The Vermont Statutes Online
The Statutes below include the actions of the 2025 session of the General Assembly.
NOTE: The Vermont Statutes Online is an unofficial copy of the Vermont Statutes Annotated that is provided as a convenience.
Subchapter
012
:
SERVICE DELIVERY AND TREATMENT MODALITIES
(Cite as: 8 V.S.A. § 4098c)
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§ 4098c. Covered services provided by naturopathic physicians
(a) A health insurance plan shall provide coverage for medically necessary health care
services covered by the plan when provided by a naturopathic physician licensed in
this State for treatment within the scope of practice described in 26 V.S.A. chapter 81 and shall recognize naturopathic physicians who practice primary care to be primary
care physicians.
(b) Health care services provided by naturopathic physicians may be subject to reasonable
deductibles, co-payment and coinsurance amounts, and fee or benefit limits consistent
with those applicable to other primary care physicians under the plan, as well as
practice parameters, cost-effectiveness and clinical efficacy standards, and utilization
review consistent with any applicable rules published by the Department of Financial
Regulation. Any amounts, limits, standards, and review shall not function to direct
treatment in a manner unfairly discriminative against naturopathic care, and collectively
shall be not more restrictive than those applicable under the same plan to care or
services provided by other primary care physicians, but may allow for the management
of the benefit consistent with variations in practice patterns and treatment modalities
among different types of health care professionals.
(c) A health insurance plan may require that the naturopathic physician’s services be
provided by a licensed naturopathic physician under contract with the insurer or shall
be covered in a manner consistent with out-of-network provider reimbursement practices
for primary care physicians; however, this shall not relieve a health insurance plan
from compliance with the applicable network adequacy requirements adopted by the Commissioner
by rule.
(d) Nothing contained in this section shall be construed as impeding or preventing either
the provision or the coverage of health care services by licensed naturopathic physicians,
within the lawful scope of naturopathic practice, in hospital facilities on a staff
or employee basis.
(e) This section shall apply to Medicaid and any other public health care assistance program
offered or administered by the State or by any subdivision or instrumentality of the
State. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)