State of Vermont Data Sharing. As described in sections 6, 7, and 9, the GMCB, in collaboration with AHS, shall supply CMS reports, information, and data on ACO Scale Targets, Statewide Health Outcomes and Quality of Care Targets, and Statewide Financial Targets. The GMCB, in collaboration with AHS, shall submit this information on a regular basis to support CMS’s monitoring and evaluation of the Model and retain such documentation in accordance with section 19. The data shall include certain Vermont Medicaid claims data, Vermont Commercial Plan claims data and any available Vermont Self-insured Plan claims data specified in separately provided guidance by CMS that the State will submit on an annual basis to support CMS’s monitoring and evaluation of the Model. Vermont may provide these claims data from a combination of sources, including its APCD, the Vermont ACOs, Vermont Medicaid, Vermont Commercial Plans, or Vermont Self-insured Plans. All information will be provided to CMS in a manner consistent with all applicable federal and state laws and regulations, including the Health Insurance Portability and Accountability Act (“HIPAA”) and its implementing regulations.
i. CMS also may use these reports, information, and data to conduct analyses and may publish, and potentially co-publish with Vermont, the data and analyses in de-identified form.
ii. The State shall ensure that for each Performance Year the State’s APCD captures any available claims data from Vermont Commercial Plans and Vermont Self-insured Plans such that it represents claims data for at least 80 percent of Vermont residents with health insurance provided under Vermont Commercial Plans or Vermont Self-insured Plans. If the State cannot ensure such a condition, Vermont shall notify CMS within 90 days after the Performance Year ends and shall thereafter work with CMS to secure, within 180 calendar days after such notification is made, separate arrangements with appropriate payers to collect claims data for at least 80 percent of Vermont residents with health insurance provided under Vermont Commercial Plans or Vermont Self-insured Plans.
State of Vermont Data Sharing. As described in sections 4, 5, and 6, the State shall supply CMS reports and information on a regular basis to support CMS’s monitoring and evaluation of the Model and retain such documentation in accordance with section 19. In addition, Vermont shall provide CMS with Vermont Medicaid claims data, Vermont Commercial Plan claims data and Vermont Self-insured Plan claims data on at most an annual basis to support CMS’s monitoring and evaluation of the Model. Vermont may provide these claims data from a combination of sources, including its all-payer claims database (“APCD”), the Vermont ACOs, Vermont Medicaid, Vermont Commercial Plans, and/or Vermont Self-insured Plans. CMS also may use these reports, information, and data to conduct analyses and may publish, and potentially co-publish with Vermont, the data and analyses in de-identified form. All information will be provided to CMS in a manner consistent with all applicable federal and state laws and regulations, including the Health Insurance Portability and Accountability Act (“HIPAA”).
i. The State shall ensure that for each Performance Year the State’s APCD captures claims data from Vermont Commercial Plans and Vermont Self-insured Plans such that it represents claims data for at least 80 percent of Vermont residents with health insurance provided under a Vermont Commercial Plans or Vermont Self-insured Plans. If the State cannot ensure such a condition, Vermont and CMS shall work together to secure within 180 days after such a determination is made separate arrangements with said payers to capture claims data for at least 80 percent of Vermont residents with health insurance provided under a Vermont Commercial Plans or Vermont Self-insured Plans.
