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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.)