The HCAR Table of Contents below and the HCAR Crosswalk document 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).
HCAR Crosswalk
The HCAR Crosswalk document is a crosswalk from the old DVHA Medicaid Covered Services Rules (7100 - 7700) to the newly adopted HCAR rules (1.100 - 9.100).
***NEW - HCAR Combined Rules (10/18/2024)***
HCAR Table of Contents
Bolded 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
- 3.101 Telehealth
- 3.102 Blueprint for Health
- 3.103 Health Homes
- 3.104 Vermont Chronic Care Initiative
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 Prior Authorization
- 4.104 Medicaid Non-Covered Services
- 4.105 Medicaid Coverage Exception Requests
- 4.106 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services
- 4.107 Third Party Liability
Subchapter 2: Medicaid Covered Services
- 4.200 Inpatient Hospital Services
- 4.201 Outpatient Hospital Services
- 4.202 Dental Services Age 21 and Older
- 4.203 Dental Services Under Age 21, and Pregnant and Postpartum Women (regardless of age)
- 4.204 Medical and Surgical Services of a Dentist
- 4.205 Orthodontic Treatment
- 4.206 Mental Health and Substance Use Therapy
- 4.207 Prescribed Drugs
- 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 and Orthotic 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 Non-Emergency Medical Transportation
- 4.226 Ambulance Services
- 4.227 Hospice Services
- 4.228 Transplantation Services
- 4.229 Applied Behavior Analysis Services
- 4.230 Adult Day Services
- 4.231 Home Health Services
- 4.232 Medically Complex Nursing Services (High Technology Nursing Services prior to 1/1/2020)
- 4.233 Children's Personal Care Services (effective 4/1/2024)
- 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
- 4.238 Gender Affirmation Surgery for the Treatment of Gender Dysphoria (see GCR 23-108 for updated Hysterectomy Prior Authorization Requirements)
- 4.239 In-home Lactation Consultation Services
- 4.240 Mental Health Emergency Services
Chapter 5: Medicaid Reimbursement
- 5.100 Medical Service Payments
- 5.101 Methods, Standards, and Principles for Establishing Medicaid Payment Rates for Long-Term Care Facilities
- 5.102 Methods, Standards, and Principles for Establishing Payment Rates for Private Nonmedical Institutions Providing Residential Child Care Services
Chapter 6: Medicaid Cost Sharing
- 6.100 Medicaid Cost Sharing
Chapter 7: Specialized Services and Programs
- 7.100 Disability Services - Developmental Services
- 7.101 Brain Injury Program
- 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 Use Program/Medication Assisted Treatment
- 7.110 Children with Special Health Needs
- 7.111 Vermont Medication Assistance Program
Chapter 8: Beneficiary Rights and Responsibilities
- 8.100 Internal Appeals, Grievances, Notices, and State Fair Hearings on Medicaid Services
- 8.101 Beneficiary Rights and Responsibilities
- 8.102 Person-Centered Planning - Home- and Community-Based Services
- 8.103 Network Adequacy
Chapter 9: Provider Rights and Responsibilities
- 9.100 Provider Rights and Responsibilities
- 9.103 Supervised Billing
- 9.104 Supplementation Prohibition
- 9.105 Program Integrity (Currently Violations of Provider Responsibility)
- 9.106 Seclusion and Restraint for Children's Outpatient Services
Chapter 10: Provider Tax