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This rule sets the requirements for the Agency of Human Services (AHS) to designate nonprofit agencies (“Designated Agencies”) to deliver community mental health and intellectual/developmental disability services in specific geographic areas of Vermont. It also outlines the responsibilities of “Specialized Service Agencies,” which AHS assigns to provide either community mental health or intellectual/developmental disability services statewide. This rule updates rule 24-020 by incorporating provisions from the Provider Agreement applicable to Designated and Specialized Service Agencies which specifies administrative and operational responsibilities.

This new rule, "Estate Recovery," outlines the Medicaid Estate Recovery Procedure. Estate recovery is a federal requirement for states to recover certain Medicaid benefits paid on behalf of a Medicaid enrollee from the individual's estate. The rule needs to be updated to be added to the Health Care Administrative Rules (HCAR). The rule amends the estate recovery provisions from Medicaid Covered Services Rule 7108 "Third Party Liability". The amendments in this new rule include adding a definitions section for clarity and increasing the undue hardship estate value threshold.

This rule, Medicaid Covered Services Rule 7108 Third Party Liability, is being amended to remove the estate recovery language and adopt that language into a new rule. Estate recovery is a federal requirement for states to recover certain Medicaid benefits paid on behalf of a Medicaid enrollee from the individual's estate. This rule is not being amended other than to remove the estate recovery section.

This proposed rulemaking amends the Refugee Medical Assistance rule which was last amended effective November 1, 2019. This proposed rule establishes criteria and process used to determine eligibility and provide coverage under the Refugee Medical Assistance program. Updates to this rule are strictly formal, adopting the federal APA outline standard, as required for implementation within the Agency's upcoming eligibility and enrollment technology system. There are no substantive changes to this rule.

The Department of Disabilities, Aging and Independent Living (DAIL) has long relied on policies and program standards to determine eligibility for, and to administer, Brain Injury Program (BIP) services. DAIL now seeks to codify these policies and standards through the adoption of this new rule, which will modernize some definitions, add clarity regarding continued clinical eligibility, incorporate a required Medicaid policy regarding paying legally responsible individuals, insert federally required Electronic Visit Verification, and add an updated Case Management definition, along with a new "Service Broker" service to comply with federally required Conflict-Free Case Management rules. Once adopted, these BIP Rules will be incorporated into the Health Care Administrative Rules, a set of rules for all Vermont Medicaid services, which is maintained by the Agency of Human Services (AHS).