Vermont

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: No

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, NLC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: No
  • Distant sites explicitly allowed for Live Video: No
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: Vermont Medicaid
  2. Administrator: State Dept. of Vermont Health Access, under the Agency of Human Services
  3. Regional Telehealth Resource Center: Northeast Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 02/10/2023

Audio-Only Delivery

Medicaid: Continuing Telemedicine Coverage for Dental Services & Telephonic Coverage

STATUS: Active

Medicaid: Memo on Telephonic Services

STATUS: Active during the Federal COVID-19 Public Health Emergency and State of Emergency.  Statewide emergency has ended, but Federal PHE continues.

Last updated 02/10/2023

Cross State Licensing

Office of Professional Regulation: Out of State Licensees, Temporary Licensees & Telehealth

STATUS: Active, H.654 was signed into law, extending a modified version of the emergency provisions until March 31, 2023

Last updated 02/10/2023

Easing Prescribing Requirements

No Reference Found

Last updated 02/10/2023

Miscellaneous

Act 140: Emergency Telehealth Law

STATUS: Enacted – Resolved by Act 117. See below.

H 965:  Coronavirus Relief Fund

STATUS: Enacted

H 966:  Broadband Connectivity Program

STATUS: Enacted

H 960: Store and Forward

STATUS: Enacted

Act 117:  Telehealth Flexibilities & Audio-Only

STATUS: Enacted

H 654: Extending COVID-19 Health Care Regulatory Flexibility

Status: Active

Last updated 02/10/2023

Originating Site

Previous COVID-19 waivers expired.

Last updated 02/10/2023

Private Payer

Dep. Of Financial Regulation: Memo on COVID-19 and Telemedicine Services

STATUS: No longer accessible on main website pages. May be expired.

Dep. Of Financial Regulation: Coding and Reimbursement for Audio-Only Telephone Services Required by Act 6 of 2021

STATUS: Active. Expires Dec. 31, 2023 or until rescinded or superseded.

H 742: Insurance Reimbursement

STATUS: Enacted

SB 117: Resolves Act 91 – COVID-19 Flexibilities & Audio-Only

STATUS: Enacted

Last updated 02/10/2023

Provider Type

Medicaid: Continuing Telemedicine Coverage for Dental Services & Telephonic Coverage

STATUS: Active

Last updated 02/10/2023

Service Expansion

Medicaid: Continuing Telemedicine Coverage for Dental Services & Telephonic Coverage

STATUS: Active

Medicaid: Memo on Telephonic Services

STATUS: Active during the Federal COVID-19 Public Health Emergency and State of Emergency.  Statewide emergency has ended, but Federal PHE continues.

Medicaid:  Telehealth, Telemedicine and Telephonic Coverage

STATUS: Varies, until VT or Federal PHE ends (depending on policy)

Last updated 02/10/2023

Definitions

“Telemedicine” means the delivery of health care services, including dental services, such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k(h)(7), (Accessed Feb. 2023).

Last updated 02/10/2023

Parity

SERVICE PARITY

All health insurance plans in this State shall provide coverage for health care services and dental services delivered through telemedicine by a health care provider at a distant site to a patient at an originating site to the same extent that the plan would cover the services if they were provided through in-person consultation.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed Feb. 2023).

Audio-Only Telephone

A health insurance plan shall provide coverage for all medically necessary, clinically appropriate health care services delivered remotely by audio-only telephone to the same extent that the plan would cover the services if they were provided through in-person consultation. Services covered under this subdivision shall include services that are covered when provided in the home by home health agencies.

SOURCE: VT Statutes Annotated, Title 8 Sec. 41001. (Accessed Feb. 2023).

On or before July 1, 2021, the Department of Final the Department of Financial Regulation, in consultation with the Department of Vermont Health Access, the Green Mountain Care Board, representatives of health care providers, health insurers, and other interested stakeholders, shall determine the appropriate codes or modifiers, or both, to be used by providers and insurers, including Vermont Medicaid to the extent permitted by the Centers for Medicare and Medicaid Services, in the billing of and payment for health care services delivered using audio-only telephone in order to allow for consistent data collection, identify appropriate codes for services that do not have in-person equivalents, and minimize the administrative burden on providers. To the extent possible, the use of codes or modifiers, or both, shall be done in a manner that allows data on the use of audio-only telephone services to be identified using the Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES).

Not later than January 1, 2022, all Vermont-licensed health care providers and health insurers offering major medical health insurance plans in Vermont shall use the codes and modifiers determined by the Department of Financial Regulation pursuant to subdivision (1) of this subsection when delivering services by audio-only telephone. Vermont Medicaid shall participate to the extent permitted by the Centers for Medicare and Medicaid Services.

SOURCE:  Senate Bill 117 (2021 Session), (Accessed Feb. 2023).


PAYMENT PARITY

To be repealed Jan. 1, 2026

A health insurance plan shall provide the same reimbursement rate for services billed using equivalent procedure codes and modifiers, subject to the terms of the health insurance plan and provider contract, regardless of whether the service was provided through an in-person visit with the health care provider or through telemedicine.

This shall not apply to:

  • Services provided pursuant to the health insurance plan’s contract with a third-party telemedicine vendor to provide health care or dental services; or
  • In the event that a health insurer and health care provider enter into a value-based contract for health care services that include care delivered through telemedicine or by store-and-forward means.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed Feb. 2023).

