4.01 Receiving health benefits from another state

An individual who is receiving health benefits from another state is not eligible for health benefits in Vermont. 4.02 Rights of individuals with respect to application for and receipt of health benefits through 69 45 CFR § 155.300. General Provisions and Definitions Part 1 – Page 19 (Sec.4.00, Sub.4.02) AHS (01/01/2024, GCR 23-082) Notice of rights and responsibilities. Policies are administered in accordance with federal and state law. Individuals will be informed of their rights and responsibilities with respect to application for and receipt of health benefits. Right to nondiscrimination and equal treatment.70 AHS does not unlawfully discriminate on the basis of race, color, religion, national origin, disability, age, sex, gender identity, or sexual orientation in the administration of its health-benefits programs or activities. Right to confidentiality. The confidentiality of information obtained during the eligibility process is protected in accordance with federal and state laws and regulations. The use and disclosure of information concerning applicants, enrollees, and legally-liable third parties is restricted to purposes directly connected with the administration of health-benefits programs, with enrollment in a QHP or as otherwise required by law. Right to timely provision of benefits. Eligible individuals have the right to the timely provision of benefits, as defined in § 61.00. Right to information. Individuals who inquire have the right to receive information about health benefits, coverage-type requirements, and their rights and responsibilities as enrollees of health-benefits programs or as enrollees in QHPs. Right to apply. Any person, individually or through an authorized representative or legal representative has the right, and will be afforded the opportunity without delay, to apply for benefits. Right to be assisted by others The individual has the right to be represented by a legal representative. The individual has the right to be accompanied and represented by an authorized representative during the eligibility or appeal processes. Upon request by the individual, copies of all eligibility notices and all documents related to the eligibility or appeal process will be provided to the individual’s authorized or legal representative. An authorized representative may file an application for health benefits or an appeal on behalf of a deceased person. Right to inspect the case file. An individual has the right to inspect information in their case file and contest the accuracy of the information. Right to appeal. An individual has the right to appeal, as provided in § 68.00. Right to interpreter services. Individuals will be informed of the availability of interpreter services. Unless the 70 See, 42 USC § 18116; 45 CFR §§ 92.2 and 155.120(c)(1); 9 VSA § 4502. See, also, All Programs Rule 2000(C). General Provisions and Definitions Part 1 – Page 20 (Sec.4.00, Sub.4.03) individual chooses to provide their own interpreter services, AHS will provide either telephonic or other interpreter services whenever: The individual who is seeking assistance has limited English proficiency or sensory impairment (for example, a seeing or hearing disability) and requests interpreter services; or AHS determines that such services are necessary. 4.03 Responsibilities of individuals with respect to application for and receipt of health benefits through AHS (01/01/2024, GCR 23-082) Responsibility to cooperate. An individual must cooperate in providing information necessary to establish and maintain their eligibility, and must comply with all rules and regulations, including recovery and obtaining or maintaining available health insurance. Responsibility to report changes An individual must report changes that may affect eligibility. Such changes include, but are not limited to, income, the availability of health insurance, and third-party liability. A Medicaid enrollee must report such changes within 10 days of learning of the change. Except as specified in paragraphs (b)(4) and (5) of this subsection, a QHP enrollee must report such changes within 30 days of such change. A QHP enrollee who did not request an eligibility determination for APTC or CSR, and is not receiving APTC or CSR, need not report changes that affect eligibility for health-benefits programs. An individual, or an application filer on behalf of the individual, will be allowed to report changes via the channels available for the submission of an application, as described in § 52.02. Cooperation with quality control. An individual enrolled in a health-benefits program must cooperate with any quality-control (QC) review of their case. (§ 4.05)