The Vermont Statutes Online

Title 33: Human Services

Chapter 067: Medicare Advocacy Program

• § 6701. Definitions

  As used in this chapter:

  (1) “Dual eligible individual” means an individual who is a beneficiary of both Medicaid and Medicare.

  (2) “Medicaid” means the medical assistance program authorized under chapter 19 of this title.

  (3) “Medicare” means the health insurance programs authorized under Title XVIII of the Social Security Act. (Added 1989, No. 259 (Adj. Sess.), § 2.)

• § 6702. Program established

  A Medicare Advocacy Program is established for the purpose of ensuring through legal and other advocacy services that dual eligible individuals receive the Medicare coverage to which they are entitled. In addition to serving individual beneficiaries, the Program may participate on behalf of dual eligible individuals in reform litigation and Medicare related administrative or judicial proceedings. (Added 1989, No. 259 (Adj. Sess.), § 2.)

• § 6703. Contract for services

  (a) Subject to the provisions of subsection (b) of this section, the Commissioner of Vermont Health Access shall contract on an annual basis with individuals or private organizations to provide services authorized by this chapter to dual eligible individuals including pursuit of subrogation claims under section 6705 of this chapter.

  (b) The Commissioner shall not be required to enter into contracts under this section if both of the following conditions are met:

  (1) The amount of the State’s share of recoveries to the Medicaid program from awards obtained under this chapter during the preceding year did not exceed the payments to the contractors during that year.

  (2) The Commissioner determines that the program is not accomplishing its goal of protecting dual eligible individuals from improper denials of Medicare coverage. The Commissioner shall base this determination on information obtained from the contractors, providers of health care, area agencies on aging, and other individuals and organizations affected by the program. (Added 1989, No. 259 (Adj. Sess.), § 2; amended 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 128; 2009, No. 33, § 68; 2009, No. 156 (Adj. Sess.), § I.77; 2021, No. 20, § 341.)

• § 6704. Charges

  Dual eligible individuals shall not be charged for services provided under this chapter. (Added 1989, No. 259 (Adj. Sess.), § 2.)

• § 6705. Subrogation

  (a) Upon furnishing medical assistance under chapter 19 of this title to any individual, the Department of Vermont Health Access shall be subrogated, to the extent of the expenditure for medical care furnished, to any rights such individual may have to third-party reimbursement for such care.

  (b) The Department of Vermont Health Access or its designee shall be entitled to obtain from any medical service provider any records of the treatment of any individual covered by subsection (a) of this section that are in any way relevant to the treatment paid for through medical assistance without regard to any other privilege or right of confidentiality or privacy that may exist. The Department shall ensure that any records obtained are not released to any other individual, agency, or other entity except as necessary to pursue the Department’s rights of subrogation.

  (c) The Department of Vermont Health Access may contract with a private attorney or attorneys, or other private persons, for the purpose of obtaining third-party reimbursement for Medicaid expenditures under this section. In awarding contracts under this section, the Department shall give preference to bidders who maintain a place of business in this State. (Added 1989, No. 259 (Adj. Sess.), § 2; amended 1995, No. 152 (Adj. Sess.), § 5; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 129; 2009, No. 156 (Adj. Sess.), § I.78; 2021, No. 20, § 342.)

• § 6706. Independent analysis

  The Commissioner of Financial Regulation shall adopt rules to ensure an in-depth independent analysis by an expert, or experts, of proposed Medicare supplement insurance policy rate increases. This analysis shall be performed only when the composite average rate increase requested by insurers with 5,000 or more lives in the Vermont Medicare supplement insurance policy market exceeds three percent, or when the Commissioner finds that the proposed premium and policy changes will have a comparable adverse impact on availability or cost of coverage, or when it otherwise appears to be in the best interests of the insureds. A composite average rate is the enrollment-weighted average rate increase of all plans offered by a carrier. The independent analyst shall be made available to the public during the analysis and for the purpose of providing assistance with and testimony in connection with Medicare supplement insurance policy rate increase proposals. The cost for the analysis shall be assessed to the affected policy or certificate holders. (Added 1989, No. 259 (Adj. Sess.), § 2; amended 1991, No. 251 (Adj. Sess.); 1995, No. 180 (Adj. Sess.), § 38(a); 1999, No. 43, § 2; 2003, No. 18, § 2; 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2021, No. 20, § 343.)