EMERGENCY RULE # Administrative Procedures – Emergency ... · record if the rule is marked for...

EMERGENCY RULE # ____________

RECEIVED BY: ________ Coversheet Adopting Page Economic Impact Analysis Environmental Impact Analysis Strategy for Maximizing Public Input Scientific Information Statement (if applicable) Incorporated by Reference Statement (if applicable) Clean text of the rule (Amended text without annotation) Annotated text (Clearly marking changes from previous rule) Revised May 5, 2020 page 1

Administrative Procedures – Emergency Rule Filing

Instructions: In accordance with Title 3 Chapter 25 of the Vermont Statutes Annotated and the “Rule on Rulemaking” (CVR 04-000-001) adopted by the Office of the Secretary of State, this emergency filing will be considered complete upon filing and acceptance of these forms with the Office of the Secretary of State, the Legislative Committee on Administrative Rules and a copy with the Chair of the Interagency Committee on Administrative Rules. All forms requiring a signature shall be original signatures of the appropriate adopting authority or authorized person, and all filings are to be submitted at the Office of the Secretary of State, no later than 3:30 pm on the last scheduled day of the work week. The data provided in text areas of these forms will be used to generate a notice of rulemaking in the portal of “Proposed Rule Postings” online, and the newspapers of record if the rule is marked for publication. Publication of notices will be charged back to the promulgating agency.

This emergency rule may remain in effect for a total of 180 days from the date it first takes effect.

Certification Statement: As the adopting Authority of this rule (see 3 V.S.A. § 801(b)(11) for a definition), I believe there exists an imminent peril to public health, safety or welfare, requiring the adoption of this emergency rule.

The nature of the peril is as follows (PLEASE USE ADDITIONAL SHEETS IF SPACE IS

INSUFFICIENT). The COVID-19 outbreak that is the subject of the all-hazard State of Emergency proclaimed by the Governor on March 16, 2020.

I approve the contents of this filing entitled:

RELAXATION OF CREDENTIALING VERIFICATION PRACTICES

/s/ Michael S. Pieciak , on 9/16/2020

(signature) (date) Printed Name and Title: Michael S. Pieciak Commissioner of Financial Regulation

Emergency Rule Coversheet

Revised May 5, 2020 page 2

1. TITLE OF RULE FILING: RELAXATION OF CREDENTIALING VERIFICATION PRACTICES

2. ADOPTING AGENCY: Department of Financial Regulation

3. PRIMARY CONTACT PERSON: (A PERSON WHO IS ABLE TO ANSWER QUESTIONS ABOUT THE CONTENT OF THE RULE).

Name: Ethan McLaughlin

Agency: Department of Financial Regulation

Mailing Address: 89 Main Street, Montpelier, VT 05620 - 3101

Telephone: 802 828 - 4859 Fax: 802 828 - 1919

E-Mail: [email protected]

Web URL(WHERE THE RULE WILL BE POSTED): https://dfr.vermont.gov/about-us/legal-general-counsel/proposed-rules-and-public-comment

4. SECONDARY CONTACT PERSON: (A SPECIFIC PERSON FROM WHOM COPIES OF FILINGS MAY BE REQUESTED OR WHO MAY

ANSWER QUESTIONS ABOUT FORMS SUBMITTED FOR FILING IF DIFFERENT FROM THE

PRIMARY CONTACT PERSON).

Name: Gavin Boyles

Agency: Department of Financial Regulation

Mailing Address: 89 Main Street, Montpelier, VT 05620 - 3101

Telephone: 802 828 - 1425 Fax: 802 828 - 1919

E-Mail: [email protected]

5. RECORDS EXEMPTION INCLUDED WITHIN RULE: (DOES THE RULE CONTAIN ANY PROVISION DESIGNATING INFORMATION AS CONFIDENTIAL;

LIMITING ITS PUBLIC RELEASE; OR OTHERWISE EXEMPTING IT FROM INSPECTION AND

COPYING?) No

IF YES, CITE THE STATUTORY AUTHORITY FOR THE EXEMPTION:

