The Vermont Statutes Online

Title 33: Human Services

Chapter 063: Home Care Programs

• Subchapter 001: HOME CARE SERVICES

• §§ 6301-6303. Repealed. 2005, No. 57, § 7, eff. June 13, 2005.

• Subchapter 001A: GENERAL PROVISIONS

• § 6301. Policy

  It is the policy of the State of Vermont to ensure that all residents in every town within the State have access to comprehensive, medically necessary home health services without regard to their ability to pay for those services and to ensure that such services are delivered in an efficient and cost-effective manner, under a regulatory framework designed to control costs and ensure access to high quality home health services based on a model that promotes cooperation and nonduplication of services, rather than unregulated competition. (Added 2005, No. 57, § 8, eff. June 13, 2005.)

• § 6302. Definitions

  As used in this subchapter, unless otherwise indicated:

  (1) “Family member” means an individual who is related to a person by blood, civil marriage, civil union, or adoption, or who considers himself or herself to be family based upon bonds of affection, and who currently shares a household with such a person or has, in the past, shared a household with that person. For purposes of this definition, the phrase “bonds of affection” means enduring ties that do not depend on the existence of an economic relationship.

  (2) “Home health agency” means a for-profit or nonprofit health care facility providing part-time or intermittent skilled nursing services and at least one of the following other therapeutic services made available on a visiting basis, in a place of residence used as a patient’s home: physical, speech, or occupational therapy; medical social services; home health aide services; or other non-nursing therapeutic services, including the services of nutritionists, dieticians, psychologists, and licensed mental health counselors.

  (3) “Home health services” means activities and functions of a home health agency, including nurses, home health aides, physical therapists, occupational therapists, speech therapists, medical social workers, or other non-nursing therapeutic services directly related to care, treatment, or diagnosis of patients in the home. (Added 2005, No. 57, § 8, eff. June 13, 2005.)

• § 6303. Home health services; local plans; board composition

  (a) Consistent with the requirements of this section, the Commissioner of Disabilities, Aging, and Independent Living shall adopt by rule minimum program standards for the purpose of providing quality oversight of the home health agencies authorized to provide home health services under this subchapter. The minimum program standards shall include performance standards, quality measures, grievance and complaint procedures, patient safety standards, consumer input mechanisms, accessibility standards, medical necessity standards, and practices to ensure confidentiality of patient records. The rules shall also include minimum program standards to ensure home health agencies do not discriminate in the provision of services based on income, funding source, geographic status, or severity of health needs and to ensure the attainment or continuance of universal access to medically necessary home health services.

  (b) Designated home health agencies shall engage in planning and needs assessment processes as directed by State and federal law, which may include participating in the development of the Health Resource Allocation Plan published pursuant to 18 V.S.A. § 9405 and the community health needs assessment conducted in accordance with 26 U.S.C. § 501(r)(3).

  (c) On or before January 1, 2008, the board of each nonprofit designated home health agency shall be representative of the demographic makeup of the area or areas served by the agency or by the health care facility governed by the board. A majority of the members of the board shall be composed of individuals who have received or currently are receiving services from the agency or from the health care facility governed by the board and family members of individuals who have received or currently are receiving such services. The board president shall survey board members annually and certify to the Commissioner that the composition of the board meets the requirements of this subsection. The composition of the board shall also be confirmed by the agency’s annual independent audit. The board shall have overall responsibility and control of the planning and operation of the home health agency, including development of the local community services plan.

  (d) On or before January 1, 2008, each for-profit designated home health agency shall have an advisory board, which shall be representative of the demographic makeup of the area or areas served by the agency. A majority of the members of the advisory board shall be composed of individuals who have received or currently are receiving services from the agency and family members of individuals who have received or currently are receiving such services. The advisory board president shall survey board members annually and certify to the Commissioner that the composition of the board meets the requirements of this subsection. The composition of the board shall also be confirmed by the agency’s annual independent audit. The advisory board shall meet at least twice per year and shall advise the agency’s board of directors with respect to planning and operation of the home health agency, patient needs, and development of the local community services plan.

  (e) [Repealed.] (Added 2005, No. 57, § 8, eff. June 13, 2005; amended 2009, No. 33, § 83; 2015, No. 11, § 38; 2019, No. 156 (Adj. Sess.), § 7a, eff. Oct. 5, 2020.)

• § 6304. Designation; geographic service areas

  (a) The Commissioner shall specify by rule standards and procedures for home health agency designation, redesignation, and designation revocation. The designation shall provide each designated agency a franchise to provide home health services within one or more geographic service areas within which it shall have the obligation and responsibility of providing home health services for four years, except as provided in subsection (d) of this section. No home health agency shall render home health services to patients residing in a designated service area without being designated by the Commissioner to serve patients in that service area.

