Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 007 - SPECIALIZED SERVICES AND PROGRAMS › Section 13 174 007 - SPECIALIZED SERVICES AND PROGRAMS

Current through June, 2024
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 specialized service agency.
1.3 "Appeal" means a request for an internal
				review of an action by the Department or a designated agency or a specialized
				service agency (DA/SSA). (See Part 8).
1.4 "Applicant" means a person who files a
				written application for services, supports or benefits in accordance with Part
				4 of these regulations. If the applicant is a guardian or family member or a
				designated agency, the term "applicant" also includes the person with a
				developmental disability.
1.5
				"Authorized Funding Limit" (AFL) means all funding related to an individual's
				home and community-based services budget, including the administration amount
				available to transfer (as specified in division policy), but does not include:
				funding for state and local crisis services, the Fiscal Employer/Agent and
				statewide communication resources.
1.6 "Certification" means the process by
				which the Department of Disabilities, Aging and Independent Living determines
				whether a provider meets minimum standards for receiving funds it administers
				to provide services or supports to people with developmental disabilities.
1.7 "Certified provider" means an
				agency that has as one of its primary purposes to deliver services and supports
				for people who have developmental disabilities and that currently is certified
				by the Department of Disabilities, Aging and Independent Living in accordance
				with Part 10 of these regulations.
1.8 "Clinical Services" means assessment;
				individual, family and group therapy; and medication or medical services
				provided by clinical or medical staff, including a qualified clinician,
				therapist, psychiatrist or nurse. Clinical Services are medically necessary
				services and equipment (such as dentures, eyeglasses, assistive technology)
				that cannot be accessed through the Medicaid State Plan.
1.9 "Commissioner" means the Commissioner of
				the Department of Disabilities, Aging and Independent Living.
1.10 "Community Supports" means support
				provided to assist individuals to develop skills and social connections. The
				supports may include teaching and/or assistance in daily living, support to
				participate in community activities, and building and sustaining healthy
				personal, family and community relationships. Community Supports may involve
				individual supports or group supports (two or more people). Supports must be
				provided in accordance with the desires of the individual and their Individual
				Support Agreement and take place within settings that afford opportunities for
				choice and inclusion that are consistent with federal home and community-based
				services rules.
1.11 "Crisis
				Services" means time-limited, intensive supports provided for individuals who
				are currently experiencing, or may be expected to experience, a psychological,
				behavioral, or emotional crisis. Crisis Services may include crisis assessment,
				support and referral or crisis beds and may be individualized, regional or
				statewide.
1.12 "Day" means
				calendar day, not business day, unless otherwise specified.
1.13 "Department" means the Department of
				Disabilities, Aging and Independent Living.
1.14 "Designated Agency" (DA) means an agency
				designated by the Department, pursuant to 18 V.S.A. 8907 , and the regulations
				implementing that law, to oversee, provide and ensure the delivery of services
				and/or service authorizations for eligible individuals with developmental
				disabilities in an identified geographic area of the state. The requirements
				for being a DA are explained in the Department's Administrative Rules on Agency
				Designation.
1.15 "Designated
				Representative" means an individual, either appointed by an applicant for or
				recipient of developmental disabilities services or authorized under State or
				other applicable law, to act on behalf of the applicant or recipient in
				obtaining a determination or in participating in any of the levels of the
				appeal, fair hearing or grievance process. Unless otherwise stated in these
				regulations, the designated representative has all of the rights and
				responsibilities of an applicant or recipient in obtaining a determination or
				in dealing with any of the levels of the appeal, fair hearing or grievance
				process.
1.16 "Developmental
				Disability" (DD) means an intellectual disability or an Autism Spectrum
				Disorder which occurred before age 18 and which results in significant deficits
				in adaptive behavior that manifested before age 18 (See Part 2). Temporary
				deficits in cognitive functioning or adaptive behavior as the result of severe
				emotional disturbance before age 18 are not a developmental disability. The
				onset after age 18 of impaired intellectual or adaptive functioning due to
				drugs, accident, disease, emotional disturbance, or other causes is not a
				developmental disability.
