Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 174 - HEALTH CARE ADMINISTRATIVE RULES (HCAR) › Chapter 001 - GENERAL PROVISIONS AND DEFINITIONS › Section 13 174 001 - GENERAL PROVISIONS AND DEFINITIONS

Current through June, 2024
1.100 Health Care
				Administrative Rules Introduction.
(12/16/2016, GCR 16-076)
(a) The Agency of Human Services is the
				"single State agency," pursuant to
				42 U.S.C.
				1396a(a)(5), responsible for
				the operation of the Medicaid program in Vermont.
(b) The Agency of Human Services administers
				Vermont's Medicaid program with the support and assistance of the Departments
				that comprise the Agency. The Agency of Human Services includes the Department
				of Vermont Health Access, Department of Mental Health, Department of
				Disabilities, Aging, and Independent Living, Department for Children and
				Families, Department of Corrections, and Vermont Department of Health. The
				Agency assigns the Departments the responsibility for ensuring that persons
				eligible for Medicaid services are properly enrolled, covered services are
				provided, health care providers are paid, and the rights of beneficiaries in
				the program are respected.
(c)
				These Health Care Administrative Rules coordinate and consolidate the State of
				Vermont rules that pertain to the operation of Vermont's Medicaid program.
				Consolidated and well-organized rules written in plain language permit Medicaid
				beneficiaries and providers convenient access to the regulations, increases
				comprehension of sometimes technical concepts and program requirements, and
				ensures consistent policy administration of the program throughout the Agency
				of Human Services.
(d) The Health
				Care Administrative Rules are applicable to the entirety of Vermont's Medicaid
				program, without regard to whether the programs are operated and managed by any
				individual Department within the Agency of Human Services. As such, with two
				limited exceptions, the Health Care Administrative Rules take precedence over
				any rules, policies, and guidelines maintained by individual Departments in
				connection with their operation of the portions of the Medicaid program for
				which they are responsible, if any inconsistencies between them exist. The
				first exception concerns certain specialized services contained in programs and
				services authorized by federal "waivers" of Medicaid program requirements.
				Those programs and services are reflected at Chapter 7 of these rules, entitled
				Specialized Services and Programs. The rules, policies, and guidelines relating
				to such Specialized Services and Programs take precedence over the more general
				coverage, limitation, prior authorization, and eligibility rules contained
				throughout these Health Care Administrative Rules. The second exception relates
				to the provision of Early and Periodic, Screening, Diagnostic, and Treatment
				(EPSDT) required under the Medicaid Act. Vermont Medicaid pays for all
				medically necessary services for beneficiaries under the age of 21 without
				regard to service limitations otherwise specified in these Health Care
				Administrative Rules. Further, federal EPSDT requirements may require in
				individual cases exceptions to the general Medicaid program rules.