  (b) Initial designations shall reflect the geographic service areas of existing home health agencies and any agencies contained in a certificate of need granted under 18 V.S.A. chapter 221 prior to or following June 13, 2005, provided the certificate of need, if not yet approved, was pending on June 13, 2005. The initial geographic service areas shall include:

  (1) Addison County Home Health & Hospice, Inc.: the cities and towns of Addison County, with the exception of Hancock and Granville.

  (2) VNA & Hospice of Southwestern Vermont Health Care, Inc.: the towns of Pownal, Bennington, Woodford, Shaftsbury, and Glastenbury.

  (3) Franklin County Home Health Agency, Inc.: the cities and towns of Franklin County.

  (4) VNA of Chittenden and Grand Isle Counties, Inc.: the cities and towns of Chittenden and Grand Isle counties.

  (5) Lamoille Home Health Agency, Inc. d/b/a Lamoille Home Health & Hospice: the cities and towns of Lamoille County.

  (6) Central Vermont Home Health & Hospice, Inc.: the cities and towns of Washington County and the towns of Orange, Williamstown, and Washington.

  (7) Dorset Nursing Association, Inc.: the towns of Dorset, Rupert, and Pawlet.

  (8) Rutland Area VNA & Hospice, Inc.: the cities and towns of Rutland County, with the exception of Pawlet.

  (9) Manchester Health Services, Inc.: the towns of Manchester, Arlington, Sunderland, and Sandgate.

  (10) Northern Counties Health Care, Inc., d/b/a Caledonia Home Health Care & Hospice: the cities and towns of Caledonia County and the towns of Concord, Lunenburg, Victory, Granby, Guildhall, Maidstone, East Haven, and Greensboro.

  (11) Orleans Essex VNA & Hospice, Inc.: the cities and towns of Orleans County with the exception of Greensboro and the towns, gores, and grants of Norton, Canaan, Averill, Lewis, Lemington, Bloomfield, Brunswick, Brighton, Ferdinand, Avery’s Gore, Warren’s Gore, and Warner’s Grant.

  (12) VNA & Hospice of Vermont and New Hampshire, Inc.: the cities and towns of Windsor County, Windham County, Orange County (with the exception of the towns of Orange, Washington, and Williamstown) and the towns of Hancock, Granville, Searsburg, Readsboro, Stamford, Landgrove, Winhall, and Peru.

  (c) Designations for new home health agencies shall be established pursuant to certificates of need approved by the Green Mountain Care Board. Thereafter, designations shall be subject to the provisions of this subchapter.

  (d) The initial designations made under subsection (b) of this section shall expire according to staggered terms prescribed by the Commissioner.

  (e) Agencies seeking redesignation to continue providing home health services shall file an application for redesignation in a form and manner prescribed by the Commissioner.

  (f) In reviewing applications from agencies seeking to expand or reduce the offering of home health services, the Commissioner shall determine whether the application is consistent with the Health Resource Allocation Plan established under 18 V.S.A. § 9405. In addition, the Commissioner shall use the data collected under subsection 6305(b) of this title when reviewing any applications for additional home health agencies to operate in any area of the State.

  (g) The Commissioner shall adopt by rule standards and procedures for designation revocation. In particular, an agency’s designation shall be revoked if:

  (1) the local community services plan is inadequate to meet the needs of the area served by the home health agency;

  (2) the agency, for reasons other than the lack of resources, has failed or refused to implement an otherwise adequate local community services plan; or

  (3) the agency has failed to meet the performance standards adopted under this subchapter, has been given written notice of the performance deficiency, and has failed to remediate the deficiency within the time specified in the notice.

  (h) Nothing in this subchapter shall be construed to prohibit collaboration among two or more such home health agencies in delivering needed services to patients pursuant to an affiliation, sharing, or other agreement under appropriate circumstances approved by the Commissioner under section 6306 of this title. (Added 2005, No. 57, § 8, eff. June 13, 2005; amended 2013, No. 79, § 49c.)

• § 6305. Review of access, cost, and quality issues; remediation process

  (a) The Commissioner shall exercise such duties and responsibilities as shall be necessary for the implementation of this subchapter and for the active, ongoing supervision of the activities of the home health agencies under this subchapter.

