reglab/statecodes huggingface dataset:
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 510 - REFUGEE MEDICAL ASSISTANCE (5100) › Section 13 170 510 - REFUGEE MEDICAL ASSISTANCE (5100)

Current through June, 2024
Section 5100
				Refugee Medical Assistance
The purpose of Refugee Medical Assistance is to help in the
				  effective resettlement of refugees by providing health coverage to refugees who
				  are not eligible for Medicaid/Pr. Dynasaur. Refugee Medical Assistance (RMA) is
				  authorized by the Refugee Act of 1980 and the accompanying regulations in 45 R
				  Part 400, and Title IV; Chapter 2 of the Immigration and Nationality Act (
				  8
				  U. S. C. §
											1522(e)
				  ).
Section 5101 Medical
				Screening Examination
A medical screening examination, coordinated by the Vermont
				  Department of Health, is a covered service under RMA when the examination is
				  within the first 90 days of the refugee's initial date of entry, even if the
				  refugee is not eligible for either Medicaid or RMA.
Section 5110 Eligibility Requirements
(a) Any refugee or asylee may apply for
				medical assistance through the state or its designated agency at any time, and
				eligibility must be determined no more than 45 days from the date of
				application.
(b) "Refugee" means an
				individual who meets the definitions of a refugee under section
				101(a)
				(42) of the Immigration and Nationality
				Act.
(c) "Asylee" means an
				individual who has been granted asylum under section
				208
				of the Immigration and Nationality Act. It does not include "applicant for
				asylum," which is someone who has applied for but not been granted asylee
				status.
(d) Asylees are eligible
				for all refugee assistance and services beginning on the date they are granted
				asylum.
(e) For purposes of this
				rule, the term "refugee" includes "asylee" as defined above unless specifically
				designated otherwise and any other eligible category that meets immigration
				status and identification requirements in 45 CPR, Part 400, Subpart D.
(f) A refugee must provide
				documentation of refugee or asylee status as defined in federal rules before
				the Vermont Agency of Human Services (AHS) may grant assistance. It is the
				responsibility of AHS to document proof of status of the refugee or asylee and
				keep a copy of supporting documentation on file.
(g) AHS will promptly notify the agency (or
				local affiliate) which provided the initial resettlement of a refugee whenever
				the refugee applies for medical assistance. Any refugee who has not been
				referred by the local resettlement agency will be counseled by AHS to contact
				the local resettlement agency to benefit from other kinds of
				assistance.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 540 - VPHARM (5400) › Section 13 170 540 - VPHARM (5400)

Current through June, 2024
Section 5400 VPharm
Act 71, an Act making appropriations for the support of
				  Government authorized and established VPharm. It was adopted by the Vermont
				  General Assembly and signed into law by the Governor on June 21, 2005. In order
				  to keep Medicare beneficiaries' coverage whole, VPharm provides supplemental
				  pharmaceutical coverage starting January 1, 2006. An individual may not be
				  enrolled in Medicaid. Medicaid beneficiaries receive their secondary pharmacy
				  coverage though Medicaid (M801).
The rules which follow apply to the coverage group called
				  VPharm.
Section 5401
				Definitions
For purposes of this section concerning VPharm:
(1) "ESD" means the Economic Services
				Division of the Department for Children and Families.
(2) "Maintenance drug" means a drug approved
				by the FDA for continuous use and prescribed to treata chronic condition for a
				prolonged period of time of 30 days or longer, and includes insulin, an
				insulinsyringe, and an insulin needle.
(3) "Medicare Advantage -- Prescription Drug
				Plan" or "MA-PD" means a Medicare Advantage planthat is certified by Centers
				for Medicare and Medicaid Services (CMS) as meeting contract requirements as
				specified in
				42 C.F.R §
											422.2 that provides qualified prescription
				drug coverage under Part D of the Social Security Act.
(4) "Medicare Part D" means the prescription
				drug program established under the MedicarePrescription Drug, Improvement and
				Modernization Act of 2003, P.L. 108-173, including the
				prescriptiondrug plans offered pursuant to the act.
(5) "OVHA" means the Office of Vermont Health
				Access.
(6) "Pharmaceutical" means
				a drug that may not be dispensed unless prescribed by a health careprovider as
				defined by subdivision
				9402(8)
				of Title 18 of the Vermont Statutes Annotated (V.S.A) actingwithin the scope of
				the provider's license. The term excludes a drug determined less than effective
				under thefederal Food, Drug and Cosmetics Act.
(7) "Pharmacy" means a retail or
				institutional drug outlet licensed by the Vermont state board ofpharmacy
				pursuant to chapter 36 of Title 26 of the Vermont Statutes Annotated (V.S.A),
				or by anequivalent board in another state, in which pharmaceuticals are sold at
				retail and which has entered into awritten agreement with the state to dispense
				pharmaceuticals in accordance with the provisions of thischapter.
(8) "Prescription Drug Plan" or "PDP" means
				prescription drug coverage that is offered under a policy, contract, or plan
				that has been approved, as specified in
				42
				C.F.R. §
											423.272, and that is offered by
				a sponsor that has a contract with the Centers for Medicare and Medicaid
				Services (CMS).
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 550 - VHAP - PHARMACY (5500) › Section 13 170 550 - VHAP - PHARMACY (5500)