Audio-Only Telephone

The Department of Financial Regulation, in consultation with the Department of Vermont Health Access, the Green Mountain Care Board, representatives of health care providers, health insurers, and other interested stakeholders, shall determine the amounts that health insurance plans shall reimburse health care providers for delivering health care services by audio-only telephone during plan years 2022, 2023, and 2024. In determining the reimbursement amounts, the Department shall seek to find a reasonable balance between the costs to patients and the health care system and reimbursement amounts that do not discourage health care providers from delivering medically necessary, clinically appropriate health care services by audio-only telephone. The Department may determine different reimbursement amounts for different types of services and may modify the rates that will apply in different plan years as appropriate but shall finalize its determinations not later than April 1 for plan years after 2022.

SOURCE:  Senate Bill 117 (2021 Session), (Accessed Feb. 2023).

Beginning on January 1, 2023, health insurance plans shall provide reimbursement for audio-only telephone services billed using accepted CPT language and definitions including both CPT codes for in-person services and telephone-specific E/M codes.

Audio-only telephone services using the CPT code for in-person services shall be reimbursable if the claim is submitted with a V3 modifier or any more specific, nationally-recognized successor modifier that may subsequently be adopted by the American Medical Association (to indicate “service delivered via telephone, i.e., audio-only”) and a place of service code of “99 – other.”

  • The V3 modifier should not be used with telephone-specific E/M codes.
  • Commercial health insurance plans may additionally reimburse audio-only telephone claims with a V4 modifier to allow differential reimbursement.
    • Plans may only use differential reimbursement for audio- only services, as provided in subparagraph b below.
    • Plans may not reimburse different provider types differently for performing the same service.

In determining which codes are clinically appropriate for audio-only delivery, commercial health insurance plans shall consider providers’ clinical judgment, as documented in the medical record under Act 6. Commercial health insurance plans are also encouraged to align as closely as possible with codes identified by Vermont Medicaid as “telephone allowable.” Nothing in this order, however, shall be construed to require commercial payers to reimburse Medicaid-specific codes.

Health insurance plans shall reimburse providers for audio-only services at a rate no less than 75% of the rate for equivalent in-person or audio/visual telemedicine covered service.

  • Plans are strongly encouraged to negotiate rates with providers for audio- only telephone services that reflect their clinical value, including reimbursing E/M codes recognized by the American Medical Association (AMA) as having a “straightforward” or lower level of Medical Decision Making (MDM) at parity with in-person services.

Telephone-specific E/M codes with no in-person equivalent shall be reimbursed subject to the terms of the health insurance plan and provider contract.

Visits initiated in good faith over audio/visual telemedicine which switch to audio-only for any reason shall be reimbursed according to 8 V.S.A. § 4100k(a)(2)(A).

This Order shall remain effect until December 31, 2023, or until rescinded or superseded by further order of the Commissioner.

This Order shall be governed by and construed under the laws of the State of Vermont.

SOURCE: VT Department of Financial Regulation, Coding and Reimbursement for Audio-Only Telephone Services Required by Act 6 of 2021 (June 24, 2022). (Accessed Feb. 2023).

Last updated 02/10/2023

Requirements

Health insurance plans must provide coverage for health care service delivered through telemedicine by a health care provider at a distant site to a patient at an originating site to the same extent that the plan would cover the services if they were provided through in-person consultation.

An originating site is the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including a health care provider’s office, a hospital, or a health care facility, or the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center or patient’s workplace.

A distant site is the location of the health care provider delivering services through telemedicine at the time the services are provided.

A health plan may limit coverage to health care providers in the plan’s network.  A health plan cannot impose limitations on the number of telemedicine consultations a covered person may receive that exceed limitations on in-person services.  Health plans are not prohibited from limiting coverage to only services that are medically necessary and clinically appropriate for delivery through telemedicine, subject to the terms and conditions of the covered person’s contract.

A health insurance plan shall reimburse for health care services and dental services delivered by store-and-forward means.  A health insurance plan shall not impose more than one cost-sharing requirement on a patient for receipt of health care services or dental services delivered by store-and-forward means. If the services would require cost-sharing under the terms of the patient’s health insurance plan, the plan may impose the cost-sharing requirement on the services of the originating site health care provider or of the distant site health care provider, but not both.
In order to facilitate the use of telemedicine in treating substance use disorder, when the originating site is a health care facility, health insurers and the Department of Vermont Health Access shall ensure that the health care provider at the distant site and the health care facility at the originating site are both reimbursed for the services rendered, unless the health care providers at both the distant and originating sites are employed by the same entity.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed Feb. 2023).

Audio-Only Telephone

A health insurance plan shall provide coverage for all medically necessary, clinically appropriate health care services delivered remotely by audio-only telephone to the same extent that the plan would cover the services if they were provided through in-person consultation. Services covered under this subdivision shall include services that are covered when provided in the home by home health agencies.

A health insurance plan may charge an otherwise permissible deductible, co-payment, or coinsurance for a health care service delivered by audio-only telephone, provided that it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation.

A health insurance plan shall not require a health care provider to have an existing relationship with a patient in order to be reimbursed for health care services delivered by audio-only telephone.

SOURCE: VT Statutes Annotated, Title 8 Sec. 41001. (Accessed Feb. 2023).

