Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 760 - LONG-TERM CARE SERVICES (7600) › Section 13 170 760 - LONG-TERM CARE SERVICES (7600)

Current through June, 2024
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 "Choices for Care 1115 Long-Term Care
				  Medicaid Waiver" program (Social Security Act Section 1115 Demonstration
				  Project Number 11-W-00191/1) shall be controlling if they conflict with the
				  provisions in this chapter (7601 - 7606).
The Medicaid Program (Title XIX) includes long-term care
				  services provided to eligible beneficiaries in the following settings.
A. Nursing Facilities (NF's)
A Nursing Facility provides, directly or by contract, room,
				  board, skilled nursing and rehabilitation services on a 24-hour a day basis to
				  assist beneficiaries to reach their optimal level of functioning.
All nursing facilities, pursuant to Section 1910(2) of the
				  Social Security Act, have been certified for participation in Medicare or, if
				  not participating in Medicare, have been continuously certified since July 1,
				  1980 for participation as a nursing facility as evidenced by a valid
				  certification agreement on file with the Office of Vermont Health
				  Access.
An out-of-state nursing facility must be participating in
				  that state's Medicaid program as well as enrolled as a Vermont Medicaid
				  provider. An in-state nursing facility (or distinct part of a facility) must be
				  licensed by DAIL and enrolled as a Vermont Medicaid provider, in order to be
				  reimbursed.
1. Rehabilitation Center
				Services
Coverage of rehabilitation center services is limited to
				  Medicare-certified nursing facilities, licensed and approved for Medicaid
				  participation by the state where the facility is located, and enrolled as a
				  Vermont Medicaid provider. These services include intensive sensory
				  stimulation; intensive physical, speech and occupational therapy; adjustment
				  counseling; training in the use of prosthetics, orthotics and durable medical
				  equipment; and other medical services needed to improve the beneficiary's daily
				  living skills and/or to facilitate recuperation from disease, injury, or
				  medical event. Care must be supervised by physician specialists. The purpose of
				  rehabilitation center services is to restore a beneficiary's functional
				  abilities to the highest practical level of physical and/or mental
				  self-sufficiency which will prepare the beneficiary for discharge. The
				  discharge plan will provide for the active participation and training of family
				  members, if appropriate.
Coverage is limited to one year unless an extension beyond
				  one year is granted by DAIL when documented medical evidence shows that the
				  beneficiary is continuing to demonstrate significant physical and/or mental
				  progress and can reasonably be expected to be discharged to the setting for
				  care established in the discharge plan. Under no condition will authorization
				  extend beyond two years.