§ 1904 - Definitions - Vermont Statutes

§ 1904. Definitions

When used in this subchapter, unless otherwise indicated:

(1) "Agency" means the agency of human services.

(2) "Commissioner" means the commissioner for children and families.

(3) "Department" means the department for children and families.

(4) "Director" means the director of the office of Vermont health access.

(5) "Insurer" means any insurance company, prepaid health care delivery plan, self-funded employee benefit plan, pension fund, hospital or medical service corporation, managed care organization, pharmacy benefit manager, prescription drug plan, retirement system, or similar entity that is under an obligation to make payments for medical services as a result of an injury, illness, or disease suffered by an individual.

(6) "Legally liable representative" means a parent or person with an obligation of support to a recipient whether by contract, court order or statute.

(7) "Provider" means any person that has entered into an agreement with the state to provide any medical service.

(8) "Recipient" means any person or group of persons who receive Medicaid.

(9) "Secretary" means the secretary of the agency of human services.

(10) "Third party" means a person having an obligation to pay all or any portion of the medical expense incurred by a recipient at the time the medical service was provided. The obligation is not discharged by virtue of being undiscovered or undeveloped at the time a Medicaid claim is paid. Third parties include:

(A) Medicare.

(B) Health insurance, including health and accident but not that portion specifically designated for "income protection" which has been considered in determining recipient eligibility to participate in the Medicaid program.

(C) Medical coverage provided in conjunction with other benefit or compensation programs including military and veteran programs or workers' compensation.

(D) Liability for medical expenses as agreed to or ordered in negligence suits, support settlements or trust funds.

(E) Managed care organizations, pharmacy benefit managers, self-insured plans, and other entities that are, by statute, contract, or agreement, legally responsible for the payment of a claim for a health care item or service.

(11) "Tobacco" means all products listed in 7 V.S.A. § 1001(3).

(12) "Tobacco manufacturer" means any person engaged in the process of designing, fabricating, assembling, producing, constructing or otherwise preparing a product containing tobacco, including packaging or labeling of these products, with the intended purpose of selling the product for gain or profit. "Tobacco manufacturer" does not include persons whose activity is limited to growing natural leaf tobacco or to selling tobacco products at wholesale or retail to customers. "Tobacco manufacturer" also does not include any person who manufactures or produces firearms, dairy products, products containing alcohol or other nontobacco products, unless such person also manufactures or produces tobacco products. (Added 1973, No. 152 (Adj. Sess.), § 32, eff. April 14, 1974; amended 1995, No. 152 (Adj. Sess.), § 1; 1997, No. 142 (Adj. Sess.), § 2, eff. April 23, 1998; 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 97; 2007, No. 65, § 110a; 2007, No. 172 (Adj. Sess.), § 11.)