, eff. July 1, 1991; amended 1995, No. 160 (Adj. Sess.), § 10.

§ 902. Division of Rate Setting, Director.

1. There is hereby created in the Agency of Human Services a Division of Rate Setting which shall provide the Agency of Human Services with special financial, accounting, auditing, and related legal expertise for the purpose of rate setting and such other duties as the Secretary shall direct.
2. The Division shall be headed by a director who shall report to the Secretary of the Agency or the Secretary's designee.
3. [Repealed.]

   Added 1977, No. 204 (Adj. Sess.), § 1; amended 1995, No. 160 (Adj. Sess.), § 11; 1997, No. 61 , §§ 269, 271(b); 2005, No. 174 (Adj. Sess.), § 80; 2007, No. 172 (Adj. Sess.), § 9a.

§ 903. Division, staff.

The Director, with the approval of the Secretary, may employ such professional and clerical personnel as are necessary for the implementation of this chapter. The Director, with the approval of the Secretary, may also enter into contracts with attorneys, private auditors, consultants, and registered or certified public accountants for additional services including auditing providers as may be necessary for the proper administration of this chapter.

Added 1977, No. 204 (Adj. Sess.), § 1; amended 1997, No. 61 , § 270.

§ 904. Rate setting.

1. The Director shall establish by rule procedures for determining payment rates for care of State-assisted persons to nursing homes and to such other providers as the Secretary shall direct. The Secretary shall have the authority to establish rates that the Secretary deems sufficient to ensure that the quality standards prescribed by section 7117 of this title are maintained, subject to the provisions of section 906 of this title. Beginning in State fiscal year 2003, the Medicaid budget for care of State-assisted persons in nursing homes shall employ an annual inflation factor that is reasonable and that adequately reflects economic conditions, in accordance with the provisions of Section 5.8 of the rules adopted by the Division of Rate Setting (Methods, Standards, and Principles for Establishing Medicaid Payment Rates for Long-Term Care Facilities).
2. No payment shall be made to any nursing home, on account of any State-assisted person, unless the nursing home is certified to participate in the State/federal medical assistance program and has in effect a provider agreement.

   Added 1977, No. 204 (Adj. Sess.), § 1; amended 1981, No. 224 (Adj. Sess.), § 1, eff. May 4, 1982; 1989, No. 267 (Adj. Sess.), § 2, eff. July 1, 1991; 1995, No. 160 (Adj. Sess.), § 12; 1997, No. 61 , § 270a; 2001, No. 63 , § 99; 2013, No. 131 (Adj. Sess.), § 19, eff. May 20, 2014; 2021, No. 20 , § 280.

§ 905. Basis for determination of nursing home rates.

1. 1. Consistent with the objectives established under section 901 of this title, the Division shall develop a payment system based on cost categories established for each nursing home. The system shall include no fewer than the following three cost categories: (a) (1)  Consistent with the objectives established under section 901 of this title, the Division shall develop a payment system based on cost categories established for each nursing home. The system shall include no fewer than the following three cost categories:
      1. direct care costs, which refer, at a minimum, to nursing salaries and nursing assistant wages, fringe benefits, and payroll taxes associated therewith;
      2. indirect costs, which refer to all operating costs not established under subdivision (1) of this subdivision; and
      3. property and related costs.
   2. At the discretion of the Director, the cost categories referred to in subdivision (1) of this subsection may be subdivided. Facilities may also be divided into groups, based on considerations such as size or other appropriate determinants within each cost category or subdivision thereof.
2. 1. The basis for reimbursement within the direct care cost category shall be a resident classification system, which shall group residents into classes according to similarity of their assessed condition and required services.  Each resident shall be assigned to one of no fewer than three classes, based on the nature and extent of nursing care needed.  The Director may subdivide these classes. (b) (1)  The basis for reimbursement within the direct care cost category shall be a resident classification system, which shall group residents into classes according to similarity of their assessed condition and required services.  Each resident shall be assigned to one of no fewer than three classes, based on the nature and extent of nursing care needed.  The Director may subdivide these classes.
   2. The direct care component of a nursing home's payment rate shall be reflective of the necessary professional and paraprofessional nursing staff time and costs required to address the care needs of the residents of the facility.
   3. Assessments of residents for classification purposes shall be made on the basis of standardized information made available by each facility to the Division. Each nursing home shall assess all of its residents not less often than annually, in accordance with standards and a schedule developed by the Department of Disabilities, Aging, and Independent Living. The accuracy of the information shall be verified and final classifications made by the Department of Disabilities, Aging, and Independent Living.
3. Rates shall be determined prospectively for each facility on the basis of cost reports submitted to the Director.  The Director shall certify the rate for each facility annually by selecting a base year, setting a rate for the base year, and adjusting it annually by inflation factors which are reasonable and which adequately reflect economic conditions. The inflation factors may differ for direct care and other costs.  The base years may be changed at different intervals for direct care and other costs.  For direct care costs, such change shall occur no less frequently than once every three years, and, for other costs, no less frequently than once every four years, unless the Secretary of Human Services certifies to the General Assembly that it is not necessary to do so.

   Added 1989, No. 267 (Adj. Sess.), § 3; amended 1995, No. 160 (Adj. Sess.), § 13; 2005, No. 174 (Adj. Sess.), § 81; 2013, No. 131 (Adj. Sess.), § 20, eff. May 20, 2014.

§ 906. Facility payment.

1. The payment rate for each facility shall be the sum of its per diem allowance for each cost category, subject to such limitations as the Secretary shall prescribe by rule pursuant to section 907 of this title.
2. The payment for each facility's direct care costs shall be a function of the number of resident days of each resident class and shall be adjusted in a timely manner to reflect changes in the assessed needs of residents.

   Added 1989, No. 267 (Adj. Sess.), § 4, eff. July 1, 1991; amended 1997, No. 61 , § 270b.

§ 907. Payment limits.

1. The director shall establish payment limits consistent with the provisions of section 901 of this title to encourage the economic and efficient operation of nursing homes and other providers.
2. The payment limits shall not act as a disincentive for nursing homes to address the assessed needs or improve the conditions of residents.

   Added 1989, No. 267 (Adj. Sess.), § 5, eff. July 1, 1991; amended 1995, No. 160 (Adj. Sess.), § 14; 1997, No. 61 , § 270c.

§ 908. Powers and duties.

1. Each nursing home or other provider shall file with the Division, on request, such data, statistics, schedules, or information as the Division may require to enable it to carry out its function. Information received from a nursing home under this section shall be available to the public, except that the specific salary and wage rates of employees, other than the salary of an administrator, shall not be disclosed unless disclosure is required under 1 V.S.A. § 317(b) .
2. The Division shall have the power to examine books and accounts of any nursing home or other provider caring for State-assisted persons, to subpoena witnesses and documents, to administer oaths to witnesses, and to examine them on all matters of which the Division has jurisdiction.
3. The Secretary shall adopt all rules necessary for the implementation of this chapter.

   Added 1977, No. 204 (Adj. Sess.), § 1; amended 1995, No. 160 (Adj. Sess.), § 15; 1997, No. 131 (Adj. Sess.), § 2; 2013, No. 131 (Adj. Sess.), § 21, eff. May 20, 2014; 2015, No. 29 , § 9; 2021, No. 20 , § 281.

§ 909. Appeal.

1. A nursing home that feels aggrieved by a final order of the Division may do any of the following:
   1. Have the right of direct appeal to the Vermont Supreme Court pursuant to the Vermont Rules of Civil Procedure and the Vermont Rules of Appellate Procedure under the same terms and conditions as if the appeal were taken to the Supreme Court from the Superior Court pursuant to the laws of Vermont.
   2. Have the right to appeal de novo to the Superior Court of the county where the nursing home facility is situated.
   3. Request a review by the Secretary of Human Services. The Secretary of Human Services shall designate an independent appeals officer who shall be a registered or certified public accountant. The appeals officer shall conduct appeal hearings and make findings of fact and recommendations to the Secretary. The appeals officer shall have the power to subpoena witnesses and documents and administer oaths. A party aggrieved by a determination of the Secretary may obtain judicial review under the provisions of subdivision (1) or (2) of this subsection.
2. An appeal from any determination made under this chapter shall not be made under 3 V.S.A. § 3091 .

   Added 1977, No. 204 (Adj. Sess.), § 1; amended 1995, No. 160 (Adj. Sess.), § 16; 2021, No. 20 , § 282.

§ 910. Availability of payment for nursing home services.

The Secretary may, with 90 days' notice to the nursing home, reduce the number of days of nursing home service or the number of nursing home beds for which payments are available under the State/federal medical assistance program in order to meet State budgetary goals, provided that the standards of care required by section 7117 of this title and by rule are maintained.

Added 1977, No. 204 (Adj. Sess.), § 1; amended 1995, No. 160 (Adj. Sess.), § 17; 2013, No. 131 (Adj. Sess.), § 22, eff. May 20, 2014; 2021, No. 20 , § 283.

§ 1001. Definitions.

As used in this chapter:

1. "Able to work" means to be free of any physical, emotional, or mental condition that would prevent the individual from engaging in any combination of the work activities for at least 35 hours per week.
2. "Able to work part time" means having a physical, emotional, or mental condition that would allow the individual to engage in any combination of the work activities for at least 10 hours per week but would prevent the individual from engaging in such activities for 35 or more hours per week.
3. "Adult" means an individual who:
   1. is 18 years of age or older and not a dependent child; or
   2. is under 18 years of age and:
      1. is pregnant; or
      2. is a parent who is the caretaker for a dependent child.
4. "Assessment" means the information-gathering process, carried out by the Department's established protocol, that identifies an individual's skills, aptitudes, interests, life and work experience, and barriers, and the determination of how these factors relate to the individual's current or potential participation in the labor force and his or her family responsibilities. Where appropriate, this process includes the use of tests, other standardized measurement tools, and referrals to relevant professionals for evaluation or diagnosis. The Department shall use the information gathered as part of this process in developing the individual's family development plan, as well as, where applicable, assessing the appropriateness and feasibility of the individual's education, training, and employment goals and determining the individual's ability to work. The Department shall include a process to determine the development and well-being of the children in the family.
5. "Barrier" means any physical, emotional, or mental condition; any lack of an educational, vocational, or other skill or ability; and any lack of transportation, child care, housing, medical assistance, or other services or resources, domestic violence circumstances, caretaker responsibilities, or other conditions or circumstances that prevent an individual from engaging in employment or other work activity.
6. "Caretaker" means an individual 18 years of age or older who is fulfilling a parental role in caring for a dependent child by providing physical care, guidance, and decision making related to the child's health, school, medical care, and discipline.
7. "Case management" means the services provided by or through the Department to participating families, including assessment, information, referrals, and assistance in the preparation and implementation of a family development plan under section 1007 of this title.
8. "Commissioner" means the Commissioner for Children and Families or his or her designee.
9. "Department" means the Department for Children and Families.
10. "Dependent child" means a child who is a resident of this State and:
    1. is under 18 years of age; or
    2. is 18 years of age or older who is a full-time student in a secondary school, or attending an equivalent level of vocational or technical training, and is reasonably expected to complete the educational program before reaching 19 years of age or is not expected to complete the educational program before reaching 19 years of age solely due to a documented disability.
11. "Eligible family" means a family that is determined to be financially eligible for the programs authorized by this chapter, in accordance with rules adopted by the Commissioner.
12. "Family" means:
    1. one or more dependent children living with one or both parents or a relative or caretaker of such children; or
    2. a pregnant individual.
13. "Living with a relative or caretaker" means living with a caretaker or relative in a residence maintained by the caretaker or one or more relatives at his or her or their home.
14. "Parent" means a biological parent, stepparent, adoptive parent, or pregnant individual.
15. "Participant" or "participating adult" means an adult member of a participating family.
16. "Participating family" means an eligible family that participates in the Reach First program.
17. "Reach Ahead" means the program established under chapter 12 of this title.
18. "Reach First payment" means a one-time payment of cash as determined in section 1004 of this title.
19. "Reach First services" means the service component of the Reach First program consisting of case management services, support services, and referrals provided to eligible families to assist them in becoming self-sufficient.
20. "Reach Up" means the program established under chapter 11 of this title.
21. "Relative" means a person related to a dependent child, as defined by the Department by rule.
22. "Resources" means any income and property available from whatever source.
23. "Secretary" means the Secretary of Human Services or his or her designee.
24. "Temporary Assistance to Needy Families" or "TANF" means the block grant provided to this State and established in accordance with Part A of Title IV of the federal Social Security Act, as amended, and the regulations promulgated under the Act by the U.S. Secretary of Health and Human Services.
25. "Unable to work" means not able to work and not able to work part time.
26. "Work activities" means the following activities limited to the extent and degree that they are allowed and countable in accordance with Part A of Title IV of the Social Security Act:
    1. unsubsidized employment;
    2. subsidized private sector employment;
    3. subsidized public sector employment;
    4. work experience (including work associated with the refurbishing of publicly assisted housing) if sufficient private sector employment is not available;
    5. on-the-job training;
    6. job search and job readiness assistance;
    7. community service programs;
    8. vocational educational training (not to exceed 12 months with respect to any individual);
    9. job skills training directly related to employment;
    10. education directly related to employment, in the case of a recipient who has not received a high school diploma or a certificate of high school equivalency;
    11. satisfactory attendance at secondary school or in a course of study leading to a certificate of general equivalence, in the case of a recipient who has not completed secondary school or received such a certificate;
    12. the provision, consistent with the Department's rules applicable to self-employment, of child care services to an individual who is participating in a community service program;
    13. attendance at a financial literacy class; and
    14. any other work activity recognized in accordance with Part A of Title IV of the Social Security Act, as amended.
27. "Work-ready" means the participant possesses the education or skills demanded by the local job market or is capable of participating in one or more work activities at the level required by the participant's work requirement, and is not subject to any barrier.

    Added 2007, No. 30 , § 1, eff. May 17, 2007; amended 2021, No. 20 , § 284.

§ 1002. Purpose.

1. The purpose of the Reach First program is:
   1. to stabilize families in crisis, assess the family's strengths and needs, and orient families to the programs, services, assistance, and participant responsibilities available to improve self-sufficiency, attain economic independence, and ensure the well-being of children;
   2. to refer families without recent work histories, recognizing individual and unique characteristics, to an appropriate program available to assist the family in obtaining the opportunities and skills necessary for self-sufficiency and economic independence;
   3. to assist families with recent work histories by providing short-term financial support and support services to stabilize the family while the family transitions back to employment;
   4. to support parental responsibility and positive parental role models, both custodial and noncustodial;
   5. to improve the well-being of children by providing short-term supports to their families and referrals to appropriate programs and services;
   6. to conserve State public financial resources by operating the system of human services in a manner that is efficient and avoids federal fiscal sanctions; and
   7. to conform to the federal TANF law.
2. The critical elements of developing a short-term stabilization, assessment, and orientation program that assists families to maintain or attain self-sufficiency are:
   1. cooperative and realistic goal-setting, coupled with individualized case management that addresses each individual's situation and barriers to self-sufficiency;
   2. a short-term monetary payment and support services of a limited duration to provide for immediate, short-term needs of the family until the family attains employment quickly, or transitions to an appropriate program to assist the family in order to ensure the family's well-being and success to reaching self-sufficiency; and
   3. clear and comprehensive information on available options and appropriate services communicated to families in a simple fashion and easy transition to programs, such as Reach Ahead, Reach Up, the Postsecondary Education Program, and any other solely State-funded or separate State-funded programs.

      Added 2007, No. 30 , § 1, eff. May 17, 2007.

§ 1003. Eligibility.

1. A family shall be eligible for the Reach First program if the family's income and resources are below the limits established for the Reach Up program, and the family resides in Vermont. All applicants for programs under this chapter or chapter 11 or 12 of this title shall be provided an orientation, initial assessments, the Reach First payment, and, if appropriate for the family, in-depth assessment, a family development plan, and services through Reach First.
2. Reach First payments and services shall be available only once every 12 months for a family, except as provided for by rule. Families who have received Reach First within the past 12 months shall be provided financial assistance and services through Reach Up, the Postsecondary Education Program, or other program appropriate for the family. Families applying for or participating in other programs may also receive Reach First assessments, payments, or services as provided for by rule.
3. The Commissioner may use the eligibility rules for Reach Up instead of adopting new eligibility rules for this program.
4. An adult who accepts employment after reporting as directed under section 1007 of this title may receive Reach First or Reach Up, provided that the family remains financially eligible for the program in accordance with Department rules.

   Added 2007, No. 30 , § 1, eff. May 17, 2007.

§ 1004. Reach First payment.

1. An eligible family shall receive a short-term cash payment, which is the equivalent of up to 120 days of Reach Up financial assistance for the relevant family size with the same income. The family may receive the payment in installments or a lump sum, if needed to avert a crisis as determined in the initial assessment or the family development plan, during the period in which the family seeks immediate employment or participates in assessment and creating a family development plan. The Commissioner may establish by rule exceptions to the limit on the amount of the payment, as long as the exceptions are budget-neutral to the program.
2. The Department shall offer every eligible family the option of electronic or direct payment of the family's housing or other expenses to the person providing the lodging, utilities, or other service as provided for by rule.
3. For the purposes of calculating the payment, child support shall be treated as income, except that the first $50.00 amount of child support shall be disregarded from income.

   Added 2007, No. 30 , § 1, eff. May 17, 2007.

§ 1005. Required services to participating families.

1. The Commissioner shall provide to all eligible families an orientation and an initial, up-front assessment to determine which programs, referrals, or services are appropriate. The orientation shall provide the family with information about services and referrals available to the family, and the programs established under chapters 11 and 12 of this title, including program requirements, participant responsibilities, and incentives for participation and obtaining employment.
2. If needed by the family to improve the family's prospects for job placement and job retention, the Commissioner shall provide participating families in-depth assessments of the full range of services needed by each family, intensive case management or case consultation services, referral to any agencies or programs that provide the services needed by participating families, and transition to other programs established under chapters 11 and 12 of this title. Services or referrals for services shall include:
   1. Appropriate child care, available at times that will enable employment or participation in services indicated by the participating family's family development plan. As used in this subdivision, "appropriate child care" shall not include:
      1. child care that the Department classifies as legally exempt child care, and that a parent or caretaker determines to be unacceptable; and
      2. child care that the Department classifies as either a registered family child care home or a licensed child care facility, and that a parent or caretaker determines to be unacceptable when such determination is confirmed by the Department.
   2. Transportation which will enable employment or participation in services indicated by the participating family's family development plan.
   3. Career counseling, education, and training, and job search assistance consistent with the purposes of this chapter.
   4. Vocational rehabilitation.
   5. Medical and dental assistance.
   6. Homelessness prevention and housing assistance.
   7. Family planning education and counseling.
   8. Assistance with obtaining documentation of an apparent or claimed physical, emotional, or mental condition that reasonably can be presumed to limit or eliminate the individual's capacity to engage in employment or other work activity.
   9. Transfer to a State-funded program under subchapter 3 of chapter 11 of this title, the Reach Up program, or the Reach Ahead program.
   10. Any other services identified in the family development plan and determined by the Commissioner to be necessary and appropriate to achieve the purposes of this chapter or chapter 11 of this title.

       Added 2007, No. 30 , § 1, eff. May 17, 2007.

§ 1006. Case management; family development plans; coordinated services.

1. If a family needs or requests in-depth assessment and ongoing services, the Commissioner shall provide all Reach First services to these participating families through a case management model. The case manager, with the full involvement of the family, shall recommend, and the Commissioner shall establish and modify as necessary, a family development plan for each participating family in need of ongoing services, with a right of appeal as provided by section 1132 of this title. A case manager shall be assigned to each participating family as soon as the family is determined to be eligible for this program and in need of services.
2. The family development plan shall include:
   1. Each parent or caretaker's employment goal.
   2. An assessment of each parent or caretaker's strengths and barriers. The initial assessment shall include a literacy evaluation followed by a referral to an appropriate resource or program.
   3. An identification of the services, supports, and accommodations needed to overcome any barriers, to enable the family to achieve self-sufficiency, and to fulfill each parent or caretaker's personal and family responsibilities.
   4. An assignment of responsibilities, family development plan requirements, and activities among the case manager and family members, together with a time schedule for such responsibilities, requirements, and activities.
3. The initial family development plan shall be completed within 30 days of the first meeting with the case manager. The case manager shall establish a schedule for periodic review of the family development plan.
4. The Commissioner shall adopt rules, consistent with research on best practices, establishing maximum caseloads for case managers.

   Added 2007, No. 30 , § 1, eff. May 17, 2007.

§ 1007. Required participation.

1. Each participating adult in a family receiving Reach First services shall participate in necessary assessments and developing a family development plan, if applicable, unless good cause exists for such noncompliance as defined by the Commissioner by rule. The Commissioner may use the same rules applicable to good cause as established in the Reach Up program.
2. 1. If an adult does not comply with the following requirements without good cause, the Department shall initiate the conciliation process to determine the reason that the adult has not complied with the requirements and shall modify the requirements, if necessary, or provide the adult with a second opportunity to comply: (b) (1)  If an adult does not comply with the following requirements without good cause, the Department shall initiate the conciliation process to determine the reason that the adult has not complied with the requirements and shall modify the requirements, if necessary, or provide the adult with a second opportunity to comply:
      1. The single parent or caretaker in a family who has no barriers to obtaining and maintaining a job and a recent and stable work history, including receiving wages for his or her most recent job that, when annualized, equal or exceed 150 percent of the federal poverty level applicable to the family, shall report to the Department of Labor for an immediate job search within two working days of having filed an application.
      2. The able-to-work adult in a two-parent family (when the other parent is able to work part time or unable to work) who has no barriers to obtaining and maintaining a job and a recent and stable work history, including receiving wages for his or her most recent job that, when annualized, equal or exceed 150 percent of the federal poverty level applicable to the family, shall report to the Department of Labor for an immediate job search within two working days of having filed an application.
      3. The adult in a two-parent family (when both parents are able to work) who is not the primary caretaker of the children shall report to the Department of Labor for an immediate job search within two working days of having filed an application.
   2. The Reach First payment may be withheld during the conciliation process and until the adult complies.
   3. If the adult does not report without good cause to the Department of Labor after the second opportunity, the adult shall be denied Reach First and Reach Up.
3. 1. If an adult does not comply with the following requirements without good cause, the Department shall initiate the conciliation process to determine the reason that the adult has not complied with the requirements and shall modify the requirements, if necessary: (c) (1)  If an adult does not comply with the following requirements without good cause, the Department shall initiate the conciliation process to determine the reason that the adult has not complied with the requirements and shall modify the requirements, if necessary:
      1. Each participating adult shall participate in the development of his or her family development plan.
      2. Each participating adult who is not referred to the Department of Labor pursuant to this subsection shall report as directed by the Department for assessment and evaluation activities.
      3. Each participating adult shall begin to comply with his or her family development plan requirements as soon as possible, and not later than 10 days following identification of initial requirements at the initial family development plan meeting. Each participating adult shall continue to comply with such family development plan requirements until such time as the family is ineligible or transferred to Reach Up or Reach Ahead. If a family is transferred to another program, the rules of that program apply.
   2. If conciliation is unsuccessful, the Department may apply the Reach Up sanctions and transfer the family to the Reach Up program for further case management and other services.

      Added 2007, No. 30 , § 1, eff. May 17, 2007; 2021, No. 20 , § 285.

§ 1011. Transition to other programs.

1. The Department shall transfer the family to Reach Up, a separate State program, or a solely State-funded program established under chapter 11 of this title if, after four months of receiving support in Reach First or sooner at the Department's discretion, a family is assessed to need ongoing financial assistance and the family is financially eligible for Reach Up, a separate State program, or a solely State-funded program established under chapter 11 of this title, unless the family chooses not to participate.
2. If a family finds employment meeting or exceeding the work requirements for Reach Up for the family's size and composition, but is financially eligible for Reach Up, the Department shall transfer the family to Reach Up, unless the family chooses not to participate. A family transferring from Reach First to Reach Up shall be treated as a recipient for the purposes of income calculation.
3. If a family finds employment meeting or exceeding the work requirements for Reach Up for the family's size and composition, is not financially eligible for Reach Up, and is eligible for the Reach Ahead program, the Department shall transfer the family to Reach Ahead, unless the family chooses not to participate. A family transferring from Reach First to Reach Ahead shall be treated as a recipient for the purposes of income calculation.
4. A family transferring to another program under subsections (a) through (c) of this section shall not be required to complete a new application. Verification of income or other documentation may be required as provided for by rule.
5. Transitional medical assistance of up to 36 months shall be provided to families with a working adult who leaves Reach First and is not eligible for Reach Up, as provided for in the Vermont Medicaid rule M302.21 in effect on May 1, 2007, provided that federal financial participation is available for such transitional medical assistance.

   Added 2007, No. 30 , § 1, eff. May 17, 2007; amended 2009, No. 67 (Adj. Sess.), § 92, eff. Feb. 25, 2010.

§ 1012. Notice and appeal.

A participant may appeal decisions in accordance with 3 V.S.A. § 3091 . The Commissioner shall provide notice to each participant of the standards and procedures applicable to such appeals. All federal and Agency of Human Services rules regarding conciliation, notice, hearing, and appeal shall be followed in connection with such appeals.

Added 2007, No. 30 , § 1, eff. May 17, 2007.

§ 1101. Definitions.

As used in this chapter:

1. "Able to work" means to be free of any physical, emotional, or mental condition that would prevent the individual from engaging in any combination of the work activities identified in subdivisions (28)(A) through (E) of this section for at least 35 hours per week.
2. "Able to work part time" means having a physical, emotional, or mental condition that would allow the individual to engage in any combination of the work activities identified in subdivisions (28)(A) through (E) of this section for at least 10 hours per week but would prevent the individual from engaging in such activities for 35 or more hours per week.
3. "Adult" means an individual who:
   1. is 18 years of age or older and not a dependent child; or
   2. is under 18 years of age and:
      1. is pregnant; or
      2. is a parent who is the caretaker for a dependent child.
4. "Assessment" means the information-gathering process, carried out by the Department's established protocol, that identifies an individual's skills, aptitudes, interests, life and work experience, and barriers, and the determination of how these factors relate to the individual's current or potential participation in the labor force and his or her family responsibilities. Where appropriate, this process includes the use of tests, other standardized measurement tools, and referrals to relevant professionals for evaluation or diagnosis. The Department shall use the information gathered as part of this process in developing the individual's family development plan as well as, where applicable, assessing the appropriateness and feasibility of the individual's education, training, and employment goals and determining the individual's ability to work. The Department shall include a process to determine the development and well-being of the children in the family.
5. "Barrier" means any physical, emotional, or mental condition; any lack of an educational, vocational, or other skill or ability; and any lack of transportation, child care, housing, medical assistance, or other services or resources, domestic violence circumstances, caretaker responsibilities, or other conditions or circumstances that prevent an individual from engaging in employment or other work activity.
6. "Caretaker" means an individual 18 years of age or older who is fulfilling a parental role in caring for a dependent child by providing physical care, guidance, and decision making related to the child's health, school, medical care, and discipline.
7. "Case management" means the services provided by or through the Department to participating families, including assessment, information, referrals, and assistance in the preparation and implementation of a family development plan under section 1107 of this title.
8. "Commissioner" means the Commissioner for Children and Families or his or her designee.
9. "Department" means the Department for Children and Families.
10. "Dependent child" means a child who is a resident of this State and:
    1. is under 18 years of age; or
    2. is 18 years of age or older who is a full-time student in a secondary school, or attending an equivalent level of vocational or technical training, and is reasonably expected to complete the educational program before reaching 19 years of age or is not expected to complete the educational program before reaching 19 years of age solely due to a documented disability.
11. "Eligible family" means a family that is determined to be financially eligible for the programs authorized by this chapter, in accordance with rules adopted by the Commissioner.
12. "Family" means:
    1. one or more dependent children living with one or both parents or a relative or caretaker of such children; or
    2. a pregnant individual.
13. "Financial assistance" means cash, payments, electronic or direct payments for a family's housing or other expenses, and other forms of benefits designed to meet a family's ongoing basic needs that are available through the Reach Up program. A family's ongoing basic needs include food, clothing, shelter, utilities, household goods, personal care items, and general incidental expenses.
14. "Living with a relative or caretaker" means living with a caretaker or relative in a residence maintained by the caretaker or one or more relatives as his or her or their home.
15. "Parent" means:
    1. the same as in 15C V.S.A. § 102(16);
    2. stepparents; and
    3. pregnant individuals.
16. "Participant" or "participating adult" means an adult member of a participating family.
17. "Participating family" means an eligible family that participates in the Reach Up program.
18. "Reach Ahead" means the program established in chapter 12 of this title.
19. "Reach First" means the program established in chapter 10 of this title.
20. "Reach Up " means the program administered by the Department that assists and enables eligible families to become self-sufficient by providing financial assistance and Reach Up services.
21. "Reach Up services" means the service component of the Reach Up program consisting of case management services, support services, and referrals provided to eligible families to assist them in becoming self-sufficient.
22. "Relative" means a person related to a dependent child, as defined by the Department by rule.
23. "Resources" means any income and property available from whatever source.
24. "Secretary" means the Secretary of Human Services or his or her designee.
25. "Subsidized job" means employment for which the employer receives a subsidy from TANF funds or other public funds to offset some or all of the wages and costs of employing a participant.
26. "Temporary Assistance to Needy Families" or "TANF" means the block grant provided to this State and established in accordance with Part A of Title IV of the federal Social Security Act, as amended, and the regulations promulgated under the Act by the U.S. Secretary of Health and Human Services.
27. "Unable to work" means not able to work and not able to work part time.
28. "Work activities" means the following activities, limited to the extent and degree that they are allowed and countable in accordance with Part A of Title IV of the Social Security Act:
    1. unsubsidized employment;
    2. subsidized private sector employment;
    3. subsidized public sector employment;
    4. work experience (including work associated with the refurbishing of publicly assisted housing) if sufficient private sector employment is not available;
    5. on-the-job training;
    6. job search and job readiness assistance;
    7. community service programs;
    8. vocational educational training (not to exceed 12 months with respect to any individual);
    9. job skills training directly related to employment;
    10. education directly related to employment, in the case of a recipient who has not received a high school diploma or a certificate of high school equivalency;
    11. satisfactory attendance at secondary school or in a course of study leading to a certificate of general equivalence, in the case of a recipient who has not completed secondary school or received such a certificate;
    12. the provision, consistent with the Department's rules applicable to self-employment, of child care services to an individual who is participating in a community service program;
    13. attendance at a financial literacy class; and
    14. any other work activity recognized in accordance with Part A of Title IV of the Social Security Act as amended.
29. "Work-ready" means the participant possesses the education or skills demanded by the local job market or is capable of participating in one or more work activities at the level required by the participant's work requirement, and is not subject to any barrier.

    Added 1967, No. 147 , § 4, eff. date, see note below; amended 1969, No. 256 (Adj. Sess.), § 6, eff. April 6, 1970; 1973, No. 152 (Adj. Sess.), §§ 20, 30, 37, eff. April 14, 1974; 1981, No. 108 , § 320; 1999, No. 147 (Adj. Sess.), § 4; 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; 2005, No. 113 (Adj. Sess.), § 2; 2005, No. 174 (Adj. Sess.), § 82; 2007, No. 30 , § 2, eff. May 17, 2007; 2013, No. 131 (Adj. Sess.), § 23, eff. May 20, 2014; 2019, No. 72 , § E.323.2; 2021, No. 20 , § 286.

§ 1102. Purpose.

1. The purpose of the Reach Up program is:
   1. to assist families, recognizing individual and unique characteristics, to obtain the opportunities and skills necessary for self-sufficiency;
   2. to encourage economic independence by removing barriers and disincentives to work and providing positive incentives to work;
   3. to support parental nurturing;
   4. to support parental responsibility and positive parental role models, both custodial and noncustodial;
   5. to measure the success of the system by what is best for children;
   6. to improve the well-being of children by providing for their immediate basic needs, including food, housing, and clothing;
   7. to respect the dignity of individuals and families receiving assistance by providing employment, education, and other services through social service delivery systems available to all Vermont residents and by encouraging the private sector to integrate families receiving assistance into the mainstream of the employment market;
   8. to recognize the challenges facing many families receiving assistance by minimizing structural financial disincentives to increased earnings and the abrupt termination of assistance before parents are fully integrated into the employment market;
   9. to conserve State public financial resources by operating the system of aid in a manner that is efficient and avoids federal fiscal sanctions; and
   10. to conform to the federal TANF law.
2. The critical elements of developing a program that assists families to attain self-sufficiency are:
   1. the opportunity and obligation to work for those parents who are physically, emotionally, and otherwise able to do so;
   2. cooperative and realistic goal-setting, coupled with individualized case management that addresses each individual's situation and barriers to self-sufficiency;
   3. rigorous child support collection from noncustodial parents; and
   4. a full range of supportive modalities, including appropriate training, education, financial assistance, child care, counseling, and transportation.

      Added 1993, No. 106 (Adj. Sess.), § 2, eff. Jan. 12, 1994; amended 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; 2007, No. 30 , § 3, eff. May 17, 2007.

§ 1103. Eligibility and benefit levels.

1. Financial assistance shall be given for the benefit of a dependent child to the relative or caretaker with whom the child is living, unless otherwise provided. The amount of financial assistance to which an eligible person is entitled shall be determined with due regard to the income, resources, and maintenance available to that person and, as far as funds are available, shall provide that person a reasonable subsistence compatible with decency and health. The Commissioner may fix by rule maximum amounts of financial assistance and act to ensure that the expenditures for the programs shall not exceed appropriations for them consistent with section 101 of this title. In no case shall the Department expend State funds in excess of the appropriations for the programs under this chapter.
2. Financial assistance may include the maintenance of one or both parents, if in need and in the dependent child's home, or a relative or caretaker with whom a dependent child is living, if the relative or caretaker is without sufficient means of support.
3. The Commissioner shall adopt rules for the determination of eligibility for the Reach Up program and benefit levels for all participating families that include the following provisions:
   1. No less than the first $250.00 per month of earnings from an unsubsidized job and 25 percent of the remaining unsubsidized earnings shall be disregarded in determining the amount of the family's financial assistance grant. The family shall receive the difference between countable income and the Reach Up payment standard in a partial financial assistance grant.
   2. No less than the first $90.00 per month of earnings from a subsidized job shall be disregarded in determining the amount of the family's financial assistance grant. The family shall receive the difference between countable income and the Reach Up payment standard in a partial financial assistance grant. Earnings from subsidized jobs shall qualify for federal and State earned income credit if the family is otherwise eligible for such credit.
   3. Each family development plan shall provide for an incentive payment to be paid to the participating family for completing a required activity or task.
   4. Education stipends, employment stipends, job training stipends, and incentive payments, as determined by the Commissioner, shall be excluded in calculating the financial assistance grant.
   5. 1. The asset limitation shall be $9,000.00 for families for the purposes of determining initial and continuing eligibility for the Reach Up program, and the following savings accounts shall not be considered in the calculation for determining the asset limitation: (5) (A) The asset limitation shall be $9,000.00 for families for the purposes of determining initial and continuing eligibility for the Reach Up program, and the following savings accounts shall not be considered in the calculation for determining the asset limitation:
         1. a retirement account, such as an individual retirement arrangement (IRA), a defined contribution plan qualified under 26 U.S.C. § 401(k) , or any similar account as defined in 26 U.S.C. § 408; and
         2. a qualified child education savings account, such as the Vermont Higher Education Investment Plan, established in 16 V.S.A. § 2877 , or any similar plan qualified under 26 U.S.C. § 529.
      2. The value of assets accumulated from the earnings of adults and children in participating families and from any federal or Vermont earned income tax credit shall be excluded for purposes of determining continuing eligibility for the Reach Up program.
   6. Transitional medical assistance of up to 36 months shall be provided to families with a working adult who becomes ineligible for financial assistance due to increased earnings, unless family income exceeds 185 percent of the federal poverty level, and provided that federal financial participation is available for such transitional medical assistance.
   7. The equity value of one operable motor vehicle for each adult in the family and the equity value of one operable motor vehicle for any child of driving age who needs a vehicle to attend school or work shall be excluded for purposes of determining eligibility for the Reach Up program. The Commissioner shall take all steps necessary to retain current resource protections under the Supplemental Nutrition Assistance Program (SNAP) so that the rules under SNAP and the Reach Up program are compatible.
   8. An individual domiciled in Vermont shall be exempt from the disqualification provided for in 21 U.S.C. § 862a .
   9. [Repealed.]
4. In determining eligibility and benefit levels for two-parent participating families, the Commissioner shall:
   1. Allow two-parent families with earned income who would otherwise qualify for assistance to receive financial assistance, regardless of the number of hours worked, and supplement their earnings with partial financial assistance and medical assistance.
   2. Eliminate the requirements for two-parent families that the primary worker must have worked at least six quarters and be unemployed for at least 30 days. It is the intent of this subdivision that two-parent and one-parent families receive financial assistance under more similar rules.
5. In determining eligibility and benefit levels for parents who are under 18 in participating families, the Commissioner shall:
   1. Require parents who are under 18 to attend school or an appropriate alternative education or training activity.
   2. Ensure that the family development plan of a parent who is under 18 includes a requirement to take part in a case-managed support, education, and training program.
   3. Adopt rules, which shall include appropriate exemptions, requiring parents who are under 18 and who are not emancipated minors in accordance with 12 V.S.A. § 7151 to live with a parent or in an approved supervised living arrangement. The sanctions provided for noncompliance with a Reach Up family development plan requirement under section 1116 of this title shall apply to noncompliance with the rules adopted under this subdivision.
   4. Allow parents who are under 18 and who live with their parents to have their eligibility for the Reach Up program and the amount of their financial assistance grant determined without consideration of their parents' income.
6. The Commissioner shall disregard no less than $50.00 per month of child support payments in determining eligibility and benefit levels for participating families.
7. The Commissioner shall use the family composition rules applicable to the welfare demonstration project established pursuant to 1994 Acts and Resolves No. 106 in determining eligibility and benefit levels for a financial assistance grant.
8. The Department shall offer every eligible family the option of electronic or direct payment of financial assistance for the family's housing or other expenses to the person providing the lodging, utilities, or other service as provided for by rule.

