Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 110 - DEPARTMENT OF DISABILITIES, AGING AND INDEPENDENT LIVING › Chapter 002 - ATTENDANT SERVICES PROGRAM REGULATIONS › Section 13 110 002 - ATTENDANT SERVICES PROGRAM REGULATIONS

Current through June, 2024
POLICY
It is the policy of the Department of Disabilities, Aging
				  and Independent Living to make Vermont the best state in which to grow old or
				  to live with a disability with dignity, respect and independence. Toward these
				  ends, the programs of this division are administered in ways which:
a. Focus first and foremost on the needs,
				interests, and abilities of their participants as individuals;
b. Enable participants to exercise as much
				control as they wish and as they can over the direction and provision of their
				services.
It is the policy of the Department to use Medicaid funding to
				  support attendant services when the applicant or participant is eligible for
				  Medicaid-funded attendant services and to use available General Fund monies to
				  support attendant services only when this is not feasible.
ATTENDANT SERVICES PROGRAM REGULATIONS
Section 101 Statutory Basis
These regulations are promulgated pursuant to
				  33 V.S.A. §
												6321(d), relating to the
				  provision of attendant services.
Section
				102 Purpose
While attendant services may not be sufficient, by
				  themselves, to enable persons with disabilities to gain or retain independence,
				  they are a necessary component of any service system with that goal. It is the
				  purpose of the Attendant Services Program to assist individuals to gain or
				  retain independence by paying, within the limits of available funds, for
				  attendant services in Vermont for eligible adult Vermonters residing in
				  settings where such services are not otherwise available. It is also the
				  purpose of the Attendant Services Program to enable its participants to
				  exercise as much control as they wish and as they can over the direction and
				  provision of their attendant services.
Section 103 Definitions
As used in these regulations:
(a) "Action" means an occurrence of one or
				more of the following by the Department for which an internal appeal maybe
				requested:
1. denial or limitation of
				authorization of a requested covered service or eligibility for service,
				including the type, scope or level of service;
2. reduction, suspension or termination of a
				previously authorized covered service or a service plan;
3. denial, in whole or in part, of payment
				for a covered service; or
4.
				failure to act in a timely manner when required by state rule.
(b) "Activities of daily living"
				(ADL) means the assistance with activities required for eligibility for the
				Attendant Services Program, which include:
1.
				dressing and undressing;
2. bathing
				and showering;
3.
				grooming;
4. toileting;
5. transferring;
6. bed mobility;
7. range of motion exercises;
8. positioning;
9. eating; and
10. ambulation and mobility in and around the
				home.
(c) "Adult" means
				an individual at least 18 years old.
(d) "Agent" means an individual who acts on
				behalf of the participant to provide the physical assistance needed to sign
				employee time sheets. An agent is not permitted to act in lieu of the
				participant to direct his or her own care. If a participant has a power of
				attorney but can no longer direct that individual, the individual cannot act as
				an agent for the participant.
(e)
				"Appeal" means a request for an internal review of an action by the
				Department.
(f) "Applicant" means
				an individual who has submitted to the Department a completed application for
				attendant services.
(g) "Attendant
				services" means assistance with personal care (including dressing, bathing,
				shaving, and grooming), eating, meal preparation, and ambulation.
				33 V.S.A. §
												6321(a).
(h) "Department" means the Department of
				Disabilities, Aging and Independent Living.
(i) "Designee" means a person who is named or
				chosen by the applicant to complete and/or submit the ASP application on the
				applicant's behalf, such as a person holding a Power of Attorney, legal
				guardian or family member.
(j)
				"Eligible for Medicaid" means that an individual meets the requirements for
				community Medicaid. Individuals who have a "spend down" requirement are
				considered to be eligible for Medicaid for purposes of determining eligibility
				for the Attendant Services Program.
(k) "Expedited Appeal" means an appeal in an
				emergent situation in which taking the time for a standard resolution could
				seriously jeopardize the beneficiary's life or health or ability to attain,
				maintain, or regain maximum function.
