Health Care Rules

Health Care Administrative Rules
The Agency of Human Services is undertaking a comprehensive revision of Medicaid rules across the Agency of Human Services and its Departments. The Medicaid Covered Services Rules will be amended and adopted under the title of Health Care Administrative Rules (HCAR). This is a multi-year process, and during this transition phase, some Medicaid rules will remain in the Medicaid Covered Services Rules (7100 - 7700), while other rules will be adopted in the new HCAR collection of Medicaid rules.

Health Benefits Eligibility and Enrollment Rules
The Health Benefits Eligibility and Enrollment (HBEE) rules provide the eligibility standards for Medicaid and other health care programs.

VPharm Rules (5400)
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 in to 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 enrolled in Medicaid cannot receive VPharm coverage. Medicaid beneficiaries receive their secondary pharmacy coverage through Medicaid (HCAR 4.207). The rules which follow apply to the coverage group called VPharm. Please also note that repealed VHAP rules 5321 - 5323 apply to VPharm program eligibility. 

Blueprint for Health Rules (8100)
The Blueprint for Health (Blueprint) is the State of Vermont’s program for integrating a system of health care for patients, improving the health of the overall population, and improving control over health care costs by promoting health maintenance, prevention, and care coordination and management.

Healthy Vermonters Rules (5700)
This program provides a pharmacy discount to eligible Vermonters, helping beneficiaries purchase prescription medicines necessary to maintain their health and prevent unnecessary health problems. These rules describe this pharmacy program.

HIV/AIDS Rules (5800)
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." The policies which follow implement this program.

Contact Information

Agency of Human Services
280 State Drive - Center Building
Waterbury, VT
802-241-0440