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Subchapter 001: BLUEPRINT FOR HEALTH
§ 701. Definitions
As used in this chapter:
(1) “Blueprint for Health” or “Blueprint” means the State’s program for integrating a
system of health care for patients, improving the health of the overall population,
and improving control over health care costs by promoting health maintenance, prevention,
and care coordination and management.
(2) “Board” means the Green Mountain Care Board established in chapter 220 of this title.
(3) “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 and pain and symptom management. Examples of chronic conditions include diabetes,
hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance
abuse, mental condition or psychiatric disability, spinal cord injury, hyperlipidemia,
dementia, and chronic pain.
(4) “Chronic care information system” means the electronic database developed under the
Blueprint for Health that shall include information on all cases of a particular disease
or health condition in a defined population of individuals.
(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, on an ongoing basis and with the
goals of improving overall health and meeting patients’ needs:
(A) prevention of complications utilizing evidence-based practice guidelines;
(B) patient empowerment strategies;
(C) evaluation of clinical, humanistic, and economic outcomes; and
(D) advance care planning, palliative care, pain management, and hospice services, as
appropriate.
(6) “Global payment” means a payment from a health insurer, Medicaid, Medicare, or other
payer for the health services of a defined population of patients for a defined period
of time. Such payments may be adjusted to account for the population’s underlying
risk factors, including severity of illness and socioeconomic factors that may influence
the cost of health care for the population.
(7) “Health care professional” means an individual, partnership, corporation, facility,
or institution licensed or certified or authorized by law to provide professional
health care services.
(8) “Health insurance plan” has the same meaning as major medical insurance plan in 8 V.S.A. § 4011.
(9) “Health insurer” shall have the same meaning as in section 9402 of this title.
(10) “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 or intellectual disability, 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.
(11) “Hospital” shall have the same meaning as in section 9451 of this title.
(12) “Integrated delivery system” means a group of health care professionals, associated
either through employment by a single entity or through a contractual arrangement,
that provides health services for a defined population of patients and is compensated
through a global payment.
(13) “Payment reform” means modifying the method of payment from a fee for-service basis
to one or more alternative methods for compensating health care professionals, health
care provider bargaining groups created pursuant to section 9409 of this title, integrated delivery systems and other health care professional arrangements, manufacturers
of prescribed products, medical supply companies, and other companies providing health
services or health supplies, for the provision of high-quality and efficient health
services, products, and supplies while measuring quality and efficiency. The term
may include shared savings agreements, bundled payments, episode-based payments, and
global payments.
(14) “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.
(15) “Wellness services” means health services, programs, or activities that focus on the
promotion or maintenance of good health. (Added 2005, No. 191 (Adj. Sess.), § 5; amended 2009, No. 25, § 8; 2009, No. 128 (Adj. Sess.), § 13; 2011, No. 48, § 3c; 2011, No. 60, § 5, eff. June 1, 2011; 2011, No. 171 (Adj. Sess.), § 37, eff. May 16, 2012; 2013, No. 96 (Adj. Sess.), § 90; 2025, No. 11, § 14, eff. September 1, 2025.)
§ 702. Blueprint for Health; strategic plan
(a)(1) The Department of Vermont Health Access shall be responsible for the Blueprint for
Health.
(2) The Director of the Blueprint, in collaboration with the Commissioners of Health,
of Mental Health, of Vermont Health Access, and of Disabilities, Aging, and Independent
Living, shall oversee the development and implementation of the Blueprint for Health,
including a strategic plan describing the initiatives and implementation timelines
and strategies. Whenever private health insurers are concerned, the Director shall
collaborate with the Commissioner of Financial Regulation and the Chair of the Green
Mountain Care Board.