Current through June, 2024
Section 5500 VHAP-Pharmacy
Legislative Act 14, authorizing and supporting the Vermont
				  Health Access Plan, was adopted by the Vermont General Assembly and signed into
				  law by the Governor on April 12, 1995. The Vermont Health Access Plan extends a
				  pharmacy benefit and vision care services to low-income disabled and elderly
				  Vermonters to assist them to purchase the prescription medicines that maintain
				  their health and prevent unnecessary health problems. Vision care services do
				  not include eyewear.
The policies which follow describe this coverage group called
				  VHAP-Pharmacy.
Section 5501
				Beneficiary Fraud
A person, who knowingly gives false or misleading information
				  or holds back needed information in order to obtain VHAP-Pharmacy benefits may
				  be prosecuted for fraud under Vermont law or federal law or both. If convicted,
				  the individual may be fined or imprisoned or both.
When ESD learns that fraud may have been committed, it will
				  investigate the case with respect for confidentiality and the legal rights of
				  the beneficiary. If appropriate, the case will be referred to the State's
				  Attorney or Attorney General for a decision on whether or not to
				  prosecute.
Section 5510
				Eligibility
An individual must meet all of the following requirements
				  (3301.1 - 3301.74) to be found eligible for this program.
Section 5511 Age
An individual qualifying on the basis of age must be at least
				  65 years of age on the date the application is filed.
Section 5512 Disability
An individual qualifying on the basis of disability must be
				  receiving disability benefits from Social Security (OASDI) to be considered
				  disabled.
Section 5513
				Uninsured
Individuals meet the uninsured requirement if they do not
				  have any plan, including VHAP-Limited and Medicare, which pays or reimburses,
				  either in whole or in part, with the exception of VScript, or Healthy
				  Vermonters, their prescription drug expenses.
Section 5514 Citizenship and Identity
The rules for citizenship and identity are in section M170.
Section 5515 Residence
An individual is a state resident if he/she has lived in
				  Vermont during the entire 12-month period immediately preceding application for
				  the VHAP-Pharmacy program and is living in Vermont at the time of such
				  application:
a. with intent to remain
				permanently or for an indefinite period of time: or
b. while incapable of stating intent.
Temporary absences from Vermont for any of the following
				  purposes does not interrupt or end Vermont residence: visiting, obtaining
				  necessary medical care, or obtaining education or training under a program of
				  vocational rehabilitation or higher education.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 560 - VSCRIPT (5600) › Section 13 170 560 - VSCRIPT (5600)

Current through June, 2024
Section 5600 VScript
The General Assembly of the State of Vermont, in its 1989
				  passage of H.228, provided for the establishment of a state pharmaceutical
				  assistance program for low-income elderly and disabled Vermonters. The Law, Act
				  No. 48, be-came effective July 1, 1989.
The program shall be administered each fiscal year to assure
				  that expenditures do not exceed the funds authorized by the General
				  Assembly.
The General Assembly, in its 1992 passage of H.754,
				  authorized the Secretary of Human Services to assign VScript to any Department
				  within the Agency of Human Services. The term "Department", as used in these
				  policies, is the Department assigned responsibility for the administration of
				  VScript.
The policies which follow describe this program.
Section 5610 Eligibility
An individual must meet the following requirements to be
				  found eligible for this program.
Section
				5611 Citizenship and Identity
The rules for citizenship and identity are in section M170.
An individual meets the citizenship requirement if he/she
				  meets one of these two criteria:
1.
				He/she is a native-born or naturalized U.S. citizen. For purposes of qualifying
				as a United States citizen, the United States, as defined in the Immigration
				and Nationality Act, includes the 50 States, the District of Columbia, Puerto
				Rico, Guam, Virgin Islands and the Northern Mariana Islands. Nationals from
				American Samoa or Swain's Is-land also are regarded as United States citizens
				for purposes of VScript.
2. He/she
				is a resident alien lawfully admitted for permanent residence or permanently
				residing in the U.S. under color of law, including any alien who is lawfully
				present in the U.S. under the authority of Sections 203(a) 7 or 212(d)(5) of
				the Immigration and Nationality Act. (See Welfare Procedures Manual for
				documentation requirements.)
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 580 - HIV/AIDS (5800) › Section 13 170 580 - HIV/AIDS (5800)

Current through June, 2024
Section 5800 Introduction
The General Assembly of the State of Vermont, in its 1992
				  passage of H.937, directed the Department of Social Welfare to develop an
				  "HIV/AIDS Health Insurance Assistance Program." Specifically, Section 124 of H.
				  937 directs that:
(a) The Department
				of Social Welfare, in cooperation with the Department of Health, shall develop
				and implement an HIV/AIDS insurance assistance program.
(b) The program shall pay all or a portion of
				continuation health insurance premiums for those eligible individuals with
				HIV/AIDS for whom it can be determined that continuation of private insurance
				coverage is less costly to the state than other alternatives.
(c) Eligibility for this program shall be
				limited to individuals whose household income does not exceed 200% of the
				federal poverty level, after deducting unreimbursed medical expenses and health
				insurance premiums from gross income, and whose assets, exclusive of the
				primary residence and certain other exclusions to be defined by the Department
				of Social Welfare, do not exceed $ 10,000.00."
Expenditures shall not exceed the funds appropriated annually
				  by the General Assembly for this program.
The policies with follow implement this program.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 710 - MEDICAID BENEFIT DELIVERY (7100) › Section 13 170 710 - MEDICAID BENEFIT DELIVERY (7100)

