13-048 Code Vt. R. 13-140-048-X - CHILDREN WITH SPECIAL HEALTH NEEDS FINANCIAL ASSISTANCE FOR RESPITE RULE

Section I Authority

This rule is adopted under the authority of 3 V.S.A. §§ 801(b)(11) and 3003(a) and 18 V.S.A. §§ 102 and 104.

Section II Effective Date

January 1, 2013

Section III Purpose

This rule establishes eligibility requirements and procedures for the Vermont Department of Health's Children with Special Health Needs (CSHN) Financial Assistance for Respite and between January 1, 2012 and December 31, 2013 CSHN Transitional Cost-Sharing Financial Assistance. CSHN serves those Vermont children and youth aged birth to 21, who have a chronic physical or developmental condition and who also require health and related services of a type or amount beyond that required by children generally.

Section IV Eligibility for CSHN Financial Assistance for Respite

Respite is a planned break for parents or caregivers, which allows parents or caregivers time to spend with other children, schedule necessary appointments, or rest and recharge. Respite provides limited funding for short-term support and relief to families who meet the eligibility criteria below;

A) Children birth to age 21;

B) Have a chronic physical or developmental condition;

C) Require health and related services of a type or amount beyond that required by children generally;

D) Children and families who earn at or less than 500% of the Federal Poverty Level. The Federal Poverty Guidelines are published on the U.S. Department of Health and Human Services website at http://aspe.hhs.gov/poverty/12poverty.shtml#guidelines and are hereby incorporated by reference;

Section V Transitional CostSharing Financial Assistance Eligibility

A) Children and families eligible for CSHN financial assistance;

B) Children and families who have health insurance and have applied for health care coverage through the State of Vermont. (www.greenmountaincare.org); and

C) Enrolled by CSHN and receiving cost sharing assistance as of December 31, 2012;

D) Individuals between the ages of 18 and 21 may be required to apply for coverage through Working People with Disabilities.

Section VI Transitional CostSharing Financial Assistance

A) Transitional Cost-Sharing Financial Assistance takes the form of a graduated deductible or spend-down before CSHN financial assistance will begin on the purchase of services and products that are authorized by CSHN.

B) Transitional Cost-Sharing Financial Assistance will expire as of December 31, 2013.

C) All claims for transitional cost-sharing financial assistance must be filed with CSHN no later than March 31, 2014 and must have occurred on or before December 31, 2013.

Section VII Limited Financial Assistance

In the discretion of the Commissioner of Health, and subject to the availability of funds, limited financial assistance may be granted in extraordinary circumstances to children eligible under section IV of this rule to assist with medical expenses not covered by insurance or available from any other source.

Notes

13-048 Code Vt. R. 13-140-048-X

STATUTORY AUTHORITY: 3 V.S.A. §§ 801, 3003; 18 V.S.A. §§ 102, 104
EFFECTIVE DATE: August 1, 1995 Secretary of State Rule Log #95-48 (under title: Cost-Share for Patients of AHS/VDH/CSHN Programs)
AMENDED: January 1, 2013 Secretary of State Rule Log #12-046