N/A

PLEASE SUMMARIZE THE REASON FOR THE EXEMPTION:

N/A

6. LEGAL AUTHORITY / ENABLING LEGISLATION:



(THE SPECIFIC STATUTORY OR LEGAL CITATION FROM SESSION LAW INDICATING WHO THE

ADOPTING ENTITY IS AND THUS WHO THE SIGNATORY SHOULD BE. THIS SHOULD BE A

SPECIFIC CITATION NOT A CHAPTER CITATION). The authority vested in the Commissioner of the Department of Financial Regulation by §§ 6-7 of 2020 Act No. 140(amending 2020 Act No. 91) and by 18 V.S.A. § 9414 and 8 V.S.A. § 15.

7. EXPLANATION OF HOW THE RULE IS WITHIN THE AUTHORITY OF THE AGENCY: Section 6 of Act 140 states that "until the last to terminate of a declared state of emergency in Vermont as a result of COVID-19, a declared federal public health emergency as a result of COVID-19, and a declared national emergency as a result of COVID-19 … the Department of Financial Regulation shall direct health insurers to relax provider credentialing requirements for health insurance plans, in order to allow for individual health care providers to deliver and be reimbursed for services provided across health care settings as needed to respond to Vermonters’ evolving health care needs." Section 7 of Act 140 states that "[u]ntil July 1, 2021, and notwithstanding any provision of 3 V.S.A. § 844 to the contrary, the Department of Financial Regulation shall consider adopting, and shall have the authority to adopt, emergency rules to address the following for the duration of the state of emergency through June 30, 2021: (1) expanding health insurance coverage for … COVID-19 diagnosis, treatment, and prevention.…." under 18 V.S.A. § 9414 (a), "the Commissioner [of financial regulation] shall have the power and responsibility to ensure that each managed care organization provides quality health care to its members, in accordance with the provisions of this section." 18 V.S.A. § 9414 (b) states that "[t]he Commissioner shall establish, by rule, specific criteria to be considered under this section." This emergency rule relaxes provider credentialing requirements for health insurance plans, as required by Section 6 of Act 140, in order to expand health insurance coverage for COVID-19 diagnosis, treatment and prevention in accordance with Section 7 of Act 140.



The emergency rule also suspends certain specific criteria previously established by the Commissioner, by rule, regarding the credentialing practices of managed care organizations.

8. CONCISE SUMMARY (150 WORDS OR LESS):

Responding to the COVID-19 pandemic may require the provision of health care services by physicians or other health care professionals who hold an equivalent license in another State and may require health care providers to work at physical locations where such providers are not credentialed to provide services. This emergency rule temporarily suspends and relaxes certain provider credentialing verification requirements set forth in Section 5.2 of Rule H-2009-0. Suspending these requirements and requiring health insurers to relax their credentialing requirements is intended to expand health insurance coverage for COVID-19 diagnosis, treatment and prevention by facilitating reimbursement through the Medicaid program or commercial insurance during the state and federal emergencies related to COVID-19.

9. EXPLANATION OF WHY THE RULE IS NECESSARY:

Addressing and treating the health needs of Vermonters during the COVID-19 outbreak may require health care services provided in the Vermont by physicians or other health care professionals who hold an equivalent license in another State. It may also require health care providers credentialed within a health care organization to provide services at locations where such providers are not credentialed. The current requirements of Section 5.2 of Rule H-2009-03 and the existing credentialing requirements of health insurers could impede and delay the provision of such health care services by such providers.

10. EXPLANATION OF HOW THE RULE IS NOT ARBITRARY: Section 6 of Act 140 requires the Department of Financial Regulation to instruct health insurers to relax credentialing requirements. A coalition of health care provider representatives, including the Vermont Association of Hospitals and Health Systems, VNAs of Vermont, Bayada Home Health & Hospice, Vermont



Health Care Association (long term care facilities), Vermont Care Partners, Bi-State Primary Care Association, the Vermont Medical Society, the Vermont Association of Adult Days, and Dartmouth Hitchcock Health, has communicated to the Governor that relaxing credentialing requirements will help their efforts to fight the COVID-19 pandemic.