Current through June, 2024
Section 7101
				Medicaid Benefit Delivery
(06/01/2018, GCR 17-090)
7101.1 Overview
The following includes steps the department, the eligible
				  Medicaid beneficiary and the medical care provider must take for the provider
				  to receive payment for services given to the beneficiary.
(a) The department must:
(1) Give each Medicaid eligible person an
				identification document showing that the person has been found eligible for
				Medicaid; and
(2) Accept and
				process all provider claims itself or through its administrative agent;
				and
(3) Notify providers of
				decisions on claims and pay approved claims.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 171 - DEPARTMENT FOR CHILDREN AND FAMILIES; CHILD DEVELOPMENT DIVISION › Chapter 002 - STEP AHEAD RECOGNITION SYSTEM (STARS) STANDARDS › Section 13 171 002 - STEP AHEAD RECOGNITION SYSTEM (STARS) STANDARDS

Current through June, 2024
I. Purpose.
a. These rules establish the STep Ahead
				Recognition System (STARS), Vermont's Quality Recognition and Improvement
				System (QRIS) for Center Based Child Care and Preschool programs, Family Child
				Care Homes, and Afterschool Child Care programs. The purpose of STARS is to:
i. be responsive to and reflect the unique
				culture and identity of quality practices in Vermont's early childhood and
				afterschool programs;
ii. offer
				equitable opportunities for early childhood and afterschool programs and
				providers to engage in the improvement system;
iii. support early childhood and afterschool
				programs in fostering healthy development and preparing young children for
				future learning and life success;
iv. support family choice by allowing parents
				and caregivers to make informed decisions and choose the best possible care for
				their children based on a program's philosophy, quality of an early childhood
				or afterschool program, and services provided by that program;
v. represent early childhood and afterschool
				programs' strengths to families; and
vi. demonstrate early childhood and
				afterschool programs' progress toward quality improvements.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 172 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF); FAMILY SERVICES DIVISION › Chapter 200 - RESPONSE TO CHILD ABUSE AND NEGLECT (2000) › Section 13 172 200 - RESPONSE TO CHILD ABUSE AND NEGLECT (2000)

Current through June, 2024
Section 2000
				Purpose and Statutory Authority
The broad purpose of these regulations is to:
1. Protect children whose health and welfare
				may be adversely affected through abuse or neglect;
2. Strengthen the family and make the home
				safe for children whenever possible;
3. Provide a temporary or permanent nurturing
				and safe environment for children when necessary; and,
4. Establish a range of responses to child
				abuse and neglect that take into account different degrees of child abuse or
				neglect and which recognize that child perpetrators should be treated
				differently from adult perpetrators.
Specifically, the section sets forth:
1. Criteria for determining whether to
				conduct an assessment or an investigation.
2. Procedures for assessment and service
				delivery.
3. Procedures for
				investigations. The statutory authority for these regulations can be found at
				33 V.S.A. §
											4922. More detailed guidance to division
				staff is also provided in division policy and practice guidance.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 172 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF); FAMILY SERVICES DIVISION › Chapter 300 - CHILD PROTECTION REGISTRY AND ADMINISTRATIVE REVIEW PROCESS (3000) › Section 13 172 300 - CHILD PROTECTION REGISTRY AND ADMINISTRATIVE REVIEW PROCESS (3000)

Current through June, 2024
Section 3000
				Purpose and Statutory Authority
This rule is effective March 1, 2019.
These rules cover the following:
1. The conduct of reviews of substantiation
				decisions.
2. The criteria for
				determining risk levels for the purposes of eligibility to petition for
				expungement from the Child Protection Registry.
3. The conduct of reviews of expungement
				petitions.
4. The maintenance of
				records related to reviews of substantiation decisions and expungement
				petitions. Nothing in these rules is intended to permit or require sharing
				information which is restricted or protected from such sharing by federal or
				state statute or regulation, or to prevent disclosure when otherwise authorized
				by law. The statutory authority for these regulations can be found at
				33 V.S.A. §
											4922.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 172 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF); FAMILY SERVICES DIVISION › Chapter 800 - CHILD PROTECTION REGISTRY (8000) › Section 13 172 800 - CHILD PROTECTION REGISTRY (8000)

Current through June, 2024
Section 8000
				Introduction
These rules have been established to provide guidance
				  regarding the Child Protection Registry that reflects a designated child
				  protection level related to the risk of future harm to children.
The commissioner will maintain a child protection registry,
				  which will contain a record of all investigations that have resulted in a
				  substantiated report on or after January 1, 1992.
These rules establish:
1. A tiered child protection
				registry.
2. Registry levels, based
				on risk.
3. Documentation and
				expungement.
The statutory authority for these regulations can be found at
				  33 V.S.A. § 4911-4916
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 172 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF); FAMILY SERVICES DIVISION › Chapter 900 - MAINTENANCE AND ACCESS TO RECORDS (9000) › Section 13 172 900 - MAINTENANCE AND ACCESS TO RECORDS (9000)

