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Quality Measurement and Reporting in Vermont

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Vermont law attempts to improve the quality of health care in several ways. The state authorizes the Department of Vermont Health Access to draft the Blueprint for Health, which must articulate clinical quality and performance measures and provide guidelines to establish patient-centered medical homes, community health teams, and accountable care organizations.1

Health care facilities and health insurers must comply with Vermont’s quality standards.2 The Department of Mental Health and Department of Financial Regulation must establish separate database systems that enable them to collect and analyze health quality data.3

The commissioner of financial regulation must review every health insurer’s quality improvement procedures.4 The commissioner of financial regulation must contract with the Vermont Program for Quality in Health Care to implement a statewide quality assurance system to evaluate the quality of health care services.5

The Department of Vermont Health Access must establish a Medicaid and exchange advisory committee to provide recommendations on improving health care provided to individuals receiving services through Medicaid, Medicaid-funded programs, and the Vermont health benefit exchange.6

Health care providers and insurers must have mechanisms to address patients’ grievances.7 Patients have the right to external reviews of coverage denials by health insurers.8

 

Footnotes

  • 1. 18 Vermont Statutes §§702, 704, 705, 709
  • 2. 8 Vermont Statutes §4089b; 18 Vermont Statutes §§9461; 9462; 33 Vermont Statutes §§6303, 6305
  • 3. 18 Vermont Statutes §§7256, 9403, 9410
  • 4. 18 Vermont Statutes §9414
  • 5. 18 Vermont Statutes §§9416; 26 Vermont Statutes §§1445, 1448
  • 6. 33 Vermont Statutes §402
  • 7. 33 Vermont Statutes §§6308; 7302
  • 8. 8 Vermont Statutes §4089a

 

