1. Program Definition and Services

Residential Support Services in Vermont provide 24-hour or scheduled in-home assistance and skill-building for individuals with intellectual or developmental disabilities or acquired brain injuries (ABI) under Vermont’s 1115 Global Commitment and HCBS waivers. Services include:

• 24-Hour Support & Habilitation: Continuous or structured oversight, behavioral interventions, crisis stabilization, and direct ADL/IADL care
• Skill Development: Individual training in financial management, household care, medication adherence, and community safety

2. Regulations

• Vermont Administrative Rules on Agency Designation (DAIL)
• Vermont Licensing Regulations for Residential Care Homes and Assisted Living Residences
• Vermont DAIL DDSD Quality Review Enforcement Rules
• Federal HCBS Final Settings Rule (42 CFR 441.301)

3. Licensing or Certification

Standard waiver-funded placements do not require a standalone state residential license; instead, agencies contract through region-specific Designated Agencies (DAs) or Specialized Services Agencies (SSAs). Homes serving three or more unrelated corporate residents require a Residential Care Home license from the DAIL Division of Licensing and Protection (DLP).

4. Responsible State Agency

• Vermont DAIL (ASD/DDSD): Manages regional agency designation and program compliance
• Department of Vermont Health Access (DVHA): Oversees Medicaid system enrollment and claims
• Regional Designated Agencies (DAs): Coordinate local authorizations, safety inspections, and case placement

5. Application Process

• Register your business legal entity with the Vermont Secretary of State
• Create an organization profile via the secure vEnterprise registry system
• Apply to contract with the regional Designated Agency (DA) serving your target county
• Pass fingerprint-based criminal, adult abuse, and child protective registry background checks for all staff
• Secure local zoning, municipal fire safety clearances, and egress inspections for the property
• Complete electronic provider onboarding with the DVHA

6. Required Documentation

• Corporate incorporation files, active Federal EIN, and a Type 2 NPI
• Executed sub-contract agreements or formal approval letters from the regional DA/SSA
• Policy & Procedure Manual (staffing patterns, medication logs, fire evacuation paths, behavior de-escalation, grievances, and HIPAA)
• Fire safety and environmental inspection approvals for all physical sites
• Background clearances, High School diplomas/GEDs, and CPR/First Aid cards for all staff
• Certificates of commercial general liability, professional liability, property, and workers' compensation insurance

7. Timeline for Approval

The end-to-end setup and contract execution process typically takes 3 to 5 months.

8. Pre-Application Process

Form a legal entity with the Vermont Secretary of State, secure your EIN and Type 2 NPI, purchase or lease an accessible property, and contact the local county DA to verify regional capacity needs.

9. Pre-Application Training

Management and direct support staff must complete mandatory regional orientation frameworks, including Abuse, Neglect, and Exploitation Prevention (ANEP), medication administration training, and Person-Centered Service Plan tracking.

10. Additional Notes

• Shared Living (Host Homes): Placing a participant with an independent contractor requires rigorous home safety and background checks under DAIL rules
• HCBS Settings Compliance: Properties must offer legally enforceable lease agreements, privacy locks on bedroom doors, and open choice regarding daily dining schedules and visitors
• Data Tracking: Staff must log shift data against targets in the Individual Support Agreement (ISA); missing fields risk retrospective Medicaid billing clawbacks
• Medication Administration: Non-licensed staff must complete a state-approved curriculum and pass periodic competency reviews by a Registered Nurse (RN)

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

To get started, click the link to request portal access