   Added 1967, No. 147 , § 4; amended 1973, No. 152 (Adj. Sess.), § 21, eff. April 14, 1974; 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; 2005, No. 113 (Adj. Sess.), § 1; 2007, No. 30 , § 4, eff. May 17, 2007; 2009, No. 1 (Sp. Sess.), § E.323; 2013, No. 131 (Adj. Sess.), § 24, eff. May 20, 2014; 2013, No. 198 (Adj. Sess.), § 1, eff. July 1, 2015; 2015, No. 58 , § E.323; 2015, No. 172 (Adj. Sess.), § E.323.2; 2017, No. 29 , § 2; 2017, No. 109 (Adj. Sess.), § 1; 2019, No. 72 , § E.323.1; 2021, No. 74 , § E.323.1.

§ 1104. Abandonment or desertion; reporting.

Immediately upon granting assistance for the benefit of a dependent child who has been abandoned or deserted by a parent, the Commissioner shall give notice to the appropriate prosecuting officer charged with the duty of enforcing laws relating to the abandonment or desertion of children or minors.

Added 1967, No. 147 , § 4; amended 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; 2013, No. 131 (Adj. Sess.), § 25, eff. May 20, 2014.

§ 1105. Child support payments.

1. A financial assistance case shall not be closed until child support payments, minus the first $50.00 per month in such payments received on behalf of the family, in combination with other countable income, have exceeded the financial assistance payment standard in 12 consecutive calendar months.
2. Notwithstanding any other provision of law, if financial assistance to a participating family is terminated due to receipt of child support, minus the first $50.00 per month in such payments, that in combination with other countable income is in excess of the financial assistance cash payment standard, and the family again becomes eligible for financial assistance within the following 12 calendar months solely because the family no longer receives excess child support, financial assistance shall be paid as of the date of the family's reapplication.

   Added 1993, No. 106 (Adj. Sess.), § 2, eff. Jan. 12, 1994; amended 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; 2007, No. 30 , § 5, eff. May 17, 2007.

§ 1106. Required services to participating families.

1. The Commissioner shall provide participating families case management services, periodic reassessment of service needs and the family development plan, and referral to any agencies or programs that provide the services needed by participating families to improve the family's prospects for job placement and job retention, including the following:
   1. Appropriate child care, available at times that will enable employment or participation in services indicated by the participating family's family development plan. As used in this subdivision, "appropriate child care" shall not include:
      1. child care that the Department classifies as legally exempt child care, and that a parent or caretaker determines to be unacceptable; and
      2. child care that the Department classifies as either a registered family child care home or a licensed child care facility, and that a parent or caretaker determines to be unacceptable when such determination is confirmed by the Department.
   2. Transportation which will enable employment or participation in services indicated by the participating family's family development plan.
   3. Career counseling, education, and training, job search assistance, and postsecondary education consistent with the purposes of this chapter.
   4. Vocational rehabilitation.
   5. Medical assistance.
   6. Homelessness prevention and housing assistance. For homeless families, housing search is a "job-readiness assistance activity" as long as consistent with the Department's rules.
   7. Family planning education and counseling.
   8. Assistance with obtaining documentation of an apparent or claimed physical, emotional, or mental condition that reasonably can be presumed to limit or eliminate the individual's capacity to engage in employment or other work activity.
   9. Services for teen parents through the teen parent education program established in cooperation with the Agency of Education.
   10. Any other services identified in the family development plan and determined by the Commissioner to be necessary and appropriate to achieve the purposes of this chapter.
2. The Commissioner shall provide specialized case management services to families no later than four months after a family's financial assistance grant has been reduced as a result of a sanction under section 1116 of this title. The specialized case management shall be provided through a performance-based contract in order to intervene in the family's situation with the goal of compliance with an appropriate family development plan or work requirements as required under sections 1112 and 1113 of this title. The contract may be performed by another department within the Agency or by a community-based organization. If, after two months, a family fails to participate in specialized case management, case management shall resume through Reach Up.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2007, No. 30 , § 6, eff. May 17, 2007; 2009, No. 146 (Adj. Sess.), § C12; 2013, No. 92 (Adj. Sess.), § 291, eff. Feb. 14, 2014; 2015, No. 172 (Adj. Sess.), § E.323.3.

§ 1107. Case management; family development plans; coordinated services.

1. 1. The Commissioner shall provide all Reach Up services to participating families through a case management model informed by knowledge of the family's home, community, employment, and available resources. Services may be delivered in the district office, the family's home, or the community in a way that facilitates progress toward accomplishment of the family development plan. Case management may be provided to other eligible families. The case manager, with the full involvement of the family, shall recommend, and the Commissioner shall modify as necessary, a family development plan established under the Reach First or Reach Up program for each participating family, with a right of appeal as provided by section 1132 of this title. A case manager shall be assigned to each participating family as soon as the family begins to receive financial assistance. If administratively feasible and appropriate, the case manager shall be the same case manager the family was assigned in the Reach First program. The applicant for or recipient of financial assistance under this chapter shall have the burden of demonstrating the existence of his or her condition. (a) (1)  The Commissioner shall provide all Reach Up services to participating families through a case management model informed by knowledge of the family's home, community, employment, and available resources. Services may be delivered in the district office, the family's home, or the community in a way that facilitates progress toward accomplishment of the family development plan. Case management may be provided to other eligible families. The case manager, with the full involvement of the family, shall recommend, and the Commissioner shall modify as necessary, a family development plan established under the Reach First or Reach Up program for each participating family, with a right of appeal as provided by section 1132 of this title. A case manager shall be assigned to each participating family as soon as the family begins to receive financial assistance. If administratively feasible and appropriate, the case manager shall be the same case manager the family was assigned in the Reach First program. The applicant for or recipient of financial assistance under this chapter shall have the burden of demonstrating the existence of his or her condition.
   2. The case manager shall meet with each participating family following any statutory or rule changes affecting the amount of the earned income disregard, asset limitations, or other eligibility or benefit criteria in the Reach Up program to inform the family of the changes and advise the family about ways to maximize the opportunities to achieve earned income without a corresponding loss of benefits.
2. The case manager shall establish a schedule for periodic review of the family development plan. In addition, the case manager shall review, and modify if necessary, the plan in the following circumstances:
   1. there is a lack of satisfactory progress in achieving the goals of the plan;
   2. the parent or caretaker has lost unsubsidized or subsidized employment;
   3. a family member has failed to comply with a family development plan requirement or a work requirement;
   4. services required by the plan are unavailable;
   5. at least 30 days prior to when the parent or caretaker would become work-ready or would otherwise be deemed work-ready on the basis of 12-cumulative-month receipt of financial assistance;
   6. a deferment or modification of the work requirements imposed by section 1113 of this title has been requested or is due for review;
   7. within 30 days of when the parent or caretaker has started an unsubsidized or subsidized job; or
   8. changes to the plan are needed to protect the well-being of the children.
3. The Commissioner shall adopt rules, consistent with research on best practices, establishing maximum caseloads for case managers.
4. The Secretary of Education, with the assistance and support of the Commissioner for Children and Families, the Commissioner of Disabilities, Aging, and Independent Living, and the Commissioner of Labor, shall develop and implement comparable and reciprocally recognized literacy assessment protocols that will be used for all clients seeking adult education and literacy services; related services of the Agency of Education; or the services of the Department of Disabilities, Aging, and Independent Living, the Department of Labor, or the Department for Children and Families, when such services are being sought for the purpose of developing or strengthening competencies or skills related to the clients' current or future employment. Such protocols shall, to the extent practicable, utilize the same terminology and apply comparable criteria, consistent with individual program purposes and authorization, in determining when testing, other standardized measurement tools, or referrals to relevant professionals for evaluation or diagnosis are appropriate.
5. The Secretary shall work cooperatively with public and private, local, and regional entities:
   1. to develop subsidized jobs with employers, using the same health and safety standards in effect for unsubsidized jobs;
   2. to develop work placements that incorporate an adult education and literacy component into the hours of work for participants who need to continue to work on their secondary education while fulfilling their work requirement;
   3. to adopt rules which set priorities for services of benefit to the people of Vermont, and which prevent displacement of previous unsubsidized workers by subsidized Reach Up program participants; and
   4. to ensure that necessary support services are available, appropriate, and within a reasonable distance, including child care, health care, and transportation.
6. The Secretary shall:
   1. work with community providers to develop and maintain an adequate number and variety of supervised living alternatives designed to meet the individual needs of parents who are under 18;
   2. work with community providers to develop and maintain parenting, training, and education options for parents who are under 18;
   3. establish and maintain an information program to enable parents to learn about and take advantage of benefits and services that are available to parents who work outside the home;
   4. increase public awareness of the federal and State earned income tax credits, and encourage families who may be eligible to apply for such tax credits; and
   5. in partnership with the Human Resources Investment Council, develop and maintain one or more job training and employment programs for noncustodial parents to encourage long-term economic self-sufficiency and, by extension, their ability to pay child support.

      Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 103 (Adj. Sess.), § 3, eff. April 5, 2006; 2005, No. 174 (Adj. Sess.), § 83; 2007, No. 30 , § 7, eff. May 17, 2007; 2013, No. 50 , § E.323; 2013, No. 92 (Adj. Sess.), § 292, eff. Feb. 14, 2014; 2013, No. 131 (Adj. Sess.), § 26, eff. May 20, 2014; 2013, No. 198 (Adj. Sess.), § 2; 2017, No. 109 (Adj. Sess.), § 2.

§ 1108. Limits on family financial assistance.

1. Except for grants to children in the care of persons other than their parents, only participating families who have received fewer than 60 cumulative months of financial assistance, including those months in which any type of cash assistance funded by a TANF block grant was received in other states or territories of the United States, shall be eligible for benefits under the Reach Up program.
2. Deferment granted for the following reasons shall not count toward the Reach Up program's cumulative 60-month lifetime eligibility period:
   1. the participant is not able-to-work;
   2. the participant is a parent or caretaker who is caring for a child during the first year of a possible two-year deferment pursuant to subdivision 1114(b)(3) of this chapter;
   3. the participant is affected by domestic violence pursuant to subdivision 1114(b)(9) of this chapter; and
   4. the participant is needed in the home on a full-time basis to care for an ill or disabled parent, spouse, or child pursuant to subdivision 1114(b)(5) of this chapter.
3. The cumulative 60-month lifetime eligibility period shall not begin to toll until the parent or parents of a participating family have reached the age of 18.
4. Notwithstanding subsection (a) of this section, a participating family that does not have a qualifying deferment under section 1114 of this title and that has exceeded the cumulative 60-month lifetime eligibility period set forth in subsection (a) of this section shall qualify for a hardship exemption that allows the adult member of the participating family to receive:
   1. a wage equivalent to that of the participating family's cash benefit under the Reach Up program for participation in any of the work activities listed in subdivision 1101(28) of this title, with the exception of subdivision (28)(L); or
   2. supplemental benefits to the wages of the adult member of the participating family if the work requirement is otherwise being met.

      Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2007, No. 30 , § 8, eff. May 17, 2007; 2013, No. 50 , § E.323.1, eff. May 1, 2014; 2015, No. 172 (Adj. Sess.), § E.323.

§ 1112. Family development plan requirements.

1. Each participating adult in a family applying for or receiving financial assistance shall comply with each Reach Up family development plan requirement provided for in the family development plan, unless good cause exists for such noncompliance as defined by the Commissioner by rule.
2. The family's receipt of the full financial assistance amount allowable and avoidance of fiscal sanctions are contingent on the participating adult assisting in the development of his or her family development plan and engaging in the family development plan activities for the number of hours per week that the activities are scheduled and available, unless good cause exists for not doing so as defined by the Commissioner by rule.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2005, No. 103 (Adj. Sess.), § 3, eff. April 5, 2006; 2007, No. 30 , § 9, eff. May 17, 2007.

§ 1113. Work requirements.

1. Each participating adult in a family receiving a financial assistance grant shall fulfill a work requirement in accordance with this section. Subject to the provisions of this chapter, and provided that all services required by this chapter are offered when appropriate and are available when needed to support fulfillment of the work requirement, an adult having a work requirement shall obtain employment or participate in one or more work activities, and shall work in accordance with the requirements of this section, in order to maintain continued eligibility for financial assistance and to avoid fiscal sanctions.
2. 1. The work requirement shall become effective as soon as the participating adult is work-ready, or upon the family's receipt of 12 cumulative months of financial assistance, whichever is sooner, unless at the end of the 12-cumulative-month period the participant's case manager concludes that the participant is unable to meet the hours of the applicable unmodified work requirement, as established in subsection (c) of this section. In such cases, the case manager shall prepare a written request on behalf of the participant for an extension of up to six months. The request shall identify the particular reasons why the participant is unable to meet the work requirement and the remedial actions and services to be provided to the recipient to enable fulfillment of the requirement. The request shall be submitted to the Commissioner or the Commissioner's designee for approval. The request shall be approved unless the participant is able to meet the work requirement or a modified work requirement established in accordance with section 1114 of this title. (b) (1)  The work requirement shall become effective as soon as the participating adult is work-ready, or upon the family's receipt of 12 cumulative months of financial assistance, whichever is sooner, unless at the end of the 12-cumulative-month period the participant's case manager concludes that the participant is unable to meet the hours of the applicable unmodified work requirement, as established in subsection (c) of this section. In such cases, the case manager shall prepare a written request on behalf of the participant for an extension of up to six months. The request shall identify the particular reasons why the participant is unable to meet the work requirement and the remedial actions and services to be provided to the recipient to enable fulfillment of the requirement. The request shall be submitted to the Commissioner or the Commissioner's designee for approval. The request shall be approved unless the participant is able to meet the work requirement or a modified work requirement established in accordance with section 1114 of this title.
   2. A participant may meet the work requirement through a combination of work activities until the participant has received 24 months of financial assistance. After that time, the participant shall meet the work requirement through employment.
3. A participating family shall be deemed to meet the work requirement if:
   1. In two-parent families in which neither parent receives Supplemental Security Income (SSI), a combined total of at least 35 hours a week of employment or work activities or the number of hours the parents have been determined able-to-work by the Department is completed. One or both parents may contribute to the completion of the employment or work activities required by this subdivision.
   2. In a two-parent family in which one parent receives SSI:
      1. If the family includes a child six years of age or older, the work-eligible parent shall participate in one or more work activities for at least 30 hours per week or the number of hours the parent has been determined able-to-work by the Department.
      2. If the family includes a child under six years of age, the work-eligible parent shall participate in one or more work activities for at least 20 hours per week or the number of hours the parent has been determined able-to-work by the Department.
      3. As used in this subdivision (c)(2), "work-eligible parent" means a parent who is not receiving SSI.
   3. In a single-parent family:
      1. If the family's youngest child is six years of age or older, the participant shall participate in one or more work activities for at least 30 hours per week or the number of hours the parent has been determined able-to-work by the Department.
      2. If the family's youngest child is under six years of age, the participant shall participate in one or more work activities for at least 20 hours per week or the number of hours the parent has been determined able-to-work by the Department.
   4. A pregnant individual who is employed shall continue such employment unless there has been a medical determination that the individual is unable-to-work, or the individual is exempt from the work requirement based on other criteria established by the Commissioner by rule. A pregnant individual shall not be required to begin new employment.
4. 1. A participant required to fulfill a work requirement shall accept any unsubsidized job he or she is capable of performing, even if it pays wages that are less than the financial assistance grant. In cases in which monthly wages are less than the financial assistance grant and the family is otherwise eligible, the wages shall be supplemented with a partial financial assistance grant. The Commissioner shall establish by rule criteria for jobs that must be accepted if offered, including the criterion that each job must pay at least minimum wage. (d) (1)  A participant required to fulfill a work requirement shall accept any unsubsidized job he or she is capable of performing, even if it pays wages that are less than the financial assistance grant. In cases in which monthly wages are less than the financial assistance grant and the family is otherwise eligible, the wages shall be supplemented with a partial financial assistance grant. The Commissioner shall establish by rule criteria for jobs that must be accepted if offered, including the criterion that each job must pay at least minimum wage.
   2. A participating adult who had wages in the three months prior to his or her application for financial assistance that, when annualized, equal or exceed 150 percent of the federal poverty level applicable to the participating adult's family shall not be required to accept employment with annualized earnings of less than 150 percent of the federal poverty level applicable to the participating adult's family for the three-month period after being deemed eligible for financial assistance, provided that the participant:
      1. has not been disqualified within the prior six months from receiving unemployment compensation benefits for failing, without good cause, either to apply for available, suitable work when so directed by the employment office or the Commissioner of Labor, or to accept suitable work when offered;
      2. is not sanctioned within the three-month period immediately following being deemed eligible for financial assistance;
      3. does not leave an unsubsidized job without good cause within the three-month period immediately following being deemed eligible for financial assistance;
      4. follows through in a satisfactory manner on all referrals to employment opportunities;
      5. is engaged in acceptable work activities in accordance with this section; and
      6. agrees to accept any unsubsidized job if still unemployed after completion of the three-month period immediately following the determination of eligibility to receive financial assistance.
   3. A postsecondary education program participant who has received a degree and any Reach Up participant who has recently completed specialized vocational training shall not be required to accept an unsubsidized job that is unrelated to his or her training or degree for the three-month period immediately following completion of such education or training, provided that the participant:
      1. is not sanctioned within that three-month period;
      2. does not leave an unsubsidized job related to his or her training or degree without good cause within that three-month period;
      3. follows through in a satisfactory manner on all referrals to employment opportunities related to his or her training or degree;
      4. is engaged in acceptable work activities in accordance with this section; and
      5. agrees to accept any unsubsidized job if still unemployed after such three-month period.
5. The Commissioner may require a participant to participate in a job search, coordinated by the Commissioner, for the number of hours per week that corresponds to the participant's work requirement hours under subsection (c) of this section, or a lesser amount that in combination with the participant's unsubsidized employment equals the participant's work requirement hours under subsection (c) of this section.
6. Notwithstanding any other provision of this chapter, a participant's hours of unpaid work activities that are not primarily education, job search, job readiness, or training activities shall not exceed the levels established by the Fair Labor Standards Act. Adjustments required to conform with the Fair Labor Standards Act shall be made pursuant to calculation standards established by the Commissioner by rule.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2007, No. 30 , § 10, eff. May 17, 2007; 2013, No. 131 (Adj. Sess.), § 27, eff. May 20, 2014; 2017, No. 109 (Adj. Sess.), § 3.

§ 1114. Deferments, modifications, and referral.

1. The Commissioner shall establish by rule criteria, standards, and procedures for granting deferments from or modifications to the work requirements established in section 1113 of this title, in accordance with the provisions of this section and for referring individuals with disabilities to the Office of Vocational Rehabilitation.
2. The work requirements shall be either modified or deferred for:
   1. A participant for whom no unsubsidized or subsidized job or other equivalent supervised work activity recognized by the Commissioner by rule is available.
   2. A participant for whom support services that are essential to employment and other work activities and identified in the family development plan cannot be arranged. Such services shall include case management, education and job training, child care, and transportation.
   3. A primary caretaker parent in a two-parent family in which one parent is able-to-work-part-time or unable-to-work, a single parent, or a caretaker who is caring for a child who has not attained 24 months of age for no more than 24 months of the parent's or caretaker's lifetime receipt of financial assistance. To qualify for such deferment, a parent or caretaker of a child older than the age of six months but younger than 24 months shall cooperate in the development of and participate in a family development plan.
   4. An individual who has exhausted the 24 months of deferment provided for in subdivision (3) of this subsection and who is caring for a child who is not yet 13 weeks of age or a primary caretaker parent in a family with two parents who are able-to-work if the primary caretaker is caring for a child under 13 weeks of age and is otherwise subject to a work requirement because the other parent in the family is being sanctioned in accordance with section 1116 of this title.
   5. A participant who is needed in the home on a full- or part-time basis in order to care for an ill or disabled parent, spouse, or child. In granting deferments, the Department shall fully consider the participant's preference as to the number of hours the participant is able to leave home to participate in work activities. A deferral or modification of the work requirement exceeding 60 days due to the existence of illness or disability pursuant to this subdivision shall be confirmed by the independent medical review of one or more physicians, physician assistants, advanced practice registered nurses, or other health care providers designated by the Secretary of Human Services prior to receipt of continued financial assistance under the Reach Up program.
   6. A participant who is under 20 years of age, who is a single head of household or married, and who maintains satisfactory attendance at secondary school or the equivalent during the month, or participates in education directly related to employment for an average of 20 or more hours per week during the month.
   7. A participant who has attained 20 years of age and who is engaged in at least 15 hours per week of classes and related learning activities for the purpose of attaining a high school diploma or General Educational Development (GED) certificate or completing a literacy program approved by the Department; provided that the participant is making satisfactory progress toward the attainment of the diploma or certificate; and provided further that a deferment or modification granted for this purpose does not exceed 18 months.
   8. A participant who is enrolled in, attending, and making satisfactory progress toward the completion of a full-time vocational training program that has a normal duration of no more than two years and who is within 12 months of expected completion of such program. Such deferment or modification shall continue until he or she has completed the program, he or she is no longer attending the program, or the 12-month expected completion period has ended, whichever occurs first.
   9. A participant for whom, due to the effects of domestic violence, fulfillment of the work requirement can be reasonably anticipated to result in serious physical or emotional harm to the participant that significantly impairs his or her capacity either to fulfill the work requirement or to care for his or her child adequately, or can be reasonably anticipated to result in serious physical or emotional harm to the child.
   10. Any other participant designated by the Commissioner in accordance with criteria established by rule.
3. A participant who is able-to-work-part-time or is unable-to-work shall be referred for assessment of the individual's skills and strengths, accommodations and support services, and vocational and other services in accordance with the provisions of his or her family development plan. The work requirement hours shall reflect the individual's ability to work. Participants with disabilities that do not meet the standards used to determine disability under Title XVI of the Social Security Act shall participate in rehabilitation, education, or training programs as appropriate. A participant who qualifies for a deferment or modification and who is able-to-work-part-time shall have his or her work requirement hours modified or deferred. In granting deferments, the Department shall fully consider the participant's estimation of the number of hours the participant is able-to-work.
4. Absent an apparent condition or claimed physical, emotional, or mental condition, participants are presumed to be able-to-work. A participant shall have the burden of demonstrating the existence of the condition asserted as the basis for a deferral or modification of the work requirement. A deferral or modification of the work requirement exceeding 60 days due to the existence of conditions rendering the participant unable-to-work shall be confirmed by the independent medical review of one or more physicians, physician assistants, advanced practice registered nurses, or other health care providers designated by the Secretary of Human Services prior to receipt of continued financial assistance under the Reach Up program.
5. Deferments and modifications granted pursuant to this section shall continue for as long as the grounds for the deferment or modification exist or until expiration of a related time period specified in subsection (b) of this section, whichever occurs first.
6. As used in this section, "health care provider" means a person, partnership, or corporation, other than a facility or institution, licensed or certified or authorized by law to provide professional health care service in this State to an individual during that individual's medical care, treatment, or confinement.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2007, No. 30 , § 11, eff. May 17, 2007; 2013, No. 50 , § E.323.2, eff. May 28, 2013; 2013, No. 179 (Adj. Sess.), § E.321.2; 2017, No. 109 (Adj. Sess.), § 4.

§ 1115. Obligation to fund services; good cause.

1. A participant's family development plan requirement under section 1112 of this title and work requirement under section 1113 of this title shall be deferred when the case management services, training and educational services, and the family support services identified in the participant's family development plan are unavailable for reasons beyond the control of the participant, including when monies appropriated are not sufficient to provide such services.
2. No family who has been determined to be eligible for child care services pursuant to section 3512 of this title shall be displaced from or denied receipt of such services because the requirements of this chapter result in additional participating families applying for and receiving financial assistance for such child care services.
3. Services related to child care that are provided to two-parent families in which both parents are able-bodied and who are determined to be eligible for services pursuant to section 3512 of this title shall be paid from nonfederal funds.
4. The Commissioner shall design the Reach Up program so that it provides access to a full array of services to participating families identified by their family development plans within the funds appropriated by the General Assembly.
5. The Commissioner shall establish good cause rules for temporary or unexpected conditions or circumstances beyond the control of the participating parent which result in a parent's inability to participate in a Reach Up family development plan requirement, to participate in a work requirement, or to accept or retain employment.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001.

§ 1116. Sanctions.

1. The financial assistance grant of a participating family shall be reduced, in accordance with the provisions of this section, if a participating adult fails without good cause to fully comply or continue to comply in full with the family development plan or work requirements in sections 1112 and 1113 of this title.
2. Prior to the reduction in a family's financial assistance grant resulting from a sanction imposed under this section, the Department shall provide an independent review of the participant's circumstances and the basis for his or her noncompliance. The Commissioner or the Commissioner's designee shall perform the review.
3. 1. For a first, second, and third month in which a participating adult is not in compliance with a family development plan or work requirement and has not demonstrated good cause for such noncompliance, the family's financial assistance grant shall be reduced by the amount of $75.00 for each adult sanctioned. (c) (1)  For a first, second, and third month in which a participating adult is not in compliance with a family development plan or work requirement and has not demonstrated good cause for such noncompliance, the family's financial assistance grant shall be reduced by the amount of $75.00 for each adult sanctioned.
   2. For the fourth and any subsequent month not subject to the reduction required by subsection (e) of this section in which a participating adult is not in compliance with a family development plan or work requirement and has not demonstrated good cause for such noncompliance, the family's financial assistance grant shall be reduced by the amount of $150.00 for each adult sanctioned.
4. A participant may cure a sanction by coming into compliance in accordance with the Department's rules. During the first 60 months of the family's receipt of financial assistance, a participating adult may have all previous sanctions forgiven by demonstrating 12 consecutive months of compliance with family development plan requirements or work requirements or any combination of the two. Subsequent acts of noncompliance after a sanctioned adult has completed a successful 12-month sanction forgiveness period will be treated in accordance with subdivisions (c)(1) and (2) of this section without consideration of the sanctions that have been forgiven.
5. [Repealed.]
6. 1. Under no circumstances during the first six months that a family's grant is reduced due to fiscal sanctions imposed pursuant to subsection (c) of this section shall the grant be reduced to less than an amount which in combination with the family's other countable income is less than the family's actual incurred housing costs up to the applicable maximum housing allowance. (f) (1)  Under no circumstances during the first six months that a family's grant is reduced due to fiscal sanctions imposed pursuant to subsection (c) of this section shall the grant be reduced to less than an amount which in combination with the family's other countable income is less than the family's actual incurred housing costs up to the applicable maximum housing allowance.
   2. The Commissioner shall provide the housing costs by electronic or direct payment to the person to whom housing costs are owed. Any balance of financial assistance remaining after the electronic or direct payment has been deducted shall be paid in two payments, the first to be paid within the first half of the calendar month and the second to be paid within the second half of the calendar month.
7. The financial assistance grant of a family that has been subject to a fiscal sanction for more than six cumulative months shall be reduced in accordance with the full sanction amounts and without any consideration of the housing costs protection established in subsection (f) of this section. This section shall not apply if the family, after the fiscal sanction period of more than six months, has an intervening period of no less than 36 months before another fiscal sanction and spends those months in a state of program compliance, grant closure, or any combination of the two.
8. To receive payments during the fiscal sanction period, an adult who is the subject of the sanction shall meet no less than once each month to report his or her circumstances to the case manager or to participate in assessments as directed by the case manager. In addition, this meeting shall be for initial assessment and development of the family development plan when such tasks have not been completed; reassessment or review and revision of the family development plan, if appropriate; and to encourage the participant to fulfill the work requirement. Meetings required under this section may take place in the district office, a community location, or in the participant's home. Facilitation of meeting the participant's family development plan goals shall be a primary consideration in determining the location of the meeting. The Commissioner may waive any meeting when extraordinary circumstances prevent a participant from attending. The Commissioner shall adopt rules to implement this subsection.
9. A family sanctioned under this section for failure to meet work or family development plan requirements shall remain eligible for Supplemental Nutrition Assistance Program benefits and shall not, because of such failure, be sanctioned under the Supplemental Nutrition Assistance Program for reasons of "failure to comply without good cause" and "voluntary quit without good cause," provided that such eligibility and waivers of such sanctions are consistent with federal law and regulations governing the Supplemental Nutrition Assistance Program.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2007, No. 30 , §§ 12, 13, eff. May 17, 2007; 2009, No. 156 (Adj. Sess.), §§ E.323.1, E.323.2; 2011, No. 63 , §§ C.105, C.105.1, eff. June 2, 2011; 2013, No. 50 , § E.323.4, eff. May 1, 2014; 2013, No. 131 (Adj. Sess.), § 28, eff. May 20, 2014; 2015, No. 23 , § 53.

§ 1121. Authorization to segregate State funds and create separate State and solely State-funded programs.

1. Consistent with the purposes of this chapter, the Commissioner shall structure payment of appropriated TANF funds, State "maintenance of effort" funds, and general funds to create separate State and solely State-funded programs to aid families eligible for the financial assistance. For purposes of this chapter:
   1. "Separate State program" means a program in which State funds are used to fund the program, and these funds are counted toward the State's maintenance-of-effort requirement under TANF.
   2. "Solely State-funded program" means a program in which State funds are used to fund the program and are not counted toward the State's maintenance-of-effort requirement in order to maintain flexibility.
2. The Commissioner shall establish by rule standards, requirements, and criteria for the administration of any program established pursuant to this section that requires rules different from the financial assistance program.
3. Programs and payment structures created pursuant to this section shall accomplish one or more of the following purposes:
   1. to provide work supports and assistance to working families while preserving their ability to receive financial assistance beyond the federal TANF 60-month lifetime limit;
   2. to foster parental nurturing of children in their own homes;
   3. to stabilize families in crisis;
   4. to preserve financial assistance options beyond the federal TANF 60-month lifetime limit for families addressing multiple issues relating to self-sufficiency;
   5. to preserve eligibility for financial assistance for certain parents who are under 18 and legal aliens whom federal law makes ineligible for TANF-funded assistance; or
   6. to ensure that the State complies with the federal TANF program requirements and is able to avoid federal fiscal sanctions.
4. 1. The following solely State-funded programs shall be established, in accordance with rules adopted by the Commissioner: (d) (1)  The following solely State-funded programs shall be established, in accordance with rules adopted by the Commissioner:
      1. the Postsecondary Education Program established under section 1122 of this title;
      2. a program for families with a single parent, a caretaker, or two parents with one parent who is able-to-work-part-time or unable-to-work that have a primary caretaker of a child under 24 months of age who chooses pursuant to subsection 1114(b) of this title to defer the work requirement and to remain at home caring for the child, provided that the deferment is limited to any 24 months over the primary caretaker's lifetime, and the elimination of such work requirement is not a State option under TANF; and
      3. a program for the following vulnerable families:
         1. a minor parent who is not meeting the TANF requirements; and
         2. families who have received TANF-funded assistance for over 60 months and do not qualify for the hardship exemption as provided for by rule.
   2. Solely State-funded programs may be established, in accordance with rules adopted by the Commissioner, for the following individuals:
      1. families in which the parents or caretakers are ineligible immigrants, who are considered work-eligible under federal law but are unable to meet the number of hours in work activities required for the family to be counted as meeting the work requirement under federal law;
      2. adults who have been in sanction for more than three months;
      3. families in which the parents have disabilities;
      4. families in which one or more child has a disability and in which a family member is considered a work-eligible individual;
      5. families in which the parents or caretakers have an application pending for Supplemental Security Income; and
      6. two-parent households who are unable to meet the number of hours in work activities required for the family to be counted as meeting the work requirement under federal law, unless the federal law allows the State to exclude these families from the work participation rate or provides for an achievable work participation rate as determined by the Commissioner.
5. The Reach Ahead program shall be a separate State program structured to pay appropriated State maintenance of effort funds to families in which the parent or caretaker is engaged in employment for the number of hours that meets the applicable TANF participation rate requirement.
6. The Commissioner may establish other separate State and solely State-funded programs necessary to meet the goals established in this chapter.
7. 1. Any family receiving or applying for Reach Up financial assistance who is being referred by the Department to apply for or who is applying for Supplemental Security Insurance (SSI) or aid to the aged, blind, or disabled (AABD) under chapter 13 of this title shall authorize the Department to reimburse the State for the amounts described in subdivision (2) of this subsection from any initial SSI payment owed the individual that includes SSI payment for retroactive amounts. The family shall authorize the Social Security Administration to send the initial SSI payment directly to the Department. The Department may require an individual to sign a recovery of financial assistance agreement as authorization. (g) (1)  Any family receiving or applying for Reach Up financial assistance who is being referred by the Department to apply for or who is applying for Supplemental Security Insurance (SSI) or aid to the aged, blind, or disabled (AABD) under chapter 13 of this title shall authorize the Department to reimburse the State for the amounts described in subdivision (2) of this subsection from any initial SSI payment owed the individual that includes SSI payment for retroactive amounts. The family shall authorize the Social Security Administration to send the initial SSI payment directly to the Department. The Department may require an individual to sign a recovery of financial assistance agreement as authorization.
   2. The Department may deduct an amount equal to the State-funded Reach Up financial assistance paid to the family for the needs of the SSI applicant during the period or periods in which the family received Reach Up financial assistance paid for with State funds. The deduction shall be for no more than the prorated portion of Reach Up financial assistance provided for those family members receiving SSI who are included in the SSI grant. The Department shall send any remainder due to the family within 10 days of receiving the payment from the Social Security Administration.
8. In furtherance of the policy goals of this section and in order to establish an excess of maintenance-of-effort State funds, the Commissioner shall maximize maintenance-of-effort State funds in the reports to the U.S. Administration for Children and Families.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2007, No. 30 , § 14, eff. May 17, 2007; 2009, No. 67 (Adj. Sess.), § 91, eff. Feb. 25, 2010; 2011, No. 63 , § E.323.

§ 1122. Postsecondary Education Program.

1. The Commissioner shall establish by rule a solely State-funded program to provide financial assistance equivalent to the Reach Up financial assistance amount the family would receive if it were participating in the Reach Up program and support services to enable parents in eligible families to pursue undergraduate postsecondary degrees in fields directly related to employment.
2. The Program authorized by this section shall be administered by the Commissioner or by a contractor designated by the Commissioner. The Program shall be supported with funds other than federal TANF block grant funds provided under Title IV-A of the Social Security Act, except that the Commissioner may fund financial assistance grants and support services of families participating in the Postsecondary Education Program with TANF block grant or State maintenance of effort funds when the participating adult's educational activities are a countable work activity under federal law and when it will further one or more of the purposes in subdivision 1121(c)(1) of this title.
3. Financial eligibility for the Program and the amount of financial assistance shall be determined using Reach Up financial assistance rules. The Commissioner may use Reach Up rules for the Postsecondary Education Program with the exception of rules inconsistent with this section or related to the work requirements.
4. To be financially eligible to participate in the Postsecondary Education Program, the family's gross income minus the participating parent's earnings shall not exceed 150 percent of the federal poverty level for the appropriate family size.
5. All financially eligible families who apply to participate in the Postsecondary Education Program will be considered for admission provided that they meet all of the following criteria:
   1. No more than one parent per family may participate at the same time.
   2. If the participating parent is in a two-parent family, the nonparticipating parent shall, if able-to-work, be working full-time; if able-to-work-part-time, shall be working at least the number of hours per week that he or she has been determined able-to-work-part-time; or, if unable-to-work, may be unemployed.
   3. 1. The participating parent has not already received a postsecondary undergraduate degree. (3) (A) The participating parent has not already received a postsecondary undergraduate degree.
      2. The participating parent has already received a postsecondary undergraduate degree and the occupations for which it prepared the participating parent are obsolete.
      3. The participating parent, due to a disability, is no longer able to perform the occupations for which the degree prepared him or her.
      4. The preparation for occupations that the participating parent received through the postsecondary undergraduate degree is outdated and not marketable in the current labor market.
   4. The participating parent shall be a matriculating student in a two-year or four-year degree program as provided for in the postsecondary education plan.
   5. The participating parent has been determined to be eligible for financial assistance from the Vermont Student Assistance Corporation, and can demonstrate that he or she has the ability to cover tuition costs.
   6. The participating parent agrees to limit employment to no more than 20 hours per week when school is in session. The Department may establish exceptions by rule to allow the participating parent to work more than 20 hours per week.
   7. The family and the participating adult maintain financial eligibility for the program and uninterrupted residency in Vermont for the duration of participation in the Postsecondary Education Program.
   8. The participating parent maintains good academic standing at the college.
6. Participation in the Program authorized by this section may be denied to parents meeting the eligibility criteria if Program funds are insufficient to allow all eligible applicants to participate. When funds are insufficient to allow all eligible applicants to participate, priority shall be given to those individuals who:
   1. have demonstrated the ability to be successful in college, have already accumulated credits that can be applied to a college degree, and qualify for financial assistance;
   2. have no postsecondary education and qualify for financial assistance;
   3. have demonstrated the ability to be successful in college, have already accumulated credits that can be applied to a college degree, and qualify for services but not financial assistance;
   4. have no postsecondary education and qualify for services but not financial assistance.
7. Continued participation in the Postsecondary Education Program is contingent on the participating parent:
   1. maintaining compliance with all program criteria in subsections (d) and (e) of this section; and
   2. remaining a member in good standing of the college and making progress toward a degree.
8. For the purposes of this section:
   1. "Full-time" means 40 hours per week or a position requiring no fewer than 35 hours of work per week that the employer defines as full-time.
   2. "Parent" means a biological parent, stepparent, or adoptive parent who has custody of and resides with a dependent minor child.
9. The Department shall offer written and verbal information pertaining to postsecondary education to an appropriate Reach Up participant based on the participant's assessment.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2007, No. 30 , § 15, eff. May 17, 2007; 2009, No. 156 (Adj. Sess.), § E.323.3; 2013, No. 50 , § E.323.5.