1.17
				"Division" means the Developmental Disabilities Services Division (DDSD) within
				the Department.
1.18 "Employment
				Supports" means support provided to assist transition age youth and adults in
				establishing and achieving work and career goals. Employment supports include
				assessment, employer and job development, job training and ongoing support to
				maintain a job, and may include environmental modification, adaptive equipment
				and transportation, as necessary.
1.19 "Family" means a group of individuals
				that includes a person with a developmental disability and that is related by
				blood, marriage or adoption or that considers itself a family based upon bonds
				of affection, which means enduring ties that do not depend upon the existence
				of an economic relationship.
1.20
				"Fiscal Employer/Agent" (FE/A) means an organization that is:
(a) Qualified under Internal Revenue Service
				rules to pay taxes and provide payroll services for employers as a fiscal
				agent; and
(b) Under contract with
				the Department to handle payroll duties for shared living providers who hire
				workers and recipients or families who choose to self/family-manage services.
1.21 "Global Commitment
				to Health Section 1115 Demonstration" ("Demonstration") means the Section 1115
				Demonstration under which the Federal government waives certain Medicaid
				coverage and eligibility requirements found in Title XIX of the Social Security
				Act.
1.22 "Home and Community-Based
				Services" (HCBS) means an array of long term services developed to support an
				individual to live and participate in his/her home and community rather than in
				an institutional setting, consistent with Centers for Medicare and Medicaid
				Services (CMS) federal HCBS Rules.
1.23 "Home Supports" means services, supports
				and supervision provided for individuals in and around their residences up to
				24 hours a day, seven days a week (24/7). Services include support for
				individuals to acquire and retain life skills and improve and maintain
				opportunities and experiences for individuals to be as independent as possible
				in their home and community. Services include maintaining health and safety and
				home modifications required for accessibility related to an individual's
				disability, including cost-effective technology that promotes safety and
				independence in lieu of paid direct support. Home supports shall be in
				compliance with HCBS rules which emphasize choice, control, privacy, tenancy
				rights, autonomy, independence and inclusion in the community.
1.24 "Individual" means a young child, a
				school-age child or an adult with a developmental disability.
1.25 "Individual Support Agreement" (ISA)
				means the agreement between an individual and an agency or Supportive
				Intermediary Service Organization that describes the plan of services and
				supports.
1.26 "In-service
				training" means training that occurs after a worker has been employed or is
				under contract. In-service training is intended to promote professional
				development and increase skills and knowledge.
1.27 "Network" means providers enrolled in
				the Vermont Medicaid program who are designated by the Commissioner to provide
				or arrange developmental disabilities services and who provide services on an
				ongoing basis to recipients.
1.28
				"Pre-service training" means training that occurs before workers are alone with
				a person with developmental disabilities.
1.29 "Provider" means a person, facility,
				institution, partnership or corporation licensed, certified or authorized by
				law to provide health care service to a recipient during that individual's
				medical care, treatment or confinement. A provider cannot be reimbursed by
				Medicaid unless they are enrolled with Medicaid; however, a provider may enroll
				to serve only a specific recipient. A developmental home provider, employee of
				a provider, or an individual or family that selffamily-manages services is not
				a provider for purposes of these regulations.
1.30 "Psychologist" means a person licensed
				to practice psychology in the state where the evaluation occurred.
1.31 "Qualified Developmental Disabilities
				Professional" (QDDP) means a person who meets the Department's qualifications
				as specified in Department policy for education, knowledge, training and
				experience in supporting people with developmental disabilities and their
				families.
1.32 "Recipient" means a
				person who meets the criteria contained in these regulations, and who has been
				authorized to receive funding or services, or a family that has been approved
				to receive funding or services under criteria specified in these regulations.