(b)(1)(A) The Commissioner of Vermont Health Access shall establish an executive committee to
advise the Director of the Blueprint on creating and implementing a strategic plan
for the development of the statewide system of chronic care and prevention as described
under this section. The Executive Committee shall include:
(i) the Commissioner of Health;
(ii) the Commissioner of Mental Health;
(iii) a representative from the Green Mountain Care Board;
(iv) a representative from the Department of Vermont Health Access;
(v) an individual appointed jointly by the President Pro Tempore of the Senate and the
Speaker of the House of Representatives;
(vi) a representative from the Vermont Medical Society;
(vii) a representative from the Vermont Nurse Practitioners Association;
(viii) a representative from a statewide quality assurance organization;
(ix) a representative from the Vermont Association of Hospitals and Health Systems;
(x) two representatives of private health insurers;
(xi) a consumer;
(xii) a representative of the complementary and alternative medicine professions;
(xiii) a primary care professional serving low-income or uninsured Vermonters;
(xiv) a licensed mental health professional with clinical experience in Vermont;
(xv) a representative of the Vermont Council of Developmental and Mental Health Services;
(xvi) a representative of the Vermont Assembly of Home Health Agencies who has clinical
experience;
(xvii) a representative from a self-insured employer who offers a health benefit plan to
its employees; and
(xviii) a representative of the State employees’ health plan, who shall be designated by the
Commissioner of Human Resources and who may be an employee of the third-party administrator
contracting to provide services to the State employees’ health plan.
(B) The Executive Committee shall engage a broad range of health care professionals who
provide health services, health insurers, professional organizations, community and
nonprofit groups, consumers, businesses, school districts, and State and local government
in developing recommendations over time for modifications to statewide implementation
of the Blueprint.
(2)(A) [Repealed.]
(B) The Director shall convene a payer implementation work group, which shall meet no
fewer than six times annually, to design the medical home and community health team
enhanced payments, including modifications over time, and to make recommendations
to the Executive Committee. The work group shall include representatives of the participating
health insurers, representatives of participating medical homes and community health
teams, and the Commissioner of Vermont Health Access or designee. The work group shall
comply with open meeting and public record requirements in 1 V.S.A. chapter 5.
(c) The Blueprint shall be developed and implemented to further the following principles:
(1) The Blueprint community health team should serve a central role in the coordination
of medical care and social services and shall be compensated appropriately for this
effort.
(2) Use of information technology should be maximized.
(3) Local service providers should be used and supported, whenever possible.
(4) Transition plans should be developed by all involved parties to ensure a smooth and
timely transition from the current model to the Blueprint model of health care delivery
and payment.
(5) Implementation of the Blueprint in communities across the State should be accompanied
by payment to providers sufficient to support care management activities consistent
with the Blueprint, recognizing that interim or temporary payment measures may be
necessary during early and transitional phases of implementation.
(6) Interventions designed to prevent chronic disease and improve outcomes for persons
with chronic disease should be maximized, should target specific chronic disease risk
factors, and should address changes in individual behavior; the physical, mental,
and social environment; and health care policies and systems.
(7) Providers should assess trauma and toxic stress to ensure that the needs of the whole
person are addressed and opportunities to build resilience and community supports
are maximized.
(d) The Blueprint for Health shall include the following initiatives:
(1) Technical assistance as provided for in section 703 of this title to implement:
(A) a patient-centered medical home;
(B) community health teams; and
(C) a model for uniform payment for health services by health insurers, Medicaid, Medicare
if available, and other entities that encourage the use of the medical home and the
community health teams.
(2) Collaboration with Vermont Information Technology Leaders established in section 9352 of this title to assist health care professionals and providers to create a statewide infrastructure
of health information technology in order to expand the use of electronic medical
records through a health information exchange and a centralized clinical registry
on the Internet.
(3) In consultation with employers, consumers, health insurers, and health care providers,
the development, maintenance, and promotion of evidence-based, nationally recommended
guidelines for greater commonality, consistency, and coordination among health insurers
in care management programs and systems.
(4) The adoption and maintenance of clinical quality and performance measures for each
of the chronic conditions included in Medicaid’s care management program established
in 33 V.S.A. § 1903a. These conditions include asthma, chronic obstructive pulmonary disease, congestive
heart failure, diabetes, and coronary artery disease.
(5) The adoption and maintenance of clinical quality and performance measures, aligned
with, but not limited to, existing indicators related to outcomes set forth in 3 V.S.A. § 2311 that are relevant to the Agency of Human Services, to be reported by health care
professionals, providers, or health insurers and used to assess and evaluate the impact
of the Blueprint for Health and cost outcomes. In accordance with a schedule established
by the Blueprint Executive Committee, all clinical quality and performance measures
shall be reviewed for consistency with those used by the Medicare program and updated,
if appropriate.
