The premise is that Vermonters who go to a medical professional for an annual exam are presumed to be healthier or more likely to address health care needs than those who do not see a medical professional on a regular basis. The Developmental Disabilities Services Division (DDSD) requires all individuals receiving HCBS have an annual physical exam by a primary care physician. Detailed documentation of the visit is specifically required for individuals receiving 24-hour supports. These visits help assure that people have the opportunity to have an “eyes-on” visit with a medical professional who will review any chronic medical issues, current medical complaints and conditions, medications, nutrition, exercise and general wellbeing. These visits not only assure regular ongoing medical care but can be proactive in identifying issues that, if unattended or untreated, could result in more critical or expensive health care. Since many adults receive acute care and/or regular and ongoing medical services during the year, the definition of “preventive/ambulatory health services” includes other related medical visits. The target for each DA/SSA is based on their baseline percentage. The overall system target is based on Vermont statewide rate of all Medicaid receipients.