The Vermont Statutes Online

Title 18: Health

Chapter 229: Office of the Health Care Advocate

• § 9601. Definitions

  As used in this chapter:

  (1) “Green Mountain Care Board” or “Board” means the Board established in chapter 220 of this title.

  (2) “Health insurance plan” means a policy, service contract, or other health benefit plan offered or issued by a health insurer and includes beneficiaries covered by the Medicaid program unless they are otherwise provided with similar services.

  (3) “Health insurer” shall have the same meaning as in section 9402 of this title. (Added 2013, No. 79, § 35a, eff. Jan. 1, 2014.)

• § 9602. Office of the Health Care Advocate; composition

  (a) The Office of the Health Care Advocate is established as an independent voice for Vermonters that is dedicated to promoting access to high-quality, affordable health care for all.

  (b) The Agency of Human Services shall maintain the Office of the Health Care Advocate by contract with any nonprofit organization.

  (c) The Office shall be administered by one or more directors, one of whom shall be the Chief Health Care Advocate, who shall be an individual with expertise and experience in the fields of health care and advocacy. The director or directors may employ legal counsel, administrative staff, and other employees and contractors as needed to carry out the duties of the Office. (Added 2013, No. 79, § 35a, eff. Jan. 1, 2014; amended 2017, No. 85, § E.300.4, eff. June 28, 2017; 2025, No. 6, § 3, eff. July 1, 2025.)

• § 9603. Duties and authority

  (a) The Office of the Health Care Advocate shall:

  (1) Assist Vermonters with health insurance plan selection by providing information, referrals, and assistance to individuals about means of obtaining and paying for health insurance coverage and services. The Office shall accept referrals from the Vermont Health Benefit Exchange and Exchange navigators created pursuant to 33 V.S.A. chapter 18, subchapter 1, to assist individuals experiencing problems related to the Exchange.

  (2) Assist Vermonters to understand their rights and responsibilities under health insurance plans.

  (3) Provide information to the public, agencies, members of the General Assembly, and others about Vermonters’ problems and concerns regarding health insurance and access to health care, as well as recommendations for resolving those problems and concerns.

  (4) Identify, investigate, and resolve complaints, questions, and inquiries on behalf of individual Vermonters with respect to issues regarding health insurance or access to health care, and assist those Vermonters with filing and pursuing complaints and appeals.

  (5) Provide consumer education to Vermonters regarding their rights and responsibilities under State and federal laws, rules, and regulations.

  (6) Analyze and monitor the development and implementation of federal, State, and local laws, rules, and policies relating to health insurance and health care, with a special focus on patients’ rights and eligibility for State and federal health care programs.

  (7) Ensure policymakers hear directly from Vermonters by facilitating public comment on health care-related laws, rules, processes, and policies.

  (8) Suggest to the Green Mountain Care Board, the Department of Financial Regulation, and other entities in State government policies, procedures, or rules that protect and promote the interests of Vermonters in matters related to health insurance and access to health care.

  (9) Collaborate with other health care- and health policy-related citizen and consumer organizations to promote affordable and accessible health care for Vermonters.

  (10) Ensure that all Vermonters have timely access to the services provided by the Office.

  (11) Submit to the Governor; the House Committees on Health Care, on Ways and Means, and on Appropriations; and the Senate Committees on Health and Welfare, on Finance, and on Appropriations, on or before January 15 of each year, a report on the activities, performance, and fiscal accounts of the Office during the preceding calendar year.

  (b) The Office of the Health Care Advocate may:

  (1) [Repealed.]

  (2) Pursue administrative, judicial, and other remedies on behalf of any individual or group of individuals experiencing problems with health insurance or access to health care.

  (3) Represent the interests of the people of the State of Vermont in matters involving health care and health insurance at the Green Mountain Care Board, the Department of Financial Regulation, or other State agencies.

  (4) Adopt policies and procedures necessary to carry out the provisions of this chapter.

  (5) Take any other action necessary to fulfill the purposes of this chapter.

  (c) The Office of the Health Care Advocate shall be able to speak to Vermonters and on behalf of the interests of Vermonters in health care- and health insurance-related matters and to carry out all duties prescribed in this chapter without being subject to any retaliatory action; provided, however, that nothing in this subsection shall limit the authority of the Agency of Human Services to enforce the terms of the contract.

  (d) Health care providers and health insurers shall cooperate with the Office of the Health Care Advocate by providing relevant records and information when an individual or the individual’s guardian or legal representative has authorized the Office to act on the individual’s behalf. A health care provider or health insurer may require the written consent of the individual or the individual’s guardian or legal representative prior to providing the records or information to the Office. (Added 2013, No. 79, § 35a, eff. Jan. 1, 2014; amended 2017, No. 85, § E.300.6, eff. June 28, 2017; 2017, No. 154 (Adj. Sess.), § 24, eff. May 21, 2018; 2019, No. 14, § 60, eff. April 30, 2019; 2025, No. 6, § 3, eff. July 1, 2025.)

