The Department of Vermont Health Access (DVHA) uses evidence-based clinical guidelines from nationally recognized sources during review of our quality and health management programs. The purpose of these developed guidelines is to provide clinical guidance to help facilitate and assure quality, effective treatment and interventions for Vermont Medicaid members.
Clinical guidelines should not be considered as the only resource and are not intended to replace the professional judgment of providers. Guidelines may not apply to every member or clinical situation and some divergence from guidelines is expected. Further, guidelines do not determine insurance coverage of health care services or products. Coverage decisions are based on member eligibility and determination of medical necessity.
DVHA has clinical criteria for coverage of specific services, and they can be found on the DVHA Clinical Criteria webpage.