(l) "Grievance" means an expression of
				dissatisfaction about any matter that is not an action, such as the quality of
				care or service provided or aspects of interpersonal relationships, such as
				rudeness of a provider or employee or failure to respect the participant's
				rights. If a grievance is not acted upon within the timeframes specified in
				rule, the participant may ask for an appeal under the definition of an action
				as being "failure to act in a timely manner when required by state rule." If a
				grievance is composed of a clear report of alleged physical harm or potential
				harm, the Department will immediately investigate or refer to the appropriate
				investigatory body (fraud, malpractice, professional regulation board, Adult
				Protective Services.)
(m) "Infant
				and child care" means bathing, dressing and feeding a non-Medicaid
				participant's infant or child to the extent that and only so long as the child
				cannot perform these tasks.
(n)
				"Instrumental Activities of Daily Living" (IADL) means physical assistance
				with:
1. light housekeeping;
2. household maintenance;
3. laundry;
4. shopping;
5. transportation;
6. meal preparation; and
7. medication management.
For the purpose of the Attendant Services Program, IADL also
				  includes physical help with infant- and child-related tasks such as bathing,
				  dressing and feeding, to the extent that the child cannot perform these tasks
				  (this service can be reimbursed under general funds services but cannot be
				  reimbursed under Medicaid PDAC); care of support animals such as seeing-eye
				  dogs and hearing-ear dogs; guiding a participant who is blind or visually
				  impaired from place to place; general care and cleaning of adaptive tools and
				  equipment; and managing personal finances and mail, including paying bills and
				  writing checks.
(o) "Participant" means an individual for
				whom attendant services have been authorized in accordance with these
				regulations.
(p)
				"Participant-directed" means services that are managed and controlled by an
				individual who is capable of assuming responsibility for, among other tasks,
				recruiting, hiring, training, scheduling, supervising and terminating an
				employee.
(q) "Permanent and severe
				disability" means a physical disability that is anticipated to last the
				duration of the individual's life that limits the individual's physical ability
				to perform activities of daily living (ADLs) and that is directly associated
				with a need for physical assistance with ADLs.
(r) "Personal assistant" means a person who,
				for compensation, provides attendant services.
Section 104 Applications
Application forms for the Attendant Services Program shall be
				  available on the Department's website, at any office of the Department, and
				  shall be made available to prospective applicants at generally accepted sources
				  of referral for attendant services, such as independent living centers, area
				  agencies on aging, rehabilitation centers, nursing homes, and hospital
				  discharge units. For an individual to be considered for the Program, the
				  Department must receive an application from the applicant or his or her
				  designee.
Section 105
				Eligibility Criteria
(a) General. To be
				eligible for any services, a person must meet specific eligibility requirements
				for a category of services (listed in subsections b, c, d and e below), be an
				adult resident of Vermont in need of attendant services to gain or retain
				independence, and meet the requirements listed in subsection f below.
(b) Personal Services. To be eligible for
				services under Personal Services, an individual shall be actively enrolled on
				one of the Attendant Services Programs but no longer able to direct his or her
				own care and shall:
1. Have a
				disability;
2. Be eligible to
				receive community Medicaid; and
3.
				Need attendant services for at least one activity of daily living or meal
				preparation.
(c)
				Participant-Directed Attendant Services. To be eligible for
				Participant-Directed Attendant Services, an individual shall:
1. Have a permanent and severe
				disability;
2. Need attendant
				services for at least two activities of daily living;
3. Be capable of directing his or her
				attendant care services; and
4. Be
				ineligible for any other Medicaid or state -funded programs.
(d) Medicaid Participant-Directed
				Attendant Services. To be eligible for Medicaid Participant-Directed Attendant
				Services, an individual shall:
1. Have a
				permanent and severe disability;
2.
				Need attendant services for at least two activities of daily living;
3. Be capable of directing his or her
				attendant care services;
4. Be
				eligible for community Medicaid; and
5. Be able and willing to employ attendants
				other than his or her spouse or civil union partner.
