Medicaid
Until recently, the Medicaid regulations were found in the Medicaid Policy Manual and had an “M” prefix, e.g. the citizenship requirement for eligibility was found at M212. However, last year, the Agency of Human Services, which includes both DAIL and ESD/DCF, began a major reorganization of its rule numbering systems, along moving to a computer-based document management system. DCF Bulletin Number 08-20F, dated September 21, 2008 describes the changes and contains a list showing the where to find the old rules in the new numbering system.
Hard copies of the new Rules are available for purchase from DCF for $150. The hard copies will be re-issued yearly. The updates to the rules during the year will only be available online. You can sign up to receive notification of rule updates via e-mail through http://dcf.vermont.gov/esd/rules. This is the web address for Proposed, Adopted and Expedited Rules. On this page, under Adopted Rules, if you click B09-26, you will access Bulletin No. 09-26, which contains the new value for the average cost of nursing home care in Vermont, at P-2420, effective 10/1/09. Further down on the page, you can access Archived Rules by year, such as the useful 2008 Bulletin No. 08-20F, mentioned above. Look at pages 39-44 in Bulletin 08-20F for the rules that used to be found at M200, pages 49-51 for the M400 rules, and pages 62-63 for some useful M100 rules. If you get tired of keyboarding, you can also telephone DCF in Waterbury at (802) 241-2100 for more information.
Judicial Reorganization
The Vermont's Probate Courts survived the 2009-2010 legislative session with each of Vermont’s fourteen counties still having its own Probate Court. With a focus on reducing costs and centralizing the organization of the court system, the Vermont Supreme Court's Commission on Judicial Operation had proposed reducing the number of probate judges to five full-time judges and having individual judges serve a wider geographic territory. The Vermont House bill would have reduced the number of Probate Judges to eight. The Senate held out for 14 Judges, to prevent more rural areas from losing access to a local court. The final version was based by both chambers on May 8, 2010. The Governor signed the bill on June 3, 2010.
Text of Act No. 154
Medicare:
Courts rule against "improvement" requirement
In two recent federal district court cases, one in Vermont, the courts ruled that Medicare was wrong to discontinue services because the Medicare recipient was not improving. The Vermont case involved home health services that were discontinued because the patient's condition was "stable and unlikely to change." District Court Judge Reiss relied on previous Vermont District Court cases and Medicare statutory language in concluding that coverage for skilled services should be based on the individual patient's need for services at the beginning of the service period, including services needed to prevent deterioration. Anderson v. Sebelius 2010 WL 4273238, No. 09-16 (D.Vt., Oct. 25, 2010)
The second case, from the District Court in Pittsburgh, said that it was wrong for Medicare to terminate skilled nursing services in a nursing home simply because the patient had reached her "maximum functional capacity." The Court said that coverage should be continued when it is necessary to maintain function and prevent deterioration. Papciak v. Sebelius, 2010 WL 3885605 (W.D.Pa. 2010)
The two cases are discussed in a November 1, 2010 article in the New York Times. Medicare Standards article The Center for Medicare Advocacy is considering further action on Medicare denials or terminations due to failure to improve. Improvement Standard article