Last updated 02/10/2023

Definitions

“Telemedicine” means the delivery of health care services, including dental services, such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k(h)(7), (Accessed Feb. 2023).

“Telehealth” means methods for health care service delivery using telecommunications technologies. Telehealth includes telemedicine, store and forward, and telemonitoring.

“Telemedicine” means health care delivery by a provider who is located at a distant site to a beneficiary at an originating site for purposes of evaluation, diagnosis, consultation, or treatment, using telecommunications technology via two-way, real-time, audio and video interactive communication, through a secure connection that complies with HIPAA.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101), Telehealth, (Accessed Feb. 2023).

Telehealth means methods for healthcare service delivery using telecommunications technologies. Telehealth includes telemedicine, store and forward, and telemonitoring.  The term telehealth is also often used more generally to describe electronic information and telecommunications technologies to support long-distance clinical healthcare, as well as patient and professional health-related education, public health and health administration.

Telemedicine means health care delivered by a provider who is located at a distant site to a beneficiary at an originating site for purposes of evaluation, diagnosis, consultation, or treatment using telecommunications technology via two-way, real-time, audio and video interactive communication, through a secure connection that complies with HIPAA.

Telemedicine encompasses the following:

  • Real-time, audio video communication tools that connect providers and patients in different locations. Tools can include interactive videoconferencing or videoconferencing using mobile health (mHealth) applications (apps) that are used on a computer or hand-held mobile device.
  • Store-and-forward technologies that collect images and data to be transmitted and interpreted later, which may also involve the use of mHealth apps.
  • Remote patient-monitoring tools such as home blood pressure monitors, Bluetooth-enabled digital scales and other devices that can communicate biometric data for review, which may also involve the use of mHealth apps.

SOURCE: Department of Vermont Health Access. Agency of Human Services. Telehealth: Methods for healthcare service delivery using telecommunications technologies. (Accessed Feb. 2023).

Last updated 02/10/2023

Email, Phone & Fax

Services delivered via audio-only telephone, facsimile, or electronic mail messages are not considered telemedicine and are not covered.

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.7), Telehealth, (Accessed Feb. 2023).

Audio-Only Telephone

Subject to the limitations of the license under which the individual is practicing and, for Medicaid patients, to the extent permitted by the Centers for Medicare and Medicaid Services, a health care provider may deliver health care services to a patient using audio-only telephone if the patient elects to receive the services in this manner and it is clinically appropriate to do so. A health care provider shall comply with any training requirements imposed by the provider’s licensing board on the appropriate use of audio-only telephone in health care delivery.

A health care provider delivering health care services using audio-only telephone shall include or document in the patient’s medical record:

  • The patient’s informed consent for receiving services using audio-only telephone in accordance with subsection (c) of this section; and
  • The reason or reasons that the provider determined that it was clinically appropriate to deliver health care services to the patient by audio-only telephone.

A health care provider shall not require a patient to receive health care services by audio-only telephone if the patient does not wish to receive services in this manner.

A health care provider shall deliver care that is timely and complies with contractual requirements and shall not delay care unnecessarily if a patient elects to receive services through an in-person visit or telemedicine instead of by audio-only telephone.

Neither a health care provider nor a patient shall create or cause to be created a recording of a provider’s telephone consultation with a patient.

Audio-only telephone services shall not be used in the following circumstances:

  • For the second certification of an emergency examination determining whether an individual is a person in need of treatment pursuant to section 7508 of this title; or
  • For a psychiatrist’s examination to determine whether an individual is in need of inpatient hospitalization pursuant to 13 V.S.A. § 4815(g)(3).

SOURCE: VT Statute 18 VSA Sec. 9362, (Accessed Feb. 2023).

On or before July 1, 2021, the Department of Final the Department of Financial Regulation, in consultation with the Department of Vermont Health Access, the Green Mountain Care Board, representatives of health care providers, health insurers, and other interested stakeholders, shall determine the appropriate codes or modifiers, or both, to be used by providers and insurers, including Vermont Medicaid to the extent permitted by the Centers for Medicare and Medicaid Services, in the billing of and payment for health care services delivered using audio-only telephone in order to allow for consistent data collection, identify appropriate codes for services that do not have in-person equivalents, and minimize the administrative burden on providers. To the extent possible, the use of codes or modifiers, or both, shall be done in a manner that allows data on the use of audio-only telephone services to be identified using the Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES).

Not later than January 1, 2022, all Vermont-licensed health care providers and health insurers offering major medical health insurance plans in Vermont shall use the codes and modifiers determined by the Department of Financial Regulation pursuant to subdivision (1) of this subsection when delivering services by audio-only telephone. Vermont Medicaid shall participate to the extent permitted by the Centers for Medicare and Medicaid Services.

The Department of Financial Regulation, in consultation with the Department of Vermont Health Access, the Green Mountain Care Board, representatives of health care providers, health insurers, and other interested stakeholders, shall determine the amounts that health insurance plans shall reimburse health care providers for delivering health care services by audio-only telephone during plan years 2022, 2023, and 2024. In determining the reimbursement amounts, the Department shall seek to find a reasonable balance between the costs to patients and the health care system and reimbursement amounts that do not discourage health care providers from delivering medically necessary, clinically appropriate health care services by audio-only telephone. The Department may determine different reimbursement amounts for different types of services and may modify the rates that will apply in different plan years as appropriate but shall finalize its determinations not later than April 1 for plan years after 2022.

