Terms Used In Vermont Statutes > Title 18 > Chapter 221 - Health Care Administration

• Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
• Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
• Agency: means the Agency of Transportation. See
• Ambulatory surgical center: means a facility or portion of a facility that provides surgical care not requiring an overnight stay. See
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Annual meeting: when applied to towns shall mean the annual town meeting in March or an adjournment thereof. See
• Annual operating expense: means that expense which, by generally accepted accounting principles, is incurred by a new health care service during the first fiscal year in which the service is in full operation after completion of the project. See
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
• Applicant: means a person who has submitted an application or proposal requesting issuance of a certificate of need. See
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Attorney-in-fact: A person who, acting as an agent, is given written authorization by another person to transact business for him (her) out of court.
• Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Board: means the Transportation Board. See
• Board: means the Green Mountain Care Board established in chapter 220 of this title. See
• Branch: means a major component of a division of a department or major unit of a department with staff functions. See
• Capital expenditure: means an expenditure for the plant or equipment that is not properly chargeable as an expense of operation and maintenance and includes acquisition by purchase, donation, leasehold expenditure, or lease that is treated as capital expense in accordance to the accounting standards established for lease expenditures by the Financial Accounting Standards Board, calculated over the length of the lease for plant or equipment, and includes assets having an expected life of at least three years. See
• Chair: means the Chair of the Transportation Board, unless otherwise specified. See
• Chambers: A judge's office.
• Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
• Claim: means any claim, bill, or request for payment for all or any portion of provided health care services that is submitted by:

• Commissioner: means the Commissioner of Motor Vehicles responsible to the Secretary for the administration of the Department. See
• Commissioner: means the Commissioner of Financial Regulation or the Commissioner's designee. See
• Community report: means the hospital report prepared under section 9405a of this title. See
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Construction: means actual commencement of any construction or fabrication of any new building, or addition to any existing facility, or any expenditure relating to the alteration, remodeling, renovation, modernization, improvement, relocation, repair, or replacement of a health care facility, including expenditures necessary for compliance with life and health safety codes. See
• Contested claim: means a claim submitted to a payer, health plan, or contracting entity that does not include:

• Contract: A legal written agreement that becomes binding when signed.
• contract: means a contract entered into, amended, or renewed between a contracting entity or health plan and a health care provider specifying the rights and responsibilities of the contracting entity and provider for the delivery of health care services to insureds, including primary care health services, preventive health services, chronic care services, and specialty health care services. See
• Contracting entity: means any entity that contracts directly or indirectly with a health care provider for either the delivery of health care services or the selling, leasing, renting, assigning, or granting of access to a contract or terms of a contract. See
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Covered entity: means an organization that enters into a contract with a contracting entity to gain access to a provider network contract. See
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• denial: means the circumstance in which the plan asserts that it has no liability to pay a claim, based on eligibility status of the patient, coverage of a service under the health plan, medical necessity of a service, liability of another payer, or other grounds. See
• Department: means the Department of Motor Vehicles. See
• Department: means the Department of Financial Regulation. See
• Dependent: A person dependent for support upon another.
• Develop: means the partition or division of any tract of land of any size by a person through sale, lease, transfer, or any other means by which any interest in or to the land or a portion of the land is conveyed to another person that will require the construction of permanent new or enlarged points of access to a State or town highway other than a limited access facility pursuant to subsection 1702a(a) of this title; excluding, however, tracts of land located entirely within a city or incorporated village. See
• Director: means the head of a division. See
• District: means a geographic subdivision of the State primarily established for maintenance purposes. See
• District clerk: means the individual elected as clerk of a union school district by the voters of the district pursuant to the provisions of sections 715 (union school district organizational meeting), 735 (unified union school district officers and election), and 753 (union elementary and union high school district officers and election) of this chapter. See
• Division: means a major unit of the Agency engaged in line functions other than the Department of Motor Vehicles. See
• editing: means a practice or procedure pursuant to which one or more adjustments are made to Current Procedural Terminology (CPT) codes, American Society of Anesthesiologists' (ASA) current procedural terminology, the American Dental Association's (ADA) current dental terminology, or Healthcare Common Procedure Coding System (HCPCS) Level II codes included in a claim that result in:

• Electorate: means the qualified voters in a school district voting at a properly warned school district meeting. See
• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
• Escrow: Money given to a third party to be held for payment until certain conditions are met.
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Executor: A male person named in a will to carry out the decedent
• Expenditure analysis: means the expenditure analysis developed pursuant to section 9383 of this title. See
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• Fee simple: Absolute title to property with no limitations or restrictions regarding the person who may inherit it.
• Fees: shall mean earnings due for official services, aside from salaries or per diem compensation. See
• Fiduciary: A trustee, executor, or administrator.
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• following: when used by way of reference to a section of the law shall mean the next preceding or following section. See
• Fraud: Intentional deception resulting in injury to another.
• gender identity: means an individual's actual or perceived gender identity, or gender-related characteristics intrinsically related to an individual's gender or gender-identity, regardless of the individual's assigned sex at birth. See
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. ^{Source: Federal Reserve}
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health care facility: means all institutions, whether public or private, proprietary or nonprofit, which offer diagnosis, treatment, inpatient, or ambulatory care to two or more unrelated persons, and the buildings in which those services are offered. See
• Health care facility: means all persons or institutions, including mobile facilities, whether public or private, proprietary or not for profit, which offer diagnosis, treatment, inpatient, or ambulatory care to two or more unrelated persons, and the buildings in which those services are offered. See
• Health care provider: means a person, partnership, or corporation, other than a facility or institution, licensed or certified or authorized by law to provide professional health care service in this State to an individual during that individual's medical care, treatment, or confinement. See
• Health care provider: means a person, partnership, corporation, facility, or institution, licensed or certified or authorized by law to provide professional health care service in this State to an individual during that individual's medical care, treatment, or confinement. See
• Health insurer: means any health insurance company, nonprofit hospital and medical service corporation, managed care organizations, and, to the extent permitted under federal law, any administrator of an insured, self-insured, or publicly funded health care benefit plan offered by public and private entities. See
• Health maintenance organization: means any person certified to operate a health maintenance organization by the Commissioner pursuant to 8 Vt. See
• Health plan: means a health insurer, disability insurer, health maintenance organization, medical or hospital service corporation, and, to the extent permitted under federal law, any administrator of an insured or self-insured plan. See
• Health plan: means a health benefit plan offered, administered, or issued by a health insurer doing business in Vermont. See
• Health Resource Allocation Plan: means the plan published by the Green Mountain Care Board in accordance with subsection 9405(b) of this title. See
• highway: includes rights-of-way, bridges, drainage structures, signs, guardrails, areas to accommodate utilities authorized by law to locate within highway limits, areas used to mitigate the environmental impacts of highway construction, vegetation, scenic enhancements, and structures. See
• Home health agency: means a for-profit or nonprofit health care facility providing part-time or intermittent skilled nursing services and at least one of the following other therapeutic services made available on a visiting basis, in a place of residence used as a patient's home: physical, speech, or occupational therapy; medical social services; home health aide services; or other non-nursing therapeutic services, including the services of nutritionists, dieticians, psychologists, and licensed mental health counselors. See
• Home health services: means activities and functions of a home health agency, including nurses, home health aides, physical therapists, occupational therapists, speech therapists, medical social workers, or other non-nursing therapeutic services directly related to care, treatment, or diagnosis of patients in the home. See
• Hospital: means an acute care hospital licensed under chapter 43 of this title. See
• Hospital: means a hospital licensed under chapter 43 of this title, except a hospital that is conducted, maintained, or operated by the State of Vermont. See
• Insured: means any person eligible for health care benefits under a health benefit plan, and includes all of the following terms: enrollee, subscriber, member, insured, dependent, covered individual, and beneficiary. See
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Legislative session: That part of a chamber's daily session in which it considers legislative business (bills, resolutions, and actions related thereto).
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Managed care organization: means any financing mechanism or system that manages health care delivery for its members or subscribers, including health maintenance organizations and any other similar health care delivery system or organization. See
• Material change: means a change to a health care project for which a certificate of need has been issued which:

• Maximum allowable cost: means the per unit drug product reimbursement amount, excluding dispensing fees, for a group of equivalent multisource generic prescription drugs. See
• Most favored nation clause: means a provision in a health care contract that:

• Municipality: shall include a city, town, town school district, incorporated school or fire district or incorporated village, and all other governmental incorporated units. See
• NCCI: means the Centers for Medicare and Medicaid Services' (CMS) published list of edits and adjustments that are made to health care providers' claims submitted for services or supplies provided to patients insured under the federal Medicare program and other federal insurance programs. See
• Nonmaterial change: means a modification that does not meet the cost threshold of a material change as defined in subdivision (11) of this section, but otherwise modifies the kind, scope, or capacity of a project for which a certificate of need has been granted under this subchapter. See
• Oath: A promise to tell the truth.
• Oath: shall include affirmation where by law an affirmation may be substituted. See
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Obligation: means an obligation for a capital expenditure which is deemed to have been incurred by or on behalf of a health care facility or health maintenance organization. See
• Oral argument: An opportunity for lawyers to summarize their position before the court and also to answer the judges' questions.
• Oversight: Committee review of the activities of a Federal agency or program.
• Participating provider: means a health care provider that has a health care contract with a contracting entity and is entitled to reimbursement for health care services rendered to an insured under the health care contract. See
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Payer: means any person or entity that assumes the financial risk for the payment of claims under a health care contract or the reimbursement for health care services rendered to an insured by a participating provider under the health care contract. See
• Permit: means any permit or license issued pursuant to this title. See
• Person: includes a municipality or State agency. See
• Person: means any individual, company, corporation, association, partnership, the U. See
• Person: shall include any natural person, corporation, municipality, the State of Vermont or any department, agency, or subdivision of the State, and any partnership, unincorporated association, or other legal entity. See
• Pharmacy benefit management: means an arrangement for the procurement of prescription drugs at a negotiated rate for dispensation within this State to beneficiaries, the administration or management of prescription drug benefits provided by a health plan for the benefit of beneficiaries, or any of the following services provided with regard to the administration of pharmacy benefits:

• Pharmacy benefit manager: means an entity that performs pharmacy benefit management, except an entity that provides pharmacy benefit management services for Vermont Medicaid. See
• Pharmacy benefit manager affiliate: means a pharmacy or pharmacist that, directly or indirectly, through one or more intermediaries, is owned or controlled by, or is under common ownership or control with, a pharmacy benefit manager. See
• Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
• prior authorization: includes preadmission review, pretreatment review, and utilization review. See
• Product: means , to the extent permitted by State and federal law, one of the following types of categories of coverage for which a participating provider may be obligated to provide health care services pursuant to a health care contract:

• Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
• provider: means a person, partnership, or corporation licensed, certified, or otherwise authorized by law to provide professional health care services in this State and shall include a health care provider group, network, independent practice association, or physician hospital organization that is acting exclusively as an administrator on behalf of a health care provider to facilitate the provider's participation in health care contracts. See
• Quorum: The number of legislators that must be present to do business.
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• road: shall include bridges thereon and their approaches. See
• School board: means the board of school directors elected to manage the schools of a school district, the prudential committee of an incorporated school district, the supervisory union board of directors, and the supervisors of unorganized towns and gores. See
• School district: means a school district organized as a town school district, city school district, incorporated school district, or union school district, unless clearly inapplicable. See
• School district meeting: means a duly warned meeting of a school district at which questions are presented to the electorate. See
• seal: shall include an impression of the official seal made upon paper alone or by means of a wafer or wax affixed thereto. See
• Secretary: means the head of the Agency who shall be a member of the Governor's Cabinet responsible directly to the Governor for the administration of the Agency. See
• Secretary: means the Secretary of Education. See
• Selectboard: includes village trustees and city councils. See
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• sexual orientation: means female or male homosexuality, heterosexuality, or bisexuality. See
• State: when applied to the different parts of the United States may apply to the District of Columbia and any territory and the Commonwealth of Puerto Rico. See
• State Health Improvement Plan: means the plan developed under section 9405 of this title. See
• Statute: A law passed by a legislature.
• submitting party: means :

• Subpoena: A command to a witness to appear and give testimony.
• Summons: Another word for subpoena used by the criminal justice system.
• Supervisory union: means an administrative, planning, and educational service unit created by the State Board under section 261 of this title, that consists of two or more school districts; if the context clearly allows, the term also means a supervisory district. See
• sworn: shall include affirmed. See
• Testify: Answer questions in court.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Throughway: means a highway specially designated giving traffic traveling on the throughway the right of way at all intersections. See
• To offer: when used in connection with health services, means that a health care provider holds itself out as capable of providing, or as having the means for the provision of, specified health services. See
• Town: includes incorporated villages and cities. See
• town: means a city or incorporated village. See
• Town: shall include city and wards or precincts therein; "selectboard members" and "board of civil authority" shall extend to and include the mayor and aldermen of cities; "trustees" shall extend to and include bailiffs of incorporated villages; and the laws applicable to the inhabitants and officers of towns shall be applicable to the inhabitants and similar officers of all municipal corporations. See
• town school district: means a city school district, or incorporated school district, and does not mean a union school district. See
• Traffic Committee: consists of the Secretary of Transportation or designee, the Commissioner of Motor Vehicles or designee, and the Commissioner of Public Safety or designee and is responsible for establishing speed zones, parking and no parking areas, rules for use of limited access highways, approval of the testing of automated vehicles as defined in 23 V. See
• Unified union school district: means a union school district organized to provide for the education of the district's resident students in all grades, prekindergarten through grade 12. See
• union district: includes a union elementary school district, union high school district, and unified union school district unless the context clearly limits it to fewer than all options. See
• Union school district: means a municipality formed under the provisions of this chapter that is governed by a single publicly elected board and that is responsible for the education of students residing in two or more towns in the grades for which the district is organized by:

• Venue: The geographical location in which a case is tried.
• Writ: A formal written command, issued from the court, requiring the performance of a specific act.