Current through June, 2024
Section 9000
				Purpose and Statutory Authority
These rules have been established to provide guidance
				  regarding appropriate maintenance and access to records of the Department that
				  are created under the authority of 33 V.S.A. Chapter 49, subchapter 2. Nothing
				  in these rules is intended to permit or require sharing information which is
				  restricted or protected from such sharing by federal or state statute or
				  regulation, or to prevent disclosure when otherwise authorized by law.
The rules cover the following:
1. The maintenance of investigation,
				assessment and administrative review conference records.
2. The use and release of information in
				investigation records, assessment records and administrative review conference
				records.
The statutory authority for these regulations can be found
				  at
				  33 V.S.A.
				  §
												4921. More detailed guidance to staff
				  is also provided in division policy.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 173 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF); VERMONT SEXUAL ASSAULT NURSE EXAMINERS (SANE) BOARD › Chapter 001 - REGULATION OF SEXUAL ASSAULT NURSE EXAMINERS › Section 13 173 001 - REGULATION OF SEXUAL ASSAULT NURSE EXAMINERS

Current through June, 2024
Section I
				Introduction
The SANE Board is established to regulate sexual assault
				  nurse examiners (SANEs) in Vermont, and oversee the Vermont SANE Program. The
				  SANE Board shall set standards for and provide Vermont certification of SANEs
				  and Pediatric SANEs, and may investigate complaints and revoke such
				  certification. The Board shall be composed of the members set forth in
				  33 V.S.A. §
											322(b).
The purpose of the Vermont SANE Program is to ensure that
				  adult, adolescent and child victims of sexual assault have access to quality
				  sexual assault examinations provided by certified SANEs and Pediatric SANEs by:
				  promoting recruitment and retention of SANEs and Pediatric SANEs; administering
				  the Vermont certification and re-certification process; coordinating initial
				  training and continuing education to ensure currency of practice; providing
				  consultation to SANEs, Pediatric SANEs and hospitals; developing standardized
				  sexual assault protocols and evidence collection kits; monitoring compliance
				  with standards of practice; developing a process for referral of complaints for
				  investigation; and promoting a multidisciplinary team approach to services for
				  victims of sexual assault.
Staffing for the Vermont SANE Program shall be funded through
				  a grant from the Vermont Center for Crime Victim Services to the Vermont
				  Network Against Domestic and Sexual Violence, subject to available funding.
				  Funding from other sources also may be used to support additional staff and
				  activities of the Vermont SANE Program.
Section II Definitions
A. Board. SANE Board established to regulate
				SANEs and Pediatric SANEs and to oversee the Vermont SANE Program.
B. Certification. Specialized requirements
				for SANEs and Pediatric SANEs practicing in Vermont.
C. Contact Hour. Sixty (60) minutes of
				education for purposes of Vermont certification and re-certification.
D. IAFN. International Association of
				Forensic Nurses.
E. Pediatric.
				Females who are pre-menarcheal or males who are pre-stage three (3) on the
				Tanner Classification of sexual maturity.
F. Pediatric SANE. SANE, with additional
				specialized training, who has Vermont certification to serve as the principal
				sexual assault examiner for pediatric patients. Certification in Vermont as a
				Pediatric SANE is not equivalent to IAFN certification as a SANE-P.
G. SANE. Sexual Assault Nurse Examiner with
				Vermont certification to serve as the principal sexual assault examiner for
				adults and adolescents. Certification in Vermont as a SANE is not equivalent to
				IAFN certification as a SANE-A.
H.
				Quorum. At least fifty (50) percent of the members of the Board or a Standing
				Committee.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 002 - PROSTHETIC AND ORTHOTIC DEVICES › Section 13 174 002 - PROSTHETIC AND ORTHOTIC DEVICES

Current through June, 2024
4.212 Prosthetic
				and Orthotic Devices.
(5/1/2023, GCR 22-099)
4.212.1 Definitions
(a) "Prosthetic devices" means replacement,
				corrective, or supportive devices to: artificially replace a missing portion of
				the body, prevent or correct physical deformity or malfunction, or support a
				weak or deformed portion of the body.
This definition is in accordance with the federal definition
				  found at 42 CFR §
													440.120(c).
(b) "Orthotic devices" means devices
				fashioned to support, correct, or improve the function of a body
				part.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 003 - MEDICAID BENEFIT DELIVER › Section 13 174 003 - MEDICAID BENEFIT DELIVER

