(a)Subject to the provisions of subsection (b) of this section, the Commissioner of Vermont Health Access shall contract on an annual basis with individuals or private organizations to provide services authorized by this chapter to dual eligible individuals including pursuit of subrogation claims under section 6705 of this chapter.
(b)The Commissioner shall not be required to enter into contracts under this section if both of the following conditions are met:
(1)The amount of the State’s share of recoveries to the Medicaid program from awards obtained under this chapter during the preceding year did not exceed the payments to the contractors during that year.
(2)The Commissioner determines that the program is not accomplishing its goal of protecting dual eligible individuals from impro
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(a) Subject to the provisions of subsection (b) of this section, the Commissioner of Vermont Health Access shall contract on an annual basis with individuals or private organizations to provide services authorized by this chapter to dual eligible individuals including pursuit of subrogation claims under section 6705 of this chapter.
(b) The Commissioner shall not be required to enter into contracts under this section if both of the following conditions are met:
(1) The amount of the State’s share of recoveries to the Medicaid program from awards obtained under this chapter during the preceding year did not exceed the payments to the contractors during that year.
(2) The Commissioner determines that the program is not accomplishing its goal of protecting dual eligible individuals from improper denials of Medicare coverage. The Commissioner shall base this determination on information obtained from the contractors, providers of health care, area agencies on aging, and other individuals and organizations affected by the program. (Added 1989, No. 259 (Adj. Sess.), § 2; amended 1999, No. 147 (Adj. Sess.), § 4; 2005, No. 174 (Adj. Sess.), § 128; 2009, No. 33, § 68; 2009, No. 156 (Adj. Sess.), § I.77; 2021, No. 20, § 341.)