See bill for requirements of Department in 2023 and 2024.

SOURCE:  Senate Bill 117 (2021 Session), (Accessed Oct. 2022).

See the Miscellaneous section of the Professional Regulation category for additional requirements.

 

Last updated 02/10/2023

Live Video

POLICY

Health insurance plans (includes Medicaid) must provide coverage for health care services and dental services delivered through telemedicine by a health care provider at a distant site to a patient at an originating site to the same extent that the plan would cover the services if they were provided through in-person consultation.

A health plan may limit coverage to health care providers in the plan’s network.  A health plan cannot impose limitations on the number of telemedicine consultations a covered person may receive that exceed limitations on in-person services.  Health plans are not prohibited from limiting coverage to only services that are medically necessary and clinically appropriate for delivery through telemedicine, subject to the terms and conditions of the covered person’s contract.

A health insurance plan shall reimburse for health care services and dental services delivered by store-and-forward means.  A health insurance plan shall not impose more than one cost-sharing requirement on a patient for receipt of health care services or dental services delivered by store-and-forward means. If the services would require cost-sharing under the terms of the patient’s health insurance plan, the plan may impose the cost-sharing requirement on the services of the originating site health care provider or of the distant site health care provider, but not both.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k (Accessed Feb. 2023).

Covered services must be clinically appropriate for delivery through telemedicine and be medically necessary.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Feb. 2023).

Health Care Administrative Rule 3.101 Telehealth can be found on the Agency of Human Services website at: https://humanservices.vermont.gov/rules-policies/health-care-rules. Providers use of telehealth practices are subject to the requirements of administrative rule. Information contained in rule will not be repeated in the provider manuals.

  • All providers are required to follow correct coding rules, including application of modifiers, and only bill for services within their scope of practice that can be done via telemedicine.
  • All professional claims (CMS-1500 form) with services billed for telemedicine must have POS 02. Modifier GT should not be used on professional services.
  • All facility claims (UB-04 form) must include modifier GT on any telemedicine services delivered via interactive audio and/or video.
  • Originating facility site providers (patient site) may be reimbursed a facility fee (Q3014)
    • Facility fees will not be reimbursed if the provider is employed by the same entity as the originating site.
    • GT modifier should not be used on Q301

Dialysis

Revenue code 780, Telemedicine – is reimbursable when billed with the appropriate HCPCS code. Pricing is the current Level II price on for the HCPCS code billed on the claim.

SOURCE: VT Agency of Human Services. General Billing and Forms Manual. Sec. 5.3.52, p. 87 & 96 (Jan. 1, 2023). (Accessed Feb. 2023).


ELIGIBLE SERVICES/SPECIALTIES

Services delivered shall:

  • Include any service that a provider would typically provide to a beneficiary in a face-to-face setting,
  • Adhere to the same program restrictions, limitations, and coverage that exist for the service when not provided through telemedicine, and
  • Be reimbursed at the same rate as the service being provided in a face-to-face setting

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Feb. 2023).

All providers are required to follow correct coding rules, including application of modifiers, and only bill for services within their scope of practice that can be done via telemedicine.  All claims must use POS 02. Modifier GT should not be used on professional services.

SOURCE: VT Agency of Human Services. General Billing and Forms Manual. Sec. 5.3.52, p. 87, (Jan. 1, 2023). (Accessed Feb. 2023).


ELIGIBLE PROVIDERS

A distant site is the location of the health care provider delivering services through telemedicine at the time the services are provided.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k.(Accessed Feb. 2023).

Must be provided by a provider who is working within the scope of his or her practice and enrolled in Vermont Medicaid.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.3), Telehealth, (Accessed Feb. 2023).

Dentists

Vermont Medicaid is encouraging Medicaid-participating providers, including dentists, to utilize telemedicine for delivery of medically necessary and clinically appropriate services to Medicaid members when possible.

SOURCE: Department of Vermont Health Access, Dental Supplement, pg. 15, (Jan. 4, 2023), (Accessed Feb. 2023).


ELIGIBLE SITES

An originating site is the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including a health care provider’s office, a hospital, or a health care facility, or the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center or patient’s workplace.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k (Accessed Feb. 2023).

The originating site may include the beneficiary’s home or another nonmedical setting (e.g., school, workplace), a health care provider’s office, a facility, or a hospital.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.1), Telehealth, (Accessed Feb. 2023).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Originating facility site providers (patient site) may be reimbursed a facility fee (Q3014).  Facility fees will not be reimbursed if the provider is employed by the same entity as the originating site. GT modifier should not be used on Q3014.

SOURCE: VT Agency of Human Services. General Billing and Forms Manual. Sec. 5.3.52, p. 87, (Jan. 17, 2023). (Accessed Feb. 2023).

Substance Use Disorder

In order to facilitate the use of telemedicine in treating substance use disorder, when the originating site is a health care facility, the Department of Vermont Health Access is required to reimburse the health care provider at the distant site and the health care facility at the originating site for services rendered, unless the providers at both the distant and originating sites are employed by the same entity.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k 2B(h), (Accessed Feb. 2023).

