Vermont § 4076 - Home health services

§ 4076. Home health services

• (a) As used in this section: (1) “Home health agency” means a nonprofit home health agency that has been certified
  under Title XVIII of the Social Security Act (42 U.S.C. § 1395 et seq.). (2) “Home health care” means care and treatment provided by a home health agency and designed
  and supervised by a health care professional, without which care and treatment a person
  would require admission to a hospital or skilled nursing facility, as those terms
  are defined by Medicare regulations. The care and treatment shall consist of one or
  more of the following: (A) Part-time or intermittent skilled nursing care. (B) Physical therapy. (C) Part-time or intermittent home health aide services that consist primarily of caring
  for the patient. (D) Medical supplies, drugs and equipment, and laboratory services to the extent that
  laboratory services would have been covered if the patient had been admitted to a
  hospital or skilled nursing facility. The medical necessity of equipment may be reviewed
  by reference to the Medicare guidelines for durable medical equipment. (b)(1) A major medical insurance plan shall provide coverage for home health care. (2) A health insurer may require evidence of insurability as a prerequisite to coverage. (3) The coverage shall consist of at least 40 visits by a home health agency in any calendar
  year, or in any continuous period of 12 months, for each person covered under the
  health insurance plan. (4) Each visit by a member of a home health care agency, other than a home health aide,
  shall be considered one home health care visit, and four hours of home health aide
  service shall be considered one home health care visit. Coverage shall be provided
  for maternity and childbirth. (c) Nothing in this section shall be deemed to require that home health care coverage
  be provided to individuals eligible for Medicare. (d) A health insurance plan shall not impose greater coinsurance, co-payment, deductible,
  or other cost-sharing requirements for coverage of home health care than apply to
  the diagnosis and treatment of any other physical or mental condition under the plan. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)