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Suspension of Credentialing Verification Practices

Regulation
Friday, March 20, 2020
Reg. H-2020-01-E

VERMONT DEPARTMENT OF FINANCIAL REGULATION

EMERGENCY RULE H-2020-01-E

Suspension of Credentialing Verification Practices

Section 1.        Purpose

This emergency rule is promulgated pursuant to 18 V.S.A. § 9414 and 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 relax provider credentialing requirements in order to facilitate the reimbursement through commercial insurance during the State of Emergency for health care services provided by physicians or other health care professionals who hold an equivalent license in another State.

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.

The requirements of Section 5.2 of Rule H-2009-03, Consumer Protection and Quality Requirements for Managed Care Organizations, are hereby suspended effective as of March 20, 2020 until September 16, 2020 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.

During the COVID-19 State of Emergency, 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.

During the COVID-19 State of Emergency, 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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Department of Financial Regulation
Consumer Services 
89 Main Street, Montpelier, VT 05620 - 3101

802-828-3301
833-DFR-HOTLINE (toll free)
833-337-4685 (toll free)

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