Current through June, 2024
3.101 Telehealth.
(01/07/2019, GCR 18-037)
3.101.1
Definitions
For the purposes of this
				rule, the term:
(a) "Telehealth" means methods
				for health care service delivery using telecommunications technologies.
				Telehealth includes telemedicine, store and forward, and
				telemonitoring.
(b) "Telemedicine"
				means health care delivery by a provider who is located at a distant site to a
				beneficiary at an originating site for purposes of evaluation, diagnosis,
				consultation, or treatment, using telecommunications technology via two-way,
				real-time, audio and video interactive communication, through a secure
				connection that complies with HIPAA.
(c) "Store and forward" means an asynchronous
				transmission of a beneficiary's medical information from a health care
				professional to a provider at a distant site, through a secure connection that
				complies with HIPAA, without the beneficiary present in real time.
(d) "Remote Patient Monitoring" means a
				health service that enables remote monitoring of a beneficiary's physiological
				health-related data by a home health agency done outside of a conventional
				clinical setting and in conjunction with a plan of care ordered by a physician,
				nurse practitioner, clinical nurse specialist, or physician
				assistant.
(e) "Originating site"
				means the site where the beneficiary is located, whether or not accompanied by
				a health care provider, when telemedicine, or audio-only services are provided.
				The originating site may include the beneficiary's home or another nonmedical
				setting (e.g., school, workplace), a health care provider's office, a facility,
				or a hospital.
(f) "Distant site"
				means the site where the provider is located, and the beneficiary is not
				located, when telemedicine or store and forward services are
				provided.
(g) "Clinically
				appropriate" means clinically accepted standards of medical practice and
				delivery methods that are considered effective in providing health care
				services to patients, including for purposes of evaluation, diagnosis,
				consultation, or treatment.
(h)
				"Audio-Only" means real-time health care delivery by a provider who is located
				at a distant site to a beneficiary at an originating site for purposes of
				evaluation, diagnosis, consultation, or treatment, using audio-only
				telecommunications technology.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 004 - MEDICAID COVERED SERVICES › Section 13 174 004 - MEDICAID COVERED SERVICES

Current through June, 2024
SUBCHAPTER 1 GENERAL PROVISIONS
4.101 Medical Necessity for Covered Services.
(07/01/20, GCR 19-060)
4.101.1 Definitions
(a) "Ameliorate" means to improve or maintain
				a beneficiary's health in the best condition possible, compensate for a health
				problem, prevent it from worsening, or prevent the development of additional
				health problems.
(b) "Generally
				accepted practice standards" means standards that are based on:
(1) credible scientific evidence published in
				peer-reviewed literature,
(2)
				physician specialty society recommendations, or
(3) the prevailing opinion of licensed health
				care providers practicing in the relevant clinical area.
(c) "Medically necessary" means health care
				services, including diagnostic testing, preventive services, and aftercare,
				that are appropriate, in terms of type, amount, frequency, level, setting, and
				duration, to the beneficiary's diagnosis or health condition, and that:
(1) help restore or maintain the
				beneficiary's health, or
(2)
				prevent deterioration or palliate the beneficiary's condition, and
(3) are the least costly, appropriate health
				service that is available, and
(4)
				are not solely for the convenience of the beneficiary's caregiver or a
				provider, and
(5) are supported by
				documentation in the beneficiary's medical records.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 005 - PODIATRY SERVICES › Section 13 174 005 - PODIATRY SERVICES

Current through June, 2024
4.221 Podiatry Services.
(5/1/2023, GCR 22-099)
4.221.1 Definitions
(a) "Podiatry services" means the diagnosis
				and treatment of ailments of the foot, ankle, and lower extremity.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 006 - MEDICAID COST SHARING › Section 13 174 006 - MEDICAID COST SHARING

Current through June, 2024
Section 6.100 Medicaid Cost Sharing
(01/01/2020, GCR 19-058)
Section
				6.100.1
Cost sharing, including deductibles, co-insurance, or
				  copayments, is charged to Medicaid beneficiaries as set forth in this
				  rule.
Section 6.100.2
				Copayment Requirements
(a) Medicaid enrolled
				beneficiaries are subject to the following copayment requirements, unless they
				are exempt under section 6.100.3 of this rule.
(1) Outpatient Services: $ 3.00 per day per
				hospital for outpatient hospital services.
(2) Dental services: $ 3.00 per provider per
				date of service.
(3) Prescription
				drugs (original or refill):
(A) $ 1.00 for
				each prescription with a Medicaid reimbursement rate of less than $ 30.00,
				or
(B) $ 2.00 for each prescription
				with a Medicaid reimbursement rate of $ 30.00 or more, but less than $ 50.00,
				or
(C) $ 3.00 for each
				prescription with a Medicaid reimbursement rate of $ 50.00 or more.
(b) Copayments are a
				portion of the Medicaid rate and are deducted from the Medicaid payment for
				each service that is subject to cost sharing, regardless of whether the
				provider has collected the payment or waived the cost sharing.
(c) If a beneficiary is unable to pay the
				copayment, providers shall not deny medical services.
(d) A beneficiary's inability to pay does not
				eliminate his or her liability for the copayment amount. Providers may bill a
				beneficiary for unpaid copayments.
(e) The State is not responsible for
				copayments that a provider may collect in error or that an individual makes on
				a service that is not paid for by Vermont Medicaid.
Section 6.100.3 Copayment Exemptions
(a) Copayments are never required from
				Medicaid beneficiaries who are:
(1) Under age
				21.
(2) Pregnant, through the
				duration of their pregnancy and through the end of the calendar month during
				which the 60 [th] day following the end of pregnancy occurs.
(3) Receiving Medicaid coverage of long-term
				care services and supports in a long-term care facility.
(4) Otherwise exempt from cost sharing by
				federal regulation at
				42
				CFR §
													447.56(a)(1).
(b) For beneficiaries also covered
				by Medicare, the prescription drug copays in 6.100.2(a)(3) do not apply to
				prescriptions covered by Medicare Part D plans.
(c) The following services are exempt from
				copayments:
(1) Sexual assault-related
				services.
(2) Preventive dental
				services.
(3) Services otherwise
				exempt from cost sharing by federal regulation at
				42
				CFR §
													447.56(a)(2).
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 008 - BENEFICIARY RIGHTS › Section 13 174 008 - BENEFICIARY RIGHTS