1.33 "Resident" means a person who
				is physically present in Vermont and intends to remain in Vermont and to make
				his or her home in Vermont, except a resident may also be:
(a) A person placed in an out of state
				school, facility, correctional center, or hospital by a department of the State
				of Vermont; or
(b) A person placed
				and supported in an unlicensed home in an adjoining state by a Vermont agency;
				or
(c) A person who meets criteria
				listed in Section 3.2.
1.34 "Respite Supports" means alternative
				caregiving arrangements for family members or home providers/foster families
				and the individual being supported, on an intermittent or time limited basis,
				because of the absence of or need for relief of those persons normally
				providing the care to the individual, when the individual needs the support of
				another caregiver.
1.35
				"Selffamily-managed" services means the recipient or his or her family plans,
				establishes, coordinates, maintains, and monitors all developmental
				disabilities services and manages the recipient's budget within federal and
				state guidelines.
1.36 "
				Selffamily-managed worker" means a person who is employed or contracted and
				directed by a recipient or by a family member and paid with Department funds to
				provide supports or services for the recipient.
1.37 "Service" means a benefit:
(a) Covered under the Global Commitment to
				Health Section 1115 Demonstration as set out in the Special Terms and
				Conditions approved by CMS;
(b)
				Included in the State Medicaid Plan if required by CMS;
(c) Authorized by state regulation or law;
				or
(d) Identified in the IGA
				between DVHA and the Agency of Human Services (AHS), DVHA and the departments
				within AHS, or DVHA and the Agency of Education for the administration and
				operation of the Global Commitment to Health Section 1115
				Demonstration.
1.38
				"Service Coordination" means assistance to recipients in planning, developing,
				choosing, gaining access to, coordinating and monitoring the provision of
				needed services and supports for a specific individual. Service Coordination
				responsibilities include, but are not limited to, developing, implementing and
				monitoring the ISA; coordinating medical and clinical services; establishing
				and maintaining a case recor 1ng off on critical incident reports; and
				providing general oversight of services and supports. The provision of Service
				Coordination will be consistent with the HCBS requirements for conflict-free
				case management.
1.39 "Shared
				management of services" means that the recipient or his or her family manages
				some but not all Medicaid-funded developmental disabilities services, and an
				agency manages the remaining services.
1.40 "Special care procedure" means nursing
				procedures that a lay individual (a person who is not a qualified health
				professional) does not typically have the training and experience to
				perform.
1.41 "Specialized service
				agency" (SSA) means an agency designated by the Department that meets criteria
				for contracting with the Department as an SSA, as described in the Department's
				Administrative Rules on Agency Designation, and that contracts with the
				Department to provide services to individuals with developmental
				disabilities.
1.42 "Supportive
				Intermediary Service Organization" (Supportive ISO) means an organization under
				contract with the Department to provide support to individuals and families to
				learn and understand the responsibilities of self/family-managed
				services.
1.43 "Supportive
				Services" means therapeutic services that cannot be accessed through State Plan
				Medicaid. These are therapeutically or medically appropriate services that
				include behavior support and consultation; assessment, consultation and
				training for communication supports; skills-based training such as dialectical
				behavior therapy skills groups or sexuality groups. This includes other
				therapeutic or medically appropriate services not covered under State Plan
				Medicaid when provided by licensed or certified individuals (such therapeutic
				horseback riding).
1.44 "System of
				Care Plan" means the plan required by 18 V.S.A. ¦sect;8725 describing
				the nature, extent, allocation and timing of services that shall be provided to
				people with developmental disabilities and their families.
1.45 "Transportation Services" means
				acquisition and maintenance of accessible transportation for an individual
				living with a home provider or family member or reimbursement for mileage for
				transportation to access Community Supports.
1.46 "Worker" means any employee or
				contractor compensated with funds paid or administered by the Department to
				provide services to one or more people with a developmental disability.
				Professionals, such as nurses or psychologists practicing under a license
				granted by the State of Vermont are not included within this definition.
				Family-hired respite workers paid by Flexible Family Funding are not included
				within this definition.
1.47
				"Young child" means a person who is not yet old enough to enter first grade.