Medicaid

On January 10, 2014, the Centers for Medicare and Medicaid Services (CMS) issued final regulations regarding home- and community-based settings (HCBS).

Choices for Care (High/Highest) provides a package of long-term services and supports to Vermonters who are age 18 years and over and need nursing home level of care. People who need nursing home level of care typically require extensive or total assistance on a daily basis with personal care. Eligible people choose where to receive their services: in their home, in their family’s home, an Adult Family Care home, Enhanced Residential Care or nursing facility. People must meet a clinical and financial eligibility for long-term care Medicaid in Vermont.

Adult High Technology services provides skilled nursing care to people age 21 and over living in home-based settings who are eligible for Medicaid and depend on medical technology to survive. Services include coordinating treatments, medical supplies, and sophisticated medical equipment. Services are provided through Designated Home Health Agencies.

NOTE: Children’s High Technology Services are managed through the Vermont Department of Health.

Vermont State Plan on Aging

Medicaid Service Rates for programs managed by the Adult Services Division can be found in the Rate Table listed below.

• ASD Billing Codes & Rates Table

The International Classification Diseases (ICD) is a coding system used to specify diagnosis and related procedures when billing for related medical services. The US Federal government, through the Centers for Medicare and Medicaid Services (CMS), has mandated the use of ICD-10-CM diagnosis codes and ICD-10-PCS for inpatient procedure coding throughout the healthcare system effective October 2015.

Adult Day Services offer community-based non-residential supports to assist adults with physical and/or cognitive impairments to remain as active in their communities as possible. Adult day centers provide a safe, supportive environment where people can come during the day and receive a range of professional health, social and therapeutic services, as well as a nutritious meal and valuable social interaction. Adult day services also provide respite, support and education to family members and caregivers.