(e) Group Directed Attendant Services. To be
				eligible for Group Directed Attendant Services, an individual shall:
1. Have a permanent and severe
				disability;
2. Need attendant
				services for at least two activities of daily living;
3. Need no fewer than four hours of attendant
				services daily;
4. Live as part of
				a group of eligible individuals in a group living situation, approved by the
				Department;
5. Be capable of
				directing his or her attendant care services; and
6. Be ineligible for any other Medicaid or
				state-funded programs.
To the extent that funds are available for this purpose, the
				  Department will support the development of Group Directed Attendant
				  Services.
(f)
				Other available sources of payment. An individual who is eligible for
				Medicaid-funded personal care or attendant care services shall not be eligible
				to receive services from the following options paid for by the General Fund:
				Personal Services, Participant-Directed Attendant Services or Group-Directed
				Attendant Services. As a condition of receiving services under General Fund
				Personal Services, Participant-Directed Attendant Services or Group-Directed
				Attendant Services, an individual shall be required by the Department to apply
				and be found ineligible for services from other Medicaid-funded personal care
				or attendant care services programs.
1. If a
				participant employs his or her spouse, and the spouse lives in the household
				with the participant, and if participation in the Choices for Care Medicaid
				Waiver Program would mean that the spouse could no longer be paid to perform
				IADL services for the participant, the participant may continue to participate
				in the Attendant Services Program.
Section 106 Services
Program funds are available to pay for assistance with
				  activities of daily living (ADLs) and instrumental activities of daily living
				  (IADLs) for eligible individuals. Assistance with IADLs shall be limited to a
				  maximum of 50% of the total award.
Section 107 Extent of Services
(a) Maximum. The Department may authorize
				payment for up to 13 hours of attendant services per day every day of the year,
				to the extent they are determined by the Department to be needed by the
				applicant or participant.
(b)
				Flexibility. A participant may, within each two-week period, adapt to his or
				her variable needs the total number of hours for which attendant services are
				authorized.
(c) Duration. Subject
				to the availability of funding, individual participants may continue to receive
				attendant services as long as they remain eligible.
(d) Insufficient program general funds. If
				program general funds are insufficient to meet the needs of all eligible
				applicants for general fund services, the Department shall maintain applicant
				waiting lists for each general fund service, by date of submission of completed
				application, and shall determine eligibility and admit eligible applicants to
				the program, as general funds become available, in the order in which they
				apply.
(e) Absences from the State.
				Program funds may be used to pay for attendant services for participants who
				are absent from Vermont for a period not to exceed six weeks. When an absence
				from Vermont exceeds six weeks, the Department may consider the specific
				circumstances of the participant in deciding whether to continue such
				payment.
(f) Special Circumstances.
				Depending on availability of funds, a temporary increase in hours may be
				approved for a participant to meet an immediate need for additional attendant
				services caused by events such as recovery from an illness or a sudden change
				in other services and supports.
Section 108 Participants
(a) Oversight of personal assistants.
				Participants, except for those receiving services under Personal Services,
				shall direct the provision of their attendant services.
1. A participant in Participant-Directed
				Attendant Services or Medicaid Participant-Directed Attendant Services shall
				accept personal responsibility for all of the requirements listed below
				regarding his or her personal assistant.
2. A participant in Personal Services shall
				designate another person as an agent to carry out some or all of the
				requirements listed below regarding the personal assistant. If the participant
				has a guardian, the Department shall require the guardian to accept personal
				responsibility for all of the requirements listed below regarding the personal
				assistant(s). If the Department has reason to believe the participant or the
				person designated to carry out these requirements is unsuitable to do so, it
				may require someone else to be designated to do so.
3. With respect to Group Directed Services,
				the group itself shall incorporate these requirements in accordance with its
				own governing rules.
4.
				Participants are responsible for carrying out all of the following tasks:
i. Hiring, training, supervision, and filing
				of personal assistants;
ii.
				Establishing work schedules;
iii.
