Letter to the editor: Vermont slow to comply with federal guardianship rules

The Vermont legislative bodies and probate courts have not been keeping up with the federal rules in state and federally licensed residential settings. This causes due process violations. 

Response to David Searles letter “In family division, guardianship is in name only”:

I believe that the Vermont Legislature and the Vermont probate courts need an education on developmental disabilities. Funding priorities are determined by the Adult Developmental Service Division. Yet, if funding is already available, it can be used appropriately under state and federal regulations.

Vermont operates under unique state managed care rules with the “goal of quality and cost containment.” In doing so, Centers for Medicaid federal rules must be implemented under the Vermont System of Care, as well. 

Most recently, Vermont was federally mandated to comply with a “legal guardian authorized Residency Agreement in all home and community based settings.” Vermont remained out of compliance since 2014 and was enforced to comply with the “settings rules” on March 17, 2023. 

The Vermont legislative bodies and probate courts have not been keeping up with the federal rules in state and federally licensed residential settings. This causes due process violations. Here is the new-to-Vermont residency agreement that was federally mandated by Centers for Medicaid. If Vermont does not comply, medical records matching legal guardian authorized disclosures may cause a failed integrity audit, causing sanctions.

It is my understanding that Vermont can legislate/enforce state compliance with Centers for Medicaid final rules, or a federal judge can mandate it, if individuals are being harmed because of it. Maybe there will be case-by-case reviews. I don’t know how out-of-compliance issues will be addressed. The Agency of Human Services Department of Vermont Health Access is deemed to provide full transparency to its stakeholders. 

My entity is awaiting Vermont licensure of providing housing under our mission statement until federal compliance issues are corrected. I am too honest and ethical to operate otherwise. The Department of Vermont Health Access ensures continuous improvement. It just appears to be taking a very … long … time, as the most vulnerable among us don’t have time to wait, or they may risk losing Medicaid from a failed integrity audit, or ending up under the Office of Public Guardian and the state chooses where they live. 

In my opinion, the Department of Aging and Independent Living federal mission statement needs to collaborate a bit closer with legal guardians to understand the unmet needs until the courts and legislative bodies catch up. A funding priority is based on a new need or a crisis. A crisis of a vulnerable loved one should be avoided with appropriate communication with those deemed with authority. This is called an “internal grievance” and can happen by bringing an issue to the grievance officer at the designated agency. 

Vermont made a “promise” after closing Brandon Training School. The most vulnerable need to be prioritized. Only the legal guardian can speak on their behalf and, as Mr. David Searles identified, the legal guardian voice is not being heard in the current system.

Speak up. Provide your designated agency with an independent clinical assessment of your loved one. Hold the designated agency accountable to providing the clinical recommendations in it. It is their job to do so.

Kathleen Burke Kourebanas

President, Martha’s Barn Inc. 

Essex

Full Article & Source:
Letter to the editor: Vermont slow to comply with federal guardianship rules

See Also:
Letter to the editor: In family division, guardianship is in name only