• § 9604. Duties of State agencies

  (a) It is the intent of the General Assembly that State agencies shall seek input from the Office of the Health Care Advocate when developing or revising significant matters of State policy affecting health care access and affordability in order to ensure that Vermonters’ perspectives are heard and considered through the voice of their independent advocate.

  (b) State agencies shall facilitate the Office’s meaningful participation in health care policymaking by complying with reasonable requests from the Office for information, assistance, and access. A request shall be considered reasonable if it relates to the Office’s statutory duties and authority.

  (1) When appropriate, State agencies shall allow the Office to access confidential or proprietary information that is otherwise exempt from public inspection and copying under the Public Records Act and to participate in meetings, deliberations, and proceedings in which confidential or proprietary information is discussed; provided, however, that nothing in this section shall require a State agency to provide or disclose information that is prohibited from disclosure by State or federal law or that would cause the provider or discloser to violate any statutory or common law privilege.

  (2) The Office shall not further disclose any confidential or proprietary information provided to the Office.

  (c) The Agency of Human Services may adopt rules necessary to ensure the cooperation of State agencies under this section. (Added 2013, No. 79, § 35a, eff. Jan. 1, 2014; amended 2017, No. 85, § E.300.7, eff. June 28, 2017; 2025, No. 6, § 3, eff. July 1, 2025.)

• § 9605. Confidentiality

  The Office of the Health Care Advocate shall maintain the confidentiality of information related to individuals using its services in accordance with all applicable State and federal laws, rules, regulations, and policies. (Added 2013, No. 79, § 35a, eff. Jan. 1, 2014; amended 2025, No. 6, § 3, eff. July 1, 2025.)

• § 9606. Conflicts of interest

  (a) The Office of the Health Care Advocate, its employees, and its contractors shall not have any conflict of interest relating to the performance of their responsibilities under this chapter. For the purposes of this chapter, a conflict of interest exists whenever the Office of the Health Care Advocate, its employees, or its contractors or a person affiliated with the Office, its employees, or its contractors:

  (1) has a direct involvement in the licensing, certification, or accreditation of a health care facility, health insurer, or health care provider;

  (2) has a direct ownership interest or investment interest in a health care facility, health insurer, or health care provider;

  (3) is employed by or participating in the management of a health care facility, health insurer, or health care provider; or

  (4) receives or has the right to receive, directly or indirectly, remuneration under a compensation arrangement with a health care facility, health insurer, or health care provider.

  (b) The Office shall report any potential conflicts of interest to the Agency of Human Services.

  (c) It shall not constitute a conflict of interest per se for an employee or contractor of the Office to serve without compensation on the board of directors of a nonprofit health care entity whose primary regulator is not an agency of the State of Vermont. (Added 2013, No. 79, § 35a, eff. Jan. 1, 2014; amended 2025, No. 6, § 3, eff. July 1, 2025.)

• § 9607. Funding; allocation of expenses

  (a) The Office of the Health Care Advocate shall specify in its annual report filed pursuant to this chapter the sums expended by the Office in carrying out its duties, including identifying the specific amount expended for actuarial services.

  (b)(1) Expenses incurred by the Office of the Health Care Advocate for services related to the Green Mountain Care Board’s and Department of Financial Regulation’s regulatory and supervisory duties shall be borne as follows:

  (A) 27.5 percent by the State from State monies;

  (B) 24.2 percent by the hospitals;

  (C) 24.2 percent by nonprofit hospital and medical service corporations licensed under 8 V.S.A. chapter 123 or 125; and

  (D) 24.2 percent by health insurance companies licensed under 8 V.S.A. chapter 101.

  (2) Expenses under subdivision (1) of this subsection shall be billed to persons licensed under Title 8 based on premiums paid for health care coverage, which for the purposes of this section shall include major medical, comprehensive medical, hospital or surgical coverage, and comprehensive health care services plans, but shall not include long-term care or limited benefits, disability, credit or stop loss, or excess loss insurance coverage.

  (3) The Green Mountain Care Board shall administer the bill back authority created in this subsection on behalf of the Agency of Human Services in support of the Agency’s contract with the Office of the Health Care Advocate pursuant to section 9602 of this title to carry out the duties set forth in this chapter.

  (c) It is the intent of the General Assembly that the Office of the Health Care Advocate shall maximize the amount of federal and grant funds available to support the activities of the Office. (Added 2013, No. 79, § 35a, eff. Jan. 1, 2014; amended 2015, No. 134 (Adj. Sess.), § 28; 2017, No. 85, § E.300.5, eff. June 28, 2017.)