				Approving personal assistant time reports and submitting them to the Department
				or the designated payroll agent;
iv. Assuring that all benefits to which the
				personal assistant is entitled are provided;
v. Keeping payroll records; and
vi. Maintaining any other records as
				determined by the participant or as required by the Department.
(b) Payroll reports.
				Participants shall submit payroll reports as required by the established
				payroll procedures and schedule,
(c) Department requests. Participants shall
				provide all information requested by the Department, including surveys of all
				program participants conducted for planning and evaluation purposes.
(d) Compliance with laws. Participants shall
				comply with all federal and state laws affecting employment relationships,
				including but not limited to such matters as hiring, benefits, insurance,
				conditions of work, and firing.
(e)
				Notice of changes. Participants or their agent or guardian, if applicable,
				shall notify the Department as soon as possible about any of the following
				matters:
1. Changes in name, address,
				telephone number, personal assistant, amount of attendant services needed, or
				guardianship, or agent, if any;
2.
				Plans to leave the State temporarily or permanently; or actual absences from
				the State for more than six weeks;
3. Hospitalization;
4. Stays in residences (such as residential
				care homes or nursing homes) where attendant services are available to
				residents;
5. Changes in Medicaid
				eligibility;
6. Changes in the type
				or amount of assistance services received through any other source or program
				(such as a home health agency service, or a homemaker service);
				and/or
7. Changes in need for
				attendant services (including changes in disability status, functional
				capacity, medical condition, or living situation that have a substantial impact
				on the need for attendant services).
(f) Program agreement. Participants shall
				indicate their agreement with the conditions of their participation in the
				program by signing an Attendant Services Program Agreement.
Section 109 Personal Assistants
(a) Who. A participant may choose his or her
				personal assistant(s). More than one person may provide attendant services to
				the same participant, within the amount of services authorized by the
				Department Restrictions:
1. A spouse may not
				be reimbursed for attendant care through Medicaid services.
2. An attendant whose name appears on a
				Registry for the abuse, neglect, or exploitation of a child or a vulnerable
				adult or who has a criminal conviction as set forth in the Department's
				Background Check Policy shall not be reimbursed for attendant care
				services.
3. An attendant shall not
				be permitted to provide attendant services to a participant for more than eight
				hours a day.
(b) Legal
				obligations. The participant, guardian or agent shall ensure that all personal
				assistants are employed in compliance with all applicable State and Federal
				laws affecting employment relationships.
(c) Training. Personal assistant training is
				the sole responsibility of the participant. The Department is available to
				provide technical assistance as requested, within the limits of available
				resources.
(d) Payment schedule.
				The Department or the designated payroll agent shall establish a standard
				payment schedule for all personal assistants, and shall distribute this
				schedule to all participants.
(e)
				Special circumstances.
1. Change or hiring of
				a personal assistant. When there is a change in personal assistant or the
				hiring of a replacement assistant for a participant, the Department may pay for
				the incoming personal assistant as well as the outgoing personal assistant for
				up to three days of the daily awarded time for the purposes of training. In
				order to obtain such payment, the participant shall provide to the Department
				prior written notice that the personal assistant has either resigned or been
				fired and specifying the day or days involved.
2. Participant hospitalization. To ensure
				continued availability of attendants for participants who will return home, the
				Department will use General Funds, if available, to continue payment of a
				personal assistant for a period of up to 30 days during which a participant is
				hospitalized. The Department thereafter will consider the specific
				circumstances of the participant in deciding whether to continue such
				payment.
Section
				110 Confidentiality
To the extent required by law, the Department shall protect
				  the confidentiality of all program records relating to individual applicants
				  and participants and shall ensure the identity of participants is not disclosed
				  to the public. Records may be disclosed with the written consent of the
				  applicant or participant in the context of an administrative or judicial
				  proceeding involving the applicant or participant, or upon order of a
				  court.