Quality Measurement and Reporting in Vermont

Subtopic Statute/Regulation Description
Quality Measurement and Reporting 12-4 Vt. Code R. 202:6 - Nursing home resident’s rights under the Agency of Human Services regulations “Resident’s rights under the Agency of Human Services regulations” Nursing homes must establish and adhere to a written policy...
12-4 Vt. Code R. 203:4 - Licensing procedures for homes for the terminally ill under the Agency of Human Service regulations “Licensing procedures under the Agency of Human Service regulations” The Department of Disabilities, Aging and Independent Living’s...
12-4 Vt. Code R. 203:6 - Terminally ill residents’ rights under the Agency of Human Services regulations “Residents’ rights under the Agency of Human Services regulations” Each home for the terminally ill must establish a written policy...
12-4 Vt. Code R. 204:7 - Policies and procedures regarding assisted living facilities under the Agency of Human Services regulations “Policies and procedures under the Agency of Human Services regulations” An assisted living facility must develop a quality improvement...
12-4 Vt. Code R. 205:17 - Home health agency patient rights under the Agency of Human Services regulations “Patient rights under the Agency of Human Services regulations” A patient of a home health agency has the following rights: The right...
12-4 Vt. Code R. 205:18 - Quality assurance and improvement regarding home health agencies under the Agency of Human Services regulations “Quality assurance and improvement under the Agency of Human Services regulations” A home health agency must establish a quality...
12-4 Vt. Code R. 205:20 - Enforcement against a home health agency under the Agency of Human Services regulations “Enforcement under the Agency of Human Services regulations” A home health agency may be sanctioned by the Department of Disabilities,...
12-7 Vt. Code R. 171:01 - Medicaid benefit delivery under the Agency of Human Service regulations “Medicaid benefit delivery under the Agency of Human Service regulations” The Department for Children and Families must establish...
18 Vermont Statutes §702 - Blueprint for Health; strategic plan under the health law “Blueprint for Health; strategic plan under the health law” The commissioner of Vermont Health Access must establish a committee to...
33 Vermont Statutes §6305 “Review of access, cost, and quality issues; remediation process under the human services law” The commissioner must collect and analyze...
4-5 Vt. Code R. 3:10.100 - General provisions under the Department of Financial Regulation regulations “General provisions under the Department of Financial Regulation regulations” (1.1) Managed care organizations must comply with consumer...
4-5 Vt. Code R. 3:10.600 - Additional quality and care management requirements for certain managed care organizations under the Department of Financial Regulation regulations “Additional quality and care management requirements for certain managed care organizations under the Department of Financial Regulation...
8 Vermont Statutes §4089a “Mental health care services review under the banking and insurance law” Review agents may perform service review activities of any...
Vermont Administrative Code § 12-4-200:16 “Quality assessment and assurance under the Agency of Human Service regulations” A nursing facility must maintain a quality assessment...
Vermont Administrative Code § 12-4-200:18 “Enforcement under the Agency of Human Service regulations” The Department of Disabilities, Aging and Independent Living’s division...
Vt. Stat. Ann. tit. 18, § 704 - Medical home under the health law “Medical home under the health law”  A health care professional providing a patient's medical home must: Provide...
Vt. Stat. Ann. tit. 18, § 705 - Community health teams under the health law “Community health teams under the health law”  Consistent with federal law, the community health team must consist of health care...
Vt. Stat. Ann. tit. 18, § 709 - Blueprint annual report under the health law “Annual report under the health law” The director of the blueprint must annually report on the status of implementation of the Vermont...
Vt. Stat. Ann. tit. 18, § 7253 - Clinical resource management and oversight under the health law “Clinical resource management and oversight under the health law” The commissioner of mental health, in consultation with health care...
Vt. Stat. Ann. tit. 18, § 7256 - Reporting requirements for the Department of Mental Health under the health law “Reporting requirements board under the health law” The Department of Mental Health must annually report to the state legislature on the...
Vt. Stat. Ann. tit. 18, § 9405b - Hospital community reports Hospital community reports The Commissioner of the Department of Financial Regulation with other health care stakeholders must establish a standard...
Vt. Stat. Ann. tit. 18, § 9410 - Health care database Health care database The Commissioner of the Department of Financial Regulation must establish and maintain a unified health care database in order...
Vt. Stat. Ann. tit. 18, § 9410 - Health care database “Health care database under the health law” The commissioner of Vermont health access must establish a unified health care database to...
Vt. Stat. Ann. tit. 18, § 9416 - Vermont program for quality in health care under the health law “Vermont program for quality in health care under the health law” The commissioner must contract with the Vermont Program for Quality in...
Vt. Stat. Ann. tit. 18, § 9461 - Quality indicators under the health law “Quality indicators under the health law” The Department of Health and Department of Mental Health must develop clinical and performance...
Vt. Stat. Ann. tit. 18, § 9462 - Health care workforce; strategic plan under the health law “Health care workforce; strategic plan under the health law” The Green Mountain Care Board must consider the results of any quality...
Vt. Stat. Ann. tit. 26, § 1445 - Statewide quality assurance findings under the professions and occupations law “Findings under the professions and occupations law” The Vermont Program for Quality in Health Care, Inc. is organized to implement and...
Vt. Stat. Ann. tit. 26, § 1448 - Release of clinical data authorized under the professions and occupations law “Release of clinical data authorized under the professions and occupations law” Hospitals may release clinical data to the Vermont...
Vt. Stat. Ann. tit. 33, § 402 - Medicaid and exchange advisory committee under the human services law “Medicaid and exchange advisory committee under the human services law”  (a) A Medicaid and exchange advisory committee is created...
Vt. Stat. Ann. tit. 33, § 6303 - Home health services; local plans; board composition under the human services law “Home health services; local plans; board composition under the human services law” The commissioner of the Department of Disabilities,...
Vt. Stat. Ann. tit. 33, § 6308 - Complaint process in a home health agency under the human services law “Complaint process under the human services law” The commissioner must establish standards and procedures ensuring that each home health...
Vt. Stat. Ann. tit. 33, §7302 - Adoption of grievance procedure in nursing homes under the human services law “Adoption of grievance procedure under the human services law” The state board of health must require every nursing home to submit a plan...
Vt. Stat. Ann. tit. 8, § 4089b - Health insurance coverage, mental health and substance abuse under the banking and insurance law “Health insurance coverage, mental health and substance abuse under the banking and insurance law” A health insurer must cover all...
Vt. Stat. Ann. tit. § 18, 9414 - Quality assurance for managed care organizations under the health law “Quality assurance for managed care organizations under the health law” The commissioner of financial regulation must review a managed...
Click on the individual state law in the table above to see our summary of the individual law.


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