Stay Informed and Protect Your Health.
Provider and Member Communication
The State of Vermont’s Eligibility and Enrollment System for Qualified Health Plans and Medicaid will be Unavailable July 10 – July 21 for Required Maintenance and Upgrades.
The State of Vermont’s eligibility and enrollment system for qualified health plans and Medicaid will be undergoing required system maintenance and upgrades between Friday, July 10th at 5pm and Tuesday, July 21st at 9am. Some programs will not be affected, including Medicaid for the Aged, Blind and Disabled, Long-Term Care Medicaid, Disabled Children’s Home Care (DCHC or Katie Beckett), Medicare Savings Programs, VPharm or Healthy Vermonters programs. These programs use a different enrollment system so the scheduled maintenance will not affect them.
The State began public communications last week to encourage Vermonters who may need to enroll or make a change to their account to do so before the system becomes unavailable on July 10th beginning at 5pm. During the period of scheduled maintenance and upgrades, affected customers will not have access to their account and will not be able to make changes either online or over the phone.
The Customer Support Center and the Assister hotline will remain open from 8:00am-4:30pm Monday-Friday during the time the system is undergoing the planned maintenance and upgrades to answer general questions and to assist customers and Assisters who have an urgent access to care need. Customers may still contact the Customer Support Center at 1-855-899-9600 but staff will have very limited capacity to support customers and Assisters during the system upgrade.
Additional Provider Billing:
The cost of PPE is not eligible for Medicaid reimbursement and any costs associated with the purchase of PPE may not be charged to Medicaid members. PPE are considered supplies that are incidental to a provider’s practice and may not be billed separately. Providers are required to submit claims for all Medicaid covered services and may not request payment from a Medicaid enrolled individual at the time of service. Vermont Medicaid cannot reimburse the member for services. To ensure access to care for Vermont Medicaid members, the Agency of Human Services has offered financial opportunities for providers and has developed a proposal for health care provider stabilization. As more information will be forthcoming, providers should continue to visit this webpage for the most up-to-date information. (6/10/2020)
- Uninsured Vermonters:
Vermont Medicaid has:
- Eliminated co-payments for hospital outpatient services;
- Eliminated co-payments for medications that may be used to treat the symptoms of COVID-19.
These changes ensure that no co-payments apply to COVID-19 testing, diagnosis, and treatment services. (3/31/2020)
- Provider Assistance:
- Federal Financial Relief for Medicaid Providers through the CARES Act. The U.S. Department of Health and Human Services (HHS) has released additional information regarding the CARES Act Provider Relief Fund. For Medicaid and CHIP providers, providers must submit and complete an application (see instructions here) to the HHS’ provider portal by July 20, 2020. HHS expects to distribute $15 billion to eligible Medicaid and CHIP providers through the Provider Relief Fund. For more information, visit the HHS CARES Act Provider Relief Fund website. (6/23/2020)
- Postponement of Vermont Medicaid Fee Schedule Updates. (5/15/2020)
- COVID-19-specific Sustained Monthly Retainer Payments Cover Letter and Process. (The April application process is complete; the Monthly Retainer for May/June is now open as of 4/27/2020.)
- Online Opt-In Form for the Vermont Medicaid COVID-19-specific Sustained Monthly Retainer Program. (4/27/2020)
- Frequently Asked Questions (FAQs). COVID-19-specific Medicaid Retainer. (updated 5/21/2020)
- Notice of temporary Medicaid Long-Term Care Facilities rate restructure in response to the COVID-19 National Health Emergency. Additional information of extraordinary financial relief. (4/6/2020)
- Notice of temporary Private Non-Medical Institution rate restructure in response to declared COVID-19 National Health Emergency. Additional information of extraordinary financial relief. (4/6/2020)
- Telehealth, Telemedicine and Telephonic Coverage:
(For additional information visit the DVHA Telehealth webpage)
- Vermont Medicaid-participating providers are encouraged to continue the use of telemedicine for health care delivery when possible. Telehealth Resources.
- Vermont Medicaid Continuing Telemedicine Coverage for Dental Services & Temporary New Telephonic Coverage for Brief Communication Services for Dental Providers. (4/10/2020)
- Vermont Program for Quality in Health Care (VPQHC) State-Wide Telehealth Resource Page, Including Technical Assistance for Providers. (3/30/2020)
- Frequently Asked Questions. Vermont Medicaid Payments for Telephonic Services Furnished During the Emergency Response to COVID-19. (4/23/2020)
- Vermont Medicaid Payments for Telephonic Services Furnished During the Emergency Response to COVID-19. (5/28/2020)
- Telehealth, Telemedicine & Telephonic Coverage. Updated Guidance to Support Medicaid Providers During the Emergency Response to COVID 19. (3/20/2020)
- Please note as of March 24, 2020, Vermont Medicaid has corrected the reimbursement for telemedicine 02 place of service.
- Durable Medical Equipment:
- Clinical Information:
- Pharmacy Information:
- Extension of Prior Authorizations - Response to the COVID-19 Emergency. (effective 5/1/2020)
- Covid-19 Update. (effective 3/27/2020)
- Important Pharmacy Information in Response to COVID-19. (3/30/2020)
- COVID-19 - Retail Pharmacy Home Delivery Options. (last updated 4/3/2020)
- Eligibility and Enrollment: (updated 6/12/2020)
Vermont Health Connect website
In order to manage our COVID-19 response, our temporary call center hours for Member Services will be 8:00 AM to 4:30 PM, Monday through Friday. Due to the COVID-19 Emergency, Vermont is facilitating initial and continuous health care enrollment by:
- Temporarily waiving financial verifications required for those seeking to enroll in health insurance;
- Extending Medicaid coverage periods (meaning the Department is not processing the annual “reviews” that could result in loss of Medicaid) until after the emergency ends;
- Not ending Medicaid coverage during the Emergency period unless the customer requests it;
- See below for more information on how Vermont is implementing these changes for Long-Term Care Medicaid.
- Temporarily waiving Dr. Dynasaur premiums, beginning with the April bills for the premium due in May;
- Offering a Special Enrollment Period for those who do not currently have health insurance to enroll in a qualified health plan and receive premium and cost-sharing assistance, if eligible. (Eligible Vermonters can continue to apply for, and enroll in, Medicaid at any time). This Special Enrollment Period is currently open through August 14, 2020.
- Long-Term Care Medicaid:
For Long-Term Care Medicaid, Vermont is:
- Accepting self-attestations for current income and resources from applicants for Long-Term Care Medicaid eligibility determinations and suspending transfer of asset rules (60 month look back period) during the Emergency;
- Extending the review period for Long-Term Care Medicaid members who had a review scheduled for March, April or May until the Emergency ends;
- Reviews are extended for all Long-Term Care Medicaid members scheduled for those three months whether or not they returned their review application;
- All Provider questions and concerns should be sent via EMAIL to the DVHA LTC Management Team at: AHS.DVHALTCMGMT@vermont.gov.