Section 111 Appeals
The Attendant Services Medicaid Programs are part of "Global
				  Commitment to Health," which is an 1115(a) Demonstration waiver program under
				  which the Federal government waives certain Medicaid coverage and eligibility
				  requirements found in Title 19 of the Social Security Act. The Department of
				  Vermont Health Access, as a Managed Care Entity ("MCE") under the Global
				  Commitment 1115(a) waiver, is required under 42 C.F.R. Part 438, Subpart F, to
				  have an internal grievance and appeal process for resolving service
				  disagreements between participants and Department employees and representatives
				  of the Department. An applicant or participant may request an internal review
				  by the Commissioner and a fair hearing before the Human Services Board.
A managed care entity (or MCE) means
1) the Department of Vermont Health Access
				("DVHA");
2) any State department
				with which DVHA has an Intergovernmental Agreement under the Global Commitment
				1115(a) waiver that results in that department administering or providing
				services under the Global Commitment waiver (i.e. Department for Children and
				Families, Department of Disabilities, Aging and Independent Living, Department
				of Health, Division of Mental Health);
3) DA/SSA; and
4) any contractor performing service
				authorizations or prior authorizations on behalf of the Department.
(a) Internal Appeals. An applicant or
				participant may use the internal Commissioner's review while a fair hearing is
				pending or before a fair hearing is requested, except when a service is denied,
				reduced or eliminated as mandated by federal or state law or rule, in which
				case the applicant or participant cannot use the internal review by the
				Commissioner and must appeal the decision by requesting a fair hearing before
				the Human Services Board. The Department is not required to provide a new
				service or a health service that is not a Medicaid-covered service while an
				appeal or fair hearing determination is pending. If an appeal is filed
				regarding a denial of service eligibility, the Department is not required to
				initiate service delivery.
(b)
				Commissioner's review. An applicant or participant who wishes to appeal a
				decision of the Department may request, orally or in writing, within 90
				calendar days after the date of the written notice of decision, a formal
				internal review of that decision by the Commissioner of the Department. Within
				five calendar days, the department shall notify the applicant or participant
				that it has received the request. If the issue is resolved within the five-day
				time frame, a single decision notice may be sent; a separate receipt
				acknowledgement is not required.
1. The
				internal appeal process shall include assistance by staff of the Department, as
				needed, to the applicant or participant to initiate and participate in the
				appeal. Applicants and participants shall not be subject to retribution or
				retaliation for appealing Commissioner's decision.
2. If an applicant or participant files an
				appeal with the wrong department, the Department shall notify the applicant or
				participant in writing in order to acknowledge the appeal. The written
				acknowledgement shall explain that the issue has been forwarded to the correct
				department, identify the department to which it has been forwarded, and explain
				that the appeal will be addressed by that department. This does not extend the
				deadline by which appeals must be determined.
3. Applicants or participants may withdraw
				internal appeals orally or in writing at any time. If an internal appeal is
				withdrawn orally, the withdrawal shall be acknowledged by the Department in
				writing within 5 calendar days.
4.
				The applicant or participant has the right to participate in person, by
				telephone or in writing in the Commissioner's internal review. Applicants or
				participants may submit additional information that supplements or clarifies
				information that was previously submitted and is likely to materially affect
				the decision. They will also be provided the opportunity to examine the case
				file prior to the review.
5. The
				applicant or participant shall be notified as soon as the Commissioner's
				internal review is scheduled. Commissioner's reviews shall be held during
				normal business hours and, if necessary, the review shall be rescheduled to
				accommodate individuals wishing to participate. If scheduling or re-scheduling
				results in exceeding the 45 calendar day limit (see below), an automatic 14
				calendar day time extension is effective. If a review cannot be scheduled
				within the 45 day time limit and 14 day extension, a decision will be rendered
				by the Commissioner without a meeting with the applicant or
				participant.
6. Internal appeals
				shall be decided and written notice sent to the applicant or participant within
				45 calendar days of receipt of the appeal. The 45 day period begins with the
				receipt of the appeal. If an internal appeal cannot be resolved within 45 days,
				the time frame may be extended up to an additional 14 calendar days by request
				of the applicant or participant or by the Commissioner if the extension is in
				the best interest of the applicant or participant. If the extension is at the
				request of the Commissioner, it must give the applicant or participant written
				notice of the reason for the delay. The maximum total time period for the
				resolution of an appeal, including any extension requested either by the
				applicant or participant or the Commissioner is 59 calendar days.
