The authority to collect eligibility and claims data for Vermont residents from commercial health insurers and the state Medicaid program through VHCURES was originally granted to the Department of Financial Regulation (then known as BISHCA, 18 V.S.A. § 9410) . On July 1, 2013, the Green Mountain Care Board assumed responsibility for VHCURES, Vermont's all-payer claims database (Act 79 of 2013, Section 40).
Vermont law 18 V.S.A. §9410, Regulation H-2008-01) specifies the entities required to report VHCURES data and the format of the data files to be submitted. GMCB collects data on Vermont residents from commercial health insurers and Vermont's Medicaid program. For the purposes of VHCURES data collection and by law, the definition of "health insurers" includes third-party administrators (TPAs), pharmacy benefit managers (PBMs), hospitals and health systems, administrators of self-insured or publicly insured health benefits plans, and any other similar entity with claims data, eligibility data, provider files and other information relating to health care provided to Vermont residents.
Under Vermont laws and regulations, health insurers including TPAs and PBMs providing services to even a single Vermont resident are required to register on an annual basis by December 31 with the State of Vermont. This requirement pertains to comprehensive major medical health benefit plans that may be insured or self-insured, Medicare Supplement, and Medicare Parts C and D. The registration instructions will guide registrants to the on-line registration form hosted by the State’s contractor Onpoint Health Data. All entities must register annually.
In 2014, the Board approved the implementation of a Data Governance Program. Central to the program is the Data Governance Council which oversees data stewardship in areas of data quality, risk pertaining to data privacy and security, financial sustainability of the VHCURES program, and data release to support research. This five-member council made up of GMCB staff and Board members meets at least once per month in an open, public meeting. Meeting materials for the Data Governance Council are publicly available.
VHCURES Major Milestones
- 2008- Regulation H-2008-01 adopted addressing reporting requirements and data release process.
- 2009- Onpoint Health Data was selected as the state’s data collection and consolidation vendor. Collection of commercial insurance data began spanning an incurred service date of January 1, 2007 through today. Initial implementation focused on identifying commercial insurers. The first two years focused on identifying insurers required to submit data and achieving compliance on date timeliness, completeness, and quality.
- 2010-2011- CMS approved memorandum of agreement between Banking, Insurance, Securities & Health Care Administration (BISHCA) and the Department of Vermont Health Access (DVHA) to allow the integration of Medicaid claims and eligibility data. DVHA worked with BISHCA to map Medicaid data to VHCURES format and begins monthly data submissions.
- 2013- Under a new type of data use agreement (DUA) granting state agencies borad us of Medicare data, CMS granted GMCB a DUA with discretion to re-disclose the VT beneficiary Medicare data to other VT state agencies and entites performing state-directed work partially funded by the state. VT was among the first states given a broad use DUAs.
- 2014- Medicare data was processed and mapped to the VHCURES format and became available for analysis making VHCURES a true all-payer claims database.