Current through June, 2024
8.100 INTERNAL APPEALS, GRIEVANCES, NOTICES,
				AND STATE FAIR HEARINGS ON MEDICAID SERVICES
(06/01/2018, GCR 17-090)
8.100.1 Introduction and Applicability
Rule 8.100 implements the responsibilities of the Medicaid
				  Program pursuant to 42 CFR § 438, Subpart F, regarding a grievance and
				  internal appeal system for Medicaid beneficiaries seeking Medicaid services The
				  rule also sets forth requirements for Notices of an Adverse Benefit
				  Determination, continuing services pending appeal and potential beneficiary
				  liability, and responsibilities regarding State fair hearings [1 ]
The services listed below are not subject to the grievance
				  rule at 8.100.8 and the internal appeal rule at 8.100.4. A Medicaid beneficiary
				  may request a State fair hearing, pursuant to 8.100.5, regarding these
				  services.
(a) Services funded with
				state-only dollars because federal participation is prohibited, and
(b) Services that are a coverage exception to
				Medicaid covered services.
For rules that govern Medicaid applicant and beneficiary
				  appeals regarding financial, non-financial, and categorical eligibility for
				  community Medicaid and Medicaid for long-term care services and supports and
				  Medicaid premium determinations, refer to Health Benefit Eligibility and
				  Enrollment Rules at Code of Vermont Rules 13-001-001 to 13-001-008.
Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 009 - PROVIDER RESPONSIBILITIES › Section 13 174 009 - PROVIDER RESPONSIBILITIES

Current through June, 2024
Section 9.103 Supervised Billing
(2/22/18, GCR 17-073)
Section
				9.103.1 Definitions
For the purposes of this rule, the term
(a) "Qualified Licensed Provider" means a
				provider who is licensed and enrolled in Vermont Medicaid and acting within his
				or her scope of practice.
(b)
				"Qualified Non-Licensed Provider" means a provider that is actively working
				towards licensure as specified by his or her profession.
(c) "Supervised Billing" means that a
				qualified licensed provider can bill for covered clinical services within his
				or her scope of practice provided by a qualified non-licensed provider when the
				qualified non-licensed provider is under direct supervision of the qualified
				licensed provider.
Code of Vermont Rules › Agency 14 - AGENCY OF TRANSPORTATION › Sub-Agency 010 - TRANSPORTATION BOARD › Chapter 003 - POLICY ON CONTRACTING AND SUBCONTRACTING › Section 14 010 003 - POLICY ON CONTRACTING AND SUBCONTRACTING

Current through June, 2024
Section 2.1
			 Definitions
Definitions. The following terms as used in this section are
				defined as follows:
(a) His own
			 organization shall be construed to include only workmen employed and paid
			 directly by the contractor and equipment owned, leased or rented by him from a
			 non-debarred person, with or without operators. Such term does not include
			 employees or equipment of a subcontractor, assignee, agent, or supplier of the
			 contractor.
(b) Specialty Items
			 shall be construed to be limited to work that requires highly specialized
			 knowledge, craftsmanship, or equipment not ordinarily available in the type of
			 contracting organizations qualified and expected to bid on the contract as a
			 whole. In general, such items are to be limited to minor components of the
			 overall contract. However, the fabrication and erection of certain types of
			 steel structures are of such a nature and intricacy that they should be
			 considered "Specialty Items," even though the cost of this work may constitute
			 the major portion of the contract amount.
(c) Contractor means the individual,
			 partnership, firm, corporation, or any acceptable combination thereof or joint
			 venture, which is a party to the contract with the Department, undertaking the
			 execution of the work under the terms of the contract and acting directly or
			 through its agents or employees. The term "Contractor" is referred to as the
			 prime Contractor as differentiated from the subcontractor.
(d) Subcontractor means an individual,
			 partnership, firm, corporation, or any acceptable combination thereof, or joint
			 venture, to whom the Contractor, with written consent of the Department,
			 sublets part of the contract.
(e)
			 Commercially useful function means the contractor/subcontractor is responsible
			 for the execution of a distinct element of the work of a contract and carries
			 out its responsibilities by actually performing, managing, and supervising the
			 work involved. A contractor/subcontractor must have the latitude to
			 independently:
(1) Select contracts to be
			 bid.
(2) Determine prices to be
			 quoted.
(3) Select material
			 suppliers.
(4) Hire, fire,
			 supervise and pay employees.
(5)
			 Direct or cause the direction of the management and policies of the firm. A
			 contractor/subcontractor may not broker work for another firm or act as a
			 bidding conduit.
Code of Vermont Rules › Agency 14 - AGENCY OF TRANSPORTATION › Sub-Agency 010 - TRANSPORTATION BOARD › Chapter 004 - POLICY AND PROCEDURES FOR DEBARMENT › Section 14 010 004 - POLICY AND PROCEDURES FOR DEBARMENT