§ 1123. Vermont Matched Savings Program.

1. As used in this section:
   1. "Account" means a savings account that is held in an insured financial institution that is maintained by the saver as part of an approved account program and an approved savings plan.
   2. "Agency" means the Agency of Human Services.
   3. "Approved account program" means a program approved by the Agency and administered by a service provider.
   4. "Approved savings plan" means a plan, approved by the service provider and agreed to by the saver, that defines savings goals, program requirements, and anticipated uses of the savings and matching funds. The plan shall be a contract between the saver and the service provider. The plan shall limit the maximum amount of savings that is the basis for receipt of matching funds to no more than $500.00 per saver per calendar year and $1,000.00 per family per calendar year, and to no more than $2,000.00 per lifetime of the saver and $4,000.00 per lifetime of members of a family.
   5. "Education" means a postsecondary program of instruction approved by the service provider and provided by a college, university, community college, area vocational technical school, professional institution, or specialized college or school legally authorized to grant degrees. The term also means any job training or related educational program approved by the service provider.
   6. "Eligible uses" means education, training that leads to employment, the purchase or improvement of a home, the purchase or repair of a vehicle necessary to participate in an employment-related activity, or participation in or development of an entrepreneurial activity.
   7. "Entrepreneurial activity" means the purchase of or investment in a for-profit venture in which the saver will be a principal.
   8. "Financial institution" means any insured federal or State chartered bank, bank and trust company, savings bank, savings and loan association, trust company, or credit union, approved by the service provider for the establishment of an individual development savings account.
   9. "Fund" means the Vermont Matched Savings Grant Special Fund established by this section.
   10. "Minimum savings amount" means the minimum amount of the saver's earnings established in the approved savings plan that the saver must deposit in order to be eligible for matching funds.
   11. "Program" means the Vermont Matched Savings Program established by this section.
   12. "Public assistance" means financial assistance provided by the Reach Up program or a separate State program established under the authority of section 1121 of this title.
   13. "Saver" means an individual who is 18 years of age or older, or who is under 18 years of age if the account is held in the name of a parent or caretaker of the saver, or a family group:
       1. who resides in this State;
       2. who has applied for and been enrolled in the individual development savings program;
       3. whose household income at the time of application is within the applicable financial eligible standards:
          1. to receive public assistance;
          2. to claim the federal earned income credit, without regard to any age limitation; or
          3. to participate in a federal savings program administered pursuant to this section; and
       4. whose net worth as of the calendar year preceding the determination of eligibility does not exceed $10,000.00, excluding the primary dwelling unit, one motor vehicle owned by members of the saver's family in a one-parent family or two motor vehicles owned by members of the saver's family in a two-parent family, and the tools of saver's trade that do not exceed $10,000.00 in value and that are necessary to continue or seek employment.
   14. "Service provider" means a nonprofit organization approved by the Agency that encourages and assists local community-based human service development, and that is an organization described in Section 501(c)(3) of the Internal Revenue Code of the United States which is exempt from taxation under Section 501(a) of such Code.
2. The Agency shall establish by rule standards and procedures to implement and administer the Vermont Matched Savings Program. The Program may include a program with eligibility criteria that satisfy federal funding requirements or the requirements of other funding sources that are more restrictive than those established in subsection (a) of this section, and a program funded by State appropriations and other revenue. Such standards and procedures shall include the following:
   1. An applicant shall apply to a service provider for a determination of eligibility for enrollment in the Program. The service provider shall develop an approved savings plan with each saver who has been determined eligible and enrolled in the Program. The approved savings plan shall specify a minimum savings amount to be saved and the frequency of deposits to be made by the saver to the savings account during the duration of the plan. The application and plan shall be prepared on forms provided and approved by the service provider.
   2. The enrolled saver shall complete a financial management training program approved by the Agency and provided by or through the service provider.
   3. An enrolled saver shall open an account in a financial institution that has been approved by the service provider as a depository for the saver's contributions. The saver and the service provider shall jointly own the account, including interest earned, jointly, with the saver as primary owner.
   4. An enrolled saver with an approved plan and account monitored by a service provider shall comply with the requirements of the plan for at least one year, but no more than five years, in order to be eligible for matching fund grants.
   5. In order to obtain matching funds, the saver shall present evidence satisfactory to the service provider that the amount to be withdrawn will be expended only for an eligible use. A withdrawal from an account for an eligible use shall be made payable to the person who provides the eligible use. The Agency, or the Vermont Student Assistance Corporation pursuant to 16 V.S.A. § 2878a , shall pay matching funds to the person that provides the eligible use. Matching funds shall not be paid to the saver.
   6. The service provider may terminate an approved savings plan for a saver who fails to meet the savings goals set out in the approved plan or who withdraws from the Program, in accordance with standards and procedures established by rule by the Agency. Any funds contributed by the saver shall revert to the sole ownership of the saver, to be used by the saver for any purpose. Funds in accounts created pursuant to a Vermont Higher Education Savings Plan shall be subject to the provisions of the Plan's participation agreement.
   7. The Agency shall monitor Program participation, and shall limit additional Program participation when the funds appropriated to carry out the purposes of this section are not sufficient to support additional approved savings plans.
   8. The Agency shall establish by rule any other standards and procedures necessary or desirable to implement the Vermont Matched Savings Program, including minimum requirements for approval of savings plans, criteria for training and counseling, reporting requirements for participating financial institutions, and matching fund allocation standards.
3. 1. The Vermont Matched Savings Grant Special Fund is established in the State Treasury and shall be administered in accordance with the provisions of 32 V.S.A. chapter 7, subchapter 5, except that interest earned on the Fund shall be retained in the Fund. Into the Fund shall be deposited proceeds from grants, donations, contributions, appropriations, and other revenue authorized by law. The Fund shall be used only for the purpose of providing matching funds for the Vermont Matched Savings Program as established in this section, and to provide grants to service providers for administrative expenses of administering the Program. (c) (1)  The Vermont Matched Savings Grant Special Fund is established in the State Treasury and shall be administered in accordance with the provisions of 32 V.S.A. chapter 7, subchapter 5, except that interest earned on the Fund shall be retained in the Fund. Into the Fund shall be deposited proceeds from grants, donations, contributions, appropriations, and other revenue authorized by law. The Fund shall be used only for the purpose of providing matching funds for the Vermont Matched Savings Program as established in this section, and to provide grants to service providers for administrative expenses of administering the Program.
   2. The Agency may make grants from the Vermont Matched Savings Grant Special Fund to service providers to provide the match for approved savings plans with enrolled savers. The amount and number of grants shall be calculated quarterly by the Agency based on the number of savers and the amounts included in their approved plans administered by each service provider so that payment of the maximum match is ensured for all savers for the period for the approved savings plans without exceeding the balance in the Fund. The Agency may award grants from the Fund to service providers to cover their expenses of training and counseling savers and to implement and administer the Vermont Matched Savings Program. The Agency may approve the use of interest earnings on grant funds as a portion of approved administrative costs.
   3. The Agency and service providers, separately or cooperatively, may solicit grants and private contributions for the Vermont Matched Savings Grant Special Fund.
4. Notwithstanding the provisions of subsections (a), (b), and (c) of this section to the contrary:
   1. a saver may open an account under this section as a Vermont Higher Education Savings Plan Account under 16 V.S.A. chapter 87, subchapter 7;
   2. the duration of the saver's ownership of a Vermont Higher Education Savings Plan Account shall not be subject to any limitation of time, except as provided in 16 V.S.A. chapter 87, subchapter 7; and
   3. the saver's ownership of a Vermont Higher Education Savings Plan Account shall not be included in the saver's income or resources for purposes of the saver's eligibility for TANF or SSI funds or services.

      Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2001, No. 11 , § 59, eff. April 25, 2001; 2018, No. 11 (Sp. Sess.), § E.325.1; 2019, No. 154 (Adj. Sess.), § E.323.1, eff. Oct. 2, 2020.

§ 1131. Administrative improvements.

For the purpose of improving the family development programs administered by the departments within the Agency of Human Services, including the Reach Up program, the Secretary shall:

1. design and implement a quality assurance function for the case management component of the Reach Up program to ensure that appropriate services are being provided to families enrolled in the program;
2. continue to improve caseload and expenditure forecasting for all social welfare programs; and
3. develop standards and procedures for the training, including diversity education, of qualified case managers in the Reach Up program.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001.

§ 1132. Notice and appeal.

1. A participant may appeal the provisions of a family development plan in accordance with 3 V.S.A. § 3091 . The Commissioner shall provide notice to each participant of the standards and procedures applicable to such appeals. All federal and Agency of Human Services rules regarding conciliation, notice, hearing, and appeal shall be followed in connection with such appeals.
2. A participant shall receive notice and an opportunity for conciliation, hearing, and appeal in accordance with all applicable federal and Agency of Human Services rules before Reach Up sanctions are applied to the participant.
3. A participant shall continue to receive financial assistance payments pending appeal to the Human Services Board of Reach Up sanctions if the appeal is received prior to the effective date of the proposed sanctions.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001.

§ 1133. Transition to other programs.

1. The Department shall transfer the family to Reach Up, a separate State program, or a solely State-funded program established under chapter 11 of this title if, after four months of receiving support in Reach First or sooner at the Department's discretion, a family is assessed as needing ongoing financial assistance and the family is financially eligible for Reach Up, a separate State program, or a solely State-funded program established under chapter 11 of this title, unless the family chooses not to participate.
2. If a family finds employment meeting or exceeding the work requirements for Reach Up for the family's size and composition, but is financially eligible for Reach Up, the Department shall transfer the family to Reach Up, unless the family chooses not to participate. A family transferring from Reach First to Reach Up shall be treated as a recipient for the purposes of income calculation.
3. If a family finds employment meeting or exceeding the work requirements for Reach Up for the family's size and composition, is not financially eligible for Reach Up, and is eligible for the Reach Ahead program, the Department shall transfer the family to Reach Ahead, unless the family chooses not to participate. A family transferring from Reach Up to Reach Ahead shall be treated as a recipient for the purposes of income calculation.
4. A family transferring to another program under subsections (a) through (c) of this section shall not be required to complete a new application. Verification of income or other required documentation may be required as provided for by rule.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. November 1, 2000; amended 2007, No. 30 , § 16, eff. May 17, 2007; 2009, No. 67 (Adj. Sess.), § 94, eff. Feb. 25, 2010; 2013, No. 131 (Adj. Sess.), § 29, eff. May 20, 2014.

§ 1134. Program evaluation.

On or before January 31 of each year, the Commissioner shall design and implement procedures to evaluate, measure, and report to the Governor and the General Assembly the Department's progress in achieving the goals of the programs provided for in sections 1002, 1102, and 1202 of this title. The report shall include:

1. the types of barriers facing Reach Up families seeking economic self-sufficiency, the number of families with each type of barrier, the frequency of occurrence of each type of barrier, and how support services and incentives assist in overcoming barriers;
2. documentation of participant results, including specific information relating to the number of persons employed, by occupation, industry, and wage; the types of subsidized and unsubsidized jobs secured by participants; any available information about results for children who have participated in the programs, including objective measures of improved conditions; the number of participating families involved in training programs; and whether the support services and incentives assist in keeping families employed;
3. data about the Supplemental Nutrition Assistance Program participation of households who have left the programs during the last fiscal year, including the number of households, adults, and children participating in the Supplemental Nutrition Assistance Program three months after leaving the applicable program, broken down by reason for termination or leaving, and the Department's plan to identify and assist eligible households to apply for Supplemental Nutrition Assistance Program benefits;
4. data about the enrollment of individuals who have left the programs during the last fiscal year in a Health Care Assistance Program, including the number of adults and children enrolled in a Health Care Assistance Program three months after leaving the applicable program, broken down by reason for termination or leaving, and the Department's plan to identify and assist eligible households to apply for health care assistance;
5. a summary of all interim and final reports submitted by independent evaluation contractors to the Agency or the Department relating to the programs;
6. a description of the work participation rates, including the method of calculating the caseload reduction credit, for the most recent federal fiscal year;
7. a description of the current basic needs budget and housing allowance, the current maximum grant amounts, and the basic needs budget and housing allowance adjusted to reflect an annual cost-of-living increase;
8. a description of the families, during the last fiscal year, that included an adult family member receiving financial assistance for 60 or more months in his or her lifetime, including:
   1. the number of families and the types of barriers facing these families; and
   2. the number of families that became ineligible for the Reach Up program pursuant to subsection 1108(a) of this title, and the types of income and financial assistance received by those families that did not return to the Reach Up program within 90 days of becoming ineligible; and
9. a description of the families in the postsecondary education program pursuant to section 1122 of this title, including the number of participating families and any barriers to their further participation.

   Added 1999, No. 147 (Adj. Sess.), § 1, eff. July 1, 2001; amended 2003, No. 19 , § 22, eff. May 6, 2003; 2005, No. 103 (Adj. Sess.), § 3, eff. April 5, 2006; 2005, No. 174 (Adj. Sess.), § 84; 2007, No. 30 , § 17, eff. May 17, 2007; 2013, No. 131 (Adj. Sess.), § 30, eff. May 20, 2014; 2015, No. 11 , § 35; 2015, No. 58 , § E.323.1; 2015, No. 172 (Adj. Sess.), § E.323.1.

§ 1201. Definitions.

As used in this chapter:

1. "Adult" means an individual who:
   1. is 18 years of age or older and not a dependent child; or
   2. is under 18 years of age and:
      1. is pregnant; or
      2. is a parent who is the caretaker for a dependent child.
2. "Barrier" means any physical, emotional, or mental condition; any lack of an educational, vocational, or other skill or ability; and any lack of transportation, child care, housing, medical assistance or other services or resources, domestic violence circumstances, caretaker responsibilities, or other conditions or circumstances that prevent an individual from engaging in employment or other work activity.
3. "Caretaker" means an individual age 18 or older who is fulfilling a parental role in caring for a dependent child by providing physical care, guidance, and decision making related to the child's health, school, medical care, and discipline.
4. "Commissioner" means the Commissioner for Children and Families or his or her designee.
5. "Department" means the Department for Children and Families.
6. "Dependent child" means a child who is a resident of this State and:
   1. is under the age of 18 years; or
   2. is 18 years of age or older who is a full-time student in a secondary school, or attending an equivalent level of vocational or technical training, and is reasonably expected to complete the educational program before reaching the age of 19 or is not expected to complete the educational program before reaching age 19 solely due to a documented disability.
7. "Eligible family" means a family that meets the requirements in section 1203 of this chapter.
8. "Family" means:
   1. one or more dependent children living with one or both parents or a relative or caretaker of such children; or
   2. a pregnant individual.
9. "Food assistance" means a monthly benefit to supplement the family's Supplemental Nutrition Assistance Program benefits as determined under section 1204 of this chapter.
10. "Living with a relative or caretaker" means living with a caretaker or relative in a residence maintained by the caretaker or one or more relatives at his or her or their home.
11. "Parent" means a biological parent, stepparent, adoptive parent, or pregnant individual.
12. "Participant" or "participating adult" means an adult member of a participating family.
13. "Participating family" means an eligible family that participates in the Reach Ahead program.
14. "Reach Ahead services" means the service component of the Reach Ahead program consisting of case management services, support services, and referrals provided to eligible families to assist them in maintaining self-sufficiency.
15. "Reach First" means the program established under chapter 10 of this title.
16. "Reach Up" means the program established under chapter 11 of this title.
17. "Relative" means a person related to a dependent child, as defined by the Department by rule.
18. "Temporary Assistance to Needy Families" or "TANF" means the block grant provided to this State and established in accordance with Part A of Title IV of the federal Social Security Act, as amended, and the regulations promulgated under the Act by the U.S. Secretary of Health and Human Services.

    Added 2007, No. 30 , § 18, eff. Oct. 1, 2008; amended 2013, No. 131 (Adj. Sess.), § 31, eff. May 20, 2014; 2021, No. 20 , § 287.

§ 1202. Purpose.

1. The purpose of the Reach Ahead program is:
   1. to assist families who have become recently employed to maintain employment by providing work supports and incentives to maximize the opportunity of the family to remain employed and not return to Reach Up;
   2. to provide families with information and referrals to workforce development options in order to ensure financial stability for the family;
   3. to support parental responsibility and positive parental role models, both custodial and noncustodial;
   4. to improve the well-being of children by providing time-limited work supports and food assistance to their families;
   5. to conserve State and public financial resources by operating the system of aid in a manner that is efficient and avoids federal fiscal sanctions; and
   6. to conform to the federal TANF law.
2. The critical elements of developing a work support program that assists families to maintain self-sufficiency are:
   1. if necessary, individualized case management that addresses each individual's situation and barriers to self-sufficiency and assists that family in maintaining employment;
   2. food assistance and support services of a limited duration to provide work support for the family;
   3. easy transition to other programs, such as Reach Up or Reach First, if needed to ensure the families' well-being and success to reaching self-sufficiency.

      Added 2007, No. 30 , § 18, eff. Oct. 1, 2008.

§ 1203. Eligibility.

A family shall be eligible for Reach Ahead if the family resides in Vermont and:

1. has left Reach Up or the postsecondary education program within the prior six months for employment that meets the work requirements for the Reach Up program for the family's size and composition;
2. is receiving Supplemental Nutrition Assistance Program benefits and has employment that meets the work requirements for Reach Up for the family's size and composition; or
3. is an individual under 21, has a child, is ineligible for Supplemental Nutrition Assistance Program benefits solely because the individual resides with the individual's parent, and has employment that meets the work requirements for Reach Up for the family's size and composition.

   Added 2007, No. 30 , § 18, eff. Oct. 1, 2008; amended 2007, No. 192 (Adj. Sess.), § 6.012; 2009, No. 67 (Adj. Sess.), § 90, eff. Feb. 25, 2010; 2013, No. 131 (Adj. Sess.), § 32, eff. May 20, 2014.

§ 1203a. Application of 21 U.S.C. § 862a.

An individual domiciled in Vermont shall be exempt from the disqualification provided for in 21 U.S.C. § 862a .

Added 2009, No. 1 (Sp. Sess.), § E.323.2.

§ 1204. Food assistance.

1. 1. An eligible family shall receive monthly food assistance equal to $50.00 to be applied to the family's electronic benefit transfer (EBT) food account for the first 12 months after the family has become eligible for Reach Ahead. (a) (1)  An eligible family shall receive monthly food assistance equal to $50.00 to be applied to the family's electronic benefit transfer (EBT) food account for the first 12 months after the family has become eligible for Reach Ahead.
   2. For the 12th through 24th months, the family shall receive a monthly food assistance of $5.00.
2. Food assistance may be used only to purchase eligible food items as defined in the Supplemental Nutrition Assistance Program federal rules and shall be disregarded as income for the purposes of determining Supplemental Nutrition Assistance Program eligibility and the amount of the Supplemental Nutrition Assistance Program benefits.
3. An eligible family shall not be required to assign child support to the Department, and all child support received by the family shall be disregarded as income.
4. The 12th through 24th months of assistance shall be funded through savings resulting from caseload reductions in the Reach Up program. If there are insufficient savings from caseload reductions to fund the 12th through 24th months of assistance, the assistance shall be suspended or modified.

   Added 2007, No. 30 , § 18, eff. Oct. 1, 2008; amended 2013, No. 131 (Adj. Sess.), § 33, eff. May 20, 2014; 2013, No. 198 (Adj. Sess.), § 3, eff. July 1, 2015.

§ 1205. Required services to participating families.

1. The Commissioner shall provide participating families Reach Ahead services, case management services if necessary, and referral to any agencies or programs, including workforce development, that provide the services needed by participating families to improve the family's prospects for employment retention. Reach Ahead services shall be provided for 24 months.
2. A participating family shall be eligible for an Enhanced Child Care Services Subsidy during its 12th through 24th months on the Reach Ahead program pursuant to subsection 3512(b) of this title.

   Added 2007, No. 30 , § 18, eff. Oct. 1, 2008; amended 2013, No. 198 (Adj. Sess.), § 6, eff. July 1, 2015.

§ 1206. Case management; family development plans; coordinated services.

The Commissioner may provide Reach Ahead services to participating families through a case management model. If a family needs case management, the Commissioner may develop a family development plan as provided for in chapters 10 and 11 of this title. If a case manager is assigned to the participating family who has been transferred from Reach First or Reach Up, if practicable, the case manager shall be the same case manager the family was assigned previously.

Added 2007, No. 30 , § 18, eff. Oct. 1, 2008.

§ 1211. Recertification.

A family's hours of employment and other countable work activities shall be verified every six months to determine continuing eligibility for the program. To the extent possible for families receiving Supplemental Nutrition Assistance Program benefits, income verification may be done at the same time as the Supplemental Nutrition Assistance Program benefit recertification or verification of employment hours.

Added 2007, No. 30 , § 18, eff. Oct. 1, 2008; amended 2007, No. 192 (Adj. Sess.), § 6.013; 2013, No. 131 (Adj. Sess.), § 34, eff. May 20, 2014.

§ 1212. Transition to other programs.

If a family loses employment meeting or exceeding the work requirements for Reach Up for the family's size and composition and is financially eligible for Reach Up, the family shall be transferred to Reach First or Reach Up without an additional application process, unless the family chooses not to participate. Verification of income or other documentation may be required as provided for by rule.

Added 2007, No. 30 , § 18, eff. Oct. 1, 2008; amended 2009, No. 67 (Adj. Sess.), § 93, eff. Feb. 25, 2010.

§ 1213. Notice and appeal.

A participant may appeal decisions in accordance with 3 V.S.A. § 3091 . The Commissioner shall provide notice to each participant of the standards and procedures applicable to such appeals. All federal and Agency of Human Services rules regarding conciliation, notice, hearing, and appeal shall be followed in connection with such appeals.

Added 2007, No. 30 , § 18, eff. Oct. 1, 2008.

§ 1301. Eligibility requirements - general.

To be eligible for State aid to the aged, blind, or disabled, in addition to the requirements in sections 1301-1303 of this chapter governing eligibility for a specific program, an individual shall:

1. Be a resident of this State when the person applies.
2. Not have made a voluntary assignment or transfer of property or income for the purpose of qualifying, nor shall the individual's spouse have made a voluntary assignment or transfer of property or income for the purpose of qualifying the individual.
3. Be a recipient of Federal Supplemental Security Income, if eligible.
4. Not have sufficient income or other resources to provide a reasonable subsistence compatible with decency and health, and not be receiving or able to secure support from persons legally responsible for the individual's support. In determining whether the income of an applicant for or a recipient of aid is sufficient, the Department for Children and Families may disregard, within the limits of available funds, income used to further the purposes of rehabilitation and self-support.

   Added 1967, No. 147 , § 3; amended 1969, No. 256 (Adj. Sess.), § 4, eff. April 6, 1970; 1973, No. 75 , § 1, eff. date, see note below; 1973, No. 152 (Adj. Sess.), § 16, eff. April 14, 1974; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 85; 2021, No. 20 , § 288.

§ 1302. State aid to the aged.

State aid to the aged shall be granted to an individual who meets the eligibility requirements of section 1301 of this title and who in addition:

1. has attained 65 years of age; and
2. is not a patient in a public institution, except a public medical institution.

   Added 1967, No. 147 , § 3; amended 1969, No. 256 (Adj. Sess.), § 7(b), eff. April 6, 1970; 1973, No. 75 , § 2, eff. date, see note under § 1301 of this title; 2021, No. 20 , § 289.

§ 1303. State aid to the disabled.

1. State aid to the disabled shall be granted to an individual who meets the eligibility requirements of section 1301 of this title and who in addition:
   1. is permanently and totally disabled as defined in Title XVI of the Social Security Act, as amended; and
   2. is not, at the date of receiving aid, an inmate of any public institution.
2. An individual is also considered disabled for purposes of this chapter if the individual was disabled as defined under this chapter and the rules in effect under this chapter on December 31, 1973 and received aid under this chapter for December 1973, provided the individual has been, since that time, continuously disabled.

   Added 1967, No. 147 , § 3; amended 1973, No. 75 , § 3, eff. date, see note under § 1301 of this title; 1973, No. 171 (Adj. Sess.), § 1; 2013, No. 131 (Adj. Sess.), § 35, eff. May 20, 2014; 2021, No. 20 , § 290.

§ 1304. State aid to the blind.

1. State aid to the blind shall be granted to an individual who meets the eligibility requirements of section 1301 of this title and in addition:
   1. is blind as defined in Title XVI of the Social Security Act, as amended; and
   2. is not, at the date of receiving aid, an inmate of any public institution.
2. An individual is also considered blind for purposes of this chapter if the individual was blind as defined under this chapter and the rules in effect under this chapter on December 31, 1973 and received aid under this chapter for December 1973, provided the individual has been, since that time, continuously blind.

   Added 1967, No. 147 , § 3; amended 1969, No. 256 (Adj. Sess.), § 7(b), eff. April 16, 1970; 1973, No. 75 , § 4, eff. date, see note under § 1301 of this title; 2013, No. 131 (Adj. Sess.), § 36, eff. May 20, 2014; 2021, No. 20 , § 291.

§ 1305. Disqualifications.

State aid to the aged, blind, and disabled shall not be granted to any individual who has real or personal property in excess of that permitted for eligibility for Supplemental Security Income under the Social Security Act as amended.

Added 1967, No. 147 , § 3; amended 1973, No. 171 (Adj. Sess.), § 2; 2021, No. 20 , § 292.

§ 1306. Application and investigation.

Applications for State aid to the aged, blind, or disabled may be made at any office of the Department for Children and Families. Upon receipt of an application, the Commissioner for Children and Families shall investigate and prescribe the amount of the grant to be given, if any. No individual shall receive more than one type of grant or aid under this chapter.

Added 1967, No. 147 , § 3; amended 1973, No. 75 , § 5, eff. date, see note under § 1301 of this title; 1973, No. 152 (Adj. Sess.), § 17, eff. April 14, 1974; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 86; 2021, No. 20 , § 293.

§ 1307. Amount of State aid.

The amount of State aid to which an eligible individual is entitled shall be determined with due regard to the income, resources, and maintenance available to the individual and, when an eligible individual lives with the individual's ineligible spouse or a needy essential person, or both, as defined by the Commissioner, with due regard to the needs of the ineligible spouse and with due regard to the needs, income, and resources of the needy essential person. To the extent funds are available, aid shall provide a reasonable subsistence compatible with decency and health. The Commissioner for Children and Families may by rule fix maximum amounts of aid and take measures to ensure that the expenditures for the programs shall not exceed the funds provided for them.

Added 1967, No. 147 , § 3; amended 1973, No. 75 , § 6, eff. date, see note under § 1301 of this title; 1973, No. 152 (Adj. Sess.), § 18, eff. April 14, 1974; 1977, No. 186 (Adj. Sess.); 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 87; 2021, No. 20 , § 294.

§ 1308. Rules.

In fixing standards and adopting rules under this chapter, the Commissioner for Children and Families shall be guided by the statutory standards set forth in this chapter, which standards shall not be deemed necessarily to incorporate by reference decisional or statutory law applicable to the aid to the aged, blind, and disabled program in effect prior to January 1, 1974.

Added 1973, No. 75 , § 7, eff. date, see note under § 1301 of this title; amended 1973, No. 152 (Adj. Sess.), § 19, eff. April 14, 1974; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 88; 2021, No. 20 , § 295.

§ 1309. Agreements.

1. The Secretary of Human Services may enter into agreements by which an agency of the federal government or other public or private entity administers any or all parts of the State aid to the aged, blind, and disabled program.
2. In cases in which the Secretary enters into such agreements with an agency of the federal government, any requirement set forth in this chapter that is inconsistent with the statutes and regulations of the federal government regarding federal administration of State supplementation of benefits under Title XVI of the Social Security Act shall be waived.
3. The Secretary shall monitor the performance of the agency of the federal government or other public or private entity administering any or all parts of the State aid to the aged, blind, and disabled program. In the event the Secretary determines, in the Secretary's best judgment, that administration by an agency of the federal government or other public or private entity is not in the best interests of the citizens of Vermont, the Secretary is hereby authorized to terminate such agreements.
4. The Department shall, upon request of any individual, provide information or assist that individual in transactions with the federal agency or other public or private entity administering any or all parts of the State aid to the aged, blind, and disabled program.

   Added 1973, No. 171 (Adj. Sess.), § 3; amended 1995, No. 178 (Adj. Sess.), § 305; 2021, No. 20 , § 296.

§ 1501. Register.

The Department of Disabilities, Aging, and Independent Living may prepare and maintain a register of persons who are blind in the State. It shall describe their condition, cause of blindness, capacity for education and vocational training, and other pertinent data.

Added 1967, No. 147 , § 2; amended 1973, No. 152 (Adj. Sess.), § 14, eff. April 14, 1974; 1981, No. 69 ; 2005, No. 174 (Adj. Sess.), § 89; 2013, No. 96 (Adj. Sess.), § 202.

§ 1502. Services for persons who are blind.

For the rehabilitation or amelioration of the condition of persons who are blind, the Department of Disabilities, Aging, and Independent Living may:

1. Ameliorate the condition of persons who are blind by devising means for their adjustment, care, instruction, and well-being, including the distribution of books, promotion of visits to elders who are blind, and by other expedient and proper means and methods.
2. Furnish medical examinations, physical restoration, guidance and counseling, vocational training, maintenance and transportation, occupational materials, tools, equipment, and licenses.
3. Assist persons who are blind in developing home industries and small business enterprises and marketing their products.
4. Act as an intermediary between persons who are blind and otherwise have a disability and industry for the purpose of arranging industrial homework of a subcontract nature, and pay inherent costs such as workers' compensation insurance and Social Security taxes.
5. Contribute to the support of persons who are blind from this State who are receiving instruction or training in schools or institutions outside the State.
6. [Repealed.]

   Added 1967, No. 147 , § 2; amended 1973, No. 152 (Adj. Sess.), § 15, eff. April 14, 1974; 1981, No. 165 (Adj. Sess.), § 1; 2005, No. 174 (Adj. Sess.), § 90; 2013, No. 96 (Adj. Sess.), § 202; 2017, No. 3 , § 66, eff. March 2, 2017.

§ 1601. Definitions.

As used in this chapter:

1. "Communication or language mode" means verbal or nonverbal communication that includes listening, speaking, American Sign Language (ASL), Signed English, Signed Support, reading, and writing in all domains of a language. Reference to the communication mode of individuals who are Deaf, Hard of Hearing, or DeafBlind distinguishes between modality and language. Systems that assist individuals using a particular modality or language include ASL, spoken English, Signed English, sign-supported speech, speech or lip reading, cued speech, and assistive technology.
2. "Deaf" means having a severe or complete absence of auditory sensitivity that impairs processing of linguistic information through hearing, with or without amplification or cochlear implants. Participation in Deaf Community culture and use of ASL are characteristic of persons who identify as Deaf.
3. "DeafBlind" means having concomitant hearing and visual impairments.
4. "Department" means the Department of Disabilities, Aging, and Independent Living.
5. "Hard of Hearing" means a reduced level of functional hearing and reliance on residual hearing and technology, including hearing aids, cochlear implants, FM listening systems, and other types of assistive listening devices to communicate via verbal language, with or without use of ASL.

   Added 2015, No. 107 (Adj. Sess.), § 1, eff. May 12, 2016.

§ 1602. Vermont Deaf, Hard of Hearing, and Deafblind Advisory Council.

1. Creation; purpose.  There is created a Vermont Deaf, Hard of Hearing, and DeafBlind Advisory Council to promote diversity, equality, awareness, and access among individuals who are Deaf, Hard of Hearing, or DeafBlind.
2. Membership.  The Advisory Council shall consist of the following members:
   1. 16 members of the public, appointed by the Governor in a manner that ensures geographically diverse membership, including:
      1. nine or fewer members who are Deaf, Hard of Hearing, or DeafBlind, provided each population is represented and that if a member represents an organization for persons who are Deaf, Hard of Hearing, or DeafBlind, no other member on the Advisory Council shall also represent that organization;
      2. two members who are each a parent or guardian of a child who is Deaf, Hard of Hearing, or DeafBlind;
      3. two members who serve persons who are Deaf, Hard of Hearing, or DeafBlind in a professional capacity, provided that these members do not represent the same organization;
      4. a professional deaf-education specialist who understands all communication and language modes;
      5. a professional interpreter; and
      6. an audiologist or hard-of-hearing education specialist;
   2. the Senior Counselor for the Deaf and Hard of Hearing in the Department's Division of Vocational Rehabilitation or designee;
   3. the Secretary of Education or designee;
   4. the Secretary of Human Services or designee;
   5. the director of the Department for Children and Families' Children's Integrated Services or designee;
   6. the director of the Vermont Early Detection and Intervention Project;
   7. a representative of the Vermont Association of the Deaf;
   8. a representative of the Vermont chapter of the Hearing Loss Association of America;

      a superintendent, selected by the Vermont Superintendents Association; and

      a special education administrator, selected by the Vermont Council of Special Education Administrators.

3. Powers and duties.
   1. The Advisory Council shall assess the services, resources, and opportunities available to children in the State who are Deaf, Hard of Hearing, or DeafBlind. It may consider and make recommendations to the General Assembly and the Governor on the following:
      1. the educational rights of children who are Deaf, Hard of Hearing, or DeafBlind, including full communication and language access in all educational environments and accessibility of qualified teachers, interpreters, and paraprofessionals;
      2. appropriate and ongoing educational opportunities that recognize each child's unique learning needs, including access to a sufficient number of communication or language mode peers and exposure to adult role models who are Deaf, Hard of Hearing, or DeafBlind;
      3. adequate family supports that promote both early development of communication skills and informed participation by parents and guardians in the education of their children;
      4. identification of all losses of or reductions in services arising from the closures of the Austine School for the Deaf and the Vermont Center for the Deaf and Hard of Hearing and evaluation of the adequacy of existing services and resources, as well as identification of those resources not currently available, adequate, or accessible to children;
      5. opportunities to restore and expand educational opportunities to children in the State who are Deaf, Hard of Hearing, or DeafBlind and their families; and
      6. appropriate data collection and reporting requirements concerning students with disabilities.
   2. The Advisory Council shall assess the services, resources, and opportunities available to adults and elders in the State who are Deaf, Hard of Hearing, or DeafBlind. It may consider and make recommendations to the General Assembly and the Governor on the following:
      1. the needs of and opportunities for adults and elders within the State who are Deaf, Hard of Hearing, or DeafBlind and their families;
      2. the adequacy and systemic coordination of existing services and resources for adults and elders throughout the State who are Deaf, Hard of Hearing, or DeafBlind and their families;
      3. proposed legislation and administrative rules pertaining to adults and elders who are Deaf, Hard of Hearing, or DeafBlind; and
      4. delivery models in other states as a point of comparison for the adequacy and systemic coordination of Vermont's existing services and resources for adults and elders who are Deaf, Hard of Hearing, or DeafBlind.
4. Assistance.  The Advisory Council shall have the administrative, technical, and legal assistance of the Agencies of Education and of Human Services. The Advisory Council and Department may consult with national experts on education of persons who are Deaf, Hard of Hearing, or DeafBlind as necessary to fulfill their obligations under this section.
5. Reports.  On or before January 15 of each year, notwithstanding 2 V.S.A. § 20(d) , the Advisory Council shall submit a written report to the Senate and House Committees on Education, the Senate Committee on Health and Welfare, the House Committee on Human Services, and the Governor with any findings and recommendations. A reading of each report shall be video recorded using ASL to ensure accessibility.
6. Appointments; meetings.
   1. The Commissioner of Disabilities, Aging, and Independent Living shall convene the first meeting of the Advisory Council on or before July 1, 2016 and shall select interpreting services, computer assisted captioning in real time (CART), or FM listening systems for the meeting if a member so requests.
   2. At its first meeting, the Advisory Council shall elect a chair and vice chair.
   3. The Chair shall select interpreting services, CART, or FM listening systems for any Advisory Council meeting if a member so requests.
   4. The Advisory Council may meet up to eight times each year to perform its functions under this section. The Secretaries of Education and of Human Services may jointly authorize additional meetings.
   5. The Advisory Council may organize its members into subcommittees to carry out the purposes of this section, including subcommittees designed to address specific age groups within the Deaf, Hard of Hearing, and DeafBlind population.
7. Reimbursement.
   1. Members of the Advisory Council who are not State employees or otherwise compensated or reimbursed for their attendance shall be entitled to per diem compensation and reimbursement of expenses pursuant to 32 V.S.A. § 1010 , payable by the Department.
   2. The Agency of Human Services shall pay for interpreting services, CART, or FM listening systems necessary to conduct all Advisory Council meetings.
   3. The Agency of Education, Department of Health, and Department of Disabilities, Aging, and Independent Living shall share costs for interpreting services, CART, or FM listening systems necessary to conduct all Advisory Council subcommittee meetings.

      Added 2015, No. 107 (Adj. Sess.), § 1, eff. May 12, 2016; amended 2019, No. 128 (Adj. Sess.), § 20.

§ 1701. Supplemental Nutrition Assistance Program.

1. The State of Vermont may participate in the federal Supplemental Nutrition Assistance Program (SNAP) pursuant to 7 U.S.C. chapter 51. The purpose of SNAP is to alleviate hunger and malnutrition among households with low income by increasing their food purchasing power and access to nutritious, safe food.
2. An individual domiciled in Vermont shall be exempt from the disqualification provided for in 21 U.S.C. § 862a .
3. The Commissioner may adopt, amend, or repeal rules governing the operation of the Program in the State pursuant to 3 V.S.A. chapter 25.
4. As used in this chapter, "Commissioner" means the Commissioner for Children and Families and "Department" means the Department for Children and Families.