11. LIST OF PEOPLE, ENTERPRISES AND GOVERNMENT ENTITIES AFFECTED BY THIS RULE:

Managed Care Organizations regulated by the State of Vermont

The Vermont Association of Hospitals and Health Systems, VNAs of Vermont, Bayada Home Health & Hospice, Vermont Health Care Association (long term care facilities), Vermont Care Partners, Bi-State Primary Care Association, the Vermont Medical Society, the Vermont Association of Adult Days, and Dartmouth Hitchcock Health

Physicians or other health care professionals who hold an equivalent license in another State

Physicians or other health care professionals credentialed within a health care organization

Patients and members insured by Managed Care Organizations regulated by the state of Vermont

12. BRIEF SUMMARY OF ECONOMIC IMPACT (150 WORDS OR LESS):

Responding to the COVID-19 pandemic may require the provision of health care services by physicians or other health care professionals who hold an equivalent license in another State and may require health care providers to work at physical locations where such providers are not credentialed to provide services. Facilitating reimbursement for such services by health insurers is expected to significantly decrease the out of pocket costs incurred by Vermont patients. Health Insurers may pay out more money to reimburse providers for the provision of such services.

13. A HEARING IS NOT SCHEDULED .

14. HEARING INFORMATION



(THE FIRST HEARING SHALL BE NO SOONER THAN 30 DAYS FOLLOWING THE POSTING

OF NOTICES ONLINE).

IF THIS FORM IS INSUFFICIENT TO LIST THE INFORMATION FOR EACH HEARING PLEASE

ATTACH A SEPARATE SHEET TO COMPLETE THE HEARING INFORMATION NEEDED FOR

THE NOTICE OF RULEMAKING. Date:

Time: AM

Street Address:

Zip Code:

Date:

Time: AM

Street Address:

Zip Code:

15. DEADLINE FOR COMMENT (NO EARLIER THAN 7 DAYS FOLLOWING LAST HEARING):

16. EMERGENCY RULE EFFECTIVE: 09/16/2020

17. EMERGENCY RULE WILL REMAIN IN EFFECT UNTIL (A DATE NO LATER THAN 180 DAYS FOLLOWING ADOPTION OF THIS EMERGENCY RULE):

06/30/2021

18. NOTICE OF THIS EMERGENCY RULE SHOULD NOT BE PUBLISHED IN THE WEEKLY NOTICES OF RULEMAKING IN THE NEWSPAPERS OF RECORD.

19. KEYWORDS (PLEASE PROVIDE AT LEAST 3 KEYWORDS OR PHRASES TO AID IN THE

SEARCHABILITY OF THE RULE NOTICE ONLINE).

Managed Care Organization

Credentialing

COVID-19

CORONAVIRUS

ATTACHMENT TO EMERGENCY RULE FILING ADDITIONAL RESPONSE REGARDING QUESTION 17

TITLE OF EMERGENCY RULE FILING: Relaxation of Credentialing Verification Practices

ADOPTING AGENCY: Department of Financial Regulation

Additional Response Regarding Question 17:

17. EMERGENCY RULE WILL REMAIN IN EFFECT UNTIL (A DATE NO LATER THAN 180 DAYS FOLLOWING ADOPTION OF THIS EMERGENCY RULE)

06/30/2021

This emergency rule is promulgated under the authority vested in the Department of Financial Regulation under Section 7 of 2020 Act 140, which grants the Department the authority until July 1, 2021 to adopt certain emergency rules “for the duration of the COVID-19 state of emergency through June 30, 2021.” Section 7 of 2020 Act 140 states that such authority is granted “notwithstanding any provision of 3 V.S.A. § 844 to the contrary[,]” such that the 180-day limit on emergency rules specified in 3 V.S.A. § 844(b) does not apply to emergency rules adopted under Section 7 for the duration of the COVID-19 state of emergency through June 30, 2021.