Current through June, 2024
Section 3.1 Purpose
This Policy sets forth rules for the debarment of and other
				measures against contracting firms or affiliates where it is demonstrated that
				government funds may not be properly utilized or the State's interest would not
				be safeguarded. These measures shall be used to protect the public interest and
				are not intended to be sanctions, penalties, or forms of punishment.
Section 3.2 Definitions
(a) Adequate evidence means information
			 sufficient to support the reasonable belief that a particular act or omission
			 has occured.
(b) Agency means the
			 Vermont Agency of Transportation.
(c) Affiliates. Persons are affiliates if,
			 directly or indirectly,
(i) either one
			 controls or can control the other, or
(ii) a third controls or can control
			 both.
(d) Board means
			 the Vermont Transportation Board.
(e) Participant means a person or an officer
			 or employee of a person who directly or indirectly participates, may
			 participate or has participated in Agency programs through an agreement of that
			 person with a recipient or contractor of any tier. The term includes, but is
			 not limited to, subcontractors, suppliers, fee appraisers, inspectors, real
			 estate agents and brokers, consultants, architects, engineers, and
			 attorneys.
(f) Person means an
			 individual, corporation, partnership or an unincorporated association, or other
			 public or private entity.
(g)
			 Secretary means the Secretary of the Vermont Agency of Transportation or
			 his/her designee.
(h) FHWA means
			 the Federal Highway Administration or any successor agency.
(i) Suspension is the action taken under
			 Section 3.3 of this Policy to disqualify a person temporarily from
			 participation in Agency contracts.
(j) Debarment is the action taken under
			 Section 3.9 of this Policy to disqualify a person from participation in Agency
			 contracts for a period not to exceed three (3) years.
(k) Voluntary Exclusion is the
			 disqualification of a bidder from Agency contracts as a result of an agreement
			 voluntarily entered into under section 3.16 of this Policy, between the Agency
			 and the person to be excluded. contracts for a period not to exceed three (3)
			 years.
Code of Vermont Rules › Agency 14 - AGENCY OF TRANSPORTATION › Sub-Agency 010 - TRANSPORTATION BOARD › Chapter 005 - HIGHWAY GRADE CROSSING PROTECTION › Section 14 010 005 - HIGHWAY GRADE CROSSING PROTECTION

Current through June, 2024
GENERAL ORDER # 1 Highway Grade Crossing Protection
Pursuant to Title 30, Vermont Statutes Annotated § 1376
				and Title 3, Vermont Statutes Annotated §
									3104(a)
				(3), it is hereby
ORDERED, that "warning boards" shall be maintained in this
				state by every railroad corporation at every public highway or street where
				such highway or street is crossed by its railroad at grade, as follows:
1. On or before January 1, 1980, a
			 railroad-highway crossing sign (crossbuck), as set forth in the attached
			 diagram marked EXHIBIT "A" entitled, Railroad Crossing Standard, shall be
			 installed and maintained on the righthand side of every roadway as it
			 approaches every crossing, on each side of the tracks
2. General Order # 21 of the State of Vermont
			 Public Service Commission shall remain in full force and effect, except as
			 modified and superseded by the terms of this order.
3. No exception shall be made to the
			 requirements of this order, except as approved in writing by this
			 Board.
4. This order shall take
			 effect immediately.
Dated at/Middlebury, Vermont, County of/Addison, and State of
				Vermont this 8th day of November, A.D., 1976.
....)
....)
....)
....)
....)
....)
....)
Filed: November 8, 1976
Attest: Executive Secretary
[See illustration in printed publication.]
Statutory Authority: 3 V.S.A. C. 55, §
										3104;
				30 V.S.A. C. 45, § 1376
Code of Vermont Rules › Agency 14 - AGENCY OF TRANSPORTATION › Sub-Agency 010 - TRANSPORTATION BOARD › Chapter 007 - RULES AND REGULATIONS FOR THE PYAMENT OF JUNKYARD SCREENING COMPENSATION › Section 14 010 007 - RULES AND REGULATIONS FOR THE PYAMENT OF JUNKYARD SCREENING COMPENSATION

Current through June, 2024
Section I RULES AND
			 REGULATIONS FOR THE PAYMENT OF JUNKYARD SCREENING COMPENSATION
(1) For the purposes of these rules and
			 regulations, the phrase "just compensation....for reasonable and necessary
			 costs incurred for the landscaping or other adequate screening" shall mean:
a. The monetary reimbursement for the actual
			 costs incurred between May 17, 1971 and December 31, 1972, in complying with
			 the screening rules and regulations adopted by the Board on April 27, 1971,
			 except that said costs shall not exceed the costs the Board would have incurred
			 if it had installed a fence deemed satisfactory to comply with the
			 aforementioned screening rules and regulations, or
b. The installation of a fence, or landscape
			 materials, to effectively screen a junkyard in compliance with the Board's
			 rules and regulations, or
c. The
			 monetary reimbursement of the costs incurred by an owner/operator in installing
			 a fence, or landscape materials, of his own choice or design, which effectively
			 screens the junkyard, except that the costs shall not exceed those which the
			 Board would have incurred had it installed the fence.
Code of Vermont Rules › Agency 14 - AGENCY OF TRANSPORTATION › Sub-Agency 010 - TRANSPORTATION BOARD › Chapter 010 - PREQUALIFICATION, BIDDING AND CONTRACT AWARDS (REPEALED) › Section 14 010 010 - PREQUALIFICATION, BIDDING AND CONTRACT AWARDS (REPEALED)

