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Health Care Administrative Rules

“Health Care Administrative Rules” or “HCAR” mean the collection of regulations adopted by the Agency of Human Services that govern the administration of Vermont Medicaid, including general provisions, eligibility, benefit delivery, covered services, reimbursement, specialized services, beneficiary rights, and provider responsibilities.


*Adopted Rules* 

The Agency of Human Services is undertaking a comprehensive revision of Medicaid rules across the Agency. All Medicaid rules will be amended and adopted under the title of Health Care Administrative Rules (HCAR). Amendments to rule may include changes to policy and operations, as well as formatting and organization. This is a multi-year process, and during this transition phase, some Medicaid rules will remain under the Department of Vermont Health Access (DVHA) Medicaid Covered Services Rules (7100 - 7700), while other rules will be adopted in the new HCAR collection of Medicaid rules.   


The HCAR Table of Contents and the Crosswalk below can be used to help determine whether a Medicaid rule is in the new HCAR format (1.100 - 9.100) or, for the time being, remains in the existing Medicaid Covered Services format (7100 - 7700).    

 The HCAR Crosswalk is available here. This is a crosswalk from the old DVHA Medicaid Covered Services Rules (7100 - 7700) to the newly adopted HCAR rules (1.100 - 9.100).

 HCAR proposed rules are available here.

 For the HCAR rules that are currently adopted, a full text verion of HCAR rules is available here

 HCAR Table of Contents

Highlighted rule numbers have been adopted under HCAR
  Chapter 1: General Provisions and Definitions
 1.100 Health Care Administrative Rules Introduction 
 1.101 Health Care Administrative Rules Definitions 
  Chapter 2: Eligibility
  This chapter is reserved for future rulemaking
  Chapter 3: Medicaid Benefit Delivery
 3.100 Medicaid Benefit Delivery
 3.101 Telehealth
 3.102 Blueprint for Health 
 3.103 Health Homes 
 3.104 Vermont Chronic Care Initiative 
 3.105 Integrating Family Services
  Chapter 4: Medicaid Covered Services
        Subchapter 1: General Provisions
 4.100 Medicaid Covered Services General Provisions 
 4.101 Medical Necessity for Covered Services
 4.102 Emergency Services
 4.103 Utilization Management
 4.104 Medicaid Non-Covered Services
 4.105 Medicaid Coverage Exception Requests
 4.106 EPSDT
        Subchapter 2: Medicaid Covered Services
 4.200 Inpatient Services
 4.201 Outpatient Services
 4.202 Dental Services Over 21
 4.203 Dental Services Under 21
 4.204 Medical and Surgical Services of a Dentist
 4.205 Orthodontic Treatment
 4.206 Mental Health and Substance Abuse Therapy
 4.207 Pharmacy Services
 4.208 Medical Supplies
 4.209 Durable Medical Equipment
 4.210 Wheelchairs, Mobility Devices and Seating Systems
 4.211 Augmentative Communication Devices/Systems
 4.212 Prosthetic Devices
 4.213 Audiology Services
 4.214 Eyewear and Vision Care Services
 4.215 Physicians and Other Licensed Practitioners
 4.216 Clinic Services
 4.217 Surgery
 4.218 Laboratory and Radiology Services
 4.219 Rehabilitative and Habilitative Therapy Services
 4.220 Chiropractic Services
 4.221 Podiatry Services
 4.222 Whole Blood
 4.223 Abortion Services
 4.224 Sterilizations and Related Procedures
 4.225 Transportation Services
 4.226 Ambulance Services
 4.227 Hospice Services
 4.228 Organ and Tissue Transplants
 4.229 Applied Behavior Analysis
 4.230 Adult Day Services
 4.231 Home Health Services
 4.232 High-Technology Nursing Services
 4.233 Personal Care Services
 4.234 Private Non-Medical Institutions
 4.235 Nursing Facility Services
 4.236 Nursing Facility Care in Hospitals - Swing Beds
 4.237 Psychiatric Residential Treatment Facilities
  Chapter 5: Medicaid Reimbursement
 5.100 Medical Service Payments
 5.101 Methodologies
  Chapter 6: Medicaid Cost Sharing
 6.100 Medicaid Cost Sharing
  Chapter 7: Specialized Services and Programs
 7.100 Disability Services - Developmental Services
 7.101 Disability Services - Traumatic Brain Injury
 7.102 Choices for Care
 7.103 Attendant Services Program
 7.104 VPharm
 7.105 Healthy Vermonters Program
 7.106 Family Services (Treatment Services)
 7.107 Adult Mental Health
 7.108 Children's Mental Health
 7.109 Alcohol and Drug Abuse Program/Medication Assisted Treatment
 7.110 Children with Special Health Needs
 7.111 Vermont Medication Assistance Program
  Chapter 8: Beneficiary Rights
 8.100 Internal Appeals, Grievances, Notices, and State Fair Hearings on Medicaid Services
 8.101 Network Adequacy
 8.102 Confidential Information
 8.103 Disclosure of Information
  Chapter 9: Provider Responsibilities
 9.103 Supervised Billing
 9.106 Seclusion and Restraint for Children's Outpatient Services
  Chapter 10: Provider Tax
 10.100 Pharmaceutical Manufacturer Fee