Vermont Mental Health Services State Plan Amendment

Table of Contents

State/Territory Name: Vermont State Plan Amendment (SPA) #: 25-0009

This file contains the following documents in the order listed: 1) Approval Letter 2) Form CMS-179 3) Approved SPA Pages

DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services 601 E. 12th St., Room 355 Kansas City, Missouri 64106

Medicaid and CHIP Operations Group

March 30, 2026 Jill Mazza Olson, Medicaid Director Vermont Agency of Human Services Building E, Third Floor, 280 State Drive Waterbury, VT 05671-1000 Re: Vermont State Plan Amendment (SPA) - 25-0009 Dear Director Olson: The Centers for Medicare & Medicaid Services (CMS) reviewed your Medicaid State Plan Amendment (SPA) submitted under transmittal number (TN) 25-0009. This amendment updates Vermont’s Community Mental Health Center services in accordance with Special Terms and Condition 4.4(c) of the Global Commitment to Health 1115 waiver wherein rehabilitation mental health services are being transferred from the waiver to the State Plan. We conducted our review of your submittal according to statutory requirements in 42 CFR §440.130. This letter informs you that Vermont’s Medicaid SPA TN 25-0009 was approved on March 30, 2026, with an effective date of July 1, 2025. Enclosed are copies of Form CMS 179 and the approved SPA pages to be incorporated into the Vermont State Plan. If you have any questions, please contact Gilson DaSilva at (617) 565-1227 or via email at Gilson.DaSilva@cms.hhs.gov. Sincerely, Nicole McKnight On Behalf of Courtney Miller, MCOG Director Enclosures cc: Dylan Frazer, Deputy Director of Medicaid Policy Anthony Carrese, Medicaid Policy Unit

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 

State: VERMONT Page 6a(2)

1. Substance Use Disorder Services (Continued) Clinical Social Assessment; Early Worker regulations Intervention; Treatment Assessment; Early Marriage & Family Licensed pursuant to VT Board Therapist of Allied Mental Health Intervention; Treatment regulations Nurse Registered Nurse Licensed Assessment; Early pursuant to VT Board of Intervention; Treatment Nursing regulations Physicians Allopathic physicians are Assessment; Early licensed pursuant to VT Board Intervention; Treatment of Medical Practice regulations; Osteopathic physicians are licensed pursuant to VT Board of Osteopathic Physicians and Surgeons regulations Assessment; Early Psychologists Licensed pursuant to VT Board of Psychological Examiners Intervention; Treatment regulations Residential Licensed pursuant to the VT Assessment; Treatment Department of Disabilities, Aging & Independent Living, Division of Licensing & Protection regulations Withdrawal Certified by the Vermont Assessment; Treatment; Early Management Department of Health Intervention Programs

TN No. 25-0013 Approval Date: 3/30/2026

State: VERMONT Page 6b

1. Community Mental Health Center Services
   In accordance with 42 CFR 440.130(d), covered services are medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under State law, for maximum reduction of physical or mental disability and restoration of a beneficiary to his best possible functional level. Covered services are provided in accordance with evidence-based best practices. These services treat individuals with mental health diagnoses and integrated mental health and substance use diagnoses. All services are delivered in accordance with the treatment plan except for emergency and crisis services. Covered Services include:

2. Emergency and Crisis Services
   (1) Emergency Services Emergency Services are episodic intensive supports available 24-hours-a-day, 7-days-a- week and are intended to resolve or stabilize the immediate crisis. Emergency Services include assessment of the individual and the circumstances leading to the crisis, crisis counseling, assessing for hospitalization or emergency placement, assessment of need for mental health and other services, referral and follow-up. This service is available to all ages. (2) Short-Term Residential Crisis Beds Provision of short-term services designed to stabilize individuals in an acute mental health crisis and to move to community-based support as soon as possible with planned discharge and placement. Services are provided to individuals, their families, or their immediate support system that may be time-limited, but necessary to maintain stability or avert destabilization. Services must be provided to, or directed exclusively toward, the treatment of the Medicaid eligible individual. This service is available to all ages.