   Added 1967, No. 147 , § 2; amended 1969, No. 169 (Adj. Sess.), eff. Feb. 16, 1970; 1973, No. 152 (Adj. Sess.), § 29, eff. April 14, 1974; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), §§ 91, 140; 2009, No. 1 (Sp. Sess.), § E.322; 2013, No. 131 (Adj. Sess.), § 37, eff. May 20, 2014; 2017, No. 104 (Adj. Sess.), § 1.

§ 1702. Payment error rate report.

On or before January 1 of the year following any federal fiscal year in which the State of Vermont receives a federal sanction for a payment error rate greater than the federal threshold in the Supplemental Nutrition Assistance Program (SNAP), the Department for Children and Families shall report to the Senate Committee on Appropriations regarding:

1. the number of households that received SNAP benefits and were discovered to have an overpayment or underpayment in the sanction year due to agency error, including the average amount of the overpayments and underpayments and the total amount of each; and
2. the Department's specific plans for sanction reinvestment to improve its error rate for the next federal fiscal year and prevent sanction in the future.

   Added 2013, No. 179 (Adj. Sess.), § E.316; amended 2017, No. 154 (Adj. Sess.), § 11, eff. May 21, 2018.

§ 1703. Changes to program administration.

1. 1. The Department shall report to the Chairs of the House Committee on Human Services and the Senate Committee on Health and Welfare and any interested stakeholders within 30 days after any substantive change in the federal law governing SNAP that: (a) (1)  The Department shall report to the Chairs of the House Committee on Human Services and the Senate Committee on Health and Welfare and any interested stakeholders within 30 days after any substantive change in the federal law governing SNAP that:
      1. restricts or improves eligibility;
      2. increases or reduces barriers or creates or eliminates hardships to access; or
      3. inhibits or increases benefit usage.
   2. Within 90 days after a change described pursuant to subdivision (1) of this subsection, the Department shall provide an analysis to the Chairs of any anticipated administrative costs to the Department and any impacts on SNAP applicants and participants as a result of the change.
2. The Commissioner may convene a meeting of interested stakeholders to discuss a change listed in subsection (a) of this section.

   Added 2017, No. 104 (Adj. Sess.), § 1.

§ 1801. Purpose.

1. It is the intent of the General Assembly to establish a Vermont Health Benefit Exchange which meets the policy established in 18 V.S.A. § 9401 and, to the extent allowable under federal law or a waiver of federal law, becomes the mechanism to create Green Mountain Care.
2. The purpose of the Vermont Health Benefit Exchange is to facilitate the purchase of affordable, qualified health benefit plans in the individual and group markets in this State in order to reduce the number of uninsured and underinsured; to reduce disruption when individuals lose employer-based insurance; to reduce administrative costs in the insurance market; to contain costs; to promote health, prevention, and healthy lifestyles by individuals; and to improve quality of health care.
3. Nothing in this chapter shall be construed to reduce, diminish, or otherwise infringe upon the benefits provided to eligible individuals under Medicare.

   Added 2011, No. 48 , § 4.

§ 1802. Definitions.

As used in this subchapter:

1. "Affordable Care Act" means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and as further amended.
2. "Commissioner" means the Commissioner of Vermont Health Access.
3. "Health benefit plan" means a policy, contract, certificate, or agreement offered or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health services. This term does not include coverage only for accident or disability income insurance, liability insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, automobile medical payment insurance, credit-only insurance, coverage for on-site medical clinics, or other similar insurance coverage where benefits for health services are secondary or incidental to other insurance benefits as provided under the Affordable Care Act. The term also does not include stand-alone dental or vision benefits; long-term care insurance; short-term, limited-duration health insurance; specific disease or other limited benefit coverage, Medicare supplemental health benefits, Medicare Advantage plans, and other similar benefits excluded under the Affordable Care Act.
4. "Health insurer" shall have the same meaning as in 18 V.S.A. § 9402 .
5. "Qualified employer":
   1. means an entity which employed an average of not more than 50 employees on working days during the preceding calendar year and which:
      1. has its principal place of business in this State and elects to provide coverage for its eligible employees through the Vermont Health Benefit Exchange, regardless of where an employee resides; or
      2. elects to provide coverage through the Vermont Health Benefit Exchange for all of its eligible employees who are principally employed in this State;
   2. on and after January 1, 2016, shall include an entity which:
      1. employed an average of not more than 100 employees on working days during the preceding calendar year; and
      2. meets the requirements of subdivisions (A)(i) and (A)(ii) of this subdivision (5).
   3. [Repealed.]
6. "Qualified entity" means an entity with experience in individual and group health insurance, benefit administration, or other experience relevant to health benefit program eligibility, enrollment, or support.
7. "Qualified health benefit plan" means a health benefit plan which meets the requirements set forth in section 1806 of this title.
8. "Qualified individual" means an individual, including a minor, who is a Vermont resident and, at the time of enrollment:
   1. is not incarcerated, or is only incarcerated awaiting disposition of charges; and
   2. is, or is reasonably expected to be during the time of enrollment, a citizen or national of the United States or an immigrant lawfully present in the United States as defined by federal law.
9. "Modified adjusted gross income" shall have the same meaning as in 26 U.S.C. § 36B(d)(2)(B).
10. "Reflective health benefit plan" means a health benefit plan that meets the requirements set forth in section 1813 of this title.

    Added 2011, No. 48 , § 4; amended 2011, No. 171 (Adj. Sess.), § 1; 2013, No. 50 , § E.307, eff. Oct. 1, 2013; 2015, No. 54 , § 13, eff. June 5, 2015; 2015, No. 151 (Adj. Sess.), § 1. 2018; 2017, No. 88 (Adj. Sess.), § 2, eff. Feb. 20, 2018; 2017, No. 131 (Adj. Sess.), § 5, eff. May 16, 2018; 2019, No. 19 , § 4, eff. Jan. 1, 2020.

§ 1803. Vermont Health Benefit Exchange.

1. 1. The Department of Vermont Health Access shall establish the Vermont Health Benefit Exchange, which shall be administered by the Department in consultation with the Advisory Committee established in section 402 of this title. (a) (1)  The Department of Vermont Health Access shall establish the Vermont Health Benefit Exchange, which shall be administered by the Department in consultation with the Advisory Committee established in section 402 of this title.
   2. The Vermont Health Benefit Exchange shall be considered a division within the Department of Vermont Health Access and shall be headed by a Deputy Commissioner as provided in 3 V.S.A. chapter 53.
2. 1. 1. The Vermont Health Benefit Exchange shall provide qualified individuals and qualified employers with qualified health benefit plans, including the multistate plans required by the Affordable Care Act, with effective dates beginning on or before January 1, 2014. The Vermont Health Benefit Exchange may contract with qualified entities or enter into intergovernmental agreements to facilitate the functions provided by the Vermont Health Benefit Exchange. (b) (1) (A)  The Vermont Health Benefit Exchange shall provide qualified individuals and qualified employers with qualified health benefit plans, including the multistate plans required by the Affordable Care Act, with effective dates beginning on or before January 1, 2014. The Vermont Health Benefit Exchange may contract with qualified entities or enter into intergovernmental agreements to facilitate the functions provided by the Vermont Health Benefit Exchange.
      2. Prior to contracting with any health insurer, the Vermont Health Benefit Exchange shall consider the insurer's historic rate increase information required under section 1806 of this title, along with the information and the recommendations provided to the Vermont Health Benefit Exchange by the Commissioner of Financial Regulation under Section 2794(b)(1)(B) of the federal Public Health Service Act.
   2. To the extent allowable under federal law, the Vermont Health Benefit Exchange may offer health benefits to populations in addition to those eligible under Subtitle D of Title I of the Affordable Care Act, including:
      1. to individuals and employers who are not qualified individuals or qualified employers as defined by this subchapter and by the Affordable Care Act;
      2. Medicaid benefits to individuals who are eligible, upon approval by the Centers for Medicare and Medicaid Services and provided that including these individuals in the Health Benefit Exchange would not reduce their Medicaid benefits;
      3. Medicare benefits to individuals who are eligible, upon approval by the Centers for Medicare and Medicaid Services and provided that including these individuals in the Health Benefit Exchange would not reduce their Medicare benefits; and
      4. State employees and municipal employees, including teachers.
   3. To the extent allowable under federal law, the Vermont Health Benefit Exchange may offer health benefits to employees for injuries arising out of or in the course of employment in lieu of medical benefits provided pursuant to 21 V.S.A. chapter 9 (workers' compensation).
   4. To the extent permitted by the U.S. Department of Health and Human Services, the Vermont Health Benefit Exchange shall permit qualified individuals and qualified employers to purchase qualified health benefit plans through the Exchange website, through navigators, by telephone, or directly from a health insurer under contract with the Vermont Health Benefit Exchange.
3. 1. The Vermont Health Benefit Exchange may determine an appropriate method to provide a unified, simplified administration system for health insurers offering qualified health benefit plans. The Exchange may include claims administration, benefit management, billing, or other components in the unified system and may achieve simplification by contracting with a single entity for administration and management of all qualified health benefit plans, by licensing or requiring the use of particular software, by requiring health insurers to conform to a standard set of systems and rules, or by another method determined by the Commissioner. (c) (1)  The Vermont Health Benefit Exchange may determine an appropriate method to provide a unified, simplified administration system for health insurers offering qualified health benefit plans. The Exchange may include claims administration, benefit management, billing, or other components in the unified system and may achieve simplification by contracting with a single entity for administration and management of all qualified health benefit plans, by licensing or requiring the use of particular software, by requiring health insurers to conform to a standard set of systems and rules, or by another method determined by the Commissioner.
   2. The Vermont Health Benefit Exchange may offer certain services, such as wellness programs and services designed to simplify administrative processes, to health insurers offering plans outside the Exchange, to workers' compensation insurers, to employers, and to other entities.
4. The Vermont Health Benefit Exchange may enter into information-sharing agreements with federal and State agencies and other state exchanges to carry out its responsibilities under this subchapter provided such agreements include adequate protections with respect to the confidentiality of the information to be shared and provided such agreements comply with all applicable State and federal laws and regulations.

   Added 2011, No. 48 , § 4; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2013, No. 144 (Adj. Sess.), § 2, eff. May 27, 2014; 2015, No. 54 , § 11, eff. June 5, 2015.

§ 1804. Qualified employers.

1. 1. Until January 1, 2016, a qualified employer shall be an entity which employed an average of not more than 50 employees on working days during the preceding calendar year, and the term "qualified employer" includes self-employed persons to the extent permitted under the Affordable Care Act. Calculation of the number of employees of a qualified employer shall not include a part-time employee who works fewer than 30 hours per week or a seasonal worker as defined in 26 U.S.C. § 4980H(c)(2)(B). (a) (1)  Until January 1, 2016, a qualified employer shall be an entity which employed an average of not more than 50 employees on working days during the preceding calendar year, and the term "qualified employer" includes self-employed persons to the extent permitted under the Affordable Care Act. Calculation of the number of employees of a qualified employer shall not include a part-time employee who works fewer than 30 hours per week or a seasonal worker as defined in 26 U.S.C. § 4980H(c)(2)(B).
   2. An employer with 50 or fewer employees that offers a qualified health benefit plan to its employees through the Vermont Health Benefit Exchange may continue to participate in the Exchange even if the employer's size grows beyond 50 employees as long as the employer continuously makes qualified health benefit plans in the Vermont Health Benefit Exchange available to its employees.
2. 1. On and after January 1, 2016, a qualified employer shall be an entity which employed an average of not more than 100 employees on working days during the preceding calendar year and the term "qualified employer" includes self-employed persons to the extent permitted under the Affordable Care Act. The number of employees shall be calculated using the method set forth in 26 U.S.C. § 4980H(c)(2). (b) (1)  On and after January 1, 2016, a qualified employer shall be an entity which employed an average of not more than 100 employees on working days during the preceding calendar year and the term "qualified employer" includes self-employed persons to the extent permitted under the Affordable Care Act. The number of employees shall be calculated using the method set forth in 26 U.S.C. § 4980H(c)(2).
   2. An employer with 100 or fewer employees that offers a qualified health benefit plan to its employees through the Vermont Health Benefit Exchange may continue to participate in the Exchange even if the employer's size grows beyond 100 employees as long as the employer continuously makes qualified health benefit plans in the Vermont Health Benefit Exchange available to its employees.
3. [Repealed.]

   Added 2011, No. 171 (Adj. Sess.), § 2; amended 2013, No. 79 , § 28, eff. Oct. 1, 2013; 2015, No. 54 , § 14, eff. June 5, 2015; 2015, No. 151 (Adj. Sess.), § 2.

§ 1805. Duties and responsibilities.

The Vermont Health Benefit Exchange shall have the following duties and responsibilities consistent with the Affordable Care Act:

1. Offering coverage for health services through qualified health benefit plans, including by creating a process for:
   1. the certification, decertification, and recertification of qualified health benefit plans as described in section 1806 of this title;
   2. enrolling qualified individuals in qualified health benefit plans, including through open enrollment periods as provided in the Affordable Care Act, and ensuring that individuals may transfer coverage between qualified health benefit plans and other sources of coverage as seamlessly as possible; and
   3. creating a simplified and uniform system for the administration of health benefits.
2. Determining eligibility for and enrolling individuals in Medicaid, Dr. Dynasaur, and VPharm pursuant to chapter 19 of this title, as well as any other public health benefit program.
3. Creating and maintaining consumer assistance tools, including a website through which enrollees and prospective enrollees of qualified health benefit plans may obtain standardized comparative information on such plans, a toll-free telephone hotline to respond to requests for assistance, and interactive online communication tools, in a manner that complies with the Americans with Disabilities Act.
4. Creating standardized forms and formats for presenting health benefit options in the Vermont Health Benefit Exchange, including the use of the uniform outline of coverage established under Section 2715 of the federal Public Health Services Act.
5. Assigning a quality and wellness rating to each qualified health benefit plan offered through the Vermont Health Benefit Exchange and determining each qualified health benefit plan's level of coverage in accordance with regulations issued by the U.S. Department of Health and Human Services.
6. Determining enrollee subsidies as required by the Secretary of the U.S. Department of the Treasury or of the U.S. Department of Health and Human Services and informing consumers of eligibility for subsidies, including by providing an electronic calculator to determine the actual cost of coverage after application of any premium tax credit under Section 36B of the Internal Revenue Code of 1986 and any cost-sharing reduction under Section 1402 of the Affordable Care Act.
7. Transferring to the Secretary of the U.S. Department of the Treasury the name and taxpayer identification number of each individual who was an employee of an employer but who was determined to be eligible for the premium tax credit under Section 36B of the Internal Revenue Code of 1986 for the following reasons:
   1. the employer did not provide minimum essential coverage; or
   2. the employer provided the minimum essential coverage, but it was determined under Section 36B(c)(2)(C) of the Internal Revenue Code to be either unaffordable to the employee or not to provide the required minimum actuarial value.
8. Performing duties required by the Secretary of the U.S. Department of Health and Human Services or the Secretary of the U.S. Department of the Treasury related to determining eligibility for the individual responsibility requirement exemptions, including:
   1. granting a certification attesting that an individual is exempt from the individual responsibility requirement or from the penalty for violating that requirement, if there is no affordable qualified health benefit plan available through the Vermont Health Benefit Exchange or the individual's employer for that individual or if the individual meets the requirements for any exemption from the individual responsibility requirement or from the penalty pursuant to Section 5000A of the Internal Revenue Code of 1986; and
   2. transferring to the Secretary of the U.S. Department of the Treasury a list of the individuals who are issued a certification under subdivision (8)(A) of this section, including the name and taxpayer identification number of each individual.
9. 1. Transferring to the Secretary of the U.S. Department of the Treasury the name and taxpayer identification number of each individual who notifies the Vermont Health Benefit Exchange that he or she has changed employers and of each individual who ceases coverage under a qualified health benefit plan during a plan year and the effective date of that cessation; and (9) (A) Transferring to the Secretary of the U.S. Department of the Treasury the name and taxpayer identification number of each individual who notifies the Vermont Health Benefit Exchange that he or she has changed employers and of each individual who ceases coverage under a qualified health benefit plan during a plan year and the effective date of that cessation; and
   2. Communicating to each employer the name of each of its employees and the effective date of the cessation reported to the U.S. Department of the Treasury under this subdivision.
10. Establishing a navigator program as described in section 1807 of this title.
11. Reviewing the rate of premium growth within and outside the Vermont Health Benefit Exchange.
12. [Repealed.]
13. Providing consumers and health care professionals with satisfaction surveys and other mechanisms for evaluating the performance of qualified health benefit plans and informing the Commissioner of Vermont Health Access and the Commissioner of Financial Regulation of such performance.
14. Ensuring consumers have easy and simple access to the relevant grievance and appeals processes pursuant to 8 V.S.A. chapter 107 and 3 V.S.A. § 3090 (Human Services Board).
15. Consulting with the Advisory Committee established in section 402 of this title to obtain information and advice as necessary to fulfill the duties outlined in this subchapter.
16. Referring consumers to the Office of the Health Care Advocate for assistance with grievances, appeals, and other issues involving the Vermont Health Benefit Exchange.
17. Establishing procedures, including payment mechanisms and standard fee or compensation schedules, that allow licensed insurance agents and brokers to be appropriately compensated outside the navigator program established in section 1807 of this title for:
    1. assisting with the enrollment of qualified individuals and qualified employers in any qualified health plan offered through the Exchange for which the individual or employer is eligible; and
    2. assisting qualified individuals in applying for premium tax credits and cost-sharing reductions for qualified health benefit plans purchased through the Exchange.

       Added 2011, No. 48 , § 4; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2011, No. 171 (Adj. Sess.), § 2d; 2013, No. 79 , § 29, eff. Oct. 1, 2013; 2013, No. 79 , § 35g, eff. January 1, 2014; 2021, No. 74 , § E.306.1, eff. Oct. 1, 2021.

§ 1806. Qualified health benefit plans.

1. Prior to contracting with a health insurer to offer a qualified health benefit plan, the Commissioner shall determine that making the plan available through the Vermont Health Benefit Exchange is in the best interests of individuals and qualified employers in this State. In determining the best interests, the Commissioner shall consider affordability; promotion of high-quality care, prevention, and wellness; promotion of access to health care; participation in the State's health care reform efforts; and such other criteria as the Commissioner, in the Commissioner's discretion, deems appropriate.
2. 1. A qualified health benefit plan shall provide the following benefits: (b) (1)  A qualified health benefit plan shall provide the following benefits:
      1. The essential benefits package required by Section 1302(a) of the Affordable Care Act and any additional benefits required by the Secretary of Human Services by rule after consultation with the Advisory Committee established in section 402 of this title and after approval from the Green Mountain Care Board established in 18 V.S.A. chapter 220.
      2. Notwithstanding subdivision (1)(A) of this subsection, a health insurer or a stand-alone dental insurer, including a nonprofit dental service corporation, may offer a plan that provides only limited dental benefits, either separately or in conjunction with a qualified health benefit plan, if it meets the requirements of Section 9832(c)(2)(A) of the Internal Revenue Code and provides pediatric dental benefits meeting the requirements of Section 1302(b)(1)(J) of the Affordable Care Act. Said plans may include child-only policies or family policies. If permitted under federal law, a qualified health benefit plan offered in conjunction with a stand-alone dental plan providing pediatric dental benefits meeting the requirements of Section 1302(b)(1)(J) of the Affordable Care Act shall be deemed to meet the requirements of this subsection.
   2. At least the bronze level of coverage as defined by Section 1302 of the Affordable Care Act and the cost-sharing limitations for individuals provided in Section 1302 of the Affordable Care Act, as well as any more restrictive cost-sharing requirements specified by the Secretary of Human Services by rule after consultation with the Advisory Committee established in section 402 of this title and after approval from the Green Mountain Care Board established in 18 V.S.A. chapter 220.
   3. For qualified health benefit plans offered to employers, a deductible which meets the limitations provided in Section 1302 of the Affordable Care Act and any more restrictive deductible requirements specified by the Secretary of Human Services by rule after consultation with the Advisory Committee established in section 402 of this title and after approval from the Green Mountain Care Board established in 18 V.S.A. chapter 220.
3. A qualified health benefit plan shall meet the following minimum prevention, quality, and wellness requirements:
   1. standards for marketing practices, network adequacy, essential community providers in underserved areas, appropriate services to enable access for underserved individuals or populations, accreditation, quality improvement, and information on quality measures for health benefit plan performance, as provided in Section 1311 of the Affordable Care Act and any more restrictive requirements provided by 8 V.S.A. chapter 107;
   2. quality and wellness standards, including a requirement for joint quality improvement activities with other plans, as specified in rule by the Secretary of Human Services, after consultation with the Commissioners of Health and of Financial Regulation and with the Advisory Committee established in section 402 of this title; and
   3. standards for participation in the Blueprint for Health as provided in 18 V.S.A. chapter 13.
4. A health insurer offering a qualified health benefit plan shall use the uniform enrollment forms and descriptions of coverage provided by the Commissioners of Vermont Health Access and of Financial Regulation.
5. 1. A health insurer offering a qualified health benefit plan shall comply with the following insurance and consumer information requirements: (e) (1)  A health insurer offering a qualified health benefit plan shall comply with the following insurance and consumer information requirements:
      1. 1. obtain premium approval through the rate review process provided in 8 V.S.A. chapter 107; and (A) (i) obtain premium approval through the rate review process provided in 8 V.S.A. chapter 107; and
         2. submit to the Commissioner of Financial Regulation a justification for any premium increase before implementation of that increase and prominently post this information on the health insurer's website.
      2. Offer at least one qualified health benefit plan at the silver level and at least one qualified health benefit plan at the gold level that meet the requirements of Section 1302 of the Affordable Care Act and any additional requirements specified by the Secretary of Human Services by rule.  In addition, a health insurer may choose to offer one or more qualified health benefit plans at the platinum level that meet the requirements of Section 1302 of the Affordable Care Act and any additional requirements specified by the Secretary of Human Services by rule.
      3. Charge the same premium rate for a health benefit plan without regard to whether the plan is offered through the Vermont Health Benefit Exchange and without regard to whether the plan is offered directly from the carrier or through an insurance agent.
      4. Provide accurate and timely disclosure of information to the public and to the Vermont Health Benefit Exchange relating to claims denials, enrollment data, rating practices, out-of-network coverage, enrollee and participant rights provided by Title I of the Affordable Care Act, and other information as required by the Commissioner of Vermont Health Access or by the Commissioner of Financial Regulation.  The Commissioner of Financial Regulation shall define, by rule, the acceptable time frame for provision of information in accordance with this subdivision.
      5. Provide information in a timely manner to an individual, upon request, regarding the cost-sharing amounts for that individual's health benefit plan.
   2. A health insurer offering a qualified health benefit plan shall comply with all other insurance requirements for health insurers as provided in 8 V.S.A. chapter 107 and as specified by rule by the Commissioner of Financial Regulation.
6. Consistent with Section 1311(e)(1)(B) of the Affordable Care Act, the Vermont Health Benefit Exchange shall not exclude a health benefit plan:
   1. on the basis that the plan is a fee-for-service plan;
   2. through the imposition of premium price controls by the Vermont Health Benefit Exchange; or
   3. on the basis that the health benefit plan provides for treatments necessary to prevent patients' deaths in circumstances the Vermont Health Benefit Exchange determines are inappropriate or too costly.
7. The Vermont Health Benefit Exchange shall clearly indicate to any prospective purchaser of a bronze-level plan, and of other plans as appropriate, the potential for significant out-of-pocket costs, in addition to the premium, associated with the plan.

   Added 2011, No. 48 , § 4; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2011, No. 171 (Adj. Sess.), §§ 2a, 2h; 2021, No. 20 , § 297.

§ 1807. Navigators.

1. 1. The Vermont Health Benefit Exchange shall establish a navigator program to assist individuals and employers in enrolling in a qualified health benefit plan offered under the Vermont Health Benefit Exchange. The Vermont Health Benefit Exchange shall select individuals and entities qualified to serve as navigators and shall award grants to navigators for the performance of their duties. (a) (1)  The Vermont Health Benefit Exchange shall establish a navigator program to assist individuals and employers in enrolling in a qualified health benefit plan offered under the Vermont Health Benefit Exchange. The Vermont Health Benefit Exchange shall select individuals and entities qualified to serve as navigators and shall award grants to navigators for the performance of their duties.
   2. The Vermont Health Benefit Exchange shall ensure that navigators are available to provide assistance in person or through interactive technology to individuals in all regions of the State in a manner that complies with the Americans with Disabilities Act.
   3. Consistent with Section 1311(i)(4) of the Affordable Care Act, health insurers shall not serve as navigators, and no navigator shall receive any compensation from a health insurer in connection with enrolling individuals or employees in qualified health benefit plans.
2. Navigators shall have the following duties:
   1. conduct public education activities to raise awareness of the availability of qualified health benefit plans;
   2. distribute fair and impartial information concerning enrollment in qualified health benefit plans and concerning the availability of premium tax credits and cost-sharing reductions;
   3. facilitate enrollment in qualified health benefit plans, Medicaid, Dr. Dynasaur, VPharm, and other public health benefit programs;
   4. provide referrals to the Office of the Health Care Advocate and any other appropriate agency for any enrollee with a grievance, complaint, or question regarding his or her health benefit plan, coverage, or a determination under that plan or coverage;
   5. provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Vermont Health Benefit Exchange; and
   6. distribute information to health care professionals, community organizations, and others to facilitate the enrollment of individuals who are eligible for Medicaid, Dr. Dynasaur, VPharm, other public health benefit programs, or the Vermont Health Benefit Exchange in order to ensure that all eligible individuals are enrolled.
   7. [Repealed.]

      Added 2011, No. 48 , § 4; amended 2011, No. 171 (Adj. Sess.), § 2b; 2013, No. 79 , §§ 22, 35h, eff. Jan. 1, 2014; 2019, No. 15 , § 1, eff. May 6, 2019.

§ 1808. Financial integrity.

1. The Vermont Health Benefit Exchange shall:
   1. keep an accurate accounting of all activities, receipts, and expenditures and submit this information annually as required by federal law; and
   2. cooperate with the Secretary of the U.S. Department of Health and Human Services or the Inspector General of the U.S. Department of Health and Human Services in any investigation into the affairs of the Vermont Health Benefit Exchange, any examination of the properties and records of the Vermont Health Benefit Exchange, or any requirement for periodic reports in relation to the activities undertaken by the Vermont Health Benefit Exchange.
2. In carrying out its activities under this subchapter, the Vermont Health Benefit Exchange shall not use any funds intended for the administrative and operational expenses of the Vermont Health Benefit Exchange for staff retreats, promotional giveaways, excessive executive compensation, or promotion of federal or State legislative or regulatory modifications.

   Added 2011, No. 48 , § 4.

§ 1809. Publication of costs and satisfaction surveys.

1. The Vermont Health Benefit Exchange shall publish the average costs of licensing, regulatory fees, and any other payments required by the Exchange, as well as the administrative costs of the Exchange, on a website intended to educate consumers about such costs. This information shall include information on monies lost to waste, fraud, and abuse.
2. The Vermont Health Benefit Exchange shall publish the deidentified results of the satisfaction surveys and other evaluation mechanisms required pursuant to subdivision 1805(13) of this title on a website intended to enable consumers to compare the qualified health benefit plans offered through the Exchange.

   Added 2011, No. 48 , § 4.

§ 1810. Rules.

The Secretary of Human Services may adopt rules pursuant to 3 V.S.A. chapter 25 as needed to carry out the duties and functions established in this subchapter.

Added 2011, No. 48 , § 4.

§ 1811. Health benefit plans for individuals and small employers.

1. As used in this section:
   1. "Health benefit plan" means a health insurance policy, a nonprofit hospital or medical service corporation service contract, or a health maintenance organization health benefit plan offered through the Vermont Health Benefit Exchange or a reflective health benefit plan offered in accordance with section 1813 of this title that is issued to an individual or to an employee of a small employer. The term does not include coverage only for accident or disability income insurance, liability insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, automobile medical payment insurance, credit-only insurance, coverage for on-site medical clinics, or other similar insurance coverage in which benefits for health services are secondary or incidental to other insurance benefits as provided under the Affordable Care Act. The term also does not include stand-alone dental or vision benefits; long-term care insurance; short-term, limited-duration health insurance; specific disease or other limited benefit coverage; Medicare supplemental health benefits; Medicare Advantage plans; and other similar benefits excluded under the Affordable Care Act.
   2. "Registered carrier" means any person, except an insurance agent, broker, appraiser, or adjuster, who issues a health benefit plan and who has a registration in effect with the Commissioner of Financial Regulation as required by this section.
   3. 1. Until January 1, 2016, "small employer" means an entity which employed an average of not more than 50 employees on working days during the preceding calendar year. The term includes self-employed persons to the extent permitted under the Affordable Care Act. Calculation of the number of employees of a small employer shall not include a part-time employee who works fewer than 30 hours per week or a seasonal worker as defined in 26 U.S.C. § 4980H(c)(2)(B). An employer may continue to participate in the Exchange even if the employer's size grows beyond 50 employees as long as the employer continuously makes qualified health benefit plans in the Vermont Health Benefit Exchange available to its employees. (3) (A) Until January 1, 2016, "small employer" means an entity which employed an average of not more than 50 employees on working days during the preceding calendar year. The term includes self-employed persons to the extent permitted under the Affordable Care Act. Calculation of the number of employees of a small employer shall not include a part-time employee who works fewer than 30 hours per week or a seasonal worker as defined in 26 U.S.C. § 4980H(c)(2)(B). An employer may continue to participate in the Exchange even if the employer's size grows beyond 50 employees as long as the employer continuously makes qualified health benefit plans in the Vermont Health Benefit Exchange available to its employees.
      2. Beginning on January 1, 2016, "small employer" means an entity which employed an average of not more than 100 employees on working days during the preceding calendar year. The term includes self-employed persons to the extent permitted under the Affordable Care Act. The number of employees shall be calculated using the method set forth in 26 U.S.C. § 4980H(c)(2). An employer may continue to participate in the Exchange even if the employer's size grows beyond 100 employees as long as the employer continuously makes qualified health benefit plans in the Vermont Health Benefit Exchange available to its employees.
2. 1. To the extent permitted by the U.S. Department of Health and Human Services, an individual may purchase a health benefit plan through the Exchange website, through navigators, by telephone, or directly from a registered carrier under contract with the Vermont Health Benefit Exchange, if the carrier elects to make direct enrollment available. A registered carrier enrolling individuals in health benefit plans directly shall comply with all open enrollment and special enrollment periods applicable to the Vermont Health Benefit Exchange. (b) (1)  To the extent permitted by the U.S. Department of Health and Human Services, an individual may purchase a health benefit plan through the Exchange website, through navigators, by telephone, or directly from a registered carrier under contract with the Vermont Health Benefit Exchange, if the carrier elects to make direct enrollment available. A registered carrier enrolling individuals in health benefit plans directly shall comply with all open enrollment and special enrollment periods applicable to the Vermont Health Benefit Exchange.
   2. To the extent permitted by the U.S. Department of Health and Human Services, a small employer or an employee of a small employer may purchase a health benefit plan through the Exchange website, through navigators, by telephone, or directly from a registered carrier under contract with the Vermont Health Benefit Exchange.
   3. No person may provide a health benefit plan to an individual or small employer unless the plan complies with the provisions of this subchapter.
3. No person may provide a health benefit plan to an individual or small employer unless such person is a registered carrier. The Commissioner of Financial Regulation shall establish, by rule, the minimum financial, marketing, service, and other requirements for registration. Such registration shall be effective upon approval by the Commissioner of Financial Regulation and shall remain in effect until revoked or suspended by the Commissioner of Financial Regulation for cause or until withdrawn by the carrier. A carrier may withdraw its registration upon at least six months' prior written notice to the Commissioner of Financial Regulation. A registration filed with the Commissioner of Financial Regulation shall be deemed to be approved unless it is disapproved by the Commissioner of Financial Regulation within 30 days of filing.
4. 1. Guaranteed issue.  A registered carrier shall guarantee acceptance of all individuals, small employers, and employees of small employers, and each dependent of such individuals and employees, for any health benefit plan offered by the carrier, regardless of any outstanding premium amount a subscriber may owe to the carrier for coverage provided during the previous plan year. (d) (1)  Guaranteed issue.  A registered carrier shall guarantee acceptance of all individuals, small employers, and employees of small employers, and each dependent of such individuals and employees, for any health benefit plan offered by the carrier, regardless of any outstanding premium amount a subscriber may owe to the carrier for coverage provided during the previous plan year.
   2. Preexisting condition exclusions.  A registered carrier shall not exclude, restrict, or otherwise limit coverage under a health benefit plan for any preexisting health condition.
   3. Annual limitations on cost sharing.
      1. 1. The annual limitation on cost sharing for self-only coverage for any year shall be the same as the dollar limit established by the federal government for self-only coverage for that year in accordance with 45 C.F.R. § 156.130. (A) (i) The annual limitation on cost sharing for self-only coverage for any year shall be the same as the dollar limit established by the federal government for self-only coverage for that year in accordance with 45 C.F.R. § 156.130.
         2. The annual limitation on cost sharing for other than self-only coverage for any year shall be twice the dollar limit for self-only coverage described in subdivision (i) of this subdivision (A).

            In the event that the federal government does not establish an annual limitation on cost sharing for any plan year, the annual limitation on cost sharing for self-only coverage for that year shall be the dollar limit for self-only coverage in the preceding calendar year, increased by any percentage by which the average per capita premium for health insurance coverage in Vermont for the preceding calendar year exceeds the average per capita premium for the year before that.

            (ii) The annual limitation on cost-sharing for other than self-only coverage for any year in which the federal government does not establish an annual limitation on cost sharing shall be twice the dollar limit for self-only coverage described in subdivision (i) of this subdivision (B).

         3. with respect to infants, children, and adolescents, evidence-informed preventive care and screenings as set forth in comprehensive guidelines supported by the federal Health Resources and Services Administration; and
         4. with respect to women, to the extent not included in subdivision (i) of this subdivision (5)(A), evidence-informed preventive care and screenings set forth in binding comprehensive health plan coverage guidelines supported by the federal Health Resources and Services Administration.
   4. Ban on annual and lifetime limits.  A health benefit plan shall not establish any annual or lifetime limit on the dollar amount of essential health benefits, as defined in Section 1302(b) of the Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, and applicable regulations and federal guidance, for any individual insured under the plan, regardless of whether the services are provided in-network or out-of-network.
   5. 1. No cost sharing for preventive services.  A health benefit plan shall not impose any co-payment, coinsurance, or deductible requirements for: (5) (A) No cost sharing for preventive services.  A health benefit plan shall not impose any co-payment, coinsurance, or deductible requirements for:
      2. Subdivision (A) of this subdivision (5) shall apply to a high-deductible health plan only to the extent that it would not disqualify the plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.

