Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 740 - OTHER MEDICAID SERVICES (7400) › Section 13 170 740 - OTHER MEDICAID SERVICES (7400)

Current through June, 2024
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 furnished by the clinic
				  incident to covered physicians' services.
7403.1 Mental Health Clinics.
For policies, amount, duration and scope of benefits, and
				  reimbursement rates, see the Department of Mental Health regulations #81-A20.
				  The Department of Mental Health is also responsible for determining provider
				  eligibility as a Community Mental Health Clinic.
7403.2 Indian Health Service Facilities.
Indian Health Service facilities are accepted as providers on
				  the same basis as other qualified providers. The facility need not obtain a
				  license, but must meet all applicable standards for licensure.
7403.3 Rural Health Clinics.
Coverage is limited to rural health clinics which have been
				  certified for participation in Medicare as evidenced by a current agreement
				  signed by the Secretary of HEW.
Reimbursable rural health clinic services are:
Services performed by a physician who is employed by the
				  clinic to provide such services; and
Services and supplies incident to a physician's service if
				  they are of a type commonly furnished in physicians' offices; of a type
				  commonly rendered either without charge or included in the rural health
				  clinic's bill; furnished as an incidental, although integral, part of a
				  physician's service; furnished under the direct, personal supervision of a
				  physician; and, in the case of a service, furnished by a member of the clinic's
				  health care staff. Only drugs and biologicals which cannot be self-administered
				  are included in this benefit (see Section M800 for pharmaceutical items);
				  and
Nurse practitioner and physician assistant services if they
				  are furnished by a qualified professional employed by the clinic; furnished
				  under the medical supervision of a physician; furnished in accordance with
				  medical orders prepared by a physician; of a type the practitioner is legally
				  permitted to perform in the State; and of a type that would be coverable if
				  furnished by a physician; and
Services and supplies incident to a nurse practitioner's or
				  physician assistant's services if they are of a type commonly furnished in
				  physicians' offices; of a type commonly rendered either without charge or
				  included in the clinic's bill; furnished as an incidental, although integral,
				  part of professional services of a nurse practitioner or physician assistant
				  service; furnished under direct personal supervision of a nurse practitioner or
				  physician assistant; and, in the case of a service, furnished by a member of
				  the clinic's health care staff. Only drugs and biologicals which cannot be
				  self-administered are included in this benefit (see Section M800 for
				  pharmaceutical items).
Payment for rural health clinic services will be made in
				  accordance with rates established for purposes of reimbursement under Medicare
				  as provided in 42 CFR 405.2425.