(6) The adoption and maintenance of clinical quality and performance measures for pain
management, palliative care, and hospice care.
(7) The use of surveys to measure satisfaction levels of patients, health care professionals,
and health care providers participating in the Blueprint.
(8) The use of quality improvement facilitation and other means to support quality improvement
activities, including using integrated clinical and claims data, where available,
to evaluate patient outcomes and promoting best practices regarding patient referrals
and care distribution between primary and specialty care.
(e) The strategic plan developed under subsection (a) of this section shall be reviewed
biennially and amended as necessary to reflect changes in priorities. Amendments to
the plan shall be included in the report established under section 709 of this title. (Added 2005, No. 191 (Adj. Sess.), § 5; amended 2007, No. 70, § 21; 2007, No. 71, § 5; 2009, No. 128 (Adj. Sess.), § 13; 2009, No. 156 (Adj. Sess.), § I.19; 2011, No. 63, § G.101; 2011, No. 171 (Adj. Sess.), § 28, eff. May 16, 2012; 2015, No. 11, § 17; 2017, No. 204 (Adj. Sess.), § 6; 2019, No. 128 (Adj. Sess.), § 7; 2021, No. 167 (Adj. Sess.), § 6, eff. June 1, 2022.)
§ 703. Health prevention; chronic care management
(a) The Director shall develop a model for integrating a system of health care for patients,
improving the health of the overall population, and improving control over health
care costs by promoting health maintenance, prevention, and care coordination and
management through an integrated system, including a patient-centered medical home
and a community health team, and uniform payment for health services by health insurers,
Medicaid, Medicare if available, and other entities that encourage the use of the
medical home and the community health teams.
(b) When appropriate, the model may include the integration of social services provided
by the Agency of Human Services or may include coordination with a team at the Agency
of Human Services to ensure the individual’s comprehensive care plan is consistent
with the Agency’s case management plan for that individual or family.
(c) In order to maximize the participation of federal health care programs and to maximize
federal funds available, the model for care coordination and management may meet the
criteria for medical home, community health team, or other related demonstration projects
established by the U.S. Department of Health and Human Services and the criteria of
any other federal program providing funds for establishing medical homes, community
health teams, or associated payment reform.
(d) The model for care coordination and management shall include the following components:
(1) A process for identifying individuals with or at risk for chronic disease and to assist
in the determination of the risk for or severity of a chronic disease, as well as
the appropriate type and level of care management services needed to manage those
chronic conditions.
(2) Evidence-based clinical practice guidelines, which shall be aligned with the clinical
quality and performance measures provided for in section 702 of this title.
(3) Models for the collaboration of health care professionals in providing care, including
through a community health team.
(4) Education for patients on how to manage conditions or diseases, including prevention
of disease; programs to modify a patient’s behavior; and a method of ensuring compliance
of the patient with the recommended behavioral change.
(5) Education for patients on health care decision-making, including education related
to advance directives, palliative care, hospice care, and timely referrals to palliative
and hospice care, when appropriate.
(6) Measurement and evaluation of the process and health outcomes of patients.
(7) A method for all health care professionals treating the same patient on a routine
basis to report and share information about that patient.
(8) Requirements that participating health care professionals and providers have the capacity
to implement health information technology that meets the requirements of 42 U.S.C. § 300jj in order to facilitate coordination among members of the community health team, health
care professionals, and primary care practices and, where applicable, to report information
on quality measures to the Director of the Blueprint.
(9) A sustainable, scalable, and adaptable financial model reforming primary care payment
methods through medical homes supported by community health teams that lead to a reduction
in avoidable emergency room visits and hospitalizations and a shift of health insurer
expenditures from disease management contracts to financial support for local community
health teams in order to promote health, prevent disease, and manage care in order
to increase positive health outcomes and reduce costs over time.
(e) The Director of the Blueprint shall provide technical assistance and training to health
care professionals, health care providers, health insurers, and others participating
in the Blueprint. (Added 2009, No. 128 (Adj. Sess.), § 13; amended 2011, No. 60, § 6, eff. June 1, 2011.)