      (i) preventive services that have an "A" or "B" rating in the current recommendations of the U.S. Preventive Services Task Force;

      (ii) immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved;

5. A registered carrier shall offer a health benefit plan rate structure which at least differentiates between single person, two person, and family rates.
6. 1. A registered carrier shall use a community rating method acceptable to the Commissioner of Financial Regulation for determining premiums for health benefit plans. Except as provided in subdivision (2) of this subsection, the following risk classification factors are prohibited from use in rating individuals, small employers, or employees of small employers, or the dependents of such individuals or employees: (f) (1)  A registered carrier shall use a community rating method acceptable to the Commissioner of Financial Regulation for determining premiums for health benefit plans. Except as provided in subdivision (2) of this subsection, the following risk classification factors are prohibited from use in rating individuals, small employers, or employees of small employers, or the dependents of such individuals or employees:
      1. demographic rating, including age and gender rating;
      2. geographic area rating;
      3. industry rating;
      4. medical underwriting and screening;
      5. experience rating;
      6. tier rating; or
      7. durational rating.
   2. 1. The Commissioner of Financial Regulation shall, by rule, adopt standards and a process for permitting registered carriers to use one or more risk classifications in their community rating method, provided that the premium charged shall not deviate above or below the community rate filed by the carrier by more than 20 percent and provided further that the Commissioner of Financial Regulation's rules may not permit any medical underwriting and screening and shall give due consideration to the need for affordability and accessibility of health insurance. (2) (A) The Commissioner of Financial Regulation shall, by rule, adopt standards and a process for permitting registered carriers to use one or more risk classifications in their community rating method, provided that the premium charged shall not deviate above or below the community rate filed by the carrier by more than 20 percent and provided further that the Commissioner of Financial Regulation's rules may not permit any medical underwriting and screening and shall give due consideration to the need for affordability and accessibility of health insurance.
      2. The Commissioner of Financial Regulation's rules shall permit a carrier, including a hospital or medical service corporation and a health maintenance organization, to establish rewards, premium discounts, split benefit designs, rebates, or otherwise waive or modify applicable co-payments, deductibles, or other cost-sharing amounts in return for adherence by a member or subscriber to programs of health promotion and disease prevention. The Commissioner of Financial Regulation shall consult with the Commissioner of Health, the Director of the Blueprint for Health, and the Commissioner of Vermont Health Access in the development of health promotion and disease prevention rules that are consistent with the Blueprint for Health. Such rules shall:
         1. limit any reward, discount, rebate, or waiver or modification of cost-sharing amounts to not more than a total of 15 percent of the cost of the premium for the applicable coverage tier, provided that the sum of any rate deviations under subdivision (A) of this subdivision (2) does not exceed 30 percent;
         2. be designed to promote good health or prevent disease for individuals in the program and not be used as a subterfuge for imposing higher costs on an individual based on a health factor;
         3. provide that the reward under the program is available to all similarly situated individuals and shall comply with the nondiscrimination provisions of the federal Health Insurance Portability and Accountability Act of 1996; and
         4. provide a reasonable alternative standard to obtain the reward to any individual for whom it is unreasonably difficult due to a medical condition or other reasonable mitigating circumstance to satisfy the otherwise applicable standard for the discount and disclose in all plan materials that describe the discount program the availability of a reasonable alternative standard.
      3. The Commissioner of Financial Regulation's rules shall include:
         1. standards and procedures for health promotion and disease prevention programs based on the best scientific, evidence-based medical practices as recommended by the Commissioner of Health;
         2. standards and procedures for evaluating an individual's adherence to programs of health promotion and disease prevention; and
         3. any other standards and procedures necessary or desirable to carry out the purposes of this subdivision (2).
      4. The Commissioner of Financial Regulation may require a registered carrier to identify that percentage of a requested premium increase which is attributed to the following categories: hospital inpatient costs, hospital outpatient costs, pharmacy costs, primary care, other medical costs, administrative costs, and projected reserves or profit. Reporting of this information shall occur at the time a rate increase is sought and shall be in the manner and form directed by the Commissioner of Financial Regulation. Such information shall be made available to the public in a manner that is easy to understand.
7. A registered carrier shall file with the Commissioner of Financial Regulation an annual certification by a member of the American Academy of Actuaries of the carrier's compliance with this section. The requirements for certification shall be as the Commissioner of Financial Regulation prescribes by rule.
8. A registered carrier shall provide, on forms prescribed by the Commissioner of Financial Regulation, full disclosure to a small employer of all premium rates and any risk classification formulas or factors prior to acceptance of a plan by the small employer.
9. A registered carrier shall guarantee the rates on a health benefit plan for a minimum of 12 months.
10. The Commissioner of Financial Regulation or the Green Mountain Care Board established in 18 V.S.A. chapter 220, as appropriate, shall disapprove any rates filed by any registered carrier, whether initial or revised, for insurance policies unless the anticipated medical loss ratios for the entire period for which rates are computed are at least 80 percent, as required by the Affordable Care Act.
11. The guaranteed acceptance provision of subsection (d) of this section shall not be construed to limit an employer's discretion in contracting with his or her employees for insurance coverage.
12. A registered carrier shall allow for the enrollment of a pregnant individual, and of any individual who is eligible for coverage under the terms of the health benefit plan because of a relationship to the pregnant individual, at any time after the commencement of the pregnancy. Coverage shall be effective as of the first of the month following the individual's selection of a health benefit plan.

    Added 2011, No. 171 (Adj. Sess.), § 3, eff. Jan. 1, 2013; amended 2013, No. 79 , § 5n, eff. Jan. 1, 2014; 2013, No. 79 , § 30, eff. Oct. 1, 2013; 2013, No. 144 (Adj. Sess.), § 3, eff. May 27, 2014; 2015, No. 54 , § 12, eff. June 5, 2015; 2015, No. 120 (Adj. Sess.), § 4; 2017, No. 85 , § E.306.3; 2017, No. 88 (Adj. Sess.), § 3, eff. Feb. 20, 2018; 2017, No. 131 (Adj. Sess.), § 6, eff. May 16, 2018; 2019, No. 19 , § 5, eff. Jan. 1, 2020; 2019, No. 63 , § 6, eff. Jan. 1, 2020.

§ 1812. Financial assistance to individuals.

1. 1. An individual or family eligible for federal premium tax credits under 26 U.S.C. § 36B with income less than or equal to 300 percent of federal poverty level shall be eligible for premium assistance from the State of Vermont. (a) (1)  An individual or family eligible for federal premium tax credits under 26 U.S.C. § 36B with income less than or equal to 300 percent of federal poverty level shall be eligible for premium assistance from the State of Vermont.
   2. The Department of Vermont Health Access shall establish a premium schedule on a sliding scale based on modified adjusted gross income for the individuals and families described in subdivision (1) of this subsection. The Department shall reduce the premium contribution for these individuals and families by 1.5 percent below the premium amount established in 26 U.S.C. § 36B.
   3. Premium assistance shall be available for the same qualified health benefit plans for which federal premium tax credits are available.
2. 1. An individual or family with income at or below 300 percent of the federal poverty level shall be eligible for cost-sharing assistance, including a reduction in the out-of-pocket maximums established under Section 1402 of the Affordable Care Act. (b) (1)  An individual or family with income at or below 300 percent of the federal poverty level shall be eligible for cost-sharing assistance, including a reduction in the out-of-pocket maximums established under Section 1402 of the Affordable Care Act.
   2. The Department of Vermont Health Access shall establish cost-sharing assistance on a sliding scale based on modified adjusted gross income for the individuals and families described in subdivision (1) of this subsection. Cost-sharing assistance shall be established as follows:
      1. for households with income at or below 150 percent of the federal poverty level (FPL): 94 percent actuarial value;
      2. for households with income above 150 percent FPL and at or below 200 percent FPL: 87 percent actuarial value;
      3. for households with income above 200 percent FPL and at or below 250 percent FPL: 77 percent actuarial value;
      4. for households with income above 250 percent FPL and at or below 300 percent FPL: 73 percent actuarial value.
   3. Cost-sharing assistance shall be available for silver-level qualified health benefit plans purchased through the Vermont Health Benefit Exchange and shall be administered using the same methods as set forth in Section 1402 of the Affordable Care Act to the extent practicable.
3. To the extent feasible, the Department shall use the same mechanisms provided in the Affordable Care Act to establish financial assistance under this section in order to minimize confusion and complication for individuals, families, and health insurers.

   Added 2013, No. 50 , § E.307.1, eff. Oct. 1, 2013; amended 2015, No. 23 , § 54; 2017, No. 88 (Adj. Sess.), § 4, eff. Feb. 20, 2018.

§ 1813. Reflective health benefit plans.

1. 1. In the event that federal cost-sharing reduction payments to insurers are suspended or discontinued, registered carriers may offer to individuals and employees of small employers nonqualified reflective health benefit plans that do not include funding to offset the loss of the federal cost-sharing reduction payments. These plans shall be similar to, but contain at least one variation from, qualified health benefit plans offered through the Vermont Health Benefit Exchange that include funding to offset the loss of the federal cost-sharing reduction payments. (a) (1)  In the event that federal cost-sharing reduction payments to insurers are suspended or discontinued, registered carriers may offer to individuals and employees of small employers nonqualified reflective health benefit plans that do not include funding to offset the loss of the federal cost-sharing reduction payments. These plans shall be similar to, but contain at least one variation from, qualified health benefit plans offered through the Vermont Health Benefit Exchange that include funding to offset the loss of the federal cost-sharing reduction payments.
   2. In its review and approval of premium rates pursuant to 8 V.S.A. § 4062 , the Green Mountain Care Board shall ensure that:
      1. the rates for some or all qualified health benefit plans offered through the Vermont Health Benefit Exchange include funding to offset the loss of the federal cost-sharing reduction payments; and
      2. the rates for the reflective health benefit plans described in subdivision (1) of this subsection (a) do not include funding to offset the loss of the federal cost-sharing reduction payments.
   3. To the extent not expressly prohibited under federal law, the Green Mountain Care Board shall ensure that funding to offset the loss of the federal cost-sharing reduction payments is included exclusively in silver-level qualified health benefit plans offered through the Vermont Health Benefit Exchange.
2. A reflective health benefit plan shall comply with the requirements of section 1806 of this title except that the plan shall not be offered through the Vermont Health Benefit Exchange.

   Added 2017, No. 88 (Adj. Sess.), § 5, eff. Feb. 20, 2018; amended 2019, No. 19 , § 6, eff. Jan. 1, 2020.

§ 1814. Maximum out-of-pocket limit for prescription drugs in bronze plans.

1. 1. Notwithstanding any provision of 8 V.S.A. § 4089i to the contrary, the Green Mountain Care Board may approve modifications to the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i for one or more bronze-level plans, as long as the Board finds that the offering of such plans will not adversely impact the plan options available to consumers with high prescription drug needs who benefit from the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i. (a) (1)  Notwithstanding any provision of 8 V.S.A. § 4089i to the contrary, the Green Mountain Care Board may approve modifications to the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i for one or more bronze-level plans, as long as the Board finds that the offering of such plans will not adversely impact the plan options available to consumers with high prescription drug needs who benefit from the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i.
   2. The Department of Vermont Health Access shall certify at least two standard bronze-level plans that include the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i, as long as the plans comply with federal requirements. Notwithstanding any provision of 8 V.S.A. § 4089i to the contrary, the Department may certify one or more bronze-level qualified health benefit plans with modifications to the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i.
2. 1. For each individual enrolled in a bronze-level qualified health benefit plan for the previous two plan years who had out-of-pocket prescription drug expenditures that met the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i for the most recent plan year for which information is available, the health insurer shall, absent an alternative plan selection or plan cancellation by the individual, automatically reenroll the individual in a bronze-level qualified health plan for the forthcoming plan year with an out-of-pocket prescription drug limit at or below the limit established in 8 V.S.A. § 4089i . (b) (1)  For each individual enrolled in a bronze-level qualified health benefit plan for the previous two plan years who had out-of-pocket prescription drug expenditures that met the out-of-pocket prescription drug limit established in 8 V.S.A. § 4089i for the most recent plan year for which information is available, the health insurer shall, absent an alternative plan selection or plan cancellation by the individual, automatically reenroll the individual in a bronze-level qualified health plan for the forthcoming plan year with an out-of-pocket prescription drug limit at or below the limit established in 8 V.S.A. § 4089i.
   2. Prior to reenrolling an individual in a plan pursuant to subdivision (1) of this subsection, the health insurer shall notify the individual of the insurer's intent to reenroll the individual automatically in a bronze-level qualified health plan for the forthcoming plan year with an out-of-pocket prescription drug limit at or below the limit established in 8 V.S.A. § 4089i unless the individual contacts the insurer to select a different plan and of the availability of bronze-level plans with higher out-of-pocket prescription drug limits. The health insurer shall collaborate with the Department of Vermont Health Access and the Office of the Health Care Advocate as to the notification's form and content.

      Added 2017, No. 210 (Adj. Sess.), § 12, eff. June 1, 2018.

§ 1821. Purpose.

The purpose of Green Mountain Care is to provide, as a public good, comprehensive, affordable, high-quality, publicly financed health care coverage for all Vermont residents in a seamless and equitable manner regardless of income, assets, health status, or availability of other health coverage. Green Mountain Care shall contain costs by:

1. providing incentives to residents to avoid preventable health conditions, promote health, and avoid unnecessary emergency room visits;
2. establishing innovative payment mechanisms to health care professionals, such as global payments;
3. encouraging the management of health services through the Blueprint for Health; and
4. reducing unnecessary administrative expenditures.

   Added 2011, No. 48 , § 4.

§ 1822. Implementation; waiver.

1. Green Mountain Care shall be implemented 90 days following the last to occur of:
   1. Receipt of a waiver under Section 1332 of the Affordable Care Act pursuant to subsection (b) of this section.
   2. Enactment of a law establishing the financing for Green Mountain Care.
   3. Approval by the Green Mountain Care Board of the initial Green Mountain Care benefit package pursuant to 18 V.S.A. § 9375 .
   4. Enactment of the appropriations for the initial Green Mountain Care benefit package proposed by the Green Mountain Care Board pursuant to 18 V.S.A. § 9375 .
   5. A determination by the Green Mountain Care Board, as the result of a detailed and transparent analysis, that each of the following conditions will be met:
      1. Each Vermont resident covered by Green Mountain Care will receive benefits with an actuarial value of 80 percent or greater.
      2. When implemented, Green Mountain Care will not have a negative aggregate impact on Vermont's economy. This determination shall include an analysis of the impact of implementation on economic growth.
      3. The financing for Green Mountain Care is sustainable. In this analysis, the Board shall consider at least a five-year revenue forecast using the consensus process established in 32 V.S.A. § 305a , projections of federal and other funds available to support Green Mountain Care, and estimated expenses for Green Mountain Care for an equivalent time period.
      4. Administrative expenses in Vermont's health care system for which data are available will be reduced below 2011 levels, adjusted for inflation and other factors as necessary to reflect the present value of 2011 dollars at the time of the analysis.
      5. Cost-containment efforts will result in a reduction in the rate of growth in Vermont's per-capita health care spending without reducing access to necessary care or resulting in excessive wait times for services.
      6. Health care professionals will be reimbursed at levels sufficient to allow Vermont to recruit and retain high-quality health care professionals.
2. As soon as allowed under federal law, the Secretary of Administration shall seek a waiver to allow the State to suspend operation of the Vermont Health Benefit Exchange and to enable Vermont to receive the appropriate federal fund contribution in lieu of the federal premium tax credits, cost-sharing subsidies, and small business tax credits provided in the Affordable Care Act. The Secretary may seek a waiver from other provisions of the Affordable Care Act as necessary to ensure the operation of Green Mountain Care.
3. The Green Mountain Care Board's analysis prepared pursuant to subdivision (a)(5) of this section shall be made available to the General Assembly and the public and shall include:
   1. a complete fiscal projection of revenues and expenses, as described in subdivision (a)(5) of this section, including reserves, if recommended, and other costs in addition to the cost of services, over at least a five-year period for a public-private universal health care system providing benefits with an actuarial value of 80 percent or greater;
   2. the financing plans provided to the General Assembly in January 2013 pursuant to 2011 Acts and Resolves No. 48, Sec. 9;
   3. an analysis of how implementing Green Mountain Care will further the principles of health care reform expressed in 18 V.S.A. § 9371 beyond the reforms established through the Blueprint for Health; and
   4. a comparison of best practices for reducing health care costs in self-funded plans, if available.

      Added 2011, No. 48 , § 4; amended 2011, No. 171 (Adj. Sess.), § 36a, eff. May 16, 2012.

§ 1823. Definitions.

As used in this subchapter:

1. "Agency" means the Agency of Human Services.
2. "Board" means the Green Mountain Care Board established in 18 V.S.A. chapter 220.
3. "CHIP funds" means federal funds available under Title XXI of the Social Security Act.
4. "Chronic care" means health services provided by a health care professional for an established clinical condition that is expected to last a year or more and that requires ongoing clinical management attempting to restore the individual to highest function, minimize the negative effects of the condition, prevent complications related to chronic conditions, engage in advanced care planning, and promote appropriate access to palliative care. Examples of chronic conditions include diabetes, hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental condition or psychiatric disability, spinal cord injury, and hyperlipidemia.
5. "Chronic care management" means a system of coordinated health care interventions and communications for individuals with chronic conditions, including significant patient self-care efforts, systemic supports for licensed health care practitioners and their patients, and a plan of care emphasizing prevention of complications utilizing evidence-based practice guidelines, patient empowerment strategies, and evaluation of clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.
6. "Health care professional" means an individual, partnership, corporation, facility, or institution licensed, certified, or otherwise authorized by Vermont law to provide professional health services.
7. "Health service" means any treatment or procedure delivered by a health care professional to maintain an individual's physical or mental health or to diagnose or treat an individual's physical or mental condition, including services ordered by a health care professional, chronic care management, preventive care, wellness services, and medically necessary services to assist in activities of daily living.
8. "Hospital" shall have the same meaning as in 18 V.S.A. § 1902 and may include hospitals located outside the State.
9. "Preventive care" means health services provided by health care professionals to identify and treat asymptomatic individuals who have risk factors or preclinical disease, but in whom the disease is not clinically apparent, including immunizations and screening, counseling, treatment, and medication determined by scientific evidence to be effective in preventing or detecting a condition.
10. "Primary care" means health services provided by health care professionals, including naturopathic physicians licensed pursuant to 26 V.S.A. chapter 81, who are specifically trained for and skilled in first-contact and continuing care for individuals with signs, symptoms, or health concerns, not limited by problem origin, organ system, or diagnosis, and shall include family planning, prenatal care, and mental health and substance abuse treatment.
11. "Secretary" means the Secretary of Human Services.
12. "Vermont resident" means an individual domiciled in Vermont as evidenced by an intent to maintain a principal dwelling place in Vermont indefinitely and to return to Vermont if temporarily absent, coupled with an act or acts consistent with that intent. An individual shall not be considered to be a Vermont resident if he or she is 18 years of age or older and is claimed as a dependent on the tax return of a resident of another State.
13. "Wellness services" means health services, programs, or activities that focus on the promotion or maintenance of good health.

    Added 2011, No. 48 , § 4; amended 2011, No. 96 (Adj. Sess.), § 6, eff. May 2, 2012; 2013, No. 96 (Adj. Sess.), § 203.

§ 1824. Eligibility.

1. 1. Upon implementation, all Vermont residents shall be eligible for Green Mountain Care, regardless of whether an employer offers health insurance for which they are eligible. The Agency shall establish standards by rule for proof and verification of residency. (a) (1)  Upon implementation, all Vermont residents shall be eligible for Green Mountain Care, regardless of whether an employer offers health insurance for which they are eligible. The Agency shall establish standards by rule for proof and verification of residency.
   2. 1. Except as otherwise provided in subdivision (C) of this subdivision (2), if an individual is determined to be eligible for Green Mountain Care based on information later found to be false, the Agency shall make reasonable efforts to recover from the individual the amounts expended for his or her care. In addition, if the individual knowingly provided the false information, he or she shall be assessed an administrative penalty of not more than $5,000.00. (2) (A) Except as otherwise provided in subdivision (C) of this subdivision (2), if an individual is determined to be eligible for Green Mountain Care based on information later found to be false, the Agency shall make reasonable efforts to recover from the individual the amounts expended for his or her care. In addition, if the individual knowingly provided the false information, he or she shall be assessed an administrative penalty of not more than $5,000.00.
      2. The Agency shall include information on the Green Mountain Care application to provide notice to applicants of the penalty for knowingly providing false information as established in subdivision (A) of this subdivision (2).
      3. An individual determined to be eligible for Green Mountain Care whose health services are paid in whole or in part by Medicaid funds who commits fraud shall be subject to the provisions of chapter 1, subchapter 5 of this title in lieu of the administrative penalty described in subdivision (A) of this subdivision (2).
      4. Nothing in this section shall be construed to limit or restrict prosecutions under any applicable provision of law.
   3. 1. Except as otherwise provided in this section, a person who is not a Vermont resident shall not be eligible for Green Mountain Care. (3) (A) Except as otherwise provided in this section, a person who is not a Vermont resident shall not be eligible for Green Mountain Care.
      2. Except as otherwise provided in subdivision (C) of this subdivision (3), an individual covered under Green Mountain Care shall inform the Agency within 60 days of becoming a resident of another state. An individual who obtains or attempts to obtain health services through Green Mountain Care more than 60 days after becoming a resident of another state shall reimburse the Agency for the amounts expended for his or her care and shall be assessed an administrative penalty of not more than $1,000.00 for a first violation and not more than $2,000.00 for any subsequent violation.
      3. An individual whose health services are paid in whole or in part by Medicaid funds who obtains or attempts to obtain health services through Green Mountain Care more than 60 days after becoming a resident of another state shall be subject to the provisions of chapter 1, subchapter 5 of this title in lieu of the administrative penalty described in subdivision (B) of this subdivision (3).
      4. Nothing in this section shall be construed to limit or restrict prosecutions under any applicable provision of law.
2. The Agency shall establish a procedure to enroll residents in Green Mountain Care.
3. 1. The Agency shall establish by rule a process to allow health care professionals to presume an individual is eligible based on the information provided on a simplified application. (c) (1)  The Agency shall establish by rule a process to allow health care professionals to presume an individual is eligible based on the information provided on a simplified application.
   2. After submission of the application, the Agency shall collect additional information as necessary to determine whether Medicaid, Medicare, CHIP, or other federal funds may be applied toward the cost of the health services provided, but shall provide payment for any health services received by the individual from the time the application is submitted.
   3. If an individual presumed eligible for Green Mountain Care pursuant to subdivision (1) of this subsection is later determined not to be eligible for the program, the Agency shall make reasonable efforts to recover from the individual the amounts expended for his or her care.
4. The Agency shall adopt rules pursuant to 3 V.S.A. chapter 25 to ensure that Vermont residents who are temporarily out of the State and who intend to return and reside in Vermont remain eligible for Green Mountain Care while outside Vermont.
5. A nonresident visiting Vermont, or his or her insurer, shall be billed for all services received. The Agency may enter into intergovernmental arrangements or contracts with other states and countries to provide reciprocal coverage for temporary visitors and shall adopt rules pursuant to 3 V.S.A. chapter 25 to carry out the purposes of this subsection.

   Added 2011, No. 48 , § 4.

§ 1825. Health benefits.

1. 1. Green Mountain Care shall include primary care, preventive care, chronic care, acute episodic care, and hospital services and shall include at least the same covered services as those included in the benefit package in effect for the lowest cost Catamount Health plan offered on January 1, 2011. (a) (1)  Green Mountain Care shall include primary care, preventive care, chronic care, acute episodic care, and hospital services and shall include at least the same covered services as those included in the benefit package in effect for the lowest cost Catamount Health plan offered on January 1, 2011.
   2. It is the intent of the General Assembly that Green Mountain Care provide a level of coverage that includes benefits that are actuarially equivalent to at least 87 percent of the full actuarial value of the covered health services.
   3. The Green Mountain Care Board shall consider whether to impose cost-sharing requirements; if so, whether to make the cost-sharing requirements income-sensitized; and the impact of any cost-sharing requirements on an individual's ability to access care. The Board shall consider waiving any cost-sharing requirement for evidence-based primary and preventive care; for palliative care; and for chronic care for individuals participating in chronic care management and, where circumstances warrant, for individuals with chronic conditions who are not participating in a chronic care management program.
   4. 1. The Green Mountain Care Board established in 18 V.S.A. chapter 220 shall consider whether to include dental, vision, and hearing benefits in the Green Mountain Care benefit package. (4) (A) The Green Mountain Care Board established in 18 V.S.A. chapter 220 shall consider whether to include dental, vision, and hearing benefits in the Green Mountain Care benefit package.
      2. The Green Mountain Care Board shall consider whether to include long-term care benefits in the Green Mountain Care benefit package.
   5. Green Mountain Care shall not limit coverage of preexisting conditions.
   6. The Green Mountain Care Board shall approve the benefit package and present it to the General Assembly as part of its recommendations for the Green Mountain Care budget.
2. 1. 1. For individuals eligible for Medicaid or CHIP, the benefit package shall include the benefits required by federal law, as well as any additional benefits provided as part of the Green Mountain Care benefit package. (b) (1) (A)  For individuals eligible for Medicaid or CHIP, the benefit package shall include the benefits required by federal law, as well as any additional benefits provided as part of the Green Mountain Care benefit package.
      2. Upon implementation of Green Mountain Care, the benefit package for individuals eligible for Medicaid or CHIP shall also include any optional Medicaid benefits pursuant to 42 U.S.C. § 1396d or services covered under the State plan for CHIP as provided in 42 U.S.C. § 1397c c for which these individuals are eligible on January 1, 2014. Beginning with the second year of Green Mountain Care and going forward, the Green Mountain Care Board may, consistent with federal law, modify these optional benefits, as long as at all times the benefit package for these individuals contains at least the benefits described in subdivision (A) of this subdivision (b)(1).
   2. For children eligible for benefits paid for with Medicaid funds, the benefit package shall include early and periodic screening, diagnosis, and treatment services as defined under federal law.
   3. For individuals eligible for Medicare, the benefit package shall include the benefits provided to these individuals under federal law, as well as any additional benefits provided as part of the Green Mountain Care benefit package.

      Added 2011, No. 48 , § 4.

§ 1826. Blueprint for Health.

1. It is the intent of the General Assembly that within five years following the implementation of Green Mountain Care, each individual enrolled in Green Mountain Care will have a primary health care professional who is involved with the Blueprint for Health established in 18 V.S.A. chapter 13.
2. Consistent with the provisions of 18 V.S.A. chapter 13, if an individual enrolled in Green Mountain Care does not have a medical home through the Blueprint for Health, the individual may choose a primary health care professional who is not participating in the Blueprint to serve as the individual's primary care point of contact.
3. The Agency shall determine a method to approve a specialist as a patient's primary health care professional for the purposes of establishing a medical home or primary care point of contact for the patient. The Agency shall approve a specialist as a patient's medical home or primary care point of contact on a case-by-case basis and only for a patient who receives the majority of his or her health care from that specialist.
4. Green Mountain Care shall be integrated with the Blueprint for Health established in 18 V.S.A. chapter 13.

   Added 2011, No. 48 , § 4.

§ 1827. Administration; enrollment.

1. 1. The Agency shall, under an open bidding process, solicit bids from and award contracts to public or private entities for administration of certain elements of Green Mountain Care, such as claims administration and provider relations. (a) (1)  The Agency shall, under an open bidding process, solicit bids from and award contracts to public or private entities for administration of certain elements of Green Mountain Care, such as claims administration and provider relations.
   2. The Agency shall ensure that entities awarded contracts pursuant to this subsection do not have a financial incentive to restrict individuals' access to health services. The Agency may establish performance measures that provide incentives for contractors to provide timely, accurate, transparent, and courteous services to individuals enrolled in Green Mountain Care and to health care professionals.
   3. When considering contract bids pursuant to this subsection, the Agency shall consider the interests of the State relating to the economy, the location of the entity, and the need to maintain and create jobs in Vermont. The Agency may utilize an econometric model to evaluate the net costs of each contract bid.
2. Nothing in this subchapter shall require an individual with health coverage other than Green Mountain Care to terminate that coverage.
3. An individual enrolled in Green Mountain Care may elect to maintain supplemental health insurance if the individual so chooses.
4. Except for cost-sharing, Vermonters shall not be billed any additional amount for health services covered by Green Mountain Care.
5. [Repealed.]
6. Green Mountain Care shall be the payer of last resort with respect to any health service that may be covered in whole or in part by any other health benefit plan, including Medicare, private health insurance, retiree health benefits, or federal health benefit plans offered by the military or to federal employees.
7. The Agency may seek a waiver under Section 1115 of the Social Security Act to include Medicaid and under Section 2107(e)(2)(A) of the Social Security Act to include CHIP in Green Mountain Care. If the Agency is unsuccessful in obtaining one or both of these waivers, Green Mountain Care shall be the secondary payer with respect to any health service that may be covered in whole or in part by Title XIX of the Social Security Act (Medicaid) or Title XXI of the Social Security Act (CHIP), as applicable.
8. Any prescription drug coverage offered by Green Mountain Care shall be consistent with the standards and procedures applicable to the pharmacy best practices and cost control program established in section 1998 of this title.
9. Green Mountain Care shall maintain a robust and adequate network of health care professionals located in Vermont or regularly serving Vermont residents, including mental health and substance abuse professionals. The Agency shall contract with outside entities as needed to allow for the appropriate portability of coverage under Green Mountain Care for Vermont residents who are temporarily out of the State.
10. The Agency shall make available the necessary information, forms, access to eligibility or enrollment systems, and billing procedures to health care professionals to ensure immediate enrollment for individuals in Green Mountain Care at the point of service or treatment.
11. An individual aggrieved by an adverse decision of the Agency or plan administrator may appeal to the Human Services Board as provided in 3 V.S.A. § 3090 .
12. The Agency, in collaboration with the Department of Financial Regulation, shall monitor the extent to which residents of other states move to Vermont for the purpose of receiving health services and the impact, positive or negative, of any such migration on Vermont's health care system and on the State's economy, and make appropriate recommendations to the General Assembly based on its findings.

    Added 2011, No. 48 , § 4; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2013, No. 144 (Adj. Sess.), § 6, eff. May 27, 2014; 2015, No. 23 , § 55.

§ 1828. Budget proposal.

The Green Mountain Care Board, in collaboration with the Agencies of Administration and of Human Services, shall be responsible for developing each year a three-year Green Mountain Care budget for proposal to the General Assembly and to the Governor, to be adjusted annually in response to realized revenues and expenditures, that reflects any modifications to the benefit package and includes recommended appropriations, revenue estimates, and necessary modifications to tax rates and other assessments.

Added 2011, No. 48 , § 4.

§ 1829. Green Mountain Care Fund.

1. The Green Mountain Care Fund is established in the State Treasury as a special fund to be the single source to finance health care coverage for Green Mountain Care.
2. Into the Fund shall be deposited:
   1. transfers or appropriations from the General Fund, authorized by the General Assembly;
   2. if authorized by a waiver from federal law, federal funds for Medicaid, Medicare, and the Vermont Health Benefit Exchange established in chapter 18, subchapter 1 of this title; and
   3. the proceeds from grants, donations, contributions, taxes, and any other sources of revenue as may be provided by statute or by rule.
3. The Fund shall be administered pursuant to 32 V.S.A. chapter 7, subchapter 5, except that interest earned on the Fund and any remaining balance shall be retained in the Fund. The Agency shall maintain records indicating the amount of money in the Fund at any time.
4. All monies received by or generated to the Fund shall be used only for:
   1. the administration and delivery of health services covered by Green Mountain Care as provided in this subchapter; and
   2. expenses related to the duties and operation of the Green Mountain Care Board pursuant to 18 V.S.A. chapter 220.

      Added 2011, No. 48 , § 4.

§ 1830. Collective bargaining rights.

Nothing in this subchapter shall be construed to limit the ability of collective bargaining units to negotiate for coverage of health services pursuant to 3 V.S.A. § 904 or any other provision of law.

Added 2011, No. 48 , § 4.

§ 1831. Public process.

The Agency of Human Services shall provide a process for soliciting public input on the Green Mountain Care benefit package on an ongoing basis, including a mechanism by which members of the public may request inclusion of particular benefits or services. The process may include receiving written comments on proposed new or amended rules or holding public hearings or both.

Added 2011, No. 48 , § 4.

§ 1832. Rulemaking.

The Secretary of Human Services may adopt rules pursuant to 3 V.S.A. chapter 25 to carry out the purposes of this subchapter. When establishing rules relating to the Green Mountain Care benefit package, the Secretary shall ensure that the rules are consistent with the benefit package defined by the Green Mountain Care Board pursuant to section 1825 of this title and to 18 V.S.A. chapter 220.

Added 2011, No. 48 , § 4.

§ 1900. Definitions.

As used in this subchapter, unless otherwise indicated:

1. "Agency" means the Agency of Human Services.
2. "Commissioner" means the Commissioner of Vermont Health Access.
3. "Department" means the Department of Vermont Health Access.
4. "Insurer" means any insurance company, prepaid health care delivery plan, self-funded employee benefit plan, pension fund, hospital or medical service corporation, managed care organization, pharmacy benefit manager, prescription drug plan, retirement system, or similar entity that is under an obligation to make payments for medical services as a result of an injury, illness, or disease suffered by an individual.
5. "Legally liable representative" means a parent or person with an obligation of support to a recipient whether by contract, court order, or statute.
6. "Provider" means any person who has entered into an agreement with the State to provide any medical service.
7. "Recipient" means any person or group of persons who receive Medicaid.
8. "Secretary" means the Secretary of Human Services.
9. "Third party" means a person having an obligation to pay all or any portion of the medical expense incurred by a recipient at the time the medical service was provided. The obligation is not discharged by virtue of being undiscovered or undeveloped at the time a Medicaid claim is paid. Third parties include:
   1. Medicare;
   2. health insurance, including health and accident but not that portion specifically designated for "income protection" which has been considered in determining recipient eligibility to participate in the Medicaid program;
   3. medical coverage provided in conjunction with other benefit or compensation programs, including military and veteran programs or workers' compensation;
   4. liability for medical expenses as agreed to or ordered in negligence suits, support settlements, or trust funds; and
   5. managed care organizations, pharmacy benefit managers, self-insured plans, and other entities that are, by statute, contract, or agreement, legally responsible for the payment of a claim for a health care item or service.
10. "Tobacco" means all products listed in 7 V.S.A. § 1001(3) .
11. "Tobacco manufacturer" means any person engaged in the process of designing, fabricating, assembling, producing, constructing, or otherwise preparing a product containing tobacco, including packaging or labeling of these products, with the intended purpose of selling the product for gain or profit. "Tobacco manufacturer" does not include persons whose activity is limited to growing natural leaf tobacco or to selling tobacco products at wholesale or retail to customers. "Tobacco manufacturer" also does not include any person who manufactures or produces firearms, dairy products, products containing alcohol, or other nontobacco products, unless such person also manufactures or produces tobacco products.

    Added 2013, No. 131 (Adj. Sess.), § 38, eff. May 20, 2014.

§ 1901. Administration of program.

1. 1. The Secretary of Human Services or designee shall take appropriate action, including making of rules, required to administer a medical assistance program under Title XIX (Medicaid) and Title XXI (SCHIP) of the Social Security Act. (a) (1)  The Secretary of Human Services or designee shall take appropriate action, including making of rules, required to administer a medical assistance program under Title XIX (Medicaid) and Title XXI (SCHIP) of the Social Security Act.
   2. The Secretary or designee shall seek approval from the General Assembly prior to applying for and implementing a waiver of Title XIX or Title XXI of the Social Security Act, an amendment to an existing waiver, or a new state option that would restrict eligibility or benefits pursuant to the Deficit Reduction Act of 2005. Approval by the General Assembly under this subdivision constitutes approval only for the changes which are scheduled for implementation.
   3. [Repealed.]
   4. A manufacturer of pharmaceuticals purchased by individuals receiving State pharmaceutical assistance in programs administered under this chapter shall pay to the Department of Vermont Health Access, as the Secretary's designee, a rebate on all pharmaceutical claims for which State-only funds are expended in an amount that is in proportion to the State share of the total cost of the claim, as calculated annually on an aggregate basis, and based on the full Medicaid rebate amount as provided for in Section 1927(a) through (c) of the federal Social Security Act, 42 U.S.C. Section 1396r-8.
2. [Repealed.]
3. The Secretary may charge a monthly premium, in amounts set by the General Assembly, per family for pregnant women and children eligible for medical assistance under Sections 1902(a)(10)(A)(i)(III), (IV), (VI), and (VII) of Title XIX of the Social Security Act, whose family income exceeds 195 percent of the federal poverty level, as permitted under section 1902(r)(2) of that act. Fees collected under this subsection shall be credited to the State Health Care Resources Fund established in section 1901d of this title and shall be available to the Agency to offset the costs of providing Medicaid services. Any co-payments, coinsurance, or other cost sharing to be charged shall also be authorized and set by the General Assembly.
4. 1. To enable the State to manage public resources effectively while preserving and enhancing access to health care services in the State, the Department of Vermont Health Access is authorized to serve as a publicly operated managed care organization (MCO). (d) (1)  To enable the State to manage public resources effectively while preserving and enhancing access to health care services in the State, the Department of Vermont Health Access is authorized to serve as a publicly operated managed care organization (MCO).
   2. To the extent permitted under federal law, the Department of Vermont Health Access shall be exempt from any health maintenance organization (HMO) or MCO statutes in Vermont law and shall not be considered to be an HMO or MCO for purposes of State regulatory and reporting requirements. The MCO shall comply with the federal rules governing managed care organizations in 42 C.F.R. Part 438. The Vermont rules on the primary care case management in the Medicaid program shall be amended to apply to the MCO except to the extent that the rules conflict with the federal rules.
   3. The Agency of Human Services and Department of Vermont Health Access shall report to the Health Care Oversight Committee about implementation of Global Commitment in a manner and at a frequency to be determined by the Committee. Reporting shall, at a minimum, enable the tracking of expenditures by eligibility category, the type of care received, and to the extent possible allow historical comparison with expenditures under the previous Medicaid appropriation model (by department and program) and, if appropriate, with the amounts transferred by another department to the Department of Vermont Health Access. Reporting shall include spending in comparison to any applicable budget neutrality standards.
5. [Repealed.]
6. The Secretary shall not impose a prescription co-payment for individuals under age 21 enrolled in Medicaid or Dr. Dynasaur.
7. The Department of Vermont Health Access shall post prominently on its website the total per-member per-month cost for each of its Medicaid and Medicaid waiver programs and the amount of the State's share and the beneficiary's share of such cost.
8. To the extent required to avoid federal antitrust violations, the Department of Vermont Health Access shall facilitate and supervise the participation of health care professionals and health care facilities in the planning and implementation of payment reform in the Medicaid and SCHIP programs. The Department shall ensure that the process and implementation include sufficient State supervision over these entities to comply with federal antitrust provisions and shall refer to the Attorney General for appropriate action the activities of any individual or entity that the Department determines, after notice and an opportunity to be heard, violate State or federal antitrust laws without a countervailing benefit of improving patient care, improving access to health care, increasing efficiency, or reducing costs by modifying payment methods.

   Added 1967, No. 147 , § 6; amended 1997, No. 155 (Adj. Sess.), § 21; 2005, No. 159 (Adj. Sess.), § 2; 2005, No. 215 (Adj. Sess.), § 308, eff. May 31, 2006; 2007, No. 74 , § 3, eff. June 6, 2007; 2009, No. 156 (Adj. Sess.), § E.309.15, eff. June 3, 2010; 2009, No. 156 (Adj. Sess.), § I.43; 2011, No. 48 , § 16a, eff. Jan. 1, 2012; 2011, No. 139 (Adj. Sess.), § 51, eff. May 14, 2012; 2011, No. 162 (Adj. Sess.), § E.307.6; 2011, No. 171 (Adj. Sess.), § 41c; 2013, No. 79 , § 23, eff. Jan. 1, 2014; 2013, No. 79 , § 46; 2013, No. 131 (Adj. Sess.), § 39, eff. May 20, 2014; 2013, No. 142 (Adj. Sess.), § 98; 2017, No. 210 (Adj. Sess.), § 3, eff. June 1, 2018.

