§ 1900. Definitions
As used in this subchapter, unless otherwise indicated:
(1) “Agency” means the Agency of Human Services.
(2) “Commissioner” means the Commissioner of Vermont Health Access.
(3) “Department” means the Department of Vermont Health Access.
(4) “Insurer” means any insurance company, prepaid health care delivery plan, self-funded
employee benefit plan, pension fund, hospital or medical service corporation, managed
care organization, pharmacy benefit manager, prescription drug plan, retirement system,
or similar entity that is under an obligation to make payments for medical services
as a result of an injury, illness, or disease suffered by an individual.
(5) “Legally liable representative” means a parent or person with an obligation of support
to a recipient whether by contract, court order, or statute.
(6) “Provider” means any person who has entered into an agreement with the State to provide
any medical service.
(7) “Recipient” means any person or group of persons who receive Medicaid.
(8) “Secretary” means the Secretary of Human Services.
(9) “Third party” means a person having an obligation to pay all or any portion of the
medical expense incurred by a recipient at the time the medical service was provided.
The obligation is not discharged by virtue of being undiscovered or undeveloped at
the time a Medicaid claim is paid. Third parties include:
(A) Medicare;
(B) health insurance, including health and accident but not that portion specifically
designated for “income protection” that has been considered in determining recipient
eligibility to participate in the Medicaid program;
(C) medical coverage provided in conjunction with other benefit or compensation programs,
including military and veteran programs or workers’ compensation;
(D) liability for medical expenses as agreed to or ordered in negligence suits, support
settlements, or trust funds; and
(E) managed care organizations, pharmacy benefit managers, self-insured plans, and other
entities that are, by statute, contract, or agreement, legally responsible for the
payment of a claim for a health care item or service.
(10) “Tobacco” means all products listed in 7 V.S.A. § 1001(3).
(11) “Tobacco manufacturer” means any person engaged in the process of designing, fabricating,
assembling, producing, constructing, or otherwise preparing a product containing tobacco,
including packaging or labeling of these products, with the intended purpose of selling
the product for gain or profit. “Tobacco manufacturer” does not include persons whose
activity is limited to growing natural leaf tobacco or to selling tobacco products
at wholesale or retail to customers. “Tobacco manufacturer” also does not include
any person who manufactures or produces firearms, dairy products, products containing
alcohol, or other nontobacco products, unless such person also manufactures or produces
tobacco products. (Added 2013, No. 131 (Adj. Sess.), § 38, eff. May 20, 2014.)