§ 4076.
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/vt/title-8/chapter-107/4076A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§ 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.)