§ 1901a. Medicaid budget.

1. The General Assembly shall approve each year a Medicaid budget. The annual Medicaid budget shall include an annual financial plan, and a five-year financial plan accounting for expenditures and revenues relating to Medicaid and any other health care assistance program administered by the Agency of Human Services.
2. The Secretary of Human Services or his or her designee and the Commissioner of Finance and Management shall provide quarterly to the Joint Fiscal Committee such information and analysis as the Committee reasonably determines is necessary to assist the General Assembly in the preparation of the Medicaid budget.

   Added 2001, No. 142 (Adj. Sess.), § 148a; amended 2005, No. 215 (Adj. Sess.), § 309, eff. May 31, 2006; 2019, No. 144 (Adj. Sess.), § 31.

§ 1901b. Pharmacy program enrollment.

1. The Department of Vermont Health Access and the Department for Children and Families shall monitor actual caseloads, revenue, and expenditures; anticipated caseloads, revenue, and expenditures; and actual and anticipated savings from implementation of the preferred drug list, supplemental rebates, and other cost containment activities in each State pharmaceutical assistance program, including VPharm. When applicable, the Departments shall allocate supplemental rebate savings to each program proportionate to expenditures in each program.
2. As used in this section, "State pharmaceutical assistance program" means any health assistance programs administered by the Agency of Human Services providing prescription drug coverage, including the Medicaid program, VPharm, the State Children's Health Insurance Program, the State of Vermont AIDS Medication Assistance Program, the General Assistance Program, the Pharmacy Discount Plan Program, and any other health assistance programs administered by the Agency providing prescription drug coverage.

   Added 2001, No. 142 (Adj. Sess.), § 148b; amended 2005, No. 174 (Adj. Sess.), § 94; 2005, No. 215 (Adj. Sess.), §§ 316, 317; 2009, No. 156 (Adj. Sess.), § I.44; 2011, No. 171 (Adj. Sess.), § 41c; 2013, No. 79 , § 47, eff. Jan. 1, 2014.

§ 1901c. Repealed. 2011, No. 48, § 32.

§ 1901d. State Health Care Resources Fund.

1. The State Health Care Resources Fund is established in the State Treasury as a special fund to be a source of financing for health care coverage for beneficiaries of the State health care assistance programs under the Global Commitment to Health waiver approved by the Centers for Medicare and Medicaid Services under Section 1115 of the Social Security Act.
2. Into the Fund shall be deposited:
   1. -(4) [Repealed.]

      (5) premium amounts paid by individuals unless paid directly to the insurer; and

      (6) the proceeds from grants, donations, contributions, taxes, recoveries, and any other sources of revenue as may be provided by statute, rule, agreement, or act of the General Assembly.

      (7) [Repealed.]

3. The Fund shall be administered pursuant to 32 V.S.A. chapter 7, subchapter 5, except that interest earned on the Fund and any remaining balance shall be retained in the Fund. The Agency shall maintain records indicating the amount of money in the Fund at any time.
4. All monies received by or generated to the Fund shall be used only as allowed by appropriation of the General Assembly for the administration and delivery of health care covered through State health care assistance programs administered by the Agency under the Global Commitment to Health Medicaid Section 1115 waiver, immunizations under 18 V.S.A. § 1130 , and the development and implementation of the Blueprint for Health under 18 V.S.A. § 702 .

   Added 2005, No. 93 (Adj. Sess.), § 16a, eff. July 1, 2006; amended 2005, No. 191 (Adj. Sess.), § 41; 2007, No. 65 , § 387, eff. June 4, 2007; 2011, No. 45 , § 36o; 2011, No. 75 (Adj. Sess.), § 110; 2013, No. 50 , § E.307.4; 2019, No. 6 , § 65, eff. April 22, 2019; 2021, No. 20 , § 298.

§ 1901e. Global Commitment Fund.

1. The Global Commitment Fund is created in the Treasury as a special fund. The Fund shall consist of the revenues received by the Treasurer as payment of the actuarially certified premium from the Agency of Human Services to the managed care organization within the Department of Vermont Health Access for the purpose of providing services under the Global Commitment to Health waiver approved by the Centers for Medicare and Medicaid Services under Section 1115 of the Social Security Act.
2. The monies in the Fund shall be disbursed as allowed by appropriation of the General Assembly, and shall be disbursed by the Treasurer on warrants issued by the Commissioner of Finance and Management, when authorized by the Commissioner of Vermont Health Access and approved by the Commissioner of Finance and Management consistent with the interdepartmental agreements between the managed care organization within the Department of Vermont Health Access and departments delivering eligible services under the waiver. The Department of Vermont Health Access shall not modify an appropriation through an interdepartmental agreement or any other mechanism. A department or agency authorized to spend monies from this Fund under an interdepartmental agreement may spend monies appropriated as a base Medicaid expense for an allowable managed care organization investment under the terms and conditions of the Global Commitment to Health Medicaid Section 1115 waiver only after receiving approval from the Agency of Human Services.
3. Annually, on or before October 1, the Agency shall provide a detailed report to the Joint Fiscal Committee that describes the managed care organization's investments under the terms and conditions of the Global Commitment to Health Medicaid Section 1115 waiver, including the amount of the investment and the agency or departments authorized to make the investment.

   Added 2005, No. 93 (Adj. Sess.), § 16c, eff. Oct. 1, 2005; amended 2005, No. 215 (Adj. Sess.), § 307, eff. May 31, 2006; 2009, No. 156 (Adj. Sess.), § I.46; 2013, No. 131 (Adj. Sess.), § 40, eff. May 20, 2014; 2015, No. 172 (Adj. Sess.), § E.306.5; 2021, No. 20 , § 299.

§ 1901f. Medicaid program enrollment and expenditure reports.

By March 1, June 1, September 1, and December 1 of each year, the Commissioner of Vermont Health Access or designee shall submit to the General Assembly a quarterly report on enrollment and total expenditures by Medicaid eligibility group for all programs paid for by the Department of Vermont Health Access during the preceding calendar quarter and for the fiscal year to date. Total expenditures for Medicaid-related programs paid for by other departments within the Agency of Human Services shall be included in this report by Medicaid eligibility group to the extent such information is available.

Added 2011, No. 75 (Adj. Sess.), § 111, eff. March 7, 2012; amended 2015, No. 58 , § E.307.2.

§ 1901g. Medicaid coverage for home telemonitoring services.

1. The Agency of Human Services shall provide Medicaid coverage for home telemonitoring services performed by home health agencies or other qualified providers as defined by the Agency of Human Services for Medicaid beneficiaries who have serious or chronic medical conditions that can result in frequent or recurrent hospitalizations and emergency room admissions. Beginning on July 1, 2014, the Agency shall provide coverage for home telemonitoring for one or more conditions or risk factors for which it determines, using reliable data, that home telemonitoring services are appropriate and that coverage will be budget-neutral. The Agency may expand coverage to include additional conditions or risk factors identified using evidence-based best practices if the expanded coverage will remain budget-neutral or as funds become available.
2. A home health agency or other qualified provider shall ensure that clinical information gathered by the home health agency or other qualified provider while providing home telemonitoring services is shared with the patient's treating health care professionals. The Agency of Human Services may impose other reasonable requirements on the use of home telemonitoring services.
3. As used in this section:
   1. "Home health agency" means an entity that has received a certificate of need from the State to provide home health services and is certified to provide services pursuant to 42 U.S.C. § 1395x (o).
   2. "Home telemonitoring service" means a health service that requires scheduled remote monitoring of data related to a patient's health, in conjunction with a home health plan of care, and access to the data by a home health agency or other qualified provider as defined by the Agency of Human Services.

      Added 2013, No. 153 (Adj. Sess.), § 1.

§§ 1901h Repealed. 2017, No. 3, § 75a, eff. March 2, 2017.

§ 1901i. Repealed. 2017, No. 64, § 3, effective October 1, 2017.

§ 1901j. Medicaid reimbursement for long-acting reversible contraceptives.

1. As used in this section, "health care provider" has the same meaning as in 18 V.S.A. § 9402 .
2. The Department of Vermont Health Access shall reimburse health care providers for the full cost of a device providing long-acting reversible contraception when the device is inserted during a Medicaid beneficiary's postpartum hospital stay.

   Added 2017, No. 138 (Adj. Sess.), § 1.

§ 1902. Qualification for medical assistance.

1. In determining whether a person is medically indigent, the Secretary of Human Services shall prescribe and use an income standard and requirements for eligibility that will permit the receipt of federal matching funds under Title XIX of the Social Security Act.
2. Workers with disabilities whose income is less than 250 percent of the federal poverty level shall be eligible for Medicaid. The income also must not exceed the Medicaid protected income level for one or the Supplemental Security Income (SSI) payment level for two, whichever is higher, after disregarding the earnings of the working individual with disabilities; Social Security disability insurance benefits, including Social Security retirement benefits converted automatically from Social Security Disability Insurance (SSDI), if applicable; any veteran's disability benefits; and, if the working individual with disabilities is married, all income of the spouse. Earnings of the working individual with disabilities shall be documented by evidence of Federal Insurance Contributions Act tax payments, Self-Employment Contributions Act tax payments, or a written business plan approved and supported by a third-party investor or funding source. The resource limit for this program shall be $10,000.00 for an individual and $15,000.00 for a couple at the time of enrollment in the program. Assets attributable to earnings made after enrollment in the program shall be disregarded.

   Added 1967, No. 147 , § 6; amended 1987, No. 89 , § 314b; 2005, No. 56 , § 4, eff. June 13, 2005; 2015, No. 157 (Adj. Sess.), § G.1, eff. June 2, 2016; 2017, No. 210 (Adj. Sess.), § 1, eff. June 1, 2018.

§ 1902a. Confidentiality of Medicaid applications and records; disclosure to authorized representative.

1. All applications submitted and records created under the authority of this chapter concerning any applicant for or recipient of Medicaid are confidential and shall be made available only to persons authorized by the Agency, the State, or the United States for purposes directly related to plan administration. In addition, the Agency shall maintain a process to allow a Medicaid applicant or recipient or his or her authorized representative to have access to confidential information when necessary for an eligibility determination and the appeals process.
2. Applications and records considered confidential are those that disclose one or more of the following:
   1. the name and address of the applicant or recipient;
   2. medical services provided;
   3. the applicant's or recipient's social and economic circumstances;
   4. the Agency's evaluation of personal information;
   5. medical data, including diagnosis and past history of disease or disability; or
   6. any information received for the purpose of verifying income eligibility and determining the amount of medical assistance payments.
3. A person found to have violated this section may be assessed an administrative penalty of not more than $1,000.00 for a first violation and not more than $2,000.00 for any subsequent violation.
4. As used in this section:
   1. "Authorized representative" means any person designated by a Medicaid applicant or recipient to review confidential information about the Medicaid applicant or recipient pertaining to the eligibility determination and the appeals process.
   2. "Purposes directly related to plan administration" include establishing eligibility, determining the amount of medical assistance, providing services to recipients, conducting or assisting with an investigation or prosecution, and civil or criminal proceedings, or audits, related to the administration of the State Medicaid program.

      Added 2015, No. 172 (Adj. Sess.), § E.306.9; amended 2019, No. 15 , § 2, eff. May 6, 2019.

§ 1903. Contract authorized.

1. The Commissioner of Vermont Health Access may contract with a private organization to operate, under his or her control and supervision, parts of the medical assistance program.
2. The contract shall provide that either party may cancel it upon reasonable notice to the other party.
3. In furtherance of the purposes of the contract, the Commissioner of Vermont Health Access may requisition funds for the purposes of this subchapter, with the approval of the Governor, and the Commissioner of Finance and Management shall issue a warrant in favor of the contracting party to permit the contracting party to make payments to vendors under the contract. The Commissioner of Vermont Health Access shall quarterly, and at other times as the Commissioner of Finance and Management requires, render an account in a form as the Commissioner of Finance and Management prescribes of the expenditures of monies so advanced.

   Added 1967, No. 147 , § 6; amended 1983, No. 195 (Adj. Sess.), § 5; 2005, No. 174 (Adj. Sess.), § 96; 2009, No. 156 (Adj. Sess.), § I.47.

§ 1903a. Care management program.

1. The Commissioner of Vermont Health Access shall coordinate with the Director of the Blueprint for Health to provide chronic care management through the Blueprint and, as appropriate, create an additional level of care coordination for individuals with one or more chronic conditions who are enrolled in Medicaid or Dr. Dynasaur. The program shall not include individuals who are in an institute for mental disease as defined in 42 C.F.R. § 435.1009.
2. The Commissioner shall include individuals with a broad range of chronic conditions in the Blueprint for Health and the care management program.

   Added 2005, No. 191 (Adj. Sess.), § 6; amended 2007, No. 70 , §§ 22, 23; 2009, No. 146 (Adj. Sess.), § C33; 2013, No. 79 , § 24, eff. Jan. 1, 2014.

§ 1904. Repealed. 2013, No. 131 (Adj. Sess.), § 41, eff. May 20, 2014.

§ 1905. Disproportionate share program.

The Secretary of Human Services shall adopt a disproportionate share program for hospitals consistent with the requirements of Title XIX of the Social Security Act.

Added 1991, No. 253 (Adj. Sess.), § 10.

§ 1905a. Medicaid reimbursements to certain outpatient providers.

1. To the extent permitted under federal law, the Department of Vermont Health Access shall not use provider-based billing for outpatient medical services provided at an off-campus outpatient department of a hospital as a result of the provider's transfer to or acquisition by the hospital.
2. As used in this section, "off-campus" means a facility located more than 250 yards from the main hospital campus.

   Added 2015, No. 143 (Adj. Sess.), § 3.

§ 1906. Recoupment of amounts spent on child medical care.

1. The State Medicaid agency, any State agency administering health benefits or a health benefit plan for which Medicaid is a source of funding, or the Office of Child Support may recoup the amounts paid by the State for child medical expenses from any person who is required by court or administrative order to provide coverage of the cost of health services to a child eligible for medical assistance under Medicaid; and who either:
   1. Has received payment from a third party for the costs of such services, but has not used the payments to reimburse either the other parent or guardian of the child or the provider of the services. Claims for current and past due child support shall take priority over these claims.
   2. Has failed to give any notice required by 15 V.S.A. § 663(d) .
2. In addition to any other remedies available at law, all remedies available for the collection and enforcement of child support under 15 V.S.A. chapter 11 shall apply to medical support recoupment under this section.

   Added 1993, No. 231 (Adj. Sess.), § 4; amended 2015, No. 23 , § 56.

§ 1906a. Recovery against estate; homestead exemptions.

No recovery of medical expenses shall be made under this subchapter against a homestead provided that the homestead would pass to one or more lineal heirs or siblings of the decedent who either have income below 300 percent of the federal poverty level or who have contributed significantly, monetarily or otherwise, to the decedent so as to allow the decedent to delay or avoid nursing home placement. If a maximum homestead value exemption is allowed by federal law, then any recoveries due to the U.S. Department of Health and Human Services on homesteads valued between such maximum and $125,000.00 shall be paid through State general funds provided the caregiving or poverty standards set forth in this section are also met and the probate estate was opened after June 30, 2000.

Added 1999, No. 62 , § 125; amended 1999, No. 152 (Adj. Sess.), § 117a, eff. May 29, 2000; 2013, No. 131 (Adj. Sess.), § 42, eff. May 20, 2014.

§ 1907. Subrogation.

To the extent that payment for covered expenses has been made under the Medicaid program or through any State agency administering health benefits or a health benefit plan for which Medicaid is a source of funding for health care items or services furnished to an individual, in any case where a third party has a legal liability to make payments, the State is considered to have acquired the rights of the individual to payment by any other party for those health care items or services. An insurer shall accept the Agency's right to recovery and the assignment to the Agency of any right of a person to payment from the third party for medical services for which the Agency has made payment under this chapter.

Added 1993, No. 231 (Adj. Sess.), § 5; amended 2007, No. 65 , § 110b; 2013, No. 131 (Adj. Sess.), § 43, eff. May 20, 2014.

§ 1908. Medicaid; payer of last resort; release of information.

1. Any clause in an insurance contract, plan, or agreement which limits or excludes payments to a recipient is void.
2. Medicaid shall be the payer of last resort to any insurer which contracts to pay health care costs for a recipient.
3. Every applicant for or recipient of Medicaid under this subchapter is deemed to have authorized all third parties to release to the Agency all information needed by the Agency to secure or enforce its rights under this subchapter. The Agency shall inform an applicant or recipient of the provisions of this subsection at the time of application for Medicaid benefits.
4. On and after July 1, 2016, an insurer shall accept the Agency's right of recovery and the assignment of rights and shall not charge the Agency or any of its authorized agents fees for the processing of claims or eligibility requests. Data files requested by or provided to the Agency shall provide the Agency with eligibility and coverage information that will enable the Agency to determine the existence of third-party coverage for Medicaid recipients, the period during which Medicaid recipients may have been covered by the insurer, and the nature of the coverage provided, including information such as the name, address, and identifying number of the plan.
5. 1. Upon request, to the extent permitted under the federal Health Insurance Portability and Accountability Act and other federal privacy laws and notwithstanding any State privacy law to the contrary, an insurer shall transmit to the Agency, in a manner prescribed by the Centers for Medicare and Medicaid Services or as agreed between the insurer and the Agency, an electronic file of all of the insurer's identified subscribers or policyholders and their dependents. (e) (1)  Upon request, to the extent permitted under the federal Health Insurance Portability and Accountability Act and other federal privacy laws and notwithstanding any State privacy law to the contrary, an insurer shall transmit to the Agency, in a manner prescribed by the Centers for Medicare and Medicaid Services or as agreed between the insurer and the Agency, an electronic file of all of the insurer's identified subscribers or policyholders and their dependents.
   2. An insurer shall comply with a request under the provisions of this subsection not later than 60 days following the date of the Agency's request and shall be required to provide the Agency with only the information required by this section.
   3. The Agency shall request the data from an insurer once each month. The Agency shall not request subscriber or policyholder enrollment data that precede the date of the request by more than three years.
   4. The Agency shall use the data collected pursuant to this section solely for the purposes of determining whether a Medicaid recipient also has or has had coverage with the insurer providing the data.
   5. The Agency shall ensure that all data collected and maintained pursuant to this section are collected and stored securely and that such data are stored no longer than necessary to determine whether Medicaid benefits may be coordinated with the insurer, or as otherwise required by law. Insurers shall not be liable for any security incidents caused by the Agency in the collection or maintenance of the data.
6. 1. Each insurer shall submit a file containing information required to coordinate benefits, such as the name, address, group policy number, coverage type, Social Security number, and date of birth of each subscriber or policyholder and each dependent covered by the insurer, including the policy effective and termination dates, claims submission address, and employer's mailing address. (f) (1)  Each insurer shall submit a file containing information required to coordinate benefits, such as the name, address, group policy number, coverage type, Social Security number, and date of birth of each subscriber or policyholder and each dependent covered by the insurer, including the policy effective and termination dates, claims submission address, and employer's mailing address.
   2. The Agency shall adopt rules governing the exchange of information pursuant to this section. The rules shall be consistent with laws relating to the confidentiality or privacy of personal information and medical records, including the Health Insurance Portability and Accountability Act.
7. From funds recovered pursuant to this subchapter, the federal government shall be paid a portion equal to the proportionate share originally provided by the federal government to pay for medical assistance to a recipient or minor.

   Added 1995, No. 152 (Adj. Sess.), § 2; amended 2007, No. 65 , § 110c; 2015, No. 172 (Adj. Sess.), § E.306.7; 2021, No. 20 , § 300.

§ 1908a. Vermont Partnership for Long-Term Care.

1. The Secretary of Human Services or his or her designee, in consultation with the Commissioner of Financial Regulation, shall establish by rule the Vermont Partnership for Long-Term Care Program.
2. The Program shall provide Medicaid extended coverage to an individual receiving long-term care services if there is federal participation for such coverage, and if the individual:
   1. is or was covered by a long-term care insurance policy under 8 V.S.A. chapter 154 that provides coverage for three years of long-term care services in an amount which, in combination with other resources available to the individual, is sufficient to permit the individual to pay for the individual's own care while the policy remains in force and that is precertified by the Department of Financial Regulation pursuant to subsection (c) of this section;
   2. meets any other requirements for approval of participation under the Program; and
   3. has exhausted coverage and benefits under the long-term care insurance policy as required by the Program.
3. 1. The Department of Financial Regulation shall adopt rules for precertification of long-term care partnership policies and for the information needed to evaluate the Program. The Department of Financial Regulation shall consider whether all precertified policies should require: (c) (1)  The Department of Financial Regulation shall adopt rules for precertification of long-term care partnership policies and for the information needed to evaluate the Program. The Department of Financial Regulation shall consider whether all precertified policies should require:
      1. protection against loss of benefits due to inflation;
      2. coverage of individual assessment and case management;
      3. a minimum level of covered benefits, including coverage of long-term care services as defined in subsection (g) of this section;
      4. the option of a nonforfeiture benefit;
      5. a level premium;
      6. information to the purchaser about available consumer information and public education provided by the Department of Financial Regulation and the Department of Vermont Health Access; and
      7. Program information, using the uniform data set developed by other states with long-term care partnership programs, and reports necessary to document the extent of the Medicaid resource protection offered and to evaluate the partnership for long-term care.
   2. The Department of Financial Regulation shall not require all long-term care partnership insurance policies to be federally tax-qualified long-term care insurance policies.
4. The Secretary or his or her designee may enter into reciprocal agreements with other states to extend the benefits of the Vermont Partnership for Long-Term Care Program to Vermont residents who had purchased qualified long-term care policies in other states.
5. The Agency and the Department of Financial Regulation shall make available consumer information regarding the Long-Term Care Partnership Program. The Secretary and Commissioner may allocate responsibilities for providing consumer information between the Agency and Department.
6. As used in this section:
   1. "Long-term care services" includes care, treatment, maintenance, and services:
      1. provided in a nursing facility;
      2. provided in a residential care home or assisted living residence;
      3. provided by a home care services agency, certified home health agency, or long-term home health care program;
      4. provided by an adult day care program;
      5. provided by a personal care provider licensed or regulated by any other State or local agency; and
      6. such other long-term care services as determined by the Secretary or his or her designee for which medical assistance is otherwise available under the Medicaid program.
   2. "Medicaid extended coverage" means eligibility for medical assistance without regard to the resource requirements of the Medicaid program and without regard to the recovery of medical assistance from the estates of individuals and the imposition of liens pursuant to the requirements of the Medicaid program; provided, however, that nothing in this section shall prevent the imposition of a lien or recovery against property of an individual on account of medical assistance incorrectly paid. Nothing in this section shall modify what medical assistance is covered by Medicaid.

      Added 2003, No. 124 (Adj. Sess.), § 4; amended 2005, No. 174 (Adj. Sess.), § 98; 2009, No. 156 (Adj. Sess.), § I.50; 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012.

§ 1909. Direct payments to Agency; discharge of insurer's obligation.

1. When a recipient who is covered by the recipient's or a legally liable representative's insurer receives medical benefits under this subchapter, payment for covered services or notice of denial shall be issued directly to the provider.
2. A provider shall indicate on any claim form submitted to an insurer for covered services whether or not the person receiving treatment is a recipient.
3. 1. An insurer which receives notice that the Agency has made payments to the provider shall pay benefits or send notice of denial directly to the Agency. Receipt of an Agency claim form by an insurer constitutes notice that payment of the claim was made by the Agency to the provider and that form supersedes any contract requirements of the insurer relating to the form of submission. (c) (1)  An insurer which receives notice that the Agency has made payments to the provider shall pay benefits or send notice of denial directly to the Agency. Receipt of an Agency claim form by an insurer constitutes notice that payment of the claim was made by the Agency to the provider and that form supersedes any contract requirements of the insurer relating to the form of submission.
   2. An insurer shall respond to any request made by the Agency regarding a claim for payment for any health care item or service that is submitted not later than three years after the date of the provision of such health care item or service.
   3. An insurer shall not deny a claim submitted by the Agency solely on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim, if the claim is submitted by the Agency within the three-year period beginning on the date on which the item or service was furnished and any action by the Agency to enforce its rights with respect to a claim is commenced within six years of the Agency's submission of the claim.
4. An insurer which has been notified of a claim by the Agency under this section and proceeds to pay the claim to a person other than the Agency is not discharged from payment of the Agency's claim.
5. Payment to the Agency by an insurer under this section discharges the insurer's obligation for further payment on the claim to the extent of the amount paid.

   Added 1995, No. 152 (Adj. Sess.), § 3; amended 2007, No. 65 , § 110d.

§ 1910. Liability of third parties; liens.

1. The Agency shall have a lien against a third party, to the extent of the amount paid by the Agency for medical expenses, on any recovery for that claim, whether by judgment, compromise, mediation, or settlement, whenever:
   1. the Agency pays medical expenses for or on behalf of a recipient who has been injured or has an illness or disease as a result of negligence; and
   2. the recipient asserts a claim against a third party for damages resulting from the injury, illness, or disease.
2. 1. The Agency shall have a lien against the insurer, to the extent of the amount paid by the Agency for past medical expenses, on any recovery from the insurer, whenever the Agency pays medical expenses or renders medical services on behalf of a recipient who has been injured or has an injury, illness, or disease and the recipient asserts a claim against an insurer as a result of the injury, illness, or disease. (b) (1)  The Agency shall have a lien against the insurer, to the extent of the amount paid by the Agency for past medical expenses, on any recovery from the insurer, whenever the Agency pays medical expenses or renders medical services on behalf of a recipient who has been injured or has an injury, illness, or disease and the recipient asserts a claim against an insurer as a result of the injury, illness, or disease.
   2. Effective July 1, 2013, the recipient's insurer or alleged liable party's insurer, if any, shall take reasonable steps to discover the existence of the Agency's medical assistance. Payment to the recipient instead of the Agency does not discharge the insurer from payment of the Agency's claim.
3. A recipient who has applied for or has received medical assistance under this subchapter and the recipient's attorney, if any, shall cooperate with the Agency by informing the Agency in writing within a reasonable period of time after learning that the Agency has paid medical expenses for the recipient. The recipient's attorney shall take reasonable steps to discover the existence of the Agency's medical assistance.
4. Any written notice provided to the Agency pursuant to subsection (c) of this section shall disclose the identity and address of any third party and his, her, or its insurer against whom the recipient has a right of recovery, and the name of the court in which the legal recovery action, if any, was brought.
5. 1. A recipient or an attorney on behalf of a recipient shall allocate the full amount paid by the Agency for past medical expenses to or for any recovery obtained by whatever means. (e) (1)  A recipient or an attorney on behalf of a recipient shall allocate the full amount paid by the Agency for past medical expenses to or for any recovery obtained by whatever means.
   2. A recipient or an attorney on behalf of a recipient shall pay to the Agency, within 30 days after receipt of settlement proceeds or recovery of a judgment, the full amount of the medical expenses owed to the Agency. If full payment of the required sum is not made to the Agency within the 30-day period, the recipient or his or her attorney shall place a sum equal to the full amount of the medical expenses paid in an escrow account pending an agreement, mediation, or judicial determination of the Agency's right to the amount.
   3. The Agency's lien for its medical expenditures relating to the recipient's injury, illness, or disease shall be given priority over all other claims on the total amount recovered.
   4. In making the determination whether to pursue, reduce, or compromise a claim, the Agency may in its discretion consider the factual, evidentiary, and legal issues of liability between the recipient and any liable third party and the total amount available to satisfy the recipient's claim. Where the amount of reimbursement the Agency can reasonably expect to recover exceeds the costs of such recovery, the Agency shall not be required to seek reimbursement from or may reduce or compromise a claim against any liable third party, the insurer, or both. Whether or not the Agency exercises its discretion shall not be subject to any claim of abuse of discretion.
6. A lien created under this section shall not be effective unless:
   1. notice of the lien is filed in the office of the clerk of the town in which the Agency is located and contains the name and address of the recipient, acknowledgment of the recipient's application for or receipt of medical assistance, and the name of the person alleged to be liable; and
   2. the Agency mails a notice of the lien with a statement of the date it was filed to the person alleged to be liable.
7. The Agency shall send a copy of the notice of the lien required by subsection (f) of this section to the following persons, if the appropriate names and addresses can be determined:
   1. the recipient for whom the Department has paid medical expenses;
   2. any insurance carrier that may be ultimately liable; and
   3. any attorney for the recipient.
8. Within 45 days after the filing of the notice of the lien, the Agency shall send an itemized statement of the medical expenses paid by the Agency for which the Agency seeks to perfect a lien to the persons listed in subsection (g) of this section. The notice provisions contained in this subsection may be waived by agreement of the parties.
9. The Agency may, on behalf of a recipient, file a civil action in the Superior Court in Washington County against a liable third party, the third party's insurer, or both, to recover up to the full amount of medical expenses it has incurred on behalf of the recipient. The Agency may initiate this action only if:
   1. the recipient has not initiated legal proceedings against the third party within one year after the occurrence of the injury, illness, or disease resulting, at least in part, from the actions or omissions, including negligence, of the third party; and
   2. the time remaining under the statute of limitations for the action is six months or less.
10. The Attorney General shall be responsible for initiating actions on behalf of the Agency.
11. Whenever the Agency recovers under the lien and that recovery is the result of an action initiated by a recipient, the attorney for the recipient may withhold the Agency's pro rata share of reasonably necessary attorney's fees, costs, and expenses incurred in asserting the claim. If the Agency waives its right to reimbursement, it shall not be liable for any fees, costs, and expenses incurred by the recipient or attorney.
12. In cases in which the court has determined the amount of recovery allocated for past medical expenses, the Agency's lien shall be limited to that amount.

    Added 1995, No. 152 (Adj. Sess.), § 4; amended 2007, No. 192 (Adj. Sess.), § 6.014; 2011, No. 162 (Adj. Sess.), § E.307.3; 2013, No. 96 (Adj. Sess.), § 206.

§ 1911. Tobacco manufacturers; liability for Medicaid expenditures.

1. After the State has paid medical assistance benefits to eligible persons for tobacco-related health conditions under this chapter, the State may recover from tobacco manufacturers the amount paid or likely to be paid for medical assistance to such persons, plus punitive damages, costs, reasonable attorney's fees and other appropriate relief.
2. The cause of action created in this section shall be a direct cause of action and not a subrogated cause of action. Affirmative defenses relating to subrogated causes of action shall not apply to this direct cause of action.
3. In order to recover under subsection (a) of this section, the State shall prove:
   1. that the tobacco manufacturers were either negligent or produced a defective product unreasonably dangerous to the user or consumer who received or will receive medical assistance;
   2. that the tobacco product caused the health conditions for which the State seeks reimbursement; and
   3. the amount of compensatory damages and the appropriateness of any other relief sought.
4. The right of the State to bring a cause of action against a tobacco manufacturer under this section shall be independent of and not construed to affect any rights or causes of action by an individual Medicaid benefits recipient to recover damages or other relief as a result of a tobacco-related health condition. In the event that recovery of Medicaid expenditures has been achieved and the individual recipient thereafter recovers damages from a tobacco manufacturer, then the tobacco manufacturer shall be entitled to a setoff for the amount of any such Medicaid recovery which represents the expenditure on behalf of the individual recipient.
5. Existing common law and statutory actions available to recover Medicaid expenditures from a tobacco manufacturer, including direct action, are expressly preserved. An action brought pursuant to this section may be brought in addition to any existing common law or statutory action, or both, and shall not preempt, limit, or extinguish those actions.
6. In any action brought pursuant to this section:
   1. Joint and several liability applies to any judgment in favor of the State, except as provided in subdivision (2) of this subsection.
   2. The State may proceed under the market share theory for allocation of damages between or among tobacco manufacturers, provided that the tobacco products involved are substantially interchangeable among brands, and substantially similar factual and legal issues are involved in seeking recovery against each individual tobacco manufacturer. In the event the State elects to proceed under the market share theory, joint and several liability shall not apply.
   3. Sums paid to all recipients may be recovered in a single action.
   4. If the number of recipients is sufficiently large so that it is impracticable to identify the recipients, the court may require the State to release information on individual recipients including individual Medicaid and medical records which are in the possession, custody, or control of the State, to the extent necessary for the defendant to establish its defenses, subject to such orders as are necessary to maintain the privacy of the recipients and to prevent Medicaid fraud.
   5. Evidence of statistical analysis may be admissible to prove or rebut the elements of subdivisions (c)(2) and (3) of this section.
7. Before the State enters into a contract with an attorney to represent the State in an action brought pursuant to this section, the contract shall be reviewed and approved by the Joint Fiscal Committee. The Joint Fiscal Committee shall approve the contract if it determines that the contract is reasonable under the circumstances.

   Added 1997, No. 142 (Adj. Sess.), § 3, eff. April 23, 1998.

§ 1912. Findings and purpose.

1. Cigarette smoking presents serious public health concerns to the State of Vermont and to the citizens of Vermont. The Surgeon General has determined that smoking causes lung cancer, heart disease, and other serious diseases, and that there are hundreds of thousands of tobacco-related deaths in the United States each year. These diseases most often do not appear until many years after a person begins smoking.
2. Cigarette smoking also presents serious financial concerns for the State. Under certain health care programs, the State may have a legal obligation to provide medical assistance to eligible persons for health conditions associated with cigarette smoking, and those persons may have a legal entitlement to receive such medical assistance. Under these programs, the State pays millions of dollars each year to provide medical assistance to these persons for health conditions associated with cigarette smoking.
3. It is the policy of the State that financial burdens imposed on the State by cigarette smoking be borne by tobacco product manufacturers rather than by the State to the extent that such manufacturers either determine to enter into a settlement with the State or are found culpable by the courts.
4. On November 23, 1998, leading United States tobacco product manufacturers entered into a settlement agreement, entitled the "Master Settlement Agreement," with the State. In return for a release of past, present, and certain future claims against these manufacturers as described therein, the Master Settlement Agreement obligates these manufacturers to:
   1. pay substantial sums to the State, tied in part to their volume of sales;
   2. fund a national foundation devoted to the interests of public health; and
   3. make substantial changes in their advertising and marketing practices and corporate culture, with the intention of reducing underage smoking.
5. It would be contrary to the policy of the State if tobacco product manufacturers who determine not to enter into such a settlement could use a resulting cost advantage to derive large, short-term profits in the years before liability may arise, without ensuring that the State will have an eventual source of recovery from them if they are proven to have acted culpably. Consequently, it is in the interest of the State to require that such manufacturers establish a reserve fund to guarantee a source of compensation, and to prevent such manufacturers from deriving large, short-term profits and then becoming judgment-proof before liability may arise.

   Added 1999, No. 130 (Adj. Sess.), § 1, eff. May 12, 2000.

§ 1913. Definitions.

As used in this subchapter:

1. "Adjusted for inflation" means increased in accordance with the formula for inflation adjustment set forth in Exhibit C to the Master Settlement Agreement.
2. "Affiliate" means a person who directly or indirectly owns or controls, is owned or controlled by, or is under common ownership or control with, another person. Solely for purposes of this definition, the terms "owns," "is owned," and "ownership" mean ownership of an equity interest, or the equivalent thereof, of ten percent or more, and the term "person" means an individual, partnership, committee, association, corporation, or any other organization or group of persons.
3. "Allocable share" means allocable share as that term is defined in the Master Settlement Agreement.
4. 1. "Cigarette" means any product that contains nicotine, is intended to be burned or heated under ordinary conditions of use, and consists of or contains: (4) (A) "Cigarette" means any product that contains nicotine, is intended to be burned or heated under ordinary conditions of use, and consists of or contains:
      1. any roll of tobacco wrapped in paper or in any substance not containing tobacco;
      2. tobacco, in any form, that is functional in the product, which, because of its appearance, the type of tobacco used in the filler, or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a cigarette; or
      3. any roll of tobacco wrapped in any substance containing tobacco which, because of its appearance, the type of tobacco used in the filler, or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a cigarette described in subdivision (i) of this subdivision (A).
   2. The term "cigarette" includes "roll-your-own" (any tobacco which, because of its appearance, type, packaging, or labeling is suitable for use and likely to be offered to, or purchased by, consumers as tobacco for making cigarettes). For purposes of this definition, 0.09 ounces of "roll-your-own" tobacco shall constitute one individual cigarette.
5. "Master Settlement Agreement" means the settlement agreement (and related documents) entered into on November 23, 1998 by the State and leading U.S. tobacco product manufacturers.
6. "Qualified escrow fund" means an escrow arrangement with a federally or State-chartered financial institution having no affiliation with any tobacco product manufacturer and having assets of at least $1,000,000,000.00, where such arrangement requires that such financial institution hold the escrowed funds' principal for the benefit of releasing parties and prohibits the tobacco product manufacturer placing the funds into escrow, from using, accessing or directing the use of the funds' principal except as consistent with subsection 1914(b) of this title.
7. "Released claims" means released claims as that term is defined in the Master Settlement Agreement.
8. "Releasing parties" means releasing parties as that term is defined in the Master Settlement Agreement.
9. 1. "Tobacco product manufacturer" means an entity that, after the date of enactment of this subchapter, directly (and not exclusively through any affiliate): (9) (A) "Tobacco product manufacturer" means an entity that, after the date of enactment of this subchapter, directly (and not exclusively through any affiliate):
      1. manufactures cigarettes anywhere that such manufacturer intends to be sold in the United States, including cigarettes intended to be sold in the United States through an importer (except where such importer is an original participating manufacturer (as that term is defined in the Master Settlement Agreement) that will be responsible for the payments under the Master Settlement Agreement with respect to such cigarettes as a result of the provisions of Subsection II(mm) of the Master Settlement Agreement, and that pays the taxes specified in Subsection II(z) of the Master Settlement Agreement, and provided that the manufacturer of such cigarettes does not market or advertise such cigarettes in the United States);
      2. is the first purchaser anywhere for resale in the United States of cigarettes manufactured anywhere that the manufacturer does not intend to be sold in the United States; or
      3. becomes a successor of an entity described in subdivision (i) or (ii) of this subdivision (A).
   2. The term "tobacco product manufacturer" shall not include an affiliate of a tobacco product manufacturer, unless such affiliate itself falls within any of subdivisions (A)(i)-(iii) of this subdivision (9).
10. "Units sold" means the number of individual cigarettes sold in the State by the applicable tobacco product manufacturer (whether directly or through a distributor, retailer, or similar intermediary or intermediaries) during the year in question, as measured by excise taxes collected by the State on packs (or "roll-your-own" tobacco containers) bearing the excise tax stamp of the State. The Department of Taxes shall adopt rules as are necessary to ascertain the amount of the State excise tax paid on the cigarettes of such tobacco product manufacturer for each year.

