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    OpenPayerPolicy UpdatesAdministrative/Operational PolicyVermont DVHA HCAR Crosswalk Policy Update | OpenPa…
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    CurrentVermont Agency of Human Services – Department of Vermont Health AccessPolicy N/A

    Health Care Administrative Rules Crosswalk

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    Maps former Vermont Department of Vermont Health Access Medicaid Covered Services Rules numbered 7100–7700 to new Health Care Administrative Rules numbered 1.100–9.100, including renumbered, renamed, repealed, and newly introduced provisions.

    Policy Summary
    PayerVermont Agency of Human Services – Department of Vermont Health Access
    PolicyHealth Care Administrative Rules Crosswalk
    Policy CodePolicy N/A
    Change TypeAdministrative rule crosswalk and renumbering
    Effective DateN/A
    Next Review DateN/A
    Key ActionUse the crosswalk to locate the corresponding HCAR provision for each former DVHA Medicaid Covered Services Rule.
    SourceLink
    POLICY UPDATE CHANGES

    Existing Medicaid Covered Services Rules were renumbered and, in some cases, renamed under the Health Care Administrative Rules.

    Several former rules are identified as repealed, including rules for acupuncture, fertility services, massage therapy, surgery, transportation-related provisions, general equipment information, and telemonitoring.

    The crosswalk identifies newly numbered HCAR provisions for areas including definitions, introduction, telehealth, emergency services, Medicaid non-covered services, applied behavior analysis, gender affirmation surgery, in-home lactation consultation, Medicaid cost sharing, and supervised billing.

    7100–7700Former rule range
    1.100–9.100New HCAR range

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    4Explicitly repealed rules
    10.100Pharmaceutical manufacturer fee
    1.100–1.101New introduction and definitions

    Health Care Administrative Rules Transition

    This crosswalk documents the transition from the former DVHA Medicaid Covered Services Rules, numbered 7100–7700, to the Health Care Administrative Rules (HCAR), numbered 1.100–9.100. The HCAR provisions listed in the crosswalk have been adopted under the new rule structure.

    Former Rules and HCAR Provisions

    Former rule numberFormer rule nameHCAR provision numberHCAR provision name
    7103Medical Necessity4.101Medical Necessity for Covered Services
    7110Global Commitment Appeals & Grievances8.100Internal Appeals, Grievances, Notices, and State Fair Hearings on Medicaid Services
    7201Global Commitment Appeals & Grievances Inpatient Services - Medical and Psychiatric4.200Fair Hearings on Medicaid Services Inpatient Hospital Services
    7203Outpatient Services4.201Outpatient Hospital Services
    7302Abortion4.223Abortion
    7303AcupunctureRepealedNone (Repealed)
    7304Chiropractic Services4.220Chiropractic Services
    7305Covered Organ and Tissue Transplants4.228Transplantation Services
    7306Fertility ServicesRepealedNone (Repealed)
    7307Massage TherapyRepealedNone (Repealed)
    7308Podiatry Services4.221Podiatry Services
    7309Sterilizations and Related Procedures4.224Sterilizations and Related Procedures
    7310SurgeryRepealedNone (Repealed)
    7311Medical and Surgical Services of a Dentist; Dental Services for Beneficiaries Under Age 214.204Medical and Surgical Services of a Dentist
    7312Dental Services for Beneficiaries Under Age 21, and Pregnant and Postpartum Women4.203Dental Services for Beneficiaries Under Age 21, and Pregnant and Postpartum Women
    7313Dental Services for Beneficiaries Age 21 and Older4.202Dental Services for Beneficiaries Age 21 and Older
    7314Orthodontic Treatment4.205Orthodontic Treatment
    7507Augmentative Communication Devices/Systems4.211Augmentative Communication Devices and Systems
    7315Audiology Services/Hearing Aids4.213Audiology Services
    7316Eyewear and Vision Care Services4.214Eyewear and Vision Care Services
    7401Home Health Agency Services4.231Home Health Services
    7402Hospice Services4.227Hospice Services
    7407Ambulance Services4.226Ambulance Services
    7408Transportation4.225Non-Emergency Medical Transportation
    7409TransportationRepealedNone (Repealed)
    —Early and Periodic Screening, Diagnosis and Treatment (EPSDT)4.106Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services
    7412Treatment (EPSDT) High Tech Nursing Services4.232Medically Complex Nursing Services
    —Pharmaceuticals, Medical Supplies and Equipment - General InformationRepealedNone (Repealed)
    7501/7502Equipment - General Information; Prescribed DrugsRepealed; 4.207None (Repealed); Prescribed Drugs
    7502/7503Prescribed Drugs; Whole Blood4.207; 4.222Prescribed Drugs; Whole Blood
    7503/7504Whole Blood; Medical Supplies4.222; 4.208Whole Blood; Medical Supplies
    7505Durable Medical Equipment (DME)4.209Durable Medical Equipment
    7506Wheelchairs, Mobility Devices and Seating Systems4.210Wheelchairs, Mobility Devices, and Seating Systems
    7508Prosthetics Devices4.212Prosthetic and Orthotic Devices
    7701Pharmaceutical Manufacturer Fee10.100Pharmaceutical Manufacturer Fee
    7702TelemonitoringRepealedNone (Repealed)
    ——1.101Health Care Administrative Rules Definitions
    ——1.100Health Care Administrative Rules Introduction
    ——3.101Telehealth
    ——4.102Emergency Services
    ——4.103Medicaid Non-Covered Services
    ——4.229Applied Behavior Analysis Services
    ——4.238Gender Affirmation Surgery for the Treatment of Gender Dysphoria
    ——4.239In-home Lactation Consultation Services
    ——6.100Medicaid Cost Sharing
    ——9.103Supervised Billing

    Policy Changes

    2023-09-01Crosswalk updateLatest

    Updated the crosswalk from former Medicaid Covered Services Rules 7100–7700 to Health Care Administrative Rules 1.100–9.100, including renumbered and renamed provisions, repealed rules for services such as acupuncture, fertility services, massage therapy, surgery, transportation, equipment information, and telemonitoring, and newly introduced provisions covering definitions, telehealth, emergency services, non-covered services, applied behavior analysis, gender affirmation surgery, in-home lactation consultation, cost sharing, and supervised billing.

    Policy Summary
    PayerVermont Agency of Human Services – Department of Vermont Health Access
    PolicyHealth Care Administrative Rules Crosswalk
    Policy CodePolicy N/A
    Change TypeAdministrative rule crosswalk and renumbering
    Effective DateN/A
    Next Review DateN/A
    Key ActionUse the crosswalk to locate the corresponding HCAR provision for each former DVHA Medicaid Covered Services Rule.
    SourceLink
    On This Page
    Health Care Administrative Rules TransitionFormer Rules and HCAR ProvisionsPolicy Changes