Administrative Procedures – Adopting Page Instructions:

This form must accompany each filing made during the rulemaking process:

Note: To satisfy the requirement for an annotated text, an agency must submit the entire rule in annotated form with proposed and final proposed filings. Filing an annotated paragraph or page of a larger rule is not sufficient. Annotation must clearly show the changes to the rule.

When possible the agency shall file the annotated text, using the appropriate page or pages from the Code of Vermont Rules as a basis for the annotated version. New rules need not be accompanied by an annotated text.

1. TITLE OF RULE FILING: RELAXATION OF CREDENTIALING VERIFICATION PRACTICES


3. TYPE OF FILING (PLEASE CHOOSE THE TYPE OF FILING FROM THE DROPDOWN MENU

BASED ON THE DEFINITIONS PROVIDED BELOW):

AMENDMENT - Any change to an already existing rule, even if it is a complete rewrite of the rule, it is considered an amendment as long as the rule is replaced with other text.

NEW RULE - A rule that did not previously exist even under a different name.

REPEAL - The removal of a rule in its entirety, without replacing it with other text.

This filing is A NEW RULE .

4. LAST ADOPTED (PLEASE PROVIDE THE SOS LOG#, TITLE AND EFFECTIVE DATE OF

THE LAST ADOPTION FOR THE EXISTING RULE):

Secretary of State Rule Log #17-001

21 040 010. RULE H-2009-03 - CONSUMER PROTECTION AND QUALITY REQUIREMENTS FOR MANAGED CARE ORGANIZATIONS

January 24, 2017

Adopting Page page 2



Administrative Procedures – Economic Impact Analysis Instructions:

In completing the economic impact analysis, an agency analyzes and evaluates the anticipated costs and benefits to be expected from adoption of the rule; estimates the costs and benefits for each category of people enterprises and government entities affected by the rule; compares alternatives to adopting the rule; and explains their analysis concluding that rulemaking is the most appropriate method of achieving the regulatory purpose.

Rules affecting or regulating schools or school districts must include cost implications to local school districts and taxpayers in the impact statement, a clear statement of associated costs, and consideration of alternatives to the rule to reduce or ameliorate costs to local school districts while still achieving the objectives of the rule (see 3 V.S.A. § 832b for details).

Rules affecting small businesses (excluding impacts incidental to the purchase and payment of goods and services by the State or an agency thereof), must include ways that a business can reduce the cost or burden of compliance or an explanation of why the agency determines that such evaluation isn’t appropriate, and an evaluation of creative, innovative or flexible methods of compliance that would not significantly impair the effectiveness of the rule or increase the risk to the health, safety, or welfare of the public or those affected by the rule.

1. TITLE OF RULE FILING:



3. CATEGORY OF AFFECTED PARTIES: LIST CATEGORIES OF PEOPLE, ENTERPRISES, AND GOVERNMENTAL ENTITIES POTENTIALLY

AFFECTED BY THE ADOPTION OF THIS RULE AND THE ESTIMATED COSTS AND BENEFITS

ANTICIPATED:

Managed Care Organizations

Health Insurers

Health Care Providers

Insured Patients

4. IMPACT ON SCHOOLS:

Economic Impact Analysis


INDICATE ANY IMPACT THAT THE RULE WILL HAVE ON PUBLIC EDUCATION, PUBLIC

SCHOOLS, LOCAL SCHOOL DISTRICTS AND/OR TAXPAYERS CLEARLY STATING ANY

ASSOCIATED COSTS:

None.

5. ALTERNATIVES: CONSIDERATION OF ALTERNATIVES TO THE RULE TO REDUCE OR

AMELIORATE COSTS TO LOCAL SCHOOL DISTRICTS WHILE STILL ACHIEVING THE OBJECTIVE

OF THE RULE.

N/A

6. IMPACT ON SMALL BUSINESSES: INDICATE ANY IMPACT THAT THE RULE WILL HAVE ON SMALL BUSINESSES (EXCLUDING

IMPACTS INCIDENTAL TO THE PURCHASE AND PAYMENT OF GOODS AND SERVICES BY THE

STATE OR AN AGENCY THEREOF):

Financial impacts on small business are not anticipated.