    Added 1999, No. 130 (Adj. Sess.), § 1, eff. May 12, 2000; amended 2015, No. 23 , § 136.

§ 1914. Requirements.

1. Any tobacco product manufacturer selling cigarettes to consumers within the State (whether directly or through a distributor, retailer, or similar intermediary or intermediaries) after the date of enactment of this subchapter shall do one of the following:
   1. become a participating manufacturer (as that term is defined in Section II(jj) of the Master Settlement Agreement) and generally perform its financial obligations under the Master Settlement Agreement; or
   2. place into a qualified escrow fund by April 15 of the year following the year in question, the following amounts (as such amounts are adjusted for inflation):
      1. 2000: $0.0104712 per unit sold after the effective date of this subchapter;
      2. for each year, 2001 and 2002: $0.0136125 per unit sold;
      3. for each year, 2003 through 2006: $0.0167539 per unit sold;
      4. for 2007 and each year thereafter: $0.0188482 per unit sold.
2. A tobacco product manufacturer that places funds in escrow under subdivision (a)(2) of this section shall receive the interest or other appreciation on such funds as earned. Such funds themselves shall be released from escrow only under the following circumstances:
   1. to pay a judgment or settlement on any released claim brought against such tobacco product manufacturer by the State or any releasing party located or residing in the State. Funds shall be released from escrow under this subdivision in the order in which they were placed into escrow and only to the extent and at the time necessary to make payments required under such judgment or settlement;
   2. to the extent that a tobacco product manufacturer establishes that the amount it was required to place into escrow on account of units sold in the State in a particular year was greater than the Master Settlement Agreement payments, as determined pursuant to section IX(i) of that Agreement, including after final determination of all adjustments, that such manufacturer would have been required to make on account of such units sold had it been a participating manufacturer, the excess shall be released from escrow and revert back to such tobacco product manufacturer; or
   3. to the extent not released from escrow under subdivision (1) or (2) of this subsection, funds shall be released from escrow and revert back to such tobacco product manufacturer 25 years after the date on which they were placed into escrow.
3. Each tobacco product manufacturer that elects to place funds into escrow under subdivision (a)(2) of this section shall annually certify to the Attorney General of this State that it is in compliance with this section. The Attorney General may bring a civil action on behalf of the State against any tobacco product manufacturer that fails to place into escrow the funds required under this section. Any tobacco product manufacturer that fails in any year to place into escrow the funds required under this section shall:
   1. Be required within 15 days to place such funds into escrow as shall bring it into compliance with this section. The court, upon a finding of a violation of subdivision (a)(2) or subsection (b) of this section, may impose a civil penalty, payable to the General Fund of the State, in an amount not to exceed five percent of the amount improperly withheld from escrow per day of the violation, and in a total amount not to exceed 100 percent of the original amount improperly withheld from escrow.
   2. In the case of a knowing violation, be required within 15 days to place such funds into escrow as shall bring it into compliance with this section. The court, upon a finding of a knowing violation of subdivision (a)(2) or subsection (b) of this section, may impose a civil penalty to be paid to the General Fund of the State in an amount not to exceed 15 percent of the amount improperly withheld from escrow per day of the violation, and in a total amount not to exceed 300 percent of the original amount improperly withheld from escrow.
   3. In the case of a second knowing violation, be prohibited from selling cigarettes to consumers within the State whether directly or through a distributor, retailer or similar intermediary for a period not to exceed two years.
   4. Pay the reasonable attorney's fees and costs of the Attorney General in bringing an action under this section.
4. Each failure to make an annual deposit required under this section shall constitute a separate violation.

   Added 1999, No. 130 (Adj. Sess.), § 1, eff. May 12, 2000; amended 2003, No. 14 , §§ 7, 8.

§ 1915. Findings and purpose.

1. The General Assembly finds that the provisions of this subchapter will enhance compliance with subchapter 1A of this chapter and further the policies and purposes of that subchapter.
2. The provisions of this subchapter are not intended to amend and shall not be interpreted as amending subchapter 1A of this chapter.

   Added 2003, No. 14 , § 1.

§ 1916. Definitions.

As used in this subchapter:

1. "Brand family" means all styles of cigarettes sold under the same trademark and differentiated from one another by means of additional modifiers or descriptors, including "menthol," "lights," "kings," and "100s," and includes a brand name (alone or in conjunction with any other word), trademark, logo, symbol, motto, selling message, recognizable pattern of colors, or any other indicia of product identification identical or similar to, or identifiable with, a previously known brand of cigarettes.
2. "Cigarette" has the same meaning as in subdivision 1913(4) of this title.
3. "Commissioner" means the Commissioner of Taxes.
4. "Wholesale dealer" has the same meaning as in 32 V.S.A. § 7702(16) .
5. "Master Settlement Agreement" has the same meaning as in subdivision 1913(5) of this title.
6. "Nonparticipating manufacturer" means any tobacco product manufacturer that is not a participating manufacturer.
7. "Participating manufacturer" has the same meaning as in section II(jj) of the Master Settlement Agreement and all amendments to the Agreement.
8. "Qualified escrow fund" has the same meaning as in subdivision 1913(6) of this title.
9. "Retail dealer" has the same meaning as in 32 V.S.A. § 7702(10) .
10. [Repealed.]
11. "Tobacco product manufacturer" has the same meaning as in subdivision 1913(9) of this title.
12. "Units sold" has the same meaning as in subdivision 1913(10) of this title.

    Added 2003, No. 14 , § 1; amended 2015, No. 57 , § 83, eff. June 11, 2015; 2021, No. 20 , § 301.

§ 1917. Certifications.

1. Every tobacco product manufacturer whose cigarettes are sold in this State, whether directly or through a licensed wholesale dealer, retailer, or similar intermediary or intermediaries, shall execute and deliver on a form prescribed by the Attorney General a certification to the Attorney General not later than April 30 each year certifying under penalty of perjury that, as of the date of such certification, such tobacco product manufacturer either is a participating manufacturer or is in full compliance with subchapter 1A of this chapter, including all quarterly installment payments required by section 1922 of this title.
2. A participating manufacturer shall:
   1. include in its certification a list of its brand families;
   2. update its list 30 calendar days prior to any addition to or modification of its brand families by executing and delivering a supplemental certification to the Attorney General.
3. A nonparticipating manufacturer shall:
   1. include in its certification:
      1. a list of all of its brand families and the number of units sold for each brand family that were sold in the State during the previous calendar year;
      2. a list of all of its brand families that have been sold in the State during the current calendar year;
      3. a list of any brand family sold in the State during the preceding calendar year that is no longer being sold in the State as of the date of such certification; and
      4. the name and business address of any other tobacco product manufacturer that has manufactured in the past calendar year or is currently manufacturing or selling any brand family listed in the nonparticipating manufacturer's certification;
   2. also certify:
      1. that the nonparticipating manufacturer is registered to do business in the State or has appointed an in-state agent for service of process and provided notice thereof as required by this subchapter;
      2. that the nonparticipating manufacturer has established and continues to maintain a qualified escrow fund; has executed an escrow agreement that both governs the qualified escrow fund and has been reviewed and approved by the Attorney General; and is in full compliance with subchapter 1A of this chapter;
      3. the following information with respect to each qualified escrow fund established pursuant to subchapter 1A of this chapter:
         1. the name, address, and telephone number of the financial institution where the nonparticipating manufacturer has established such qualified escrow fund;
         2. the account number of such qualified escrow fund and any subaccount number for the State;
         3. the amount the nonparticipating manufacturer placed in such fund for cigarettes sold in the State during the preceding calendar year, the dates and amount of each deposit, and evidence or verification as may be deemed necessary by the Attorney General to confirm the foregoing; and
         4. the amounts and dates of any withdrawal or transfer of funds the nonparticipating manufacturer made at any time from the fund; and
      4. that the nonparticipating manufacturer is in full compliance with this subchapter and any rules adopted pursuant to this subchapter; and
   3. update its list of brand families 30 calendar days prior to any addition or modification of its brand families by executing and delivering supplemental certification to the Attorney General.
4. 1. A tobacco product manufacturer may not include a brand family in its certification unless: (d) (1)  A tobacco product manufacturer may not include a brand family in its certification unless:
      1. in the case of a participating manufacturer, the participating manufacturer affirms that the brand family shall be deemed to be its cigarettes for purposes of calculating its payments under the Master Settlement Agreement for the relevant year, in the volume and shares determined pursuant to the Master Settlement Agreement; and
      2. in the case of a nonparticipating manufacturer, the nonparticipating manufacturer affirms that the brand family shall be deemed to be its cigarettes for purposes of subchapter 1A of this chapter.
   2. Nothing in this subsection shall be construed as limiting or otherwise affecting the State's right to contend that the manufacture or sale of a brand family constitutes cigarettes of a different tobacco product manufacturer for purposes of calculating payments under the Master Settlement Agreement or for purposes of subchapter 1A of this chapter.
5. A tobacco product manufacturer shall maintain all invoices and documentation of sales and other such information relied upon for such certification for a period of five years from the date the certification is executed, unless otherwise required by law to maintain them for a greater period of time.

   Added 2003, No. 14 , § 1; amended 2015, No. 57 , § 84, eff. June 11, 2015; 2021, No. 20 , § 302.

§ 1918. Directory of cigarettes approved for stamping and sale.

1. The Attorney General shall develop and publish on its website a directory listing all tobacco product manufacturers that have provided current and accurate certifications conforming to the requirements of this subchapter (the "directory") and all brand families that are listed in such certifications, except as noted in this subsection.
   1. The Attorney General shall not include or retain in such directory any brand family of any tobacco product manufacturer that has failed to provide the required certification or whose certification the Attorney General determines is not in compliance with this subchapter, unless the Attorney General determines that such violation has been cured to the satisfaction of the Attorney General.
   2. Neither a tobacco product manufacturer nor any brand family of the tobacco product manufacturer shall be included or retained in the directory if the Attorney General concludes that either:
      1. any escrow funds required to be deposited pursuant to subchapter 1A of this chapter for any period related to any brand family, whether or not listed by such tobacco product manufacturer in its certification, have not been placed into a qualified escrow fund governed by an escrow agreement that has been approved by the Attorney General; or
      2. any outstanding judgment, including interest thereon, obtained pursuant to subchapter 1A of this chapter related to that tobacco product manufacturer or any brand family of the tobacco product manufacturer has not been fully satisfied.
2. The Attorney General shall update the directory in order to correct mistakes and add or remove a tobacco product manufacturer or brand family to keep the directory in conformity with the requirements of this subchapter, and the Attorney General shall transmit by e-mail or other practicable means to each stamping agent, and to any other entity that registers with the Department of Taxes or the Attorney General requesting receipt of the same, notice at least 30 days prior to any removal from the directory of any tobacco product manufacturer or brand family.
3. Unless otherwise provided by agreement between a licensed wholesale dealer and a tobacco product manufacturer, a licensed wholesale dealer shall be entitled to a refund from a tobacco product manufacturer for any money paid by the licensed wholesale dealer to the tobacco product manufacturer for any cigarettes of that tobacco product manufacturer still in the possession of the licensed wholesale dealer on the date of the Attorney General's removal from the directory of that tobacco product manufacturer or the individual styles or brands of cigarettes of that tobacco product manufacturer. Also, unless otherwise provided by agreement between a retail dealer and a licensed wholesale dealer or a tobacco product manufacturer, a retail dealer shall be entitled to a refund from either a licensed wholesale dealer or a tobacco product manufacturer for any money paid by the retail dealer to the licensed wholesale dealer or tobacco product manufacturer for any cigarettes of that licensed wholesale dealer or tobacco product manufacturer still in the possession of the retail dealer on the date of the Attorney General's removal from the directory of that tobacco product manufacturer or the individual styles or brands of cigarettes of that tobacco product manufacturer. The Attorney General shall not restore to the directory a tobacco product manufacturer or any individual styles or brands or cigarettes or, if applicable, brand families of that tobacco product manufacturer until the tobacco product manufacturer has paid all licensed wholesale dealers any refund due pursuant to this section.
4. The Commissioner shall refund to a licensed wholesale dealer any tax paid under 32 V.S.A. chapter 205 on products no longer saleable in the State under this subchapter.
5. A determination of the Attorney General not to list or to remove from the directory a tobacco product manufacturer, an individual style or brand of cigarette or, if applicable, brand family is a final agency decision with the same status as an agency decision or order in a contested case under the Vermont Administrative Procedure Act. A tobacco product manufacturer aggrieved by a determination of the Attorney General under this section may appeal to the Superior Court in Washington County, which shall review the matter pursuant to 3 V.S.A. § 815 .
6. If a nonparticipating manufacturer who has not been listed on the directory for the previous three years files a certification pursuant to this section, or if the Attorney General determines that a nonparticipating manufacturer who has filed a certification pursuant to this section poses an elevated risk for noncompliance with sections 1912-1914 of this title, neither the nonparticipating manufacturer nor any of its brand families shall be included or retained on the directory unless and until the nonparticipating manufacturer or its U.S. importer that undertakes joint and several liability for the manufacturer's performance in accordance with section 1925 of this title and amendments to that section has posted a bond in accordance with this subsection. Proof of the bond shall be submitted with the certification on a form approved by the Attorney General.
   1. The bond required under this subsection shall be written in favor of the State of Vermont and shall be conditioned on the performance by the nonparticipating manufacturer or its U.S. importer that undertakes joint and several liability for the manufacturer's performance in accordance with sections 1912-1914 and 1925 of this title. The bond shall be issued by a surety company in good standing and authorized to transact business in this State to secure the payment of any escrow due or which may become due from the nonparticipating manufacturer or its U.S. importer. The bond shall be maintained as a condition to the nonparticipating manufacturer and its brand families being included on the directory and shall remain in place for the pendency of such listing.
   2. The bond required shall be $20,000.00 for a nonparticipating manufacturer that has not been listed on the Vermont directory for at least three years prior to the nonparticipating manufacturer's application for certification.
   3. The bond required shall be $50,000.00 for a nonparticipating manufacturer that poses an elevated risk for noncompliance with sections 1912-1914 of this title.
   4. A nonparticipating manufacturer shall be deemed to pose an elevated risk for noncompliance with sections 1912-1914 of this title if it:
      1. failed in the previous three years to make a full and timely escrow deposit due pursuant to section 1914 of this title, unless the failure was promptly cured upon notice;
      2. was involuntarily removed from any state's directory, unless the removal was determined to have been erroneous or illegal; or
      3. has litigation pending against it in any state for escrow or for penalties, costs, or attorney's fees related to noncompliance with any state's escrow laws.
   5. If a nonparticipating manufacturer that has posted a bond has failed to make or to have made on its behalf by an entity with joint and several liability escrow deposits equal to the full amount owed for a quarter within 15 days following the due date for the quarter under sections 1914 and 1925 of this title, the State may execute upon the bond first to recover delinquent escrow, which amount shall be deposited into a qualified escrow account under section 1914, and then to recover civil penalties and costs authorized under that section. Escrow obligations above the amount collected on the bond remain due from that nonparticipating manufacturer and, as provided in section 1925 of this title, from importers that sold its cigarettes in the calendar quarter.

      Added 2003, No. 14 , § 1; amended 2003, No. 113 (Adj. Sess.), § 2; 2013, No. 14 , § 22; 2015, No. 57 , § 85, eff. June 11, 2015; 2021, No. 20 , § 303.

§ 1919. Prohibition against the stamping and sale of cigarettes not included in the directory.

No person shall affix a tax stamp to or sell or offer for sale in this State any package or container of cigarettes manufactured by a tobacco product manufacturer or belonging to a brand family that is not included in the directory, or sell, offer, or possess for sale, in this State, cigarettes of a tobacco product manufacturer or brand family not included in the directory.

Added 2003, No. 14 , § 1.

§ 1920. Agent for service of process.

1. Any nonresident or foreign nonparticipating manufacturer that has not registered to do business in the State as a foreign corporation or other business entity shall, as a condition precedent to having its brand families included or retained in the directory, appoint and continually engage without interruption the services of an agent in this State to act as agent for the service of process on whom all process, and any action or proceeding against it concerning or arising out of the enforcement of this subchapter or subchapter 1A of this chapter, or both, may be served in any manner authorized by law. Such service shall constitute legal and valid service of process on the nonparticipating manufacturer. The nonparticipating manufacturer shall provide the name, address, telephone number, and satisfactory proof of the appointment and availability of such agent to the Attorney General. The Secretary of State shall be designated as agent for service of process for importers of nonparticipating manufacturers located outside the United States. Service shall be made upon the Secretary of State in accordance with the provisions of 12 V.S.A. §§ 851 and 852.
2. The nonparticipating manufacturer shall provide notice to the Attorney General 30 calendar days prior to termination of the authority of any such agent and shall further provide proof to the satisfaction of the Attorney General of the appointment of a new agent no less than five calendar days prior to the termination of an existing agent appointment. In the event an agent terminates an agent appointment, the nonparticipating manufacturer shall notify the Attorney General of said termination within five calendar days and shall include proof to the satisfaction of the Attorney General of the appointment of a new agent.
3. Any nonparticipating manufacturer whose cigarettes are sold in this State who has not appointed and engaged an agent as required by this section shall be deemed to have appointed the Secretary of State as such agent and may be proceeded against in courts of this State by service of process upon the Secretary of State; provided, however, that the appointment of the Secretary of State as such agent shall not satisfy the condition precedent, required by subsection (a) of this section, for having the individual styles or brands of cigarettes or, if applicable, brand families of the nonparticipating manufacturer included or retained in the directory.

   Added 2003, No. 14 , § 1; amended 2011, No. 166 (Adj. Sess.), § 5; 2021, No. 20 , § 304.

§ 1921. Reporting and sharing of information.

1. At the date specified in 32 V.S.A. § 7785 or 7813, for monthly reports from licensed wholesale dealers, or at such date and frequency as the Commissioner may require for other licensed wholesale dealers, which will be at least quarterly, each licensed wholesale dealer shall submit such information as the Commissioner requires to facilitate compliance with subchapter 1A of this chapter and this subchapter, including a list by brand family of the total number of cigarettes, or, in the case of roll-your-own tobacco, the equivalent stick count, as determined pursuant to the formula set forth in subchapter 1A of this chapter, for which the licensed wholesale dealer affixed stamps during the reporting period or otherwise paid the tax due for such cigarettes. Licensed wholesale dealers shall maintain, and make available to the Commissioner, all documentation and other information relied upon in reporting to the Commissioner for a period of six years.
2. The Attorney General may require at any time from a nonparticipating manufacturer proof from the financial institution in which a tobacco product manufacturer has established a qualified escrow fund for the purpose of compliance with subchapter 1A of this chapter of the amount of money being held in such fund on behalf of the State and the dates of deposits, and listing the amounts of all withdrawals from such fund and the dates thereof; any such nonparticipating manufacturer shall provide the requisite proof within 10 business days of the date it is requested. In the event that a nonparticipating manufacturer fails to provide the requisite proof within said time period, the Attorney General shall remove the nonparticipating manufacturer and all of its styles or brands of cigarettes from the directory.
3. The Attorney General may require a licensed wholesale dealer or tobacco product manufacturer to submit any additional information, including samples of the packaging or labeling of each brand family, as is necessary to enable the Attorney General to determine whether a tobacco product manufacturer is in compliance with this subchapter and subchapter 1A of this chapter.
4. The Attorney General is authorized to disclose to the Commissioner and, notwithstanding the provisions of 32 V.S.A. chapter 103, the Commissioner is authorized to disclose to the Attorney General any information received under this subchapter or subchapter 1A of this chapter, if such information is requested by the other for the purposes of determining compliance with or enforcing the provisions of those statutes. The Attorney General and Commissioner shall share with each other the information received under this subchapter or subchapter 1A of this chapter, and may share such information with other federal, State, or local agencies as necessary for the purposes of enforcement of this subchapter, the State's nonparticipating tobacco manufacturers' statutes, or corresponding laws of other states.

   Added 2003, No. 14 , § 1; amended 2003, No. 113 (Adj. Sess.), § 1; 2015, No. 57 , § 86, eff. June 11, 2015.

§ 1922. Quarterly escrow deposits.

To promote compliance with the provisions of this subchapter, the Attorney General may adopt rules requiring a nonparticipating manufacturer to make the escrow deposits required by subchapter 1A of this chapter in quarterly installments during the year in which the sales covered by such deposits are made.

Added 2003, No. 14 , § 1; amended 2015, No. 23 , § 137.

§ 1923. Penalties and other remedies.

1. In addition to or in lieu of any other civil or criminal remedy provided by law, upon a determination that a stamping agent has violated this subchapter or any rule adopted pursuant to this subchapter, the Attorney General may, for each violation of this subchapter, also impose a civil penalty in an amount not to exceed the greater of 500 percent of the retail value of the cigarettes sold, offered for sale, or possessed for sale in violation of this subchapter or $5,000.00. Each stamp affixed and each sale or offer to sell cigarettes in violation of section 1919 of this subchapter shall constitute a separate violation.
2. The Attorney General may seek an injunction to restrain a threatened or actual violation of this subchapter by a stamping agent and to compel the stamping agent to comply with the provisions of this subchapter. In any action brought pursuant to this section, the State shall be entitled to recover the costs of investigation, expert witness fees, costs of the action, and reasonable attorney's fees.
3. It shall be unlawful for a person to:
   1. Sell or distribute cigarettes that the person knows or should know are intended for distribution or sale in the State in violation of this subchapter.
   2. Acquire, hold, own, possess, transport, import, or cause to be imported cigarettes that the person knows or should know are intended for distribution or sale in the State in violation of this subchapter. A violation of this section shall be a misdemeanor punishable by imprisonment for not more than one year and a fine of not more than $5,000.00, or both.
4. A person who violates section 1919 of this title engages in an unfair and deceptive trade practice in violation of the State's Consumer Protection Act, 9 V.S.A. § 2451 et seq.
5. If a court determines that a person has violated the provisions of this subchapter, the court shall order any profits, gain, gross receipts, or other benefit from the violation to be disgorged and paid to the State Treasurer for deposit in the Tobacco Litigation Settlement Fund established pursuant to 32 V.S.A. § 435a .
6. Unless otherwise expressly provided, the penalties or remedies, or both, provided by this subchapter are cumulative to each other and to the penalties or remedies, or both, available under all other laws of this State.

   Added 2003, No. 14 , § 1; amended 2011, No. 109 (Adj. Sess.), § 3, eff. May 8, 2012; 2011, No. 136 (Adj. Sess.), § 1b, eff. May 18, 2012; 2021, No. 20 , § 305.

§ 1924. Miscellaneous provisions.

1. The first report of stamping agents required by section 1921 of this title shall be due 30 days after the effective date of this subchapter; the initial certification of a tobacco product manufacturer required by section 1917 of this title shall be due 45 days after the effective date of this subchapter; and the directory described in section 1918 of this title shall be published or made available within 120 days after the effective date of this subchapter.
2. Both the Attorney General and the Commissioner may adopt rules necessary to effect the purposes of this subchapter.
3. In any action brought by the State to enforce the provisions of this subchapter, the State shall be entitled to recover the costs of investigation, expert witness fees, costs of the action, and reasonable attorney's fees.
4. If a court of competent jurisdiction finds that the provisions of this subchapter and subchapter 1A of this chapter conflict and cannot be harmonized, then such provisions of subchapter 1A shall control. If any section, subsection, subdivision, sentence, or phrase of this subchapter causes subchapter 1A of this chapter to no longer constitute a qualifying act or model statute, as those terms are defined in the Master Settlement Agreement, then that portion of this subchapter shall not apply. If any section, subsection, subdivision, sentence, or phrase of this subchapter is for any reason held to be invalid, unlawful, or unconstitutional, such decision shall not affect the validity of the remaining portions of this subchapter or any part thereof.

   Added 2003, No. 14 , § 1; amended 2021, No. 20 , § 306.

§ 1925. Joint and several liability of importers on nonparticipating manufacturer's brand families.

Each nonparticipating manufacturer located outside the United States and each importer of any nonparticipating manufacturer's brand families that are sold in the State shall bear joint and several liability for the deposit of all escrow due and payment of all penalties, costs, and attorney's fees imposed under this subchapter. The nonparticipating manufacturer, as a condition to being listed on the directory, shall provide a declaration on a form prescribed by the Attorney General from each of its importers of any of its brand families to be sold in the State that the importer accepts joint and several liability for all escrow deposits due pursuant to section 1914 of this title and for all penalties, costs, and attorney's fees assessed under section 1914 of this title.

Added 2011, No. 166 (Adj. Sess.), § 4, eff. May 16, 2012.

§ 1950. Purpose.

1. The purpose of this subchapter is to establish assessments on health care providers, which funds shall be used in the State's health care program in such a way as to be eligible for federal financial participation.
2. The Secretary and the Commissioner shall interpret and administer the provisions of this subchapter so as to maximize federal financial participation and avoid disallowances of federal financial participation.
3. If the purpose of this subchapter can no longer be accomplished, the Secretary of Human Services shall so notify the General Assembly on or before the following February 15.

   Added 1991, No. 253 (Adj. Sess.), § 1; amended 1993, No. 56 , § 1, eff. June 3, 1993; 2005, No. 71 , § 282; 2009, No. 156 (Adj. Sess.), § I.51.

§ 1951. Definitions.

As used in this subchapter:

1. "Assessment" means a tax levied on a health care provider pursuant to this chapter.
2. 1. "Home health services" means any of the following: (2) (A) "Home health services" means any of the following:
      1. those medically necessary, intermittent, skilled home health services provided by Medicare-certified home health agencies of the type covered under Title XVIII (Medicare) or XIX (Medicaid) of the Social Security Act;
      2. services covered under the adult and pediatric High Technology Home Care programs as of January 1, 2015;
      3. personal care, respite care, and companion care services provided through the Choices for Care program contained within Vermont's Global Commitment to Health Section 1115 demonstration; and
      4. hospice services.
   2. The term "home health services" shall not include any other service provided by a home health agency, including:
      1. private duty services;
      2. case management services, except to the extent that such services are performed in order to establish an individual's eligibility for services described in subdivision (A) of this subdivision (2);
      3. homemaker services;
      4. adult day services;
      5. group-directed attendant care services;
      6. primary care services;
      7. nursing home room and board when a hospice patient is in a nursing home; and
      8. health clinics, including occupational health, travel, and flu clinics.
   3. The term "home health services" shall not include any services provided by a home health agency under any other program or initiative unless the services fall into one or more of the categories described in subdivision (A) of this subdivision (2). Other programs and initiatives include:
      1. the Flexible Choices or Assistive Devices options under the Choices for Care program contained within Vermont's Global Commitment to Health Section 1115 demonstration;
      2. services provided to children under the early and periodic screening, diagnostic, and treatment Medicaid benefit;
      3. services provided pursuant to the Money Follows the Person demonstration project;
      4. services provided pursuant to the Traumatic Brain Injury Program; and
      5. maternal-child wellness services, including services provided through the Nurse Family Partnership program.
3. "Commissioner" means the Commissioner of Vermont Health Access.
4. [Repealed.]
5. "Health care provider" means any hospital, nursing home, intermediate care facility for people with intellectual disabilities, home health agency, or retail pharmacy.
6. "Home health agency" means an entity that has received a certificate of need from the State to provide home health services or is certified to provide services pursuant to 42 U.S.C. § 1395x (o).
7. "Hospital" means a hospital licensed under 18 V.S.A. chapter 43.
8. "Intermediate Care Facility for People with Developmental Disabilities" (ICF/DD) means a facility which provides long-term health related care to residents with developmental disabilities pursuant to subdivision 1902(a)(31) of the Social Security Act ( 42 U.S.C. § 1396a (a)(31)).
9. "Mental hospital" or "psychiatric facility" means a hospital as defined in 18 V.S.A. § 1902(1)(B) or (H), but does not include psychiatric units of general hospitals.
10. "Net patient revenues" means a provider's gross charges related to patient care services less any deductions for bad debts, charity care, contractual allowances, and other payer discounts.
11. "Nursing home" means a health care facility licensed under chapter 71 of this title.
12. "Department" means the Department of Vermont Health Access.
13. "Pharmacy" means a Vermont drug outlet licensed by the Vermont State Board of Pharmacy pursuant to 26 V.S.A. chapter 36 in which prescription drugs are sold at retail.
14. "Secretary" means the Secretary of Human Services.
15. "Ambulance agency" means an ambulance agency licensed pursuant to 18 V.S.A. chapter 17.

    Added 1991, No. 94 , § 1; amended 1991, No. 253 (Adj. Sess.), § 2; 1993, No. 56 § 1, eff. June 3, 1993; 1999, No. 49 , § 200; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 71 , § 283; 2005, No. 215 (Adj. Sess.), § 318; 2009, No. 156 (Adj. Sess.), § I.52; 2013, No. 96 (Adj. Sess.), § 207; 2013, No. 131 (Adj. Sess.), § 44, eff. May 20, 2014; 2015, No. 134 (Adj. Sess.), § 29; 2017, No. 73 , § 18, eff. June 13, 2017; 2019, No. 6 , § 75, eff. April 22, 2019.

§ 1952. General provisions.

1. The Secretary of Human Services shall adopt rules necessary for the implementation of this subchapter.
2. The Department may use not more than one percent of the assessments received under the provisions of this subchapter for necessary administrative expenses associated with this subchapter.
3. The budget of any hospital assessed under the provisions of this subchapter that includes a nursing home, home health agency, or physician's office practice shall have its assessment based only on the hospital portion of its budget. The nursing home and home health agency components of the budget shall be assessed separately as provided for in this subchapter.
4. No health care provider conducted, maintained, or operated by the U.S. government shall be subject to an assessment levied under the provisions of this subchapter.
5. Each assessment imposed pursuant to this subchapter is the liability of the health care provider and no portion thereof shall be charged directly to any patient or resident, but may be treated as a cost of doing business for the purpose of determining rates and charges.
6. If a health care provider fails to pay its assessments under this subchapter according to the schedule or a variation thereof adopted by the Commissioner, the Commissioner may, after notice and opportunity for hearing, deduct these assessment arrears and any late-payment penalties from Medicaid payments otherwise due to the provider. The deduction of these assessment arrears may be made in one or more installments on a schedule to be determined by the Commissioner.

   Added 1991, No. 94 , § 1; amended 1991, No. 253 (Adj. Sess.), § 3; 1993, No. 56 § 1, eff. June 3, 1993; 1999, No. 49 , § 201; 2005, No. 71 , § 284; 2007, No. 190 (Adj. Sess.), § 49, eff. June 6, 2008; 2009, No. 156 (Adj. Sess.), § I.53.

§ 1953. Hospital assessment.

1. Hospitals shall be subject to an annual assessment as follows:
   1. Beginning July 1, 2012, each hospital's annual assessment, except for hospitals assessed under subdivision (2) of this subsection, shall be six percent of its net patient revenues (less chronic, skilled, and swing bed revenues).
   2. Beginning July 1, 2004, each mental hospital or psychiatric facility's annual assessment shall be 4.21 percent, provided that the U.S. Department of Health and Human Services grants a waiver to the uniform assessment rate, pursuant to 42 C.F.R. § 433.68(e). If the U.S. Department of Health and Human Services fails to grant a waiver, mental hospitals and psychiatric facilities shall be assessed under subdivision (1) of this subsection.
2. Each hospital shall be notified in writing by the Department of the assessment made pursuant to this section. If no hospital submits a request for reconsideration under section 1958 of this title, the assessment shall be considered final.
3. Each hospital shall submit its assessment to the Department according to a payment schedule adopted by the Commissioner. Variations in payment schedules shall be permitted as deemed necessary by the Commissioner.
4. Any hospital that fails to make a payment to the Department on or before the specified schedule, or under any schedule for delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive this late payment assessment provided for in this subsection for good cause shown by the hospital.

   Added 1991, No. 94 , § 1; amended 1993, No. 56 , § 1, eff. June 3, 1993; 1995, No. 5 , § 26, eff. March 3, 1995; 1995, No. 14 , § 2, eff. April 12, 1995; 1997, No. 59 , §§ 69, 70, eff. June 30, 1997; 1999, No. 49 , § 199; 2001, No. 65 , § 13; 2003, No. 66 , § 306; see effective date note set out below; 2003, No. 163 (Adj. Sess.), § 7; 2005, No. 71 , § 285; 2007, No. 190 (Adj. Sess.), § 47, eff. June 6, 2008; 2009, No. 156 (Adj. Sess.), § E.309.4; 2011, No. 45 , § 24, eff. May 24, 2011; 2011, No. 128 (Adj. Sess.), § 36.

§ 1954. Nursing home assessment.

1. Beginning July 1, 2011, each nursing home's annual assessment shall be $4,509.57, and beginning October 1, 2011, $4,919.53 per bed licensed pursuant to section 7105 of this title on June 30 of the immediately preceding fiscal year. The annual assessment for each bed licensed as of the beginning of the fiscal year shall be prorated for the number of days during which the bed was actually licensed and any overpayment shall be refunded to the facility. To receive the refund, a facility shall notify the Commissioner in writing of the size of the decrease in the number of its licensed beds and dates on which the beds ceased to be licensed.
2. The Department shall provide written notification of the assessment amount to each nursing home. The assessment amount determined shall be considered final unless the home requests a reconsideration. Requests for reconsideration shall be subject to the provisions of section 1958 of this title.
3. Each nursing home shall submit its assessment to the Department according to a schedule adopted by the Commissioner. The Commissioner may permit variations in the schedule of payment as deemed necessary.
4. Any nursing home that fails to make a payment to the Department on or before the specified schedule, or under any schedule of delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive the late-payment assessment provided for in this subsection for good cause shown by the nursing home.

   Added 1991, No. 94 , § 1; amended 1991, No. 253 (Adj. Sess.), § 4; 1993, No. 56 , § 1, eff. June 3, 1993; 1995, No. 5 , § 27, eff. March 9, 1995; 1995, No. 14 , § 3, eff. April 12, 1995; 1999, No. 49 , § 202; 2001, No. 65 , § 14; 2001, No. 142 (Adj. Sess.), § 120a; 2001, No. 143 (Adj. Sess.), § 49, eff. June 21, 2002; 2003, No. 66 , § 307; 2003, No. 163 (Adj. Sess.), § 8; 2005, No. 71 , § 286; 2007, No. 76 , § 9, eff. June 7, 2007; 2007, No. 190 (Adj. Sess.), § 50, eff. June 6, 2008; 2009, No. 156 (Adj. Sess.), § I.54; 2011, No. 45 , § 25, eff. May 24, 2011.

§ 1955. ICF/DD assessment.

1. Beginning October 1, 2011, each ICF/DD's annual assessment shall be 5.9 percent of the ICF/DD's total annual direct and indirect expenses for the most recently settled ICF/DD audit.
2. The Department shall provide written notification of the assessment amount to each ICF/DD. The assessment amount determined shall be considered final unless the facility requests a reconsideration. Requests for reconsideration shall be subject to the provisions of section 1958 of this title.
3. Each ICF/DD shall remit its assessment to the Department according to a schedule adopted by the Commissioner. The Commissioner may permit variations in the schedule of payment as deemed necessary.
4. Any ICF/DD that fails to make a payment to the Department on or before the specified schedule, or under any schedule of delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive the late-payment assessment provided for in this subsection for good cause shown by the ICF/DD.

   Added 1991, No. 94 , § 1; amended 1993, No. 56 , § 1, eff. June 3, 1993; 2005, No. 71 , § 287; 2007, No. 190 (Adj. Sess.), § 48, eff. June 6, 2008; 2009, No. 156 (Adj. Sess.), § I.55; 2011, No. 45 , § 26, eff. May 24, 2011; 2013, No. 96 (Adj. Sess.), § 208.

§ 1955a. Home health agency assessment. Section 1955a repealed effective July 1, 2023.

1. 1. Each home health agency's assessment shall be 4.25 percent of its net patient revenues from home health services provided exclusively in Vermont. (a) (1)  Each home health agency's assessment shall be 4.25 percent of its net patient revenues from home health services provided exclusively in Vermont.
   2. On or before May 1 of each year, each home health agency shall provide to the Department a copy of its most recent audited financial statement prepared in accordance with generally accepted accounting principles. The amount of the tax shall be determined by the Commissioner based on the home health net patient revenue attributable to services reported on the agency's financial statement.
   3. For providers who began operations as a home health agency after January 1, 2005, the tax shall be assessed as follows:

      Until such time as the home health agency submits audited financial statements for its first full year of operation as a home health agency, the Commissioner, in consultation with the home health agency, shall annually estimate the amount of tax payable and shall prescribe a schedule for interim payments.

      At such time as the full-year audited financial statement is filed, the final assessment shall be determined, and the home health agency shall pay any underpayment or the Department shall refund any overpayment. The assessment for the State fiscal year in which a provider commences operations as a home health agency shall be prorated for the proportion of the State fiscal year in which the new home health agency was in operation.