Last updated 02/10/2023

Miscellaneous

A qualified telemedicine and store-and-forward provider must:

  • Meet or exceed federal and state legal requirements of medical and health information privacy, including HIPAA
  • Provide appropriate informed consent in a language the beneficiary understands. Specific requirements exist, see rule.
  • Take appropriate steps to establish the provider-patient relationship and conduct all appropriate evaluations and history of the beneficiary consistent with traditional standards of care.
  • Maintain medical records for all beneficiaries receiving health care services through telemedicine that are consistent with established laws and regulations governing patient health care records.
  • Establish an emergency protocol when care indicates that acute or emergency treatment is necessary for the safety of the beneficiary.
  • Address needs for continuity of care for beneficiaries (e.g., informing beneficiary or designee how to contact provider or designee and/or providing beneficiary or identified providers timely access to medical records).
  • If prescriptions are contemplated, follow traditional standards of care to ensure beneficiary safety in the absence of a traditional physical examination.

Services provided through telehealth are subject to the same prior authorization requirements that exist for the service when not provided through telehealth.

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.5-6), Telehealth, (Accessed Feb. 2023).

 

Last updated 02/10/2023

Out of State Providers

No Reference Found

Last updated 02/10/2023

Overview

Vermont Medicaid reimburses for live video under certain circumstances. Home health monitoring is considered a Medicaid benefit and is available under certain conditions.  An administrative rule indicates store-and-forward is reimbursed for teledermatology and teleophthalmology.  Additionally, audio-only telephone is also required to be reimbursed under certain circumstances.

Last updated 02/10/2023

Remote Patient Monitoring

POLICY

See Health Care Administrative Rule 3.101 on Telehealth for requirements of telemonitoring.

Home Telemonitoring is a health service that allows and requires scheduled remote monitoring of data related to an individual’s health, and transmission of the data from the individual’s home to a licensed home health agency. Scheduled periodic reporting of the individual’s data to a licensed physician is required, even when there have been no readings outside the parameters established in the physician’s orders. In the event of a measurement outside of the established individual’s parameters, the provider shall use the health care professionals noted above to be responsible for reporting the data to a physician.

SOURCE: VT Agency of Human Services. Home Health Agency, Assistive Community Care and Enhanced Residential Care Supplement.  Sec. 1.3.11 Telemonitoring, p. 7 (Jan. 24, 2022), (Accessed Feb. 2023).

“Telemonitoring” means a health service that enables remote monitoring of a beneficiary’s health-related data by a home health agency done outside of a conventional clinical setting and in conjunction with a physician’s plan of care.

VT Medicaid covers telemonitoring for specific conditions when data is reviewed by certain types of licensed professionals (see below requirements).

SOURCE: VT Health Care Administrative Rule 3.101  (Accessed Feb. 2023).

VT Medicaid is required to cover home telemonitoring services performed by home health agencies or other qualified providers for beneficiaries who have serious or chronic medical conditions that can result in frequent or recurrent hospitalizations and emergency room admissions.

“Home telemonitoring service” means a health service that requires scheduled remote monitoring of data related to a patient’s health, in conjunction with a home health plan of care, and access to the data by a home health agency or other qualified provider as defined by the Agency of Human Services.

SOURCE: VT Statutes Annotated Title 33 Sec. 1901g. (Accessed Feb. 2023).

 


CONDITIONS

The Agency shall provide coverage for home telemonitoring for one or more conditions or risk factors for which it determines, using reliable data, that home telemonitoring services are appropriate and that coverage will be budget-neutral. The Agency may expand coverage to include additional conditions or risk factors identified using evidence-based best practices if the expanded coverage will remain budget-neutral or as funds become available.

SOURCE: VT Statutes Annotated Title 33 Sec. 1901g(a). (Accessed Feb. 2023).

To be covered, services shall be:

  • Clinically appropriate for delivery through telemonitoring,
  • Medically necessary, and
  • Be limited to a Congestive Heart Failure diagnosis.

For telemonitoring services, beneficiaries shall:

  • Have Medicaid as their primary insurance or Medicaid and dually enrolled in Medicare with a non-homebound status,
  • Have a Congestive Heart Failure diagnosis,
  • Be clinically eligible for home health services, and
  • Have a physician’s plan of care with an order for home telemonitoring services

SOURCE:  VT Health Care Administrative Rules 13.174.003  (3.101.2) & (3.101.4), Telehealth, (Accessed Feb. 2023).


PROVIDER LIMITATIONS

The Agency of Human Services shall provide Medicaid coverage for home telemonitoring services performed by home health agencies or other qualified providers as defined by the Agency of Human Services for Medicaid beneficiaries who have serious or chronic medical conditions that can result in frequent or recurrent hospitalizations and emergency room admissions.

A home health agency or other qualified provider shall ensure that clinical information gathered by the home health agency or other qualified provider while providing home telemonitoring services is shared with the patient’s treating health care professionals. The Agency of Human Services may impose other reasonable requirements on the use of home telemonitoring services.

SOURCE: VT Statutes Annotated Title 33 Sec. 1901g. (Accessed Feb. 2023).