§ 704. Medical home
(a) Consistent with federal law to ensure federal financial participation, a health care
professional providing a patient’s medical home shall:
(1) provide comprehensive prevention and disease screening for his or her patients and
managing his or her patients’ chronic conditions by coordinating care;
(2) enable patients to have access to personal health information through a secure medium,
such as through the Internet, consistent with federal health information technology
standards;
(3) use a uniform assessment tool provided by the Blueprint in assessing a patient’s health;
(4) collaborate with the community health teams, including by developing and implementing
a comprehensive plan for participating patients;
(5) ensure access to a patient’s medical records by the community health team members
in a manner compliant with the Health Insurance Portability and Accountability Act;
12 V.S.A. § 1612; sections 1852, 7103, 9332, and 9351 of this title; and 21 V.S.A. § 516; and
(6) meet regularly with the community health team to ensure integration of a participating
patient’s care.
(b) A naturopathic physician licensed pursuant to 26 V.S.A. chapter 81 may serve as a patient’s medical home. (Added 2009, No. 128 (Adj. Sess.), § 13; amended 2011, No. 96 (Adj. Sess.), § 3, eff. May 2, 2012.)
§ 705. Community health teams
(a) Consistent with federal law to ensure federal financial participation, the community
health team shall consist of health care professionals from multiple disciplines,
including obstetrics and gynecology, pharmacy, nutrition and diet, social work, behavioral
and mental health, chiropractic, other complementary and alternative medical practice
licensed by the State, home health care, public health, and long-term care.
(b) The Director shall assist communities to identify the service areas in which the teams
work, which may include a hospital service area or other geographic area.
(c) Health care professionals participating in a community health team shall:
(1) Collaborate with other health care professionals and with existing State agencies
and community-based organizations in order to coordinate disease prevention, manage
chronic disease, coordinate social services if appropriate, and provide an appropriate
transition of patients between health care professionals or providers. Priority may
be given to patients willing to participate in prevention activities or patients with
chronic diseases or conditions identified by the Director of the Blueprint.
(2) Support a health care professional or practice that operates as a medical home, including
by:
(A) assisting in the development and implementation of a comprehensive care plan for a
patient that integrates clinical services with prevention and health promotion services
available in the community and with relevant services provided by the Agency of Human
Services. Priority may be given to patients willing to participate in prevention activities
or patients with chronic diseases or conditions identified by the Director of the
Blueprint;
(B) providing a method for health care professionals, patients, caregivers, and authorized
representatives to assist in the design and oversight of the comprehensive care plan
for the patient;
(C) coordinating access to high-quality, cost-effective, culturally appropriate, and patient-
and family-centered health care and social services, including preventive services,
activities that promote health, appropriate specialty care, inpatient services, medication
management services provided by a pharmacist, and appropriate complementary and alternative
(CAM) services;
(D) providing support for treatment planning, monitoring the patient’s health outcomes
and resource use, sharing information, assisting patients in making treatment decisions,
avoiding duplication of services, and engaging in other approaches intended to improve
the quality and value of health services;
(E) assisting in the collection and reporting of data in order to evaluate the Blueprint
model on patient outcomes, including collection of data on patient experience of care,
and identification of areas for improvement; and
(F) providing a coordinated system of early identification and referral for children at
risk for developmental or behavioral problems, such as through the use of health information
technology or other means as determined by the Director of the Blueprint.
(3) Provide care management and support when a patient moves to a new setting for care,
including by:
(A) providing on-site visits from a member of the community health team, assisting with
the development of discharge plans and medication reconciliation upon admission to
and discharge from the hospital, nursing home, or other institution setting;
(B) generally assisting health care professionals, patients, caregivers, and authorized
representatives in discharge planning, including by assuring that postdischarge care
plans include medication management as appropriate;
(C) referring patients as appropriate for mental and behavioral health services;
(D) ensuring that when a patient becomes an adult, his or her health care needs are provided
for; and
(E) serving as a liaison to community prevention and treatment programs. (Added 2009, No. 128 (Adj. Sess.), § 13.)
§ 706. Health insurer participation
(a) As set forth in 8 V.S.A. § 4025, health insurance plans shall be consistent with the Blueprint for Health as determined
by the Commissioner of Financial Regulation.
(b) Health insurers shall participate in the Blueprint for Health as a condition of doing
business in this State as provided for in this section and in 8 V.S.A. § 4025.