  (b) In a form and manner and at intervals prescribed by the Commissioner, the Commissioner shall collect and analyze data regarding access to and the cost and quality of home health services in Vermont. The data shall include information on complaints, waiting lists, numbers of individuals ineligible for services, numbers of individuals eligible for but not provided services, numbers of patients served under 65 years of age and 65 years of age and over, total number of visits and hours provided to patients by each of the existing home health agencies; the results of patient surveys conducted by the home health agencies; data pertaining to federal and State surveys; scoring by any national accrediting organization; charitable and subsidized programs and services for uninsured individuals or individuals with low income in their respective communities; copies of audited financial statements and annual cost reports; and any other quality measures or data deemed relevant by the Commissioner to monitor and evaluate access to and the cost and quality of home health services by the designated home health agencies.

  (c) The Commissioner shall consider the data collected under subsection (b) of this section in undertaking active, ongoing supervision to monitor performance of the designated home health agencies with respect to access, cost, and quality of home health services.

  (d) If the Commissioner determines that a home health agency has failed to comply with any performance standards established by the Commissioner related to access, cost, or quality issues in any area of the State, or has violated a rule or provision of this subchapter, the Commissioner may investigate and enforce the provisions of this subchapter pursuant to the authority and procedures conferred upon the Commissioner under chapter 71 of this title as if the home health agency were a nursing home, except that the Commissioner shall adopt by rule penalties specific to home health agencies. (Added 2005, No. 57, § 8, eff. June 13, 2005; amended 2015, No. 11, § 39; 2021, No. 20, § 337; 2021, No. 105 (Adj. Sess.), § 625, eff. July 1, 2022.)

• § 6306. Collaboration and shared service agreements

  (a) In order to further the State’s goals of facilitating universal access to a full range of quality home health services at the lowest practicable cost throughout the State, the home health agencies are authorized and encouraged by the General Assembly to enter into and perform the following types of cooperative arrangements among two or more agencies:

  (1) agreements or understandings to pool or share one or more administrative functions, services, or expenses;

  (2) agreements or understandings to pool or share certain staffing, including skilled nursing and other personnel;

  (3) group purchasing arrangements designed to obtain the benefits of volume discounts and achieve other cost savings and efficiencies for the benefit of consumers;

  (4) agreements with managed care plans or other third-party payers, at their request and on a nonexclusive basis, to provide their members with prescribed home health services on discounted groupwide or statewide rates, terms, and conditions;

  (5) agreements or understandings to provide home health services, on an occasional or sporadic basis, to patients located in the designated service area of another home health agency due to special needs or other exceptional circumstances preventing the prompt and efficient servicing of such patients by that other home health agency or where otherwise necessary to achieve the purposes of this subchapter; and

  (6) agreements related to the sharing of information and technology.

  (b) No agreement or understanding of the types specified in subsection (a) of this section, which are entered into subsequent to June 13, 2005, shall be valid or effective unless and until it has received the written approval of the Commissioner. Any such agreement or understanding shall be submitted to the Commissioner for approval or disapproval within 30 days of execution, and the Commissioner shall have 90 days from receipt of such filing within which to approve or disapprove the agreement.

  (c) Any and all agreements or understandings of the types specified in subsection (a) of this section, which have been entered into prior to June 13, 2005, shall be valid and effective for 12 months following June 13, 2005 but not thereafter, unless they have received within that 12-month period the written approval of the Commissioner. The Commissioner shall have 90 days from receipt of such filing within which to approve or disapprove the agreement.

  (d) In rendering a decision on any application submitted under subsection (b) or (c) of this section, the Commissioner shall actively scrutinize the terms of the proposed agreement and consider all relevant facts and circumstances surrounding the agreement, as determined in the Commissioner’s discretion and pursuant to procedures specified by rule by the Commissioner. The Commissioner shall approve the agreement only if the Commissioner determines that it is in the public interest and is consistent with the purposes and policies set forth in this subchapter, including ensuring that all residents of the State have access to quality home health services delivered in an efficient and cost-effective manner.

  (e) Agreements or understandings to pool or share certain staffing, including skilled nursing and other personnel, entered into on a temporary basis, as that term may be defined by the Commissioner, to meet the particular needs of an agency’s patients and avoid temporary gaps in services shall be valid and effective without the necessity of obtaining approval by the Commissioner under subsection (b) or (c) of this section.

  (f) In authorizing the agreements and understandings of the types specified in subsection (a) of this section and the activities conducted under those agreements and understandings, the General Assembly intends that its action have the effect of permitting and granting State action immunity for any actions that might otherwise be considered to be in violation of State or federal antitrust laws, in order to accomplish the public policy objectives of this subchapter. (Added 2005, No. 57, § 8, eff. June 13, 2005; amended 2021, No. 20, § 338.)

• § 6307. Contracts with nondesignated agencies

  The Commissioner may enter into agreements with home health agencies or with any public or private agency for the purpose of establishing specialized home health services needed but not available from the designated home health agencies. (Added 2005, No. 57, § 8, eff. June 13, 2005.)