Qualified telemonitoring providers shall:

  • Use the following licensed health care professionals to review data:
    • Registered nurse (RN)
    • Nurse Practitioner (NP)
    • Clinical nurse specialist (CNS)
    • Licensed practical nurse (LPN) under the supervision of a RN or physician assistant (PA), and
  • Follow data parameters established by a licensed physician’s plan of care, and
  • Meet or exceed applicable federal and state legal requirements of medical and health information privacy, including compliance with HIPAA.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.5), Telehealth, (Accessed Feb. 2023).

Home Telemonitoring is a health service that allows and requires scheduled remote monitoring of data related to an individual’s health, and transmission of the data from the individual’s home to a licensed home health agency. Scheduled periodic reporting of the individual’s data to a licensed physician is required, even when there have been no readings outside the parameters established in the physician’s orders. In the event of a measurement outside of the established individual’s parameters, the provider shall use the health care professionals noted above to be responsible for reporting the data to a physician.

SOURCE: VT Agency of Human Services. Home Health Agency, Assistive Community Care and Enhanced Residential Care Supplement.  Sec. 1.3.11 Telemonitoring, p. 7 (Jan. 24, 2022). (Accessed Feb. 2023).


OTHER RESTRICTIONS

No Reference Found

Last updated 02/10/2023

Store and Forward

POLICY

“Store and forward” means an asynchronous transmission of a beneficiary’s medical information from a health care professional to a provider at a distant site, through a secure connection that complies with HIPAA, without the beneficiary present in real time.

A qualified telemedicine and store-and-forward provider must:

  • Meet or exceed federal and state legal requirements of medical and health information privacy, including HIPAA
  • Provide appropriate informed consent in a language the beneficiary understands. Specific requirements exist, see rule.
  • Take appropriate steps to establish the provider-patient relationship and conduct all appropriate evaluations and history of the beneficiary consistent with traditional standards of care.
  • Maintain medical records for all beneficiaries receiving health care services through telemedicine that are consistent with established laws and regulations governing patient health care records.
  • Establish an emergency protocol when care indicates that acute or emergency treatment is necessary for the safety of the beneficiary.
  • Address needs for continuity of care for beneficiaries (e.g., informing beneficiary or designee how to contact provider or designee and/or providing beneficiary or identified providers timely access to medical records).
  • If prescriptions are contemplated, follow traditional standards of care to ensure beneficiary safety in the absence of a traditional physical examination.

Services provided through telehealth are subject to the same prior authorization requirements that exist for the service when not provided through telehealth.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.1) & (3.101.5-6), Telehealth, (Accessed Feb. 2023).

“Store and forward” means an asynchronous transmission of medical information, such as one or more video clips, audio clips, still images, x-rays, magnetic resonance imaging scans, electrocardiograms, electroencephalograms, or laboratory results, sent over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191 to be reviewed at a later date by a health care provider at a distant site who is trained in the relevant specialty. In store and forward, the health care provider at the distant site reviews the medical information without the patient present in real time and communicates a care plan or treatment recommendation back to the patient or referring provider, or both.

A health insurance plan (including Medicaid) shall reimburse for health care services and dental services delivered by store-and-forward means.

A health insurance plan shall not impose more than one cost-sharing requirement on a patient for receipt of health care services or dental services delivered by store-and-forward means. If the services would require cost-sharing under the terms of the patient’s health insurance plan, the plan may impose the cost-sharing requirement on the services of the originating site health care provider or of the distant site health care provider, but not both.

A health insurer shall not construe a patient’s receipt of services delivered through telemedicine or by store-and-forward means as limiting in any way the patient’s ability to receive additional covered in-person services from the same or a different health care provider for diagnosis or treatment of the same condition.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed Feb. 2023).


ELIGIBLE SERVICES/SPECIALTIES

DVHA will not reimburse for teleophthalmology or teledermatology by store-and-forward means.*

SOURCE: VT Agency of Human Services. General Billing and Forms Manual. Sec. 5.3.52, p. 86, (Oct. 5, 2022). (Accessed Oct. 2022).

To be covered, services shall:

  • Be clinically appropriate for delivery through store-and-forward
  • Be medically necessary
  • Only be allowed for teledermatology and teleophthalmology.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Oct. 2022).

Effective July 1, 2020, Vermont Medicaid announced continued coverage and reimbursement for HCPCS G2010 and new coverage and reimbursement for interprofessional consultations when performed through store and forward technology (i.e., provider to provider store and forward, CPT codes 99451 & 99452). The allowed modifier for CPT codes 99451 & 99452 is modifier GQ (i.e., “through an asynchronous telecommunications system”).”

SOURCE: Department of Vermont Health Access. Agency of Human Services. Telehealth: Methods for healthcare service delivery using telecommunications technologies. (Accessed Mar. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/10/2023

Cross State Licensing

The Telehealth Working Group was created by Act 21 of 2021 to compile and evaluate methods for facilitating the practice of health care professionals throughout the United States using telehealth modalities. The Working Group’s report is due to the General Assembly by December 15, 2021.

SOURCE: Vermont Secretary of State Office of Professional Regulation, Telehealth Taskforce, (Accessed Feb. 2023).

Provider Update to Telehealth Registration Requirements for Out of State

In accordance with Act 85, health care providers who hold an out of state license and provide services through telehealth to patients/clients located in the State of Vermont will be required to obtain an Interim Telehealth Registration effective April 1, 2022.  Providers are encouraged to visit the Office of Professional Regulation’s (OPR’s) website for more information.

