Health Care Improvement Program

V.S.A. tit. 33, ch. 19, subch. 2

in effect

33 V.S.A. § 1950 Purpose

1950. Purpose (a) 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. (b) 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. (c) 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.

33 V.S.A. § 1951 Definitions

1951. Definitions As used in this subchapter: (1) “Assessment” means a tax levied on a health care provider pursuant to this chapter. (2)(A) “Home health services” means any of the following: (i) 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; (ii) services covered under the adult and pediatric High Technology Home Care programs as of January 1, 2015; (iii) 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 (iv) hospice services. (B) The term “home health services” shall not include any other service provided by a home health agency, including: (i) private duty services; (ii) 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); (iii) homemaker services; (iv) adult day services; (v) group-directed attendant care services; (vi) primary care services; (vii) nursing home room and board when a hospice patient is in a nursing home; and (viii) health clinics, including occupational health, travel, and flu clinics. (C) 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: (i) the Flexible Choices or Assistive Devices options under the Choices for Care program contained within Vermont’s Global Commitment to Health Section 1115 demonstration; (ii) services provided to children under the early and periodic screening, diagnostic, and treatment Medicaid benefit; (iii) services provided pursuant to the Money Follows the Person demonstration project; (iv) services provided pursuant to the Traumatic Brain Injury Program; and (v) 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 that 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.

33 V.S.A. § 1952 General provisions

1952. General provisions (a) The Secretary of Human Services shall adopt rules necessary for the implementation of this subchapter. (b) 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. (c) 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. (d) 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. (e) 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. (f) 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.

33 V.S.A. § 1953 Hospital assessment

1953. Hospital assessment (a) 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. (b) 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. (c) 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. (d) 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.

33 V.S.A. § 1954 Nursing home assessment

1954. Nursing home assessment (a) 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. (b) 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. (c) 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. (d) 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.

33 V.S.A. § 1955 ICF/DD assessment

1955. ICF/DD assessment (a) 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. (b) 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. (c) 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. (d) 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.

33 V.S.A. § 1955b Pharmacy assessment

1955b. Pharmacy assessment (a) Beginning July 1, 2005, each pharmacy’s monthly assessment shall be $0.10 for each prescription filled and refilled. (b) 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. (c) Each pharmacy shall submit its assessment payment to the Department monthly. Variations in payment timing shall be permitted as deemed necessary by the Commissioner. (d) 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.

33 V.S.A. § 1956 Proceeds from assessments

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.

33 V.S.A. § 1957 Audits

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 that 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.

33 V.S.A. § 1958 Appeals

1958. Appeals (a) 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. (b) 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. (c) 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.

33 V.S.A. § 1959 Ambulance agency assessment

1959. Ambulance agency assessment (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. (2) 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. (b) 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. (c) 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. (d) 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.

Source: Vermont General Assembly (legislature.vermont.gov)URL: https://legislature.vermont.gov/statutes/chapter/33/019Fetched: 10/21/2026