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.

Designated Agency (DA) and Specialized Service Agency (SSA) staff, specifically including Service Coordinators; home providers and group home managers; family members and guardians; adults with developmental disabilities; health care providers; Developmental Disabilities Services Quality Management Reviewers.

• Service Coordinators working with individuals receiving services, their guardians and other team members to ensure necessary medical appointments, including physicals or equivalent health care visits, take place on an annual basis.
• Educate and encourage individuals and families of individuals who choose not to make and/or attend medical appointments to do so.

The data is based on calendar year HEDIS reports.

• The data show a very high percentage of adults receiving HCBS are seen by physicians or other health care professional on a regular basis.
• Improve and increase education, training and technical assistance to DA/SSA staff, home providers, family members and guardians on the DDSD Health and Wellness Guidelines.
• Based on preliminary review of the data, it was found that many of the individuals who did not show up as having received an annual preventive health services actually did see a physician. The following are reasons why some individuals did not show up as part of the count:
  • The physician determine the individual did not need an annual physical and has recommended less frequent than yearly visits;
  • The individual's yearly annual physical was delayed and was not scheduled until after the first of the year;
  • The individual or their family made the choice to not to see a physician or get an annual physical; or
  • The individual receives specialty medical care or end of life care so codes identified for preventative health services category are not being billed.
• It had been previously thought that HEDIS data did not include Medicare visits but it does in fact include Medicare crossover claims.