(c)(1) The Blueprint payment reform methodologies shall include per-person per-month payments
to medical home practices by each health insurer and Medicaid for their attributed
patients and for contributions to the shared costs of operating the community health
teams. Per-person per-month payments to practices shall be based on the official National
Committee for Quality Assurance’s Physician Practice Connections-Patient Centered
Medical Home (NCQA PPC-PCMH) score to the extent practicable and shall be in addition
to their normal fee-for-service or other payments.
(2) Consistent with recommendations of the Blueprint Executive Committee, the Director
of the Blueprint may recommend to the Commissioner of Vermont Health Access changes
to the payment amounts or to the payment reform methodologies described in subdivision
(1) of this subsection, including by providing for enhanced payment to health care
professional practices that operate as a medical home, including primary care naturopathic
physicians’ practices; payment toward the shared costs for community health teams;
or other payment methodologies required by the Centers for Medicare and Medicaid Services
(CMS) for participation by Medicaid or Medicare.
(3) Health insurers shall modify payment methodologies and amounts to health care professionals
and providers as required for the establishment of the model described in sections
703 through 705 of this title and this section, including any requirements specified by the Centers for Medicare
and Medicaid Services (CMS) in approving federal participation in the model to ensure
consistency of payment methods in the model.
(4) In the event that the Secretary of Human Services is denied permission from the Centers
for Medicare and Medicaid Services (CMS) to include financial participation by Medicare,
health insurers shall not be required to cover the costs associated with individuals
covered by Medicare.
(d) An insurer may appeal a decision to require a particular payment methodology or payment
amount to the Commissioner of Vermont Health Access, who shall provide a hearing in
accordance with 3 V.S.A. chapter 25. An insurer aggrieved by the decision of the Commissioner may appeal to the Superior
Court for the Washington District within 30 days after the Commissioner issues his
or her decision. (Added 2009, No. 128 (Adj. Sess.), § 13; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2011, No. 96 (Adj. Sess.), § 4, eff. May 2, 2012; 2015, No. 172 (Adj. Sess.), § E.306.2; 2019, No. 128 (Adj. Sess.), § 8; 2023, No. 6, § 105, eff. July 1, 2023; 2025, No. 11, § 15, eff. September 1, 2025.)
§ 707. Participation by health care professionals and hospitals
(a) Hospitals shall participate in the Blueprint for Health by creating or maintaining
connectivity to the State’s Health Information Exchange Network as provided in this
section and in section 9456 of this title.
(b) The Director of Health Care Reform or designee shall ensure hospitals have access
to State and federal resources to support connectivity to the State’s Health Information
Exchange Network.
(c) The Director of the Blueprint shall engage health care professionals and providers
to encourage participation in the Blueprint, including by providing information and
assistance. (Added 2009, No. 128 (Adj. Sess.), § 13; amended 2013, No. 79, § 33, eff. June 7, 2013; 2023, No. 6, § 106, eff. July 1, 2023.)
§ 708. Repealed. 2013, No. 79, § 52(b), effective June 7, 2013.
§ 709. Annual report
(a) The Director of the Blueprint shall report annually, on or before January 31, on the
status of implementation of the Vermont Blueprint for Health for the prior calendar
year and shall provide the report to the House Committee on Health Care, the Senate
Committee on Health and Welfare, and the Health Reform Oversight Committee.
(b) The report required by subsection (a) of this section shall include the number of
participating insurers, health care professionals, and patients; the progress made
in achieving statewide participation in the chronic care management plan, including
the measures established under this subchapter; the expenditures and savings for the
period; the results of health care professional and patient satisfaction surveys;
the progress made toward creation and implementation of privacy and security protocols;
information on the progress made toward the requirements in this subchapter; and other
information as requested by the Committees. The provisions of 2 V.S.A. § 20(d) (expiration of required reports) shall not apply to the report to be made under subsection
(a) of this section. (Added 2009, No. 128 (Adj. Sess.), § 13; amended 2011, No. 63, § G.102; 2011, No. 171 (Adj. Sess.), § 41c; 2013, No. 142 (Adj. Sess.), § 33; 2017, No. 113 (Adj. Sess.), § 55.)