TN No. 01-07 Approval Date: 3/30/2026

State: VERMONT Page 6c

1. Assessment Services
   (1) Clinical Assessment An evidence-based evaluation designed to determine the extent and severity of mental health diagnoses, comprehensive rehabilitative treatment needs, eligibility for services, and level of treatment determination. A biopsychosocial, multi-dimensional assessment is administered by qualified mental health providers trained in the applicable tools and instruments, with sign-off by a licensed health care professional if necessary. Clinical assessments may be administered in schools, hospitals, clinics, correctional facilities, and other community settings. This service is available to all ages. (2) Screening Tool A State of Vermont identified screening tool will be used to determine areas of function for all ages as a mechanism to measure progress over time in treatment. Screening will be required at least annually for adults and at least every 6 months for children and youth. Staff must be trained to utilize the screening tool and certified if applicable. This service is available to all ages.

2. Outpatient Services
   (1) Psychotherapy Includes individual, couples, family, and group therapy and aims to resolve symptoms, improve function, facilitate emotional and psychological rehabilitation of a mental health diagnosis, psychosocial stress, relationship problems, and difficulties in coping in the social environment. This service is available to all ages. (2) Community Supports Rehabilitative and goal-oriented services that are available as individualized and group supports. Services include service planning and coordination, treatment planning, monitoring progress, identification of shifting needs, change in level of treatment, and communication that is integral to continuity of treatment for the individual. This service is available to all ages.

State: VERMONT Page 6d

1. Specialized Services (1) Medication Evaluation, Management and Consultation Services These services include evaluating the need for psychiatric medication, prescribing and monitoring medication, and providing medical oversight, support and consultation for an individual’s mental health treatment in coordination with other medical providers. This service is available to all ages. (2) Peer Supports These services are provided under 42 CFR 440.130(d) as a benefit of rehabilitative services. Peer supports are wellness-oriented, person-centered, and relationship-focused services that support individuals by using their unique lived experience under clinical supervision. These services include supporting individuals in advocating for themselves by assisting them LQ DFFHVVLQJ FRPPXQLW\ဨEDVHG UHVRXUFHV VXSSRUWHG HPSOR\PHQW DQG health and wellness supports. Peers may not practice psychotherapy, create treatment plans, or engage in any service that requires a license. Peer support specialists are supervised by mental health professionals. Services can be provided individually or in a group setting. This service is available to all ages. (3) Nursing Services These services provide support to individuals with their mental health rehabilitation and reduces the need to place individuals in higher levels of treatment solely due to nursing needs. The following nursing services may be provided:

x Injection x IV Push or infusion x Teaching and Education (including diabetes, asthma, tobacco cessation) x Blood draws x Medication management x Transition/discharge planning - Nurse to Nurse Reports x Nursing Assessment/Observation x Wound Care and Nursing Procedure

This service is available to all ages.

State: VERMONT Page 6e

1. Residential Services (1) Adult Residential Services Rehabilitative treatment in a residential setting designed to provide individualized, recovery-oriented treatment plan services and includes intensive individualized wrap- around residential treatment, intensive recovery residential treatment, and transitional residential treatment. Component services can include residential treatment planning, rehabilitative skill building, community integration activities, psychotherapy, psychiatry, psychoeducation, medication monitoring, and discharge planning. This service is available to adults only. (2) Therapeutic Foster Care This service is a treatment-focused form of foster care provided in a family setting by trained and licensed caregivers for children and adolescents with serious emotional or behavioral needs. This service is designed to be short-term in nature to support the child/youth and family to develop the skills necessary to improve functioning and safety by reducing mental health symptoms and behavioral challenges so the youth can transition back into their home. This service includes skilled caregiving by consistent single or paired home providers who are trained in trauma-informed approaches, deescalation techniques, youth development, and rehabilitative treatment interventions. This service supports youth to implement skills learned in treatment services (e.g. self- regulation, distress tolerance) in the daily interactions of a supportive and normative family home setting. Services may be provided 24-hours-a-day, 7-days-a-week.

x Providers are specially trained to respond to crises and to provide special

therapeutic interventions in response to an individual’s needs.

x Service is limited to coverage of therapeutic services and does not include foster

care services or placement activities as part of a foster care program.

x This service is available to children and youth only.