Current through June, 2024
STATUTORY AUTHORITY:
				19 V.S.A. §§
											2,
				7
Code of Vermont Rules › Agency 14 - AGENCY OF TRANSPORTATION › Sub-Agency 010 - TRANSPORTATION BOARD › Chapter 012 - STANDARDS AND RULES FOR DESIGNATION, MAINTENANCE AND RECONSTRUCTION OF SCENIC ROADS › Section 14 010 012 - STANDARDS AND RULES FOR DESIGNATION, MAINTENANCE AND RECONSTRUCTION OF SCENIC ROADS

Current through June, 2024
Appendix C STATE OF VERMONT TRANSPORTATION BOARD
133 State Street, Montpelier, Vermont 05602
Reprinted below are the standards and rules for designation,
				maintenance and reconstruction of scenic roads as adopted by the Transportation
				Board following recommendation by the Scenery Preservation Council.
The standards and rules provide procedures for use in selection
				and designation of scenic highways as a means of preserving the scenic quality
				of the rural landscape. In addition, they describe techniques for
				reconstruction and maintenance of designated scenic highways in a manner which
				will preserve scenic quality without reduction in the level of service or
				safety required by users of the highway.
The publication entitled "Designating Scenic Roads, A Vermont
				Fieldguide," additional copies of the "Scenic Road Criteria" and copies of the
				Scenic Roads Statute, No. 58 of the Acts of 1977 are available on
				request.
Paul H. Guare, Executive Secretary
Transportation Board
133 State Street
Montpelier, VT 05602
Tel: 802-828-2669
Section
			 1 DESIGNATION AND DISCONTINUANCE OF SCENIC ROADS
(a) The criteria to be used by the State and
			 Towns in designating scenic roads shall be those contained in the document
			 entitled "Criteria for the Designation of Scenic Roads," as promulgated by the
			 Transportation Board as a part of these rules and regulations.
(b) Such criteria may be reviewed annually by
			 the Scenery Preservation Council for continued appropriateness and may be
			 revised, as necessary by the Transportation Board on the recommendation of the
			 Scenery Preservation Council.
(c) A
			 publication, entitled "Designating Scenic Roads, A Vermont Fieldguide," adopted
			 by the Transportation Board, shall serve as the official guide for the use of
			 the designation criteria. Copies may be obtained from district transportation
			 administrators (formerly known as district highway engineers).
(d) Prior to the public hearing which must
			 precede designation or discontinuation of any highway as a scenic road, the
			 State Transportation Board or legislative body of the town shall give Public
			 Notice of the date, place and purpose of the hearing. Public Notice here and at
			 other points in these rules shall mean notice in a newspaper of general
			 publication in the municipality affected, the posting of such notice in one or
			 more public places within the municipality, and by written notice to the
			 district transportation administrator, regional and town planning commissions
			 not less than fifteen (15) days prior to the date of the public
			 hearing.
Code of Vermont Rules › Agency 14 - AGENCY OF TRANSPORTATION › Sub-Agency 010 - TRANSPORTATION BOARD › Chapter 016 - RULES REGARDING PAYMENT FOR CERTAIN UTILITY RELOCATIONS REQUIRED BY HIGHWAY CONSTRUCTION PROJECTS › Section 14 010 016 - RULES REGARDING PAYMENT FOR CERTAIN UTILITY RELOCATIONS REQUIRED BY HIGHWAY CONSTRUCTION PROJECTS

Current through June, 2024
Section 1 PURPOSE
These rules are adopted to comply with Sec. 1a of Act No. 35 of
				1991, adding a new Sec. 1512 to Title 19 of the Vermont Statutes
				Annotated.
Their purpose is to set standards for determining when and to
				what extent the authority granted by Sec. 1512(a) may be exercised.
Section 2 DEFINITIONS
(a) "Environmental considerations" are
			 requirements set forth in any applicable permit or approval issued by a federal
			 and/or state agency, board or commission responsible for the protection of
			 scenic, natural or historical resources.
(b) "Non-discriminating local ordinances" are
			 municipal regulations that apply to similar development or construction,
			 whether undertaken by an individual, a governmental body, or the municipality
			 itself.
(c) "Relocation" means
			 required adjustments of utility facilities necessitated by planned highway
			 maintenance or construction activities. "Normal relocation" means constructing
			 a replacement facility, in kind, that is both functionally equivalent to the
			 existing facility and necessary for the continuous operation of the utility
			 service, highway project economy, or sequence of highway construction or
			 maintenance.
(d) "Safety
			 considerations" are requirements set forth in any applicable permit or approval
			 issued by a federal and/or state agency, board or commission responsible for
			 highway and traffic safety.
(e)
			 "Utility" means a privately, publicly, or cooperatively owned line, facility or
			 system for producing, transmitting, or distributing communications, cable
			 television, power, electricity, light, heat, gas, oil, crude products, water,
			 steam, waste, stormwater not connected with the highway drainage, or any other
			 similar commodity, including any fire or police signal system or street
			 lighting system, which directly or indirectly serves the public. The term
			 "utility" shall also mean the utility company inclusive of any wholly owned or
			 controlled subsidiary.