Vermont Regulations
Department of Financial Regulation
Office of the Secretary of State 2020-04-15
PUBLICATION DATE: 04/15/2020
ACTION DATE: 03/20/2020
EFFECTIVE DATE: 03/20/2020
EXPIRATION DATE: 09/16/2020
PUBLICATION TYPE: Agency
REGISTER SOURCE: Secretary of State Notices of Rulemaking 2020-03-22
PUBLICATION DATE: 03/22/2020
ACTION DATE: 03/20/2020
EFFECTIVE DATE: 03/20/2020
EXPIRATION DATE: 07/18/2020
PUBLICATION TYPE: Centralized Repository
REGISTER SOURCE: Secretary of State Notices of Rulemaking 2020-03-22
PUBLICATION DATE: 03/22/2020
ACTION DATE: 03/20/2020
EFFECTIVE DATE: 03/20/2020
EXPIRATION DATE: 09/16/2020
PUBLICATION TYPE: Centralized Repository

EMERGENCY RULE# 20-E01

Emergency Rule Coversheet

1. TITLE OF RULE FILING:

SUSPENSION OF CREDENTIALING VERIFICATION PRACTICES

2. ADOPTING AGENCY:

Department of Financial Regulation

3. PRIMARY CONTACT PERSON:

(A PERSON WHO IS ABLE TO ANSWER QUESTIONS ABOUT THE CONTENT OF THE RULE).

Name: Ethan McLaughlin

Agency: Department of Financial Regulation

Mailing Address: 89 Main Street, Montpelier, VT 05620 - 3101

Telephone: 802 828 - 4859 Fax: -

E-Mail: ethan.mclaughlin@Vermont.gov

Web URL (WHERE THE RULE WILL BE POSTED):

https://dfr.Vermont.gov/about-us/legal-general-counsel/proposed-rules-and-public-comment

4. SECONDARY CONTACT PERSON:

(A SPECIFIC PERSON FROM WHOM COPIES OF FILINGS MAY BE REQUESTED OR WHO MAY ANSWER QUESTIONS ABOUT FORMS SUBMITTED FOR FILING IF DIFFERENT FROM THE PRIMARY CONTACT PERSON).

Name: Gavin Boyles

Agency: Department of Financial Regulation

Mailing Address: 89 Main Street, Montpelier, VT 05620 - 3101

Telephone: 802 828 - 1425 Fax: 802 828 - 1919

E-Mail: gavin.boyles@vermont.gov

5. RECORDS EXEMPTION INCLUDED WITHIN RULE:

(DOES THE RULE CONTAIN ANY PROVISION DESIGNATING INFORMATION AS CONFIDENTIAL; LIMITING ITS PUBLIC RELEASE; OR OTHERWISE EXEMPTING IT FROM INSPECTION AND COPYING?) NO

IF YES, CITE THE STATUTORY AUTHORITY FOR THE EXEMPTION:

N/A

PLEASE SUMMARIZE THE REASON FOR THE EXEMPTION:

N/A

6. LEGAL AUTHORITY / ENABLING LEGISLATION:

(THE SPECIFIC STATUTORY OR LEGAL CITATION FROM SESSION LAW INDICATING WHO THE ADOPTING ENTITY is AND THUS WHO THE SIGNATORY SHOULD BE. THIS SHOULD BE A SPECIFIC CITATION NOT A CHAPTER CITATION).

This rule is issued pursuant to the authority vested in the Commissioner of the Department of Financial Regulation by 18 V.S.A. § 9414 and 8 V.S.A. §§ 15.

7. EXPLANTION OF HOW THE RULE IS WITHIN THE AUTHORITY OF THE AGENCY:

8 V.S.A. § 9414 (A) STATES THAT “THE COMMISSIONER [OF FINANCIAL REGULATION] SHALL HAVE THE POWER AND RESPONSIBILITY TO ENSURE THAT EACH MANAGED CARE ORGANIZATION PROVIDES QUALITY HEALTH CARE TO ITS MEMBERS, IN ACCORDANCE WITH THE PROVISIONS OF THIS SECTION.“ 8 V.S.A. § 9414 (B) STATES THAT “[T]HE COMMISSIONER SHALL ESTABLISH, BY RULE, SPECIFIC CRITERIA TO BE CONSIDERED UNDER THIS SECTION.“ THIS EMERGENCY RULE SUSPENDS CERTAIN SPECIFIC CRITERIA PREVIOUSLY ESTABLISHED BY THE COMMISSIONER, BY RULE, REGARDING THE CREDENTIALING PRACTICES OF MANAGED CARE ORGANIZATIONS.

8. CONCISE SUMMARY (150 WORDS OR LESS):

During the COVID-19 State of Emergency, this emergency rule temporarily suspends Section 5.2 of Rule H-2009-03 and requires health insurers to relax credentialing requirements for health care providers. Section 5.2 specifies certain provider credentialing verification requirements and procedures that managed care organizations must follow and implement. Temporarily suspending these credentialing verification requirements and requiring health insurers to relaxing their credentialing requirements during the State of Emergency is intended to facilitate reimbursement through the Medicaid program or commercial insurance during the State of Emergency for health care services provided in the State of Vermont by physicians or other health care professionals who hold an equivalent license in another State.

9. EXPLANATION OF WHY THE RULE IS NECESSARY:

Addressing and treating the health needs of Vermonters during the COVID-19 outbreak may require health care services provided in the State of Vermont by physicians or other health care professionals who hold an equivalent license in another State. The current requirements of Section 5.2 of Rule H-2009-03 and the existing credentialing requirements of health insurers could impede and delay the provision of such health care services by such providers.

