Vermont Administrative Code

Section 2400 Postsecondary Education (PSE). a. The postsecondary education (PSE) program is a solely state- funded (SSF) program to assist parents in eligible households to obtain two- or four- year postsecondary undergraduate degrees. b. The PSE program provides financial assist…

Section 2500 Introduction to Reach Ahead (7/1/2015, 15-08) The Reach Ahead program assists employed families with unsubsidized earnings who have recently left Reach Up or the Postsecondary Education program. The purpose of the program is to assist these families in their transiti…

Section 2600 General Assistance General assistance (GA) is an emergency financial assistance program for eligible applicant households whose emergency needs, according to department standards, cannot be met under any other assistance program administered by the department and can…

Section 2700 Aid to the Aged, Blind or Disabled (AABD) Effective January 1, 1974, the major portion of Vermont's federal-state program of Aid to the Aged, Blind or Disabled (AABD) became the federal program of Supplemental Security Income (SSI) through amendment of title XVI of t…

Section 2800 Emergency Assistance (EA) Emergency assistance (EA) is assistance provided for eligible families with dependent children whose emergency needs, according to department standards, cannot be met under any other assistance program administered by the department and cann…

Section 2900 Fuel Program 11/01/09 The Low-Income Home Energy Assistance Act, Title XXVI of the Omnibus Budget Reconciliation Act of 1981, authorized grants to states to help eligible households with home heating expenses. This act was reauthorized, with amendment, by Title VI of…

Section 3000 Refugee Cash Assistance (RCA) The Refugee Act of 1980 gives the Immigration and Naturalization Service (INS) jurisdiction over an individual who is admitted to the United States as a refugee. The Act will result in a standardized identity for all refugees without reg…

Section 4100 Medicaid Program Medicaid is a federal-state program of financial help with the cost of medical care. Vermont began participating in the Medicaid program in 1967 to assist Vermont 's eligible low income individuals to gain access to needed medical services. The feder…

Section 4200 Medicaid, Aged, Blind, and Disabled Individuals who are aged, blind, or disabled (M211) are eligible for Medicaid if they meet the financial and nonfinancial requirements for participation in the Medicaid program. Financial requirements (M220-M223) relate to the avai…

Section 4300 Medicaid, Families and Children Individuals under age 21 or pregnant, as well as parents and caretaker relatives of a dependent child, are categorically eligible for ANFC-related Medicaid if they meet the nonfinancial and financial requirements for participation in t…

Section 4400 Spenddown, Patient Share, and Resource Transfer The following spenddown, patient share and transfer of resources provisions apply to individuals requesting SSI-related and ANFC-related Medicaid depending on their living arrangement (M401-M401.2). They are calculated …

Section 5100 Refugee Medical Assistance The purpose of Refugee Medical Assistance is to help in the effective resettlement of refugees by providing health coverage to refugees who are not eligible for Medicaid/Pr. Dynasaur. Refugee Medical Assistance (RMA) is authorized by the Re…

Section 5321 Income (05/01/2010, 10-02) Countable income is all earned and unearned income, as defined in this section, less all allowed deductions. Income in the month of application (or review) and future months is estimated based on income in the calendar month prior to the mo…

Section 5400 VPharm Act 71, an Act making appropriations for the support of Government authorized and established VPharm. It was adopted by the Vermont General Assembly and signed into law by the Governor on June 21, 2005. In order to keep Medicare beneficiaries' coverage whole, …

Section 5500 VHAP-Pharmacy Legislative Act 14, authorizing and supporting the Vermont Health Access Plan, was adopted by the Vermont General Assembly and signed into law by the Governor on April 12, 1995. The Vermont Health Access Plan extends a pharmacy benefit and vision care s…

Section 5600 VScript The General Assembly of the State of Vermont, in its 1989 passage of H.228, provided for the establishment of a state pharmaceutical assistance program for low-income elderly and disabled Vermonters. The Law, Act No. 48, be-came effective July 1, 1989. The pr…

Section 5700 Healthy Vermonters The legislature authorized the creation of the Healthy Vermonters program with the passage of Act 127 (2002). This program provides a pharmacy discount to eligible Vermonters, helping beneficiaries purchase prescription medicines necessary to maint…

