Code of Vermont Rules
Agency 21 - DEPARTMENT OF FINANCIAL REGULATION
Sub-Agency 040 - DIVISION OF HEALTH CARE ADMINISTRATION
Chapter 016 - HEALTH INSURANCE COVERAGE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
Section 21 040 016 - HEALTH INSURANCE COVERAGE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES
Current through February, 2024
Section 1 General Provisions
Purpose. The five largest health insurance companies doing business in Vermont, as measured by covered lives, are required to file with the Commissioner (1) an annual report card on the health insurance plan's performance in relation to quality measures for the care, treatment, and treatment options of mental health and substance abuse conditions covered under the plan, and (2) the health insurance plan's revenue loss and expense ratio relating to the care and treatment of mental health conditions covered under the health insurance plan. This regulation sets out the minimum reporting requirements.
Section 2 Authority
This regulation is issued pursuant to the authority of the Commissioner of the Department of Banking, Insurance, Securities and Health Care Administration to promulgate regulations. 8 V.S.A. § 4089b(f) and (g) and 8 V.S.A. § 75.
Section 3 Scope
This rule applies to the five largest health insurance companies licensed in Vermont, as measured by covered Vermont lives, which shall be measured annually by the Vermont Department of Banking, Insurance, Securities and Health Care Administration as of December 31 of the year immediately preceding the report.
Section 4 Definitions
Section 5 Responsibilities of Insurers
The measures that must be filed include:
Section 6 Responsibilities of the Department
Reporting Specifications. The Division will produce an annual reporting manual with specifications for submitting each of the required report card and loss ratio elements. Where applicable, these specifications will be based on nationally accepted reporting standards such as the Health Plan Employers Data and Information Set (HEDIS).
Coordination with Rule 10. The Division will ensure that compliance with this regulation does not duplicate a reporting requirement for those insurers that are also subject to reporting requirements under the Division's Rule 10. 000, Quality Assurance Standards and Consumer Protections for Managed Care. In cases where a reporting measure is required under this regulation and under Rule 10, the reporting manual specification will be the same as in the most recent edition of the Rule 10 Implementation Manual.
Section 7 Severability
If any provision of this regulation or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of such provisions to other persons or circumstances shall not be affected thereby.
Section 8 Effective Date
This regulation shall be effective on April 2, 2001. However, the requirements of section 5(B) above shall sunset July 1, 2003.
Statutory Authority: 8 V.S.A. §§ 75 and 4089