2. Each home health agency shall be notified in writing by the Department of the assessment made pursuant to this section. If no home health agency submits a request for reconsideration under section 1958 of this title, the assessment shall be considered final.
3. Each home health agency shall submit its assessment to the Department according to a payment schedule adopted by the Commissioner. Variations in payment schedules shall be permitted as deemed necessary by the Commissioner.
4. Any home health agency that fails to make a payment to the Department on or before the specified schedule, or under any schedule for delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive the late-payment assessment provided for in this subsection for good cause shown by the home health agency.

   Added 1999, No. 49 , § 203; amended 2001, No. 65 , § 15; 2003, No. 66 , § 309; 2005, No. 71 , § 288; 2009, No. 47 , § 15; 2009, No. 156 (Adj. Sess.), § I.56; 2011, No. 45 , § 23, eff. May 24, 2011; 2013, No. 73 , § 55, eff. July 1, 2005, eff. June 5, 2013; 2017, No. 73 , § 18a, eff. June 13, 2017; repealed on July 1, 2023 by 2021, No. 73 § 13.

§ 1955b. Pharmacy assessment.

1. Beginning July 1, 2005, each pharmacy's monthly assessment shall be $0.10 for each prescription filled and refilled.
2. Each pharmacy shall declare and provide supporting documentation to the Commissioner of the total number of prescriptions filled and refilled in the previous month and remit the assessment due for that month. The declaration and payment shall be due by the end of the following month.
3. Each pharmacy shall submit its assessment payment to the Department monthly. Variations in payment timing shall be permitted as deemed necessary by the Commissioner.
4. Any pharmacy that fails to pay an assessment to the Department on or before the due date shall be assessed a late payment penalty of two percent of the assessment amount for each month it remains unpaid; but late payment penalties for any one quarter shall not exceed $500.00. The Commissioner may waive a penalty under this subsection for good cause shown by the pharmacy, as determined by the Commissioner in his or her discretion.

   Added 2005, No. 71 , § 289; amended 2009, No. 156 (Adj. Sess.), § I.57.

§ 1956. Proceeds from assessments.

All assessments, including late-payment assessments, from health care providers under this subchapter shall be deposited in the General Fund. No provision of this subchapter shall permit the State to reduce the level of State funds expended on the nursing home Medicaid program in any fiscal year below the level expended in fiscal year 1991 from the General Fund for the nursing home Medicaid program.

Added 1991, No. 94 , § 1; amended 1991, No. 253 (Adj. Sess.), § 6; 1993, No. 56 , § 1, eff. June 3, 1993; 1995, No. 14 , § 4, eff. April 12, 1995; 1995, No. 174 (Adj. Sess.), § 3; 1999, No. 49 , § 204; 1999, No. 147 (Adj. Sess.), § 4; 2001, No. 63 , § 99a; 2001, No. 65 , § 16; 2001, No. 143 (Adj. Sess.), § 50, eff. June 21, 2002; 2003, No. 66 , § 310; 2003, No. 163 (Adj. Sess.), § 9; 2005, No. 71 , § 291; 2005, No. 215 (Adj. Sess.), § 313; 2019, No. 6 , § 76, eff. April 22, 2019.

§ 1957. Audits.

The Commissioner may require the submission of audited information as needed from health care providers to determine that amounts received from health care providers were correct. If an audit identifies amounts received due to errors by the Department, the Commissioner shall make payments to any health care provider which the audit reveals paid amounts it should not have been required to pay. Payments made under this section shall be made from the Fund.

Added 1991, No. 94 , § 1; amended 1991, No. 253 (Adj. Sess.), § 7; 1993, No. 56 , § 1, eff. June 3, 1993; 2005, No. 71 , § 292; 2009, No. 156 (Adj. Sess.), § I.58.

§ 1958. Appeals.

1. Any health care provider may submit a written request to the Department for reconsideration of the determination of the assessment within 20 days of notice of the determination. The request shall be accompanied by written materials setting forth the basis for reconsideration. If requested, the Department shall hold a hearing within 90 days from the date on which the reconsideration request was received. The Department shall mail written notice of the date, time, and place of the hearing to the health care provider at least 30 days before the date of the hearing. On the basis of the evidence submitted to the Department or presented at the hearing, the Department shall reconsider and may adjust the assessment. Within 20 days following the hearing, the Department shall provide notice in writing to the health care provider of the final determination of the amount it is required to pay based on any adjustments made by it. Proceedings under this section are not subject to the requirements of 3 V.S.A. chapter 25.
2. Upon request, the Commissioner shall enter into nonbinding arbitration with any health care provider dissatisfied with the Department's decision regarding the amount it is required to pay. The arbitrator shall be selected by mutual consent, and compensation shall be provided jointly.
3. Any health care provider may appeal the decision of the Department as to the amount it is required to pay either before or after arbitration, to the Superior Court having jurisdiction over the health care provider.

   Added 1991, No. 94 , § 1; amended 1991, No. 253 (Adj. Sess.), § 8; 1993, No. 56 , § 1, eff. June 3, 1993; 2005, No. 71 , § 293; 2009, No. 156 (Adj. Sess.), § I.59; 2017, No. 210 (Adj. Sess.), § 4, eff. June 1, 2018.

§ 1959. Ambulance agency assessment.

1. 1. The annual assessment for each ambulance agency shall be 3.3 percent of the ambulance agency's annual net patient revenues for services delivered to patients in Vermont during the most recent annual fiscal period. As used in this section, "net patient revenues" means the total amount of payments an ambulance agency received during the fiscal period from Medicaid, Medicare, commercial insurance, and all other payers as payment for services rendered. The term does not include municipal appropriations, donations from any source, or any other funding unrelated to the delivery of health care services. (a) (1)  The annual assessment for each ambulance agency shall be 3.3 percent of the ambulance agency's annual net patient revenues for services delivered to patients in Vermont during the most recent annual fiscal period. As used in this section, "net patient revenues" means the total amount of payments an ambulance agency received during the fiscal period from Medicaid, Medicare, commercial insurance, and all other payers as payment for services rendered. The term does not include municipal appropriations, donations from any source, or any other funding unrelated to the delivery of health care services.

   The Department shall determine the appropriate fiscal period as necessary to ensure compliance with federal law.

   (3) Ambulance agencies shall remit the assessment amount to the Department annually on or before June 1.

2. The Department shall provide written notification of the assessment amount to each ambulance agency. The assessment amount determined shall be considered final unless the agency requests reconsideration. Requests for reconsideration shall be subject to the provisions of section 1958 of this title.
3. Each ambulance agency shall remit its assessment to the Department according to a schedule adopted by the Commissioner. The Commissioner may permit variations in the schedule of payment as deemed necessary.
4. Any ambulance agency that fails to make a payment to the Department on or before the specified schedule, or under any schedule of delayed payments established by the Commissioner, shall be assessed not more than $1,000.00. The Commissioner may waive the late-payment assessment provided in this subsection for good cause shown by the ambulance agency.

   Added 2015, No. 134 (Adj. Sess.), § 30; amended 2017, No. 73 , § 9, eff. June 13, 2017; 2017, No. 210 (Adj. Sess.), § 5, eff. June 1, 2018.

§§ 1971 Repealed. 2011, No. 171 (Adj. Sess.), § 41(h), effective January 1, 2014.

§ 1972. Repealed. 2005, No. 93 (Adj. Sess.), § 16.

§§ 1973, 1974. Repealed. 2011, No. 171 (Adj. Sess.), § 41(h), effective January 1, 2014.

§§ 1981-1985. Repealed. 2013, No. 79, § 52(c), effective January 1, 2014.

§ 1986. Repealed. 2011, No. 75 (Adj. Sess.), § 83.

§ 1991. Definitions.

As used in this chapter:

1. "Dental hygienist" means an individual licensed to practice as a dental hygienist under 26 V.S.A. chapter 12.
2. "Dental services" means preventive, diagnostic, or corrective procedures related to the teeth and associated structures of the oral cavity.
3. "Dental therapist" means an individual licensed to practice as a dental therapist under 26 V.S.A. chapter 12.
4. "Dentist" means an individual licensed to practice dentistry under 26 V.S.A. chapter 12.

   Added 2019, No. 72 , § E.306.1.

§ 1992. Medicaid coverage for adult dental services.

1. Vermont Medicaid shall provide coverage for medically necessary dental services provided by a dentist, dental therapist, or dental hygienist working within the scope of the provider's license as follows:
   1. Up to two visits per calendar year for preventive services, including prophylaxis and fluoride treatment, with no co-payment. These services shall not be counted toward the annual maximum benefit amount set forth in subdivision (2) of this subsection.
   2. Diagnostic, restorative, and endodontic procedures, to a maximum of $1,000.00 per calendar year, provided that the Department of Vermont Health Access may approve expenditures in excess of that amount when exceptional medical circumstances so require.
   3. Other dental services as determined by the Department by rule.
2. The Department of Vermont Health Access shall develop a reimbursement structure for dental services in the Vermont Medicaid program that encourages dentists, dental therapists, and dental hygienists to provide preventive care.

   Added 2019, No. 72 , § E.306.1.

§§ 1992a-1996. Repealed. 2005, No. 71, § 321(a), eff. January 1, 2006.

§ 1997. Definitions.

As used in this subchapter:

1. "Board" or "Drug Utilization Review Board" means the Drug Utilization Review Board established in connection with the Medicaid program.
2. "Commissioner" means the Commissioner of Vermont Health Access.
3. "Health benefit plan" means a health benefit plan with prescription drug coverage offered or administered by a health insurer, as defined by 18 V.S.A. § 9402 , and the out-of-state counterparts to such plans. The term includes:
   1. any State public assistance program with a health benefit plan that provides coverage of prescription drugs;
   2. any health benefit plan offered by or on behalf of the State of Vermont or any instrumentality of the State providing coverage for government employees and their dependents that agrees to participate in the Program; and
   3. any insured or self-insured health benefit plan that agrees to participate in the Program.
4. "Department" means the Department of Vermont Health Access.
5. "Participating health benefit plan" means a health benefit plan that has agreed to participate in one or more components of the Pharmacy Best Practices and Cost Control Program.
6. "Program" or "the Pharmacy Best Practices and Cost Control Program" means the Pharmacy Best Practices and Cost Control Program established by this subchapter.
7. "State public assistance program" includes the Medicaid program, VPharm, the State Children's Health Insurance Program, the State of Vermont AIDS Medication Assistance Program, the General Assistance program, the Pharmacy Discount Plan Program, and the out-of-state counterparts to such programs.

   Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2005, No. 174 (Adj. Sess.), § 100; 2009, No. 156 (Adj. Sess.), § I.61; 2013, No. 79 , § 25, eff. Jan. 1, 2014.

§ 1998. Pharmacy Best Practices and Cost Control Program established.

1. The Commissioner of Vermont Health Access shall establish and maintain a Pharmacy Best Practices and Cost Control Program designed to reduce the cost of providing prescription drugs, while maintaining high quality in prescription drug therapies. The Program shall include:
   1. use of an evidence-based preferred list of covered prescription drugs that identifies preferred choices within therapeutic classes for particular diseases and conditions, including generic alternatives and over-the-counter drugs;
   2. utilization review procedures, including a prior authorization review process;
   3. any strategy designed to negotiate with pharmaceutical manufacturers to lower the cost of prescription drugs for Program participants, including a supplemental rebate program;
   4. alternative pricing mechanisms, including consideration of using maximum allowable cost pricing for generic and other prescription drugs;
   5. alternative coverage terms, including consideration of providing coverage of over-the-counter drugs where cost-effective in comparison to prescription drugs, and authorizing coverage of dosages capable of permitting the consumer to split each pill if cost-effective and medically appropriate for the consumer;
   6. a simple, uniform prescription form, designed to implement the preferred drug list, and to enable prescribers and consumers to request an exception to the preferred drug list choice with a minimum of cost and time to prescribers, pharmacists, and consumers;
   7. a joint pharmaceuticals purchasing consortium as provided for in subdivision (c)(1) of this section; and
   8. any other cost containment activity adopted, by rule, by the Commissioner that is designed to reduce the cost of providing prescription drugs while maintaining high quality in prescription drug therapies.
2. The Commissioner shall implement the Pharmacy Best Practices and Cost Control Program for Medicaid and all other State public assistance program health benefit plans to the extent permitted by federal law.
3. 1. The Commissioner may implement the Pharmacy Best Practices and Cost Control Program for any other health benefit plan within or outside this State that agrees to participate in the Program. For entities in Vermont, the Commissioner shall directly or by contract implement the Program through a joint pharmaceuticals purchasing consortium. The joint pharmaceuticals purchasing consortium shall be offered on a voluntary basis no later than January 1, 2008, with mandatory participation by State or publicly funded, administered, or subsidized purchasers to the extent practicable and consistent with the purposes of this chapter, by January 1, 2010. If necessary, the Department of Vermont Health Access shall seek authorization from the Centers for Medicare and Medicaid to include purchases funded by Medicaid. "State or publicly funded purchasers" shall include the Department of Corrections, the Department of Mental Health, Medicaid, Dr. Dynasaur, VPharm, Healthy Vermonters, workers' compensation, and any other State or publicly funded purchaser of prescription drugs. (c) (1)  The Commissioner may implement the Pharmacy Best Practices and Cost Control Program for any other health benefit plan within or outside this State that agrees to participate in the Program. For entities in Vermont, the Commissioner shall directly or by contract implement the Program through a joint pharmaceuticals purchasing consortium. The joint pharmaceuticals purchasing consortium shall be offered on a voluntary basis no later than January 1, 2008, with mandatory participation by State or publicly funded, administered, or subsidized purchasers to the extent practicable and consistent with the purposes of this chapter, by January 1, 2010. If necessary, the Department of Vermont Health Access shall seek authorization from the Centers for Medicare and Medicaid to include purchases funded by Medicaid. "State or publicly funded purchasers" shall include the Department of Corrections, the Department of Mental Health, Medicaid, Dr. Dynasaur, VPharm, Healthy Vermonters, workers' compensation, and any other State or publicly funded purchaser of prescription drugs.
   2. The Commissioner of Vermont Health Access and the Secretary of Administration shall take all steps necessary to enable Vermont's participation in joint prescription drug purchasing agreements with any other health benefit plan or organization within or outside this State that agrees to participate with Vermont in such joint purchasing agreements.
   3. The Commissioner of Human Resources shall take all steps necessary to enable the State of Vermont to participate in joint prescription drug purchasing agreements with any other health benefit plan or organization within or outside this State that agrees to participate in such joint purchasing agreements, as may be agreed to through the bargaining process between the State of Vermont and the authorized representatives of the employees of the State of Vermont.
   4. The actions of the Commissioners and the Secretary shall include:
      1. active collaboration with the National Legislative Association on Prescription Drug Prices;
      2. active collaboration with the Pharmacy RFP Issuing States initiative organized by the West Virginia Public Employees Insurance Agency;
      3. the execution of any joint purchasing agreements or other contracts with any participating health benefit plan or organization within or outside the State which the Commissioner of Vermont Health Access determines will lower the cost of prescription drugs for Vermonters while maintaining high quality in prescription drug therapies; and
      4. with regard to participation by the State Employees Health Benefit Plan, the execution of any joint purchasing agreements or other contracts with any health benefit plan or organization within or outside the State which the Commissioner of Vermont Health Access determines will lower the cost of prescription drugs and provide overall quality of integrated health care services to the State Employees Health Benefit Plan and the beneficiaries of the Plan, and which is negotiated through the bargaining process between the State of Vermont and the authorized representatives of the employees of the State of Vermont.
   5. The Commissioners of Human Resources and of Vermont Health Access may renegotiate and amend existing contracts to which the Departments of Vermont Health Access and of Human Resources are parties if such renegotiation and amendment will be of economic benefit to the health benefit plans subject to such contracts, and to the beneficiaries of such plans. Any renegotiated or substituted contract shall be designed to improve the overall quality of integrated health care services provided to beneficiaries of such plans.
   6. [Repealed.]
   7. The Commissioner of Vermont Health Access, the Commissioner of Human Resources, the Commissioner of Financial Regulation, and the Secretary of Human Services shall establish a collaborative process with the Vermont Medical Society, pharmacists, health insurers, consumers, employer organizations and other health benefit plan sponsors, the National Legislative Association on Prescription Drug Prices, pharmaceutical manufacturer organizations, and other interested parties designed to consider and make recommendations to reduce the cost of prescription drugs for all Vermonters.
4. A participating health benefit plan other than a State public assistance program may agree with the Commissioner to limit the plan's participation to one or more program components. The Commissioner shall supervise the implementation and operation of the Pharmacy Best Practices and Cost Control Program, including developing and maintaining the preferred drug list, to carry out the provisions of the subchapter. The Commissioner may include such insured or self-insured health benefit plans as agree to use the preferred drug list or otherwise participate in the provisions of this subchapter. The purpose of this subchapter is to reduce the cost of providing prescription drugs while maintaining high quality in prescription drug therapies.
5. The Commissioner of Vermont Health Access shall develop procedures for the coordination of State public assistance program health benefit plan benefits with pharmaceutical manufacturer patient assistance programs offering free or low cost prescription drugs, including the development of a proposed single application form for such programs. The Commissioner may contract with a nongovernmental organization to develop the single application form.
6. 1. The Drug Utilization Review Board shall make recommendations to the Commissioner for the adoption of the preferred drug list. The Board's recommendations shall be based upon evidence-based considerations of clinical efficacy, adverse side effects, safety, appropriate clinical trials, and cost-effectiveness. "Evidence-based" shall have the same meaning as in 18 V.S.A. § 4621 . The Commissioner shall provide the Board with evidence-based information about clinical efficacy, adverse side effects, safety, and appropriate clinical trials and shall provide information about cost-effectiveness of available drugs in the same therapeutic class. (f) (1)  The Drug Utilization Review Board shall make recommendations to the Commissioner for the adoption of the preferred drug list. The Board's recommendations shall be based upon evidence-based considerations of clinical efficacy, adverse side effects, safety, appropriate clinical trials, and cost-effectiveness. "Evidence-based" shall have the same meaning as in 18 V.S.A. § 4621 . The Commissioner shall provide the Board with evidence-based information about clinical efficacy, adverse side effects, safety, and appropriate clinical trials and shall provide information about cost-effectiveness of available drugs in the same therapeutic class.
   2. The Board shall meet at least quarterly. The Board shall comply with the requirements of 1 V.S.A. chapter 5, subchapter 2 (Open Meeting Law) and 1 V.S.A. chapter 5, subchapter 3 (Public Records Act), except that the Board may go into executive session to discuss drug alternatives and receive information on the relative price, net of any rebates, of a drug under discussion and the drug price in comparison to the prices, net of any rebates, of alternative drugs available in the same class to determine cost-effectiveness, and in order to comply with subsection 2002(c) of this title to consider information relating to a pharmaceutical rebate or to supplemental rebate agreements, which are protected from disclosure by federal law or the terms and conditions required by the Centers for Medicare and Medicaid Services as a condition of rebate authorization under the Medicaid program.
   3. To the extent feasible, the Board shall review all drug classes included in the preferred drug list at least every 24 months and may recommend that the Commissioner make additions to or deletions from the preferred drug list.
   4. The Program shall establish Board procedures for the timely review of prescription drugs newly approved by the federal Food and Drug Administration, including procedures for the review of newly approved prescription drugs in emergency circumstances.
   5. Members of the Board shall receive per diem compensation and reimbursement of expenses in accordance with 32 V.S.A. § 1010 .
   6. The Commissioner shall encourage participation in the joint purchasing consortium by inviting representatives of the programs and entities specified in subdivision (c)(1) of this section to participate as observers or nonvoting members in the Drug Utilization Review Board and by inviting the representatives to use the preferred drug list in connection with the plans' prescription drug coverage.
7. The Department shall seek assistance from entities conducting independent research into the effectiveness of prescription drugs to provide technical and clinical support in the development and the administration of the preferred drug list and the evidence-based education program established in 18 V.S.A. chapter 91, subchapter 2.

   Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2003, No. 122 (Adj. Sess.), § 128f; 2003, No. 156 (Adj. Sess.), § 15; 2005, No. 71 , § 308; 2005, No. 174 (Adj. Sess.), § 101; 2007, No. 80 , §§ 1a, 2; 2009, No. 59 , § 9; 2009, No. 1 (Sp. Sess.), § E.309.2; 2009, No. 1 56 (Adj. Sess.), § I.62; 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2011, No. 171 (Adj. Sess.), § 41c; 2013, No. 79 , § 26, eff. Jan. 1, 2014; 2013, No. 131 (Adj. Sess.), § 45, eff. May 20, 2014; 2013, No. 142 (Adj. Sess.), § 98a; 2017, No. 85 , § E.306.1.

§ 1998a. Pharmacy mail order.

The Pharmacy Best Practices and Cost Control Program shall require consumers to purchase prescription drugs using mail order for selected pharmacy products.

Added 2005, No. 71 , § 307.

§ 1999. Consumer protection rules; prior authorization.

1. 1. The Pharmacy Best Practices and Cost Control Program shall authorize pharmacy benefit coverage when a patient's health care provider prescribes a prescription drug not on the preferred drug list, or a prescription drug that is not the list's preferred choice, if any of the circumstances set forth in subdivision (2) or (3) of this subsection applies. (a) (1)  The Pharmacy Best Practices and Cost Control Program shall authorize pharmacy benefit coverage when a patient's health care provider prescribes a prescription drug not on the preferred drug list, or a prescription drug that is not the list's preferred choice, if any of the circumstances set forth in subdivision (2) or (3) of this subsection applies.
   2. 1. The Program shall authorize coverage under the same terms as coverage for preferred choice drugs if the prescriber determines, after consultation with the pharmacist, or with the participating health benefit plan if required by the terms of the plan, that one or more of the following circumstances apply: (2) (A) The Program shall authorize coverage under the same terms as coverage for preferred choice drugs if the prescriber determines, after consultation with the pharmacist, or with the participating health benefit plan if required by the terms of the plan, that one or more of the following circumstances apply:
         1. The preferred choice or choices have not been effective, or with reasonable certainty are not expected to be effective, in treating the patient's condition.
         2. The preferred choice or choices cause or are reasonably expected to cause adverse or harmful reactions in the patient.
         3. 1. The patient is new to the Program and has been stabilized on a prescription drug that is not on the preferred drug list or is not one of the list's preferred choices, or a current patient has been stabilized on a prescription drug that has been removed from preferred drug list or is no longer one of the list's preferred choices, and it is clinically indicated that the patient should remain stabilized on the drug in order to avoid an adverse clinical impact or outcome.

            (II) The Drug Utilization Review Board and the Department of Vermont Health Access shall clinically evaluate newly introduced medications and therapeutic classes to determine their clinical appropriateness for continuation of coverage as set forth in subdivision (I) of this subdivision (iii).

      2. The prescriber's determination concerning whether the standards established in this subdivision (2) have been demonstrated shall be final if any documentation required at the direction of the Drug Utilization Review Board has been provided.
   3. The Program shall authorize coverage if the patient agrees to pay any additional cost in excess of the benefits provided by the patient's health benefit plan which is participating in the Program. The provisions of this subdivision (3) shall not apply to the extent that they may be inconsistent with any federal Medicaid laws and regulations. The provisions of this subdivision (3) shall not affect implementation by a participating health benefit plan of tiered copayments or other similar cost sharing systems.
2. The Program or any participating health benefit plan shall provide information on how prescribers, pharmacists, beneficiaries, and other interested parties can obtain a copy of the preferred drug list, whether any change has been made to the preferred drug list since it was last issued, and the process by which exceptions to the preferred list may be made.
3. , (d)  [Repealed.]

   (e) (1) The prior authorization process shall be designed to minimize administrative burdens on prescribers, pharmacists, and consumers. The provisions of this section shall apply to the Program's prior authorization process.

   (2) The prior authorization process shall ensure real-time receipt of requests, by telephone, voicemail, facsimile, electronic transmission, or mail on a 24-hour basis, seven days a week.

   (3) The prior authorization process shall provide an in-person response to emergency requests by a prescriber with telephone answering queues that do not exceed 10 minutes.

   (4) Any request for authorization or approval of a drug that the prescriber indicates, including the clinical reasons for the request, is for an emergency or urgent condition shall be responded to in no more than four hours from the time the Program or participating health benefit plan receives the request.

   (5) In emergency circumstances, or if the response to a request for prior authorization is not provided within the time period established in subdivision (4) of this subsection, a 72-hour supply of the drug prescribed shall be deemed to be authorized by the Program or the participating health benefit plan, provided it is a prescription drug approved by the Food and Drug Administration, and provided, for drugs dispensed to a Medicaid beneficiary, it is subject to a rebate agreement with the Centers for Medicare and Medicaid Services.

   (6) The Program or participating plan shall provide to participating providers a prior authorization request form for each enrolled beneficiary, known to be a patient of the provider, designed to permit the prescriber to make prior authorization requests in advance of the need to fill the prescription, and designed to be completed without unnecessary delay. The form shall be capable of being stamped with information relating to the participating provider, and if feasible at least one form capable of being copied shall contain known patient information.

   (f) The Program's prior authorization process shall require that the prescriber, not the pharmacy, request a prior authorization exemption to the requirements of this section. No later than December 31, 2004, the Commissioner shall create a pilot program designed to exempt a prescriber from the prior authorization requirement of the preferred drug list program if the Program determines that the prescriber has met compliance standards established by the Department in consultation with the Drug Utilization Review Board. This exemption does not apply to drugs that require prior authorization for clinical reasons.

   Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2003, No. 122 (Adj. Sess.), § 128k; 2005, No. 71 , §§ 309, 310; 2011, No. 171 (Adj. Sess.), § 41c; 2013, No. 131 (Adj. Sess.), § 46, eff. May 20, 2014; 2019, No. 154 (Adj. Sess.), § E.307, eff. Oct. 2, 2020.

§ 2000. Pharmacy benefit management.

The Commissioner may implement all or a portion of the Pharmacy Best Practices and Cost Control Program through a contract with a third party with expertise in the management of pharmacy benefits.

Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2005, No. 174 (Adj. Sess.), § 102; 2009, No. 156 (Adj. Sess.), § I.63.

§ 2001. Legislative oversight.

1. In connection with the Pharmacy Best Practices and Cost Control Program, the Commissioner of Vermont Health Access shall report for review by the House Committees on Appropriations, on Health Care, and on Human Services and the Senate Committees on Appropriations and on Health and Welfare prior to any modifications:
   1. the compilation that constitutes the preferred drug list or list of drugs subject to prior authorization or any other utilization review procedures;
   2. any utilization review procedures, including any prior authorization procedures; and
   3. the procedures by which drugs will be identified as preferred on the preferred drug list, and the procedures by which drugs will be selected for prior authorization or any other utilization review procedure.
2. The Committees shall closely monitor implementation of the preferred drug list and utilization review procedures to ensure that the consumer protection standards enacted pursuant to section 1999 of this title are not diminished as a result of implementing the preferred drug list and the utilization review procedures, including any unnecessary delay in access to appropriate medications. The Committees shall ensure that all affected interests, including consumers, health care providers, pharmacists, and others with pharmaceutical expertise have an opportunity to comment on the preferred drug list and procedures reviewed under this subsection.
3. The Commissioner of Vermont Health Access shall report annually on or before October 30 to the House Committees on Appropriations, on Health Care, and on Human Services and the Senate Committees on Appropriations and on Health and Welfare concerning the Pharmacy Best Practices and Cost Control Program. Topics covered in the report shall include issues related to drug cost and utilization; the effect of national trends on the pharmacy program; comparisons to other states; and decisions made by the Department's Drug Utilization Review Board in relation to both drug utilization review efforts and the placement of drugs on the Department's preferred drug list.
4. [Repealed.]
5. 1. [Repealed.] (e) (1)  [Repealed.]
   2. The Commissioner shall not enter into a contract with a pharmacy benefit manager unless the pharmacy benefit manager has agreed to disclose to the Commissioner the terms and the financial impact on Vermont and on Vermont beneficiaries of:
      1. any agreement with a pharmaceutical manufacturer to favor the manufacturer's products over a competitor's products, or to place the manufacturer's drug on the pharmacy benefit manager's preferred list or formulary, or to switch the drug prescribed by the patient's health care provider with a drug agreed to by the pharmacy benefit manager and the manufacturer;
      2. any agreement with a pharmaceutical manufacturer to share manufacturer rebates and discounts with the pharmacy benefit manager, or to pay "soft money" or other economic benefits to the pharmacy benefit manager;
      3. any agreement or practice to bill Vermont health benefit plans for prescription drugs at a cost higher than the pharmacy benefit manager pays the pharmacy;
      4. any agreement to share revenue with a mail order or internet pharmacy company;
      5. any agreement to sell prescription drug data concerning Vermont beneficiaries, or data concerning the prescribing practices of the health care providers of Vermont beneficiaries; or
      6. any other agreement of the pharmacy benefit manager with a pharmaceutical manufacturer, or with wholesale and retail pharmacies, affecting the cost of pharmacy benefits provided to Vermont beneficiaries.
   3. The Commissioner shall not enter into a contract with a pharmacy benefit manager who has entered into an agreement or engaged in a practice described in subdivision (2) of this subsection, unless the Commissioner determines that the agreement or practice furthers the financial interests of Vermont and does not adversely affect the medical interests of Vermont beneficiaries.

      Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2005, No. 174 (Adj. Sess.), § 103; 2009, No. 33 , § 83; 2009, No. 156 (Adj. Sess.), § I.64; 2011, No. 171 (Adj. Sess.), § 41c; 2015, No. 23 , § 57; 2015, No. 58 , § E.307.1; 2015, No. 97 (Adj. Sess.), § 68; 2015, No. 172 (Adj. Sess.), § E.306.10.

§ 2002. Supplemental rebates.

1. The Commissioner of Vermont Health Access, separately or in concert with the authorized representatives of any participating health benefit plan, shall use the preferred drug list authorized by the Pharmacy Best Practices and Cost Control Program to negotiate with pharmaceutical companies for the payment to the Commissioner of supplemental rebates or price discounts for Medicaid and for any other State public assistance health benefit plans designated by the Commissioner, in addition to those required by Title XIX of the Social Security Act. The Commissioner may also use the preferred drug list to negotiate for the payment of rebates or price discounts in connection with drugs covered under any other participating health benefit plan within or outside this State, provided that such negotiations and any subsequent agreement shall comply with the provisions of 42 U.S.C. § 1396r -8. The Program, or such portions of the Program as the Commissioner shall designate, shall constitute a State pharmaceutical assistance program under 42 U.S.C. § 1396r -8(c)(1)(C).
2. The Commissioner shall negotiate supplemental rebates, price discounts, and other mechanisms to reduce net prescription drug costs by means of any negotiation strategy that the Commissioner determines will result in the maximum economic benefit to the Program and to consumers in this State, while maintaining access to high-quality prescription drug therapies. The Commissioner may negotiate through a purchasing pool or directly with manufacturers. The provisions of this subsection do not authorize agreements with pharmaceutical manufacturers in which financial support for medical services covered by the Medicaid program is accepted as consideration for placement of one or more prescription drugs on the preferred drug list.
3. The Department of Vermont Health Access shall prohibit the public disclosure of information revealing company-identifiable trade secrets (including rebate and supplemental rebate amounts, and manufacturer's pricing) obtained by the Department, and by any officer, employee, or contractor of the Department in the course of negotiations conducted pursuant to this section. Such confidential information shall be exempt from public disclosure under 1 V.S.A. chapter 5, subchapter 3 (Public Records Act).

   Added 2001, No. 127 (Adj. Sess.), § 1, eff. June 13, 2002; amended 2005, No. 71 , § 311; 2005, No. 174 (Adj. Sess.), § 104; 2009, No. 156 (Adj. Sess.), § I.65; 2021, No. 20 , § 307.

§ 2003. Pharmacy discount plans.

1. The Commissioner of Vermont Health Access shall implement pharmacy discount plans, to be known as the Healthy Vermonters Program, for Vermonters without adequate coverage for prescription drugs. The provisions of subchapter 8 of this chapter shall apply to the Commissioner's authority to administer the pharmacy discount plans established by this section.
2. The Healthy Vermonters Program shall offer beneficiaries an initial discounted cost for covered drugs. Upon approval by the Centers for Medicare and Medicaid Services of a Section 1115 Medicaid Waiver Program, and upon subsequent legislative approval, the Healthy Vermonters Program shall offer beneficiaries a secondary discounted cost, which shall reflect a State payment toward the cost of each dispensed drug as well as any rebate amount negotiated by the Commissioner.
3. As used in this section:
   1. "Beneficiary" means any individual enrolled in the Healthy Vermonters Program.
   2. "Healthy Vermonters beneficiary" means any individual Vermont resident without adequate coverage:
      1. who is at least 65 years of age, or is disabled and is eligible for Medicare or Social Security disability benefits, with household income equal to or less than 400 percent of the federal poverty level, as calculated using modified adjusted gross income as defined in 26 U.S.C. § 36B(d)(2)(B); or
      2. whose household income is equal to or less than 350 percent of the federal poverty level, as calculated using modified adjusted gross income as defined in 26 U.S.C. § 36B(d)(2)(B).
   3. [Repealed.]
   4. "Initial discounted cost" means the price of the drug based on the Medicaid fee schedule.
   5. "Labeler" means an entity or person that receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale and that has a labeler code from the federal Food and Drug Administration under 21 C.F.R. § 207.20.
   6. "Participating retail pharmacy" means a retail pharmacy located in this State or another business licensed to dispense prescription drugs in this State that participates in the Program according to rules established by the Department and provides discounted prices to eligible beneficiaries of the Program.
   7. "Rebate amount" means the rebate negotiated by the Director and required from a drug manufacturer or labeler under this section. In determining the appropriate rebate, the Director shall:
      1. take into consideration the rebate calculated under the Medicaid Rebate Program under 42 U.S.C. § 1396r -8, the average wholesale price of prescription drugs, and any other information on prescription drug prices and price discounts;
      2. use his or her best efforts to obtain an initial rebate amount equal to or greater than the rebate calculated under the Medicaid program under 42 U.S.C. § 1396r -8; and
      3. use his or her best efforts to obtain an amount equal to or greater than the amount of any discount, rebate, or price reduction for prescription drugs provided to the federal government.
   8. "Secondary discounted cost" means, under the Healthy Vermonters Program, the price of the drug based on the Medicaid fee schedule, less payment by the State of at least two percent of the Medicaid rate, less any rebate amount negotiated by the Director and paid for out of the Healthy Vermonters Dedicated Fund established under subsection (h) of this section and, under the Healthy Vermonters Plus Program, the average wholesale price of the drug, less payment by the State of at least two percent of the Medicaid rate, less any rebate amount negotiated by the Director and paid for out of the Healthy Vermonters Dedicated Fund established under subsection (h) of this section.
   9. "Without adequate coverage" includes beneficiaries with no coverage for prescription drugs or certain types of prescription drugs and beneficiaries whose annual maximum coverage limit under their health benefit plan has been reached.
4. Drugs covered by the pharmacy discount plans shall include all drugs covered under the Medicaid program.
5. The Vermont Board of Pharmacy shall adopt standards of practice requiring disclosure by participating retail pharmacies to beneficiaries of the amount of savings provided as a result of the pharmacy discount plans. The standards must consider and protect information that is proprietary in nature. The Department of Vermont Health Access may not impose transaction charges under this Program on pharmacies that submit claims or receive payments under the plans. Pharmacies shall submit claims to the Department to verify the amount charged to beneficiaries under the plans. On a weekly or biweekly basis, the Department must reimburse pharmacies for the difference between the initial discounted price or the average wholesale price and the secondary discounted price provided to beneficiaries.
6. The names of drug manufacturers and labelers who do and do not enter into rebate agreements under pharmacy discount plans are public information. The Department of Vermont Health Access shall release this information to health care providers and the public on a regular basis and shall publicize participation by manufacturers and labelers. The Department shall impose prior authorization requirements in the Medicaid program, as permitted by law, to the extent the Department determines it is appropriate to do so in order to encourage manufacturer and labeler participation in the pharmacy discount plans and so long as the additional prior authorization requirements remain consistent with the goals of the Medicaid program and the requirements of Title XIX of the Social Security Act.
7. The Commissioner of Vermont Health Access shall establish, by rule, a process to resolve discrepancies in rebate amounts claimed by manufacturers, labelers, pharmacies, and the Department.
8. The Healthy Vermonters Dedicated Fund is established to receive revenue from manufacturers and labelers who pay rebates as provided in this section and any appropriations or allocations designated for the Fund. The purposes of the Fund are to reimburse retail pharmacies for discounted prices provided to individuals enrolled in the pharmacy discount plans; and to reimburse the Department of Vermont Health Access for contracted services, including pharmacy claims processing fees, administrative and associated computer costs, and other reasonable program costs. The Fund is a nonlapsing dedicated fund. Interest on Fund balances accrues to the fund. Surplus funds in the Fund must be used for the benefit of the Program.
9. [Repealed.]
10. The Department of Vermont Health Access shall undertake outreach efforts to build public awareness of the pharmacy discount plans and maximize enrollment. Outreach efforts shall include steps to educate retail pharmacists on the purposes of the Healthy Vermonters Dedicated Fund, in particular as it relates to pharmacy reimbursements for discounted prices provided to Program enrollees. The Department may adjust the requirements and terms of the pharmacy discount plans to accommodate any new federally funded prescription drug programs.
11. The Department of Vermont Health Access may contract with a third party or third parties to administer any or all components of the pharmacy discount plans, including outreach, eligibility, claims, administration, and rebate recovery and redistribution.
12. The Department of Vermont Health Access shall administer the pharmacy discount plans and other medical and pharmaceutical assistance programs under this title in a manner advantageous to the programs and enrollees. In implementing this section, the Department may coordinate the other programs and the pharmacy discount plans and may take actions to enhance efficiency