Section 5800 Introduction The General Assembly of the State of Vermont, in its 1992 passage of H.937, directed the Department of Social Welfare to develop an "HIV/AIDS Health Insurance Assistance Program." Specifically, Section 124 of H. 937 directs that: (a) The Department of So…

Section 5900 Premium Assistance In 2006, the Vermont Legislature enacted Act 191, An Act Relating to Health Care Affordability for Vermonters. Among other things, the new law created four new health-care programs, designed to expand Vermonters' access to quality, affordable healt…

Section 7101 Medicaid Benefit Delivery (06/01/2018, GCR 17-090) 7101.1 Overview The following includes steps the department, the eligible Medicaid beneficiary and the medical care provider must take for the provider to receive payment for services given to the beneficiary. (a) Th…

Section 7201 Inpatient Services - Medical and Psychiatric Coverage for inpatient services is limited to hospitals included in the Green Mountain Care Network. These hospitals are: A Vermont hospital approved for participation in Medicare; or Out-of-state hospitals that are includ…

Section 7301 Physicians and Other Licensed Practitioners Coverage of physician and other licensed practitioner services are limited to: Vermont physicians and other specified practitioners licensed by the appropriate licensing agency of the State; or Out-of-State physicians and o…

Section 7401 Renumbered Section 7402 Renumbered Section 7403 Clinic Services Covered clinic services include the following: Covered physicians' services billed by the clinic on the physician's behalf under an agreement with the physician; and Services and medical supplies furnish…

Section 7508 Prosthetic Devices. A prosthetic device is a replacement, corrective or supportive device to: 1) artificially replace a missing portion of the body; 2) prevent or correct physical deformity or malfunction; or 3) support a weak or deformed portion of the body. Prosthe…

Section 7601 Long-Term Care Services These regulations apply to all long-term care services for Medicaid beneficiaries of any age. For beneficiaries age 18 or over, regulations promulgated by the Department of Disabilities, Aging, and Independent Living (DAIL) through the "Choice…

Section 7701 Pharmaceutical Manufacturer Fee Act 80, of the 2007 legislative session, an Act relating to increasing transparency of prescription drug pricing and information, established a manufacturer fee under 33 V.S.A. § 2004 . A fee shall be collected annually by the Agency o…

Section 1.00 General Provisions. The Agency of Human Services (AHS) is the adopting authority for the Immigrant Health Insurance Plan administrative rule. The Immigrant Health Insurance Plan was enacted by the Vermont General Assembly in Act 48 of 2021 and is codified in state st…

Section I A Introduction The purpose of these regulations is to implement the Child Care Subsidy Program described in Vermont Statutes, 33 V.S.A. § 3512 - 3514 , and in U.S. Department of Health and Human Services, Administration for Children and Families, 45 CFR, Parts 98 and 99…

I. Purpose. a. These rules establish the STep Ahead Recognition System (STARS), Vermont's Quality Recognition and Improvement System (QRIS) for Center Based Child Care and Preschool programs, Family Child Care Homes, and Afterschool Child Care programs. The purpose of STARS is to…

Child Care Licensing Regulations govern child care facilities and programs in the State of Vermont. These rules are minimum requirements established to protect the health and safety of Vermont's children in out-of-home care and ensure that children in child care programs in Vermo…

FOREWORD Child Care Licensing Regulations govern child care facilities and programs in the State of Vermont. These rules are minimum requirements established to protect the health and safety of Vermont's children in out-of-home care and ensure that children in care, early educati…

LICENSING REGULATIONS FOR REGISTERED AND LICENSED FAMILY CHILD CARE HOMES FOREWORD Child Care Licensing Regulations govern child care facilities and programs in the State of Vermont. These rules are minimum requirements established to protect the health and safety of Vermont's ch…

Statutory Authority. Pursuant to 33 VSA, § 306(b)(1)-(7) and 3501 , the Vermont Department for Children and Families is the agency of government authorized and responsible for the regulation of Residential Treatment Programs for children/youth and the promulgation of standards go…

Section 2000 Purpose and Statutory Authority The broad purpose of these regulations is to: 1. Protect children whose health and welfare may be adversely affected through abuse or neglect; 2. Strengthen the family and make the home safe for children whenever possible; 3. Provide a…