(c) Expedited Appeal Requests. An
				applicant or participant may request an expedited appeal in emergent situations
				in which the participant indicates that taking the time for a standard
				resolution could seriously jeopardize his or her life or health or ability to
				attain, maintain, or regain maximum function.
1. Requests for expedited appeals may be made
				orally or in writing with the Department for any Department actions subject to
				appeal. The Department shall not take any punitive action against a participant
				who requests an expedited resolution.
2. If the request for an expedited appeal
				does not meet the criteria and is denied, the Department shall inform the
				participant that the request does not meet the criteria for expedited
				resolution and that the appeal will be processed within the standard 45 day
				time frame. Notice of the denial for an expedited appeal shall be communicated
				orally to the participant within three (3) working days and followed up within
				two (2) calendar days with a written notice.
3. If the expedited appeal request meets the
				criteria for such appeals, it must be resolved within three (3) working days.
				The written notice for any expedited appeal determination shall include a brief
				summary of the appeal, the resolution, the basis for the resolution, and the
				participant's right to request a fair hearing if not already
				requested.
(d) Financial
				Eligibility Determinations. If an applicant or participant files an appeal
				regarding only a Medicaid financial eligibility, patient share or premium
				determination, the Department shall forward it to the Department for Children
				and Families ("DCF"), Economic Services Division. The Department shall then
				notify the applicant or participant in writing that the issue has been
				forwarded to and will be resolved by DCF.
(e) Notices, Continuation of Services,
				Participant Liability for Service Costs. In cases involving a termination or
				reduction of service(s), the notice of decision must be mailed at least eleven
				(11) days before the change will take effect. Where the decision was adverse to
				the applicant or participant, the notice shall inform the applicant or
				participant when and how to file an appeal. In addition, the notice must inform
				the participant that he or she may request that covered Medicaid services be
				continued without change as well as the circumstances under which the
				participant may be required to pay the costs of those services pending the
				outcome of any Commissioner's internal review or fair hearing.
1. If requested by the participant, Medicaid
				services shall be continued during an appeal or fair hearing under the
				following circumstances:
i. The appeal or
				request for fair hearing was filed in a timely manner, meaning before the
				effective date of the proposed action;
ii. The participant has paid any required
				premiums in full;
iii. The appeal
				or fair hearing involves the termination, suspension or reduction of a
				previously authorized service plan; and
iv. Any applicable annual plan of care or
				Medicaid service authorization has not expired at the time the appeal is
				filed.
2. Where properly
				requested, a Medicaid service must be continued until any one of the following
				occurs:
i. The participant withdraws the
				appeal or request for fair hearing;
ii. Any limits on the cost, scope or level of
				service have been reached;
iii. The
				Commissioner issues a decision adverse to the participant, and the participant
				does not request a fair hearing within the applicable time frame;
iv. A fair hearing is conducted and the Human
				Services Board issues a decision adverse to the participant; or
v. The original Medicaid service period has
				expired.
3. Participants
				may waive their right to receive continued services pending appeal or fair
				hearing.
4. Continuation of
				Medicaid or other services without change does not apply when the appeal or
				request for a fair hearing is based solely on a reduction or elimination of a
				service required by federal or state law or rule affecting some or all
				participants, or when the decision does not require the minimum advance
				notice.
5. The Department is not
				required to provide a new service or any service that is not a Medicaid-covered
				service while an appeal or fair hearing determination is pending. If an appeal
				is filed regarding a denial of service eligibility, the Department is not
				required to initiate service delivery.
(f) Participant Liability for Cost of
				Services. A participant may be liable for the cost of any services provided
				after the effective date of the reduction or termination of service or the date
				of the timely appeal or request for fair hearing, whichever is later.