• § 6308. Complaint process

  The Commissioner shall establish by rule standards and procedures ensuring that each designated home health agency has in place sufficient minimum grievance procedures allowing recipients of home health services, their family members, and employees of a home health agency to file complaints about access to or the cost or quality of home health services, or about other matters related to the operations of the home health agency. In addition, the rules shall ensure that the Department of Disabilities, Aging, and Independent Living establishes and maintains an external complaint process for clients, their family members, and employees of a home health agency, including a toll-free telephone line dedicated to receiving consumer complaints. (Added 2005, No. 57, § 8, eff. June 13, 2005.)

• § 6309. Staff safety; discharge from service

  (a) If an individual was previously discharged from service by a home health agency to protect the safety of staff in accordance with the rules adopted by the Department of Disabilities, Aging, and Independent Living pursuant to subsection 6303(a) of this chapter, and the behavior or conditions causing the discharge cannot be reasonably mitigated or eliminated, a home health agency may:

  (1) deny a subsequent admission; or

  (2) decline to send a home health agency employee to make a visit if the home health agency has reason to believe that the individual who exhibited the behavior that resulted in the discharge is present in the home.

  (b) Nothing in this section shall be construed to require a home health agency to enter a home to determine if a risk can be mitigated or eliminated.

  (c) A home health agency shall provide notice of any denial of admission made pursuant to this section. The notice shall include the reason for the denial of admission and information regarding how an individual may submit a complaint pursuant to section 6308 of this chapter in accordance with the rules adopted by the Department of Disabilities, Aging, and Independent Living pursuant to subsection 6303(a) of this chapter. (Added 2023, No. 115 (Adj. Sess.), § 3, eff. July 1, 2024.)

• Subchapter 002: ATTENDANT CARE SERVICES

• § 6321. Attendant care services

  (a) As used in this section:

  (1) “Attendant care services” means one or more of the following types of care or service provided for compensation: assistance with personal care, including dressing, bathing, shaving, and grooming, and assistance with eating, meal preparation, and ambulation. Recipients of attendant care services shall have the opportunity to hire, train, and terminate the employment of attendants as necessary, establish work schedules, manage the services, and oversee payments of attendants and recordkeeping.

  (2) “Group-directed attendant care” means attendant care services provided by one or more attendants to a group of unrelated individuals who reside in the same residence.

  (3) “Personal services” means attendant care services provided to a Medicaid-eligible individual who is an elder or has a disability in his or her home, which are necessary to avoid institutionalization.

  (4) “Participant-directed attendant care” means attendant care services for an individual who has a permanent and severe disability who requires service in at least two activities of daily living in order to live independently.

  (b) The Department shall establish an Attendant Care Services Program to assist eligible individuals to gain or retain their independence. The Attendant Care Services Program shall include a Participant-Directed Attendant Care Program, a Group-Directed Attendant Care Program, and a personal services program.

  (c) Information received or compiled by the Department with respect to individuals using attendant care services shall be confidential.

  (d) The Commissioner shall adopt rules to implement the provisions of this section, including eligibility criteria for the programs, criteria for determining service needs, rules relating to control and oversight of services by beneficiaries of a program, and procedures for handling and maintaining confidential information. Prior to filing a proposed rule, the Commissioner shall seek input from individuals with disabilities, elders, and organizations that represent such individuals.

  (e) Grievances brought under this section shall be heard by the Human Services Board.

  (f) Workers who provide attendant care, as defined in program rules of the Department of Disabilities, Aging, and Independent Living, personal care, companion care, respite care, or support services to persons who receive financial assistance from the Agency of Human Services through its departments and offices, and whose payroll service is provided directly by the State or by an intermediary payroll service organization acting under the authority of the State are exempt from 21 V.S.A. § 342 and shall not be construed as State employees except for purposes of 21 V.S.A. chapters 9 and 17.

  (g) The State may provide workers’ compensation coverage to workers who provide attendant care, personal care, companion care, respite care, or support services to persons who receive financial assistance from the Agency of Human Services through programs administered by its departments and offices, and whose payroll service is provided directly by the State or by an intermediary payroll service organization acting under the authority of the State. The State or its intermediary payroll service organization shall be considered a single entity for purposes of purchasing a single workers’ compensation insurance policy providing coverage for such workers.

  (h) Subsections (f) and (g) of this section are intended to permit the State to provide workers’ compensation and unemployment compensation and shall not be considered for any other purposes. (Added 1989, No. 75, § 1; amended 2003, No. 122 (Adj. Sess.), § 147; 2005, No. 174 (Adj. Sess.), § 123; 2007, No. 192 (Adj. Sess.), § 6.019.1; 2013, No. 96 (Adj. Sess.), § 214.)