§ 701. Definitions

As used in this chapter:

(1) “Blueprint for Health” or “Blueprint” means the State‘s program for integrating a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination and management.

(2) “Board” means the Green Mountain Care Board established in chapter 220 of this title.

(3) “Chronic care” means health services provided by a health care professional for an established clinical condition that is expected to last a year or more and that requires ongoing clinical management attempting to restore the individual to highest function, minimize the negative effects of the condition, prevent complications related to chronic conditions, engage in advanced care planning, and promote appropriate access to palliative care and pain and symptom management. Examples of chronic conditions include diabetes, hypertension, cardiovascular disease, cancer, asthma, pulmonary disease, substance abuse, mental condition or psychiatric disability, spinal cord injury, hyperlipidemia, dementia, and chronic pain.

(4) “Chronic care information system” means the electronic database developed under the Blueprint for Health that shall include information on all cases of a particular disease or health condition in a defined population of individuals.

(5) “Chronic care management” means a system of coordinated health care interventions and communications for individuals with chronic conditions, including significant patient self-care efforts, systemic supports for licensed health care practitioners and their patients, and a plan of care emphasizing, on an ongoing basis and with the goals of improving overall health and meeting patients’ needs:

(A) prevention of complications utilizing evidence-based practice guidelines;

(B) patient empowerment strategies;

(C) evaluation of clinical, humanistic, and economic outcomes; and

(D) advance care planning, palliative care, pain management, and hospice services, as appropriate.

(6) “Global payment” means a payment from a health insurer, Medicaid, Medicare, or other payer for the health services of a defined population of patients for a defined period of time. Such payments may be adjusted to account for the population’s underlying risk factors, including severity of illness and socioeconomic factors that may influence the cost of health care for the population.

(7) “Health care professional” means an individual, partnership, corporation, facility, or institution licensed or certified or authorized by law to provide professional health care services.

(8) “Health benefit plan” shall have the same meaning as health insurance plan in 8 V.S.A. § 4088h.

(9) “Health insurer” shall have the same meaning as in section 9402 of this title.

(10) “Health service” means any treatment or procedure delivered by a health care professional to maintain an individual’s physical or mental health or to diagnose or treat an individual’s physical or mental condition or intellectual disability, including services ordered by a health care professional, chronic care management, preventive care, wellness services, and medically necessary services to assist in activities of daily living.

(11) “Hospital” shall have the same meaning as in section 9451 of this title.

(12) “Integrated delivery system” means a group of health care professionals, associated either through employment by a single entity or through a contractual arrangement, that provides health services for a defined population of patients and is compensated through a global payment.

(13) “Payment reform” means modifying the method of payment from a fee for-service basis to one or more alternative methods for compensating health care professionals, health care provider bargaining groups created pursuant to section 9409 of this title, integrated delivery systems and other health care professional arrangements, manufacturers of prescribed products, medical supply companies, and other companies providing health services or health supplies, for the provision of high-quality and efficient health services, products, and supplies while measuring quality and efficiency. The term may include shared savings agreements, bundled payments, episode-based payments, and global payments.

(14) “Preventive care” means health services provided by health care professionals to identify and treat asymptomatic individuals who have risk factors or preclinical disease, but in whom the disease is not clinically apparent, including immunizations and screening, counseling, treatment, and medication determined by scientific evidence to be effective in preventing or detecting a condition.

(15) “Wellness services” means health services, programs, or activities that focus on the promotion or maintenance of good health. (Added 2005, No. 191 (Adj. Sess.), § 5; amended 2009, No. 25, § 8; 2009, No. 128 (Adj. Sess.), § 13; 2011, No. 48, § 3c; 2011, No. 60, § 5, eff. June 1, 2011; 2011, No. 171 (Adj. Sess.), § 37, eff. May 16, 2012; 2013, No. 96 (Adj. Sess.), § 90.)