1. The Department may recover from the
				participant the value of any continued services paid during the appeal period
				when the participant withdraws the appeal before the relevant Department or
				fair hearing decision is made, or following a final disposition of the matter
				in favor of the Department. Participant liability will occur only if a
				Commissioner's review, fair hearing decision, Secretary's reversal and/or
				judicial opinion upholds the adverse determination, and the Department also
				determines that the participant should be held liable for service
				costs.
(g) Fair hearing.
				An applicant or participant may use the internal Commissioner's review and be
				entitled to a fair hearing before the Human Services Board. Appeals to the
				Human Services Board are conducted pursuant to
				3 V.S.A. §
													3091 and
				rules adopted by the Board.
1. A participant
				who wishes to obtain a fair hearing must request it within 90 days of the
				initial decision, or, if an internal review is requested, within 30 days of the
				date of the Commissioner's notice of decision.
2. If the participant's original request for
				an appeal was filed before the effective date of the adverse action and the
				participant has paid in full any required premiums, the participant's services
				will continue consistent with subsection (e), above.
3. Applicants and participants have the right
				to file requests for fair hearings related to eligibility and premium
				determinations. DCF shall retain responsibility for representing the State in
				any fair hearings pertaining to such eligibility and premium
				determinations.
Section 112 Grievances
A participant may file a grievance orally or in writing. A
				  grievance must include a clear statement by the participant that a written
				  response is requested from the Department.
(a) A participant or his/her representative
				must file any grievance within 60 days of the pertinent issue in order for the
				grievance to be considered. Staff members shall assist a participant or his/her
				representative if the participant requests such assistance.
(b) Written acknowledgement of the grievance
				shall be mailed within five (5) calendar days of receipt by the Department. If
				the Department decides the issue within the 5 day time frame, it need not send
				separate notices of acknowledgement and decision. The decision notice is
				sufficient in such cases.
(c)
				Participants or their representatives may withdraw grievances orally or in
				writing at any time. If a grievance is withdrawn orally, the withdrawal shall
				be acknowledged by the Department in writing within five (5) calendar
				days.
(d) All grievances shall be
				addressed within 90 calendar days of receipt. The decision maker must provide
				the participant with written notice of the disposition. The written notice
				shall include a brief summary of the grievance, information considered in
				making the decision, and the disposition. If the response is adverse to the
				participant, the notice must also inform the participant of his or her right to
				initiate a grievance review with the Department as well as information on how
				to initiate such review.
(e) If the
				grievance is decided in a manner adverse to the participant, the participant
				may request a review by the Department within 10 calendar days of the decision.
				The review will be conducted by an individual who was not involved in deciding
				the grievance under review and is not a subordinate of the individual who
				decided the original grievance.
1. The
				Department shall acknowledge grievance review requests within five (5) calendar
				days of receipt.
2. The grievance
				review will assess the merits of the grievance issue(s), the process employed
				in reviewing the issue(s), and the information considered in making a final
				determination. The primary purpose of the review shall be to ensure that the
				grievance process has functioned in an impartial manner and that the response
				was consistent with the issues and/or facts presented. The participant shall be
				notified in writing of the findings of the grievance review.
3. Although the disposition of a grievance
				may not be appealed to the Human Services Board, the participant may request a
				fair hearing for an issue raised that is appropriate for review by the Board,
				as provided by 3 V. S. A. § 3091(a).
4. The Department shall be responsible for
				resolving grievances initiated under these rules.
Section 113 Program Evaluation
(a) Annual survey. Participants and personal
				assistants will be surveyed annually to help the Department identify program
				strengths and weaknesses, including training needs.
(b) Annual meetings. The Department will meet
				informally with participants and stakeholders, on at least an annual basis to
				assess how to improve ways of providing attendant services.
(c) Advisory Committee. The Department will
				meet a minimum of two times a year with a participant/stakeholder advisory
				committee. One purpose of the committee will be to review and provide feedback
				on an anonymous sample of eligibility determinations.