The following information is currently posted on OPR’s website, “Anyone who does not hold an active, conventional Vermont license who is providing health care in Vermont via telehealth must register for an Interim Telehealth Registration. This includes mental health professionals providing telehealth services to patients or clients located in Vermont. Persons holding only an Interim Telehealth Registration may not provide in-person services to patients or clients located in Vermont. Please note that health care professionals who hold an active, conventional Vermont license do not need to obtain an Interim Telehealth Registration to practice telehealth in Vermont.”

To apply for an Interim Telehealth Registration, please submit your contact information through OPR’s Online Services Platform.

SOURCE: Agency of Human Services, Department of Vermont Health Access. (Accessed Feb. 2023).

Telehealth Licensure or Telehealth Registration

A health care professional who is not otherwise licensed, certified, or registered to practice in Vermont but is licensed, certified, or registered in good standing in all other U.S. jurisdictions in which the health care professional is or has been licensed, certified, or registered and who wishes to provide health care services to a patient or client located in Vermont using telehealth shall obtain a telehealth license or telehealth registration from the Office or the Board in accordance with this chapter.

A telehealth license or telehealth registration issued pursuant to this chapter shall authorize a health care professional to provide services to a patient or client located in Vermont using telehealth only. Telehealth licensure or telehealth registration does not authorize the health care professional to open an office in Vermont or to provide in-person health care services to patients or clients located in Vermont.

A health care professional who is not otherwise licensed, certified, or registered to practice in Vermont and provides health care services in Vermont using telehealth without a telehealth registration or telehealth license, or provides services beyond the limitations of the telehealth registration or telehealth license, is engaged in unauthorized practice as defined in 3 V.S.A. § 127 and section 1314 of this title and is subject to the penalties set forth in those sections.

A health care professional who is not otherwise licensed, certified, or registered to practice in Vermont may obtain a telehealth license to provide health care services using telehealth to a total of not more than 20 unique patients or clients located in Vermont during the two-year license term.

See bill for additional information regarding scope, health care professions, eligibility and telehealth registration.

Exemptions from registrations and Licensure Requirements 

A health care professional is not required to obtain a telehealth registration or licensure solely to provide consultation services to another health care professional regarding care for a patient or client located in Vermont, provided the consulting health care professional holds a license, certificate, or registration to practice the profession in one or more U.S. jurisdictions and the consultation is based on a review of records without in-person or remote contact between the consulting health care professional and the patient or client.

SOURCE: VT Statutes Annotated, Title 26, Ch. 56, Sec. 3053 and 3054, (Accessed Feb. 2023).

Last updated 02/10/2023

Definitions

“Telemedicine” means the delivery of health care services, including dental services, such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k(h)(7) (Accessed Feb. 2023).

“Telehealth” means health care services delivered by telemedicine, store and forward, or audio-only telephone.

“Telemedicine” means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104- 191.

SOURCE: VT Statutes Annotated, Title 26, Ch. 56, Sec. 3052, (Accessed Feb. 2023).

“Telemedicine” means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191.

SOURCE: VT Statutes Annotated, Title 18 Sec. Ch. 113, Sec. 5281, (Accessed Feb. 2023).

Last updated 02/10/2023

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (Accessed Feb. 2023).

Member of the Nurse Licensure Compact (NLC).

SOURCE: Nurse Licensure Compact Map.(Accessed Feb. 2023).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 02/10/2023

Miscellaneous

Audio-Only Telephone Requirements

Subject to the limitations of the license under which the individual is practicing and, for Medicaid patients, to the extent permitted by the Centers for Medicare and Medicaid Services, a health care provider may deliver health care services to a patient using audio-only telephone if the patient elects to receive the services in this manner and it is clinically appropriate to do so. A health care provider shall comply with any training requirements imposed by the provider’s licensing board on the appropriate use of audio-only telephone in health care delivery.

A health care provider delivering health care services using audio-only telephone shall include or document in the patient’s medical record:

  • the patient’s informed consent for receiving services using audio- only telephone in accordance with subsection (c) of this section; and
  • the reason or reasons that the provider determined that it was clinically appropriate to deliver health care services to the patient by audio- only telephone.

A health care provider shall not require a patient to receive health care services by audio-only telephone if the patient does not wish to receive services in this manner.

A health care provider shall deliver care that is timely and complies with contractual requirements and shall not delay care unnecessarily if a patient elects to receive services through an in-person visit or telemedicine instead of by audio-only telephone.

A health care provider delivering health care services by audio-only telephone shall obtain and document a patient’s oral or written informed consent for the use of audio-only telephone prior to the appointment or at the start of the appointment but prior to delivering any billable service.

Neither a health care provider nor a patient shall create or cause to be created a recording of a provider’s telephone consultation with a patient.

Audio-only telephone services shall not be used in the following circumstances:

  • for the second certification of an emergency examination determining whether an individual is a person in need of treatment pursuant to section 7508 of this title; or
  • for a psychiatrist’s examination to determine whether an individual is in need of inpatient hospitalization pursuant to 13 V.S.A. § 4815(g)(3).

SOURCE: 18 Vermont Statute Annotated Ch. 219, Sec. 9362, (Accessed Feb. 2023).