7. SMALL BUSINESS COMPLIANCE: EXPLAIN WAYS A BUSINESS CAN REDUCE THE

COST/BURDEN OF COMPLIANCE OR AN EXPLANATION OF WHY THE AGENCY DETERMINES

THAT SUCH EVALUATION ISN’T APPROPRIATE.

Only managed care organizations and health insurers are required to comply with this rule and none of these organizations are small businesses.

8. COMPARISON: COMPARE THE IMPACT OF THE RULE WITH THE ECONOMIC IMPACT OF OTHER

ALTERNATIVES TO THE RULE, INCLUDING NO RULE ON THE SUBJECT OR A RULE HAVING

SEPARATE REQUIREMENTS FOR SMALL BUSINESS: Without this rule, the provision of health care services to Vermonters during the COVID-19 outbreak could be impaired or delayed. Material impairments or delays in the provision of health care services during the COVID-19 outbreak could have devastating economic consequences for individual patients and for the economy of the state.

9. SUFFICIENCY: EXPLAIN THE SUFFICIENCY OF THIS ECONOMIC IMPACT ANALYSIS. In light of the urgency of responding to the COVID-19 outbreak, the Department of Financial Regulation believes the analysis described herein is sufficient to justify the temporary suspension of the existing rule.


Administrative Procedures – Environmental Impact Analysis Instructions:

In completing the environmental impact analysis, an agency analyzes and evaluates the anticipated environmental impacts (positive or negative) to be expected from adoption of the rule; compares alternatives to adopting the rule; explains the sufficiency of the environmental impact analysis.

Examples of Environmental Impacts include but are not limited to:

Impacts on the emission of greenhouse gases Impacts on the discharge of pollutants to water Impacts on the arability of land Impacts on the climate Impacts on the flow of water Impacts on recreation Or other environmental impacts




3. GREENHOUSE GAS: EXPLAIN HOW THE RULE IMPACTS THE EMISSION OF

GREENHOUSE GASES (E.G. TRANSPORTATION OF PEOPLE OR GOODS; BUILDING

INFRASTRUCTURE; LAND USE AND DEVELOPMENT, WASTE GENERATION, ETC.): None.

4. WATER: EXPLAIN HOW THE RULE IMPACTS WATER (E.G. DISCHARGE / ELIMINATION OF

POLLUTION INTO VERMONT WATERS, THE FLOW OF WATER IN THE STATE, WATER QUALITY

ETC.): None.

5. LAND: EXPLAIN HOW THE RULE IMPACTS LAND (E.G. IMPACTS ON FORESTRY, AGRICULTURE ETC.): None.

6. RECREATION: EXPLAIN HOW THE RULE IMPACT RECREATION IN THE STATE: None.

7. CLIMATE: EXPLAIN HOW THE RULE IMPACTS THE CLIMATE IN THE STATE: None.

Environmental Impact Analysis


8. OTHER: EXPLAIN HOW THE RULE IMPACT OTHER ASPECTS OF VERMONT’S

ENVIRONMENT: None.

9. SUFFICIENCY: EXPLAIN THE SUFFICIENCY OF THIS ENVIRONMENTAL IMPACT

ANALYSIS. None.


Administrative Procedures – Public Input

Instructions:

In completing the public input statement, an agency describes the strategy prescribed by ICAR to maximize public input, what it did do, or will do to comply with that plan to maximize the involvement of the public in the development of the rule. This form must accompany each filing made during the rulemaking process:




3. PLEASE DESCRIBE THE STRATEGY PRESCRIBED BY ICAR TO MAXIMIZE PUBLIC INVOLVEMENT IN THE DEVELOPMENT OF THE PROPOSED RULE: In light of the unprecedented urgency of addressing the COVID-19 crisis, the Department of Financial Regulation has not sought extensive public comment on this emergency rule. A coalition of health care provider representatives, including the Vermont Association of Hospitals and Health Systems, VNAs of Vermont, Bayada Home Health & Hospice, Vermont Health Care Association (long term care facilities), Vermont Care Partners, Bi-State Primary Care Association, the Vermont Medical Society, the Vermont Association of Adult Days, and Dartmouth Hitchcock Health, has communicated to the Governor that relaxing credentialing requirements will help their efforts to fight the COVID-19 pandemic. The Department has been in constant communication with industry and the provider community, including multiple calls on responses to the COVID-19 pandemic.

