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VERMONT DEPARTMENT OF FINANCIAL REGULATION
EMERGENCY RULE H-2020-05-E
RELAXATION OF CREDENTIALING VERIFICATION PRACTICES
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.
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.
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.