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Proposed Rule Changes
Proposed changes to Medicaid rules. The Bulletins found here are for proposed rule changes only. Once final proposed rules are filed, the proposed rules will be removed from this page.
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Bulletin 12-01: Out-of-Network Elective Outpatient Visits - This bulletin changes Medicaid rules to include prior authorizations for out-of-network elective outpatient office visits to ensure that Vermont’s publicly funded health care program beneficiaries receive appropriate, non-fragmented care. This rule change also ensures that primary medical care is most often provided by Green Mountain Care Network providers rather than out-of-network providers, unless it is medically necessary to see an out-of-network provider for an elective outpatient office visit. The Green Mountain Care Network is comprised of all enrolled Vermont-based providers and select out-of-state hospitals and their affiliated providers due to their close proximity to Vermont and the fact that it is the general practice of residents of Vermont to secure care and services there. Theses changes are for beneficiaries enrolled in Medicaid, VHAP, Dr. Dynasaur, and SCHIP. These rules are anticipated to be effective beginning on July 1, 2012. [Secretary of State ID #__-___]
Bulletin 12-03: Eyeglasses and Vision Care Services- This bulletin changes the Medicaid rule to allow new eyewear yearly (instead of every two years) for children under age 6 years and better clarifies coverage of medically necessary routine eye exams. This bulletin also clarifies the rule language to indicate that only routine eye exams are limited and that coverage of routine eye exams is limited to the following combinations within a two year period: one comprehensive and one intermediate or two intermediate eye exams. Theses changes are for beneficiaries enrolled in Medicaid, VHAP, Dr. Dynasaur, and SCHIP. These rules are anticipated to be effective beginning on July 1, 2012. [Secretary of State ID #__-___]