State: VERMONT Page 6e(1)

(3) Staffed Living Staffed living programs are homes for no more than 8 children/youth with significant mental health/behavioral needs. This service is targeted for children and adolescents who are at risk of residential treatment, are transitioning to the community from psychiatric inpatient or intensive residential treatment, and/or adolescents with significant mental health needs who are transitioning to adulthood. Staffed Living delivers individualized rehabilitative support in a home-like setting through staff who are trained in trauma-informed approaches, deescalation techniques, and rehabilitative treatment interventions to support the youth’s individualized plan for emotional regulation, social skill development, and engagement in normative community activities. The youth also receive an additional individualized array of services that can include assessment, service coordination, medication management, individual, group and family therapies, and supportive counseling that focuses on skill-building and integration with community resources.

x Services are provided 24-hours-a-day, 7-days-a-week for individuals with acute

mental health needs who meet medical necessity criteria.

x Staffed Living must be provided in a freestanding, nonhospital-based facility. x This service is available to children and youth only.

1. Provider Qualifications

Provider/Practitioner License/Certification Services Provided

Physicians Allopathic physicians are licensed pursuant to VT Board of Medical Practice regulations, and Osteopathic Residential Services, physicians are licensed Medication Evaluation, pursuant to VT Board of Management and Osteopathic Physicians and Consultation Services Surgeons regulations

State: VERMONT Page 6e(2)

Psychiatric Nurse Practitioner Licensed pursuant to the VT Board of Nursing Regulations, VT Office of Professional Regulation Residential Services, Medication Evaluation, Management and Consultation Services Registered Nurse Licensed pursuant to the VT Community supports, Board of Nursing Facility-based crisis bed Regulation, VT Office of stabilization services, Professional Regulation Facility-based Adult Residential Services, Nursing Services Licensed Practical Nurse (LPN) Licensed pursuant to the VT Community supports, Board of Nursing Facility-based crisis bed Regulation, VT Office of stabilization services, Professional Regulation Facility-based Adult Residential Services, Nursing Services Psychologist Licensed via Vermont’s Office of Professional Regulation. Residential Services Licensed Marriage & Family Therapist (LMFT) regulations. Residential Services

State: VERMONT Page 6e(3)

Licensed Clinical Mental Health Counselor (LCMHC) regulations. Residential Services Licensed Independent Clinical Social Worker (LICSW) regulations. Residential Services Licensed Alcohol & Drug Counselor (LADC) regulations Residential Services Qualified Mental Health Certification pursuant to the Provider (QMHP) Department of Mental Services, Adult Residential Health Services Peer Support Specialist Certification pursuant to the Peer Supports Department of Mental Health or Office of Professional Regulation Meets minimum training requirements as defined by the Department of Mental Health Case Manager, Community At least 18 years of age and Short-Term Residential Support Worker, Adult high school graduate or Crisis Beds Services, Residential Staff GED, having completed Screening Tool, Community employee orientation and Supports, Adult Residential background check. Services

State: VERMONT Page 6e(4)

Staffed Living Provider Licensed as a Residential Staffed Living Treatment Facility through the Department for Children and Families Practitioners are trained in trauma-informed approaches, deescalation techniques, and rehabilitative treatment interventions. Therapeutic Foster Care Licensed by the Department Therapeutic Foster Care Provider for Children and Families or a Child Placing Agency pursuant to the Licensing Regulations for Child Placing Agencies in Vermont. Practitioners are trained in trauma-informed approaches, deescalation techniques, youth development, and rehabilitative treatment interventions.