Section 3000 Purpose and Statutory Authority This rule is effective March 1, 2019. These rules cover the following: 1. The conduct of reviews of substantiation decisions. 2. The criteria for determining risk levels for the purposes of eligibility to petition for expungement from …

Section 7000 Introduction These rules have been established to provide for a range of age-appropriate services for youth to help ensure a successful transition to adulthood, including the avoidance of homelessness, incarceration, and substance abuse, and to enable youth to become…

Section 8000 Introduction These rules have been established to provide guidance regarding the Child Protection Registry that reflects a designated child protection level related to the risk of future harm to children. The commissioner will maintain a child protection registry, wh…

Section 9000 Purpose and Statutory Authority These rules have been established to provide guidance regarding appropriate maintenance and access to records of the Department that are created under the authority of 33 V.S.A. Chapter 49, subchapter 2. Nothing in these rules is inten…

Section I Introduction The SANE Board is established to regulate sexual assault nurse examiners (SANEs) in Vermont, and oversee the Vermont SANE Program. The SANE Board shall set standards for and provide Vermont certification of SANEs and Pediatric SANEs, and may investigate com…

1.100 Health Care Administrative Rules Introduction. (12/16/2016, GCR 16-076) (a) The Agency of Human Services is the "single State agency," pursuant to 42 U.S.C. 1396a(a)(5) , responsible for the operation of the Medicaid program in Vermont. (b) The Agency of Human Services admi…

4.212 Prosthetic and Orthotic Devices. (5/1/2023, GCR 22-099) 4.212.1 Definitions (a) "Prosthetic devices" means replacement, corrective, or supportive devices to: artificially replace a missing portion of the body, prevent or correct physical deformity or malfunction, or support…

3.101 Telehealth. (01/07/2019, GCR 18-037) 3.101.1 Definitions For the purposes of this rule, the term: (a) "Telehealth" means methods for health care service delivery using telecommunications technologies. Telehealth includes telemedicine, store and forward, and telemonitoring. …

SUBCHAPTER 1 GENERAL PROVISIONS 4.101 Medical Necessity for Covered Services. (07/01/20, GCR 19-060) 4.101.1 Definitions (a) "Ameliorate" means to improve or maintain a beneficiary's health in the best condition possible, compensate for a health problem, prevent it from worsening…

4.221 Podiatry Services. (5/1/2023, GCR 22-099) 4.221.1 Definitions (a) "Podiatry services" means the diagnosis and treatment of ailments of the foot, ankle, and lower extremity. 4.221.2 Covered Services (a) Vermont Medicaid covers medically necessary podiatry services. (b) Routi…

Section 6.100 Medicaid Cost Sharing (01/01/2020, GCR 19-058) Section 6.100.1 Cost sharing, including deductibles, co-insurance, or copayments, is charged to Medicaid beneficiaries as set forth in this rule. Section 6.100.2 Copayment Requirements (a) Medicaid enrolled beneficiarie…

7.100 CHOICES FOR CARE Part 1 Definitions The following terms are defined for the purpose of these regulations. 1.1 "Adult" means a person age 18 or older. The term includes people age 18 or older who attend school. 1.2 "Agency" means the responsible designated agency or speciali…

8.100 INTERNAL APPEALS, GRIEVANCES, NOTICES, AND STATE FAIR HEARINGS ON MEDICAID SERVICES (06/01/2018, GCR 17-090) 8.100.1 Introduction and Applicability Rule 8.100 implements the responsibilities of the Medicaid Program pursuant to 42 CFR § 438, Subpart F, regarding a grievance …

Section 9.103 Supervised Billing (2/22/18, GCR 17-073) Section 9.103.1 Definitions For the purposes of this rule, the term (a) "Qualified Licensed Provider" means a provider who is licensed and enrolled in Vermont Medicaid and acting within his or her scope of practice. (b) "Qual…

4.228 Transplantation Services. (5/1/2023, GCR 22-099) 4.228.1 Definitions For the purposes of this rule, the term: "Transplantation services" means a medical procedure performed to replace a diseased or damaged body part with a healthy one. 4.228.2 Covered Services Vermont Medic…

Part I DEFINITIONS PERSONNEL 1.010 Airman. An individual who engages in air navigation of aircraft and (excepting an individual employed outside the United States or by a manufacturer of aircraft, aircraft engines, propellers or appliances to perform duties as inspector or mechan…