10. EXPLANATION OF HOW THE RULE IS NOT ARBITRARY:

A coalition of health care provider representatives, including the Vermont Association of Hospitals and Health Systems, VNAs of Vermont, Bayada Home Health ∏ Hospice, Vermont Health Care Association (long term care facilities), Vermont Care Partners, Bi-State Primary Care Association, the Vermont Medical Society, the Vermont Association of Adult Days, and Dartmouth Hitchcock Health, has communicated to the Governor that relaxing credentialing requirements will help their efforts to fight the COVID-19 pandemic.

11. LIST OF PEOPLE, ENTERPRISES AND GOVERNMENT ENTITIES AFFECTED BY THIS RULE:

Managed Care Organizations regulated by the state of Vermont

The Vermont Association of Hospitals and Health Systems, VNAs of Vermont, Bayada Home Health ∏ Hospice, Vermont Health Care Association (long term care facilities), Vermont Care Partners, Bi-State Primary Care Association, the Vermont Medical Society, the Vermont Association of Adult Days, and Dartmouth Hitchcock Health

Physicians or other health care professionals who hold an equivalent license in another State

Patients and members insured by Managed Care Organizations regulated by the state of Vermont

12. BRIEF SUMMARY OF ECONOMIC IMPACT (150 WORDS OR LESS):

Responding to the COVID-19 pandemic may require the provision of health care services by physicians or other health care professionals who hold an equivalent license in another State and may require health care professionals to work at physical locations where such providers are not credentialed to provide services. Facilitating the reimbursement for such services by health insurers is expected to significantly decrease the out of pocket costs incurred by Vermont patients. Health Insurers are likely Emergency Rule Coversheet to pay out more money to reimburse providers for the provision of such services.

13. A HEARING IS NOT SCHEDULED.

14. HEARING INFORMATION

(THE FIRST HEARING SHALL BE NO SOONER THAN 30 DAYS FOLLOWING THE POSTING OF NOTICES ONLINE).

IF THIS FORM IS INSUFFICIENT TO LIST THE INFORMATION FOR EACH HEARING PLEASE ATTACH A SEPARATE SHEET TO COMPLETE THE HEARING INFORMATION NEEDED FOR THE NOTICE OF RULEMAKING.

15. DEADLINE FOR COMMENT (NO EARLIER THAN 7 DAYS FOLLOWING LAST HEARING):

16. EMERGENCY RULE EFFECTIVE: 03/20/2020

17. EMERGENCY RULE WILL REMAIN IN EFFECT UNTIL

(A DATE NO LATER THAN 180 DAYS FOLLOWING ADOPTION OF THIS EMERGENCY RULE):

09/16/2020

18. NOTICE OF THIS EMERGENCY RULE SHOULD NOT BE PUBLISHED IN THE WEEKLY NOTICES OF RULEMAKING IN THE NEWSPAPERS OF RECORD.

19. KEYWORDS (PLEASE PROVIDE AT LEAST 3 KEYWORDS OR PHRASES TO AID IN THE SEARCHABILITY OF THE RULE NOTICE ONLINE).

Managed Care Organization

Credentialing

COVID-19

CORONAVIRUS

VERMONT DEPARTMENT OF FINANCIAL REGULATION

EMERGENCY RULE H-2020-01-E

SUSPENSION OF CREDENTIALING VERIFICATION PRACTICES

Section 1. Purpose

This emergency rule is promulgated pursuant to 18 V.S.A. § 9414 and 8 V.S.A. § 15 and in response to the State of Emergency declared by the Governor of the State of Vermont on March 16, 2020 regarding the outbreak of COVID-19. The purpose of this emergency rule is to relax provider credentialing requirements in order to facilitate the reimbursement through commercial insurance during the State of Emergency for health care services provided by physicians or other health care professionals who hold an equivalent license in another State.

Section 2. Definitions.

Terms used in this emergency rule and not defined herein shall have the meanings given to such terms, if any, in Rule H-2009-03, Consumer Protection and Quality Requirements for Managed Care Organizations.

Section 3. Temporary Suspension of Provider Credentialing Verification Requirements.

The requirements of Section 5.2 of Rule H-2009-03, Consumer Protection and Quality Requirements for Managed Care Organizations, are hereby suspended effective as of March 20, 2020 until September 16, 2020 with respect to physicians or other health care professionals who hold a license in another State and provide health care services to or on behalf of patients in Vermont, either in person or remotely, by means of telemedicine or otherwise, and with respect to other health care professionals who have been issued provisional or temporary Vermont licensure during the COVID-19 State of Emergency.

Section 4. Relaxation of Provider Credentialing Requirements.

(a) During the COVID-19 State of Emergency, except as otherwise required by applicable federal law or applicable accreditation standards of the National Committee for Quality Assurance, a health insurer shall allow for individual health care providers to deliver and be reimbursed for services provided across health care settings as needed to respond to Vermonters' evolving health care needs, including, but not limited to relaxing provider credentialing requirements for physicians or other health care professionals who hold a license in another State and provide health care services to or on behalf of patients in Vermont, either in person or remotely, by means of telemedicine or otherwise, and with respect to other health care professionals who have been issued provisional or temporary Vermont licensure during the COVID-19 State of Emergency.

(b) During the COVID-19 State of Emergency, except as otherwise required by applicable federal law or applicable accreditation standards of the National Committee for Quality Assurance, a health insurer shall not refuse, because of lack of credentials, to pay claims submitted by providers credentialed within a health care organization but not at that health care organization's location where the service was provided or at a location not in that health care organization.