4. PLEASE LIST THE STEPS THAT HAVE BEEN OR WILL BE TAKEN TO COMPLY WITH THAT STRATEGY: See response to 3, above.

5. BEYOND GENERAL ADVERTISEMENTS, PLEASE LIST THE PEOPLE AND ORGANIZATIONS THAT HAVE BEEN OR WILL BE INVOLVED IN THE DEVELOPMENT OF THE PROPOSED RULE:

Public Input page 2


Vermont Association of Hospitals and Health Systems, VNAs of Vermont, Bayada Home Health & Hospice, Vermont Health Care Association (long term care facilities), Vermont Care Partners, Bi-State Primary Care Association, the Vermont Medical Society, the Vermont Association of Adult Days, and Dartmouth Hitchcock Health

VERMONT DEPARTMENT OF FINANCIAL REGULATION

EMERGENCY RULE H-2020-05-E


Section 1. Purpose This emergency rule is promulgated pursuant to §§ 6-7 of 2020 Act No. 140 (amending 2020 Act No. 91), 18 V.S.A. § 9414, 8 V.S.A. § 15 and in response to the State of Emergency declared by the Governor of the State of Vermont on March 16, 2020 regarding the outbreak of COVID-19. The purpose of this emergency rule is to expand health insurance coverage for COVID-19 diagnosis, treatment and prevention by relaxing provider credentialing requirements in order to facilitate the reimbursement through commercial insurance for health care services provided by physicians or other health care professionals who hold an equivalent license in another State or who provide care at physical locations where such health care providers are not credentialed. Section 2. Definitions. Terms used in this emergency rule and not defined herein shall have the meanings given to such terms, if any, in Rule H-2009-03, Consumer Protection and Quality Requirements for Managed Care Organizations. Section 3. Temporary Suspension of Provider Credentialing Verification Requirements. Effective as of September 16, 2020 until the last to terminate of a declared state of emergency in Vermont as a result of COVID-19, a declared federal public health emergency as a result of COVID-19, and a declared national emergency as a result of COVID-19, the requirements of Section 5.2 of Rule H-2009-03, Consumer Protection and Quality Requirements for Managed Care Organizations, are hereby suspended with respect to physicians or other health care professionals who hold a license in another State and provide health care services to or on behalf of patients in Vermont, either in person or remotely, by means of telemedicine or otherwise, and with respect to other health care professionals who have been issued provisional or temporary Vermont licensure during the COVID-19 State of Emergency. Section 4. Relaxation of Provider Credentialing Requirements.

(a) Effective as of September 16, 2020 until the last to terminate of a declared state of emergency in Vermont as a result of COVID-19, a declared federal public health emergency as a result of COVID-19, and a declared national emergency as a result of COVID-19, except as otherwise required by applicable federal law or applicable accreditation standards of the National Committee for Quality Assurance, a health insurer shall allow for individual health care providers to deliver and be reimbursed for services provided across health care settings as needed to respond to Vermonters’ evolving health care needs, including, but not limited to relaxing provider credentialing requirements for physicians or other health care professionals who hold a license in another State and

provide health care services to or on behalf of patients in Vermont, either in person or remotely, by means of telemedicine or otherwise, and with respect to other health care professionals who have been issued provisional or temporary Vermont licensure during the COVID-19 State of Emergency.

(b) Effective as of September 16, 2020 until the last to terminate of a declared state of emergency in Vermont as a result of COVID-19, a declared federal public health emergency as a result of COVID-19, and a declared national emergency as a result of COVID-19, except as otherwise required by applicable federal law or applicable accreditation standards of the National Committee for Quality Assurance, a health insurer shall not refuse, because of lack of credentials, to pay claims submitted by providers credentialed within a health care organization but not at that health care organization’s location where the service was provided or at a location not in that health care organization.

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