“Store and forward” means an asynchronous transmission of medical information, such as one or more video clips, audio clips, still images, x-rays, magnetic resonance imaging scans, electrocardiograms, electroencephalograms, or laboratory results, sent over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191 to be reviewed at a later date by a health care provider at a distant site who is trained in the relevant specialty. In store and forward, the health care provider at the distant site reviews the medical information without the patient present in real time and communicates a care plan or treatment recommendation back to the patient or referring provider, or both.

SOURCE: VT Statutes Annotated, Title 26, Ch. 56, Sec. 3052, (Accessed Feb. 2023).

Last updated 02/10/2023

Online Prescribing

Providers may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient in person, through telemedicine, or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings.

SOURCE: VT Statutes Annotated, Title 18 Sec. 9361(b)  (Accessed Feb. 2023).

A physician shall not be subject to any civil or criminal liability or professional disciplinary action if the physician prescribes to a patient with a terminal condition medication to be self-administered for the purpose of hastening the patient’s death and the physician affirms by documenting in the patient’s medical record that all of the following occurred:

  • The patient made an oral request to the physician in the physician’s physical presence or by telemedicine, if the physician determines the use of telemedicine to be clinically appropriate, for medication to be self- administered for the purpose of hastening the patient’s death.
  • Not fewer than 15 days after the first oral request, the patient made a second oral request to the physician in the physician’s physical presence or by telemedicine, if the physician determines the use of telemedicine to be clinically appropriate, for medication to be self- administered for the purpose of hastening the patient’s death.

SOURCE VT Statutes Annotated, Title 18, Ch. 113, Sec. 5283, (Accessed Feb. 2023).

Last updated 02/10/2023

Professional Board Standards

No Reference Found

Last updated 02/10/2023

Definition of Visit

An Encounter at a FQHC/RHC is defined as a face-to-face visit between a member and a provider. Face-to-face visits with more than one provider and multiple visits with the same provider that take place on the same day and the same location constitute a single visit, except when one of the following conditions exists

  • After the first encounter, the member suffers illness or injury requiring additional diagnosis or treatment
  • The patient has a medical visit with a physician, physician assistant, nurse practitioner, nurse midwife, or a visiting nurse, and a visit with a clinical psychologist, clinical social worker, or other health professional for mental health services. Vermont Medicaid follows the same list of health professionals as Medicare.

A Vermont Medicaid encounter does not include total OB care.

SOURCE: Vermont Medicaid Federally Qualified Health Centers (FQHC)/Rural Health Clinics (RHC) Supplement (Jan. 2022), (Accessed Feb. 2023).

Last updated 02/10/2023

Eligible Distant Site

A distant site is defined broadly to mean the location of a health care provider delivering services through telemedicine at the time the services are provided. However, there is no explicit reference to FQHCs.

See: VT Medicaid Live Video Eligible Providers.

Last updated 02/10/2023

Eligible Originating Site

An originating site is defined as the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including a health care provider’s office, a hospital, or a health care facility, or the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center or patient’s workplace.  However, there is no explicit reference to FQHCs.

See: VT Medicaid Live Video Eligible Sites.

Last updated 02/10/2023

Facility Fee

Originating site providers may be reimbursed a facility fee using Q3014. However, there is no explicit reference to whether or not FQHCs qualify for this fee.

See: VT Medicaid Live Video Facility/Transmission Fee

Last updated 02/10/2023

Home Eligible

No Reference Found.

Last updated 02/10/2023

Modalities Allowed

Live Video

Health insurance plans (includes Medicaid) must provide coverage for health care services and dental services delivered through telemedicine by a health care provider at a distant site to a patient at an originating site to the same extent that the plan would cover the services if they were provided through in-person consultation.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k (Accessed Feb. 2023).

Covered services must be clinically appropriate for delivery through telemedicine and be medically necessary.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.2), Telehealth, (Accessed Feb. 2023).

No explicit reference to whether or not FQHC’s are eligible telehealth providers.

See: VT Medicaid Live Video


Store and Forward

While some reimbursement is allowed for store-and-forward in VT Medicaid, including HCPCS G2010, it is unclear whether or not FQHCs can bill for these services.

See: VT Medicaid Store and Forward


Remote Patient Monitoring  

While reimbursement for some remote patient monitoring is provided in VT Medicaid, it is not explicitly specified whether or not FQHCs can bill for these services.

See: VT Medicaid Remote Patient Monitoring


Audio-Only

Beginning Jan. 1, 2022, VT Medicaid is required to permit audio-only services to the extent the Centers for Medicare and Medicaid Services does.

SOURCE:  Senate Bill 117 (2021 Session), (Accessed Feb. 2023).

During the COVID public health emergency, VT Medicaid is reimbursing G0071 for FQHC dental providers, which includes telephone virtual check-ins.

SOURCE: VT Health Access, Letter to Dental Providers: Vermont Medicaid Continuing Telemedicine Coverage for Dental Services & Temporary New Telephonic Coverage for Brief Communication Services for Dental Providers, 2/10/21, (Accessed Feb. 2023).

See: VT Medicaid Audio-Only

Last updated 02/10/2023

Patient-Provider Relationship

No Reference Found.

Last updated 02/10/2023

PPS Rate

No Reference Found.

Last updated 02/10/2023

Same Day Encounters

Face-to-face visits with more than one provider and multiple visits with the same provider that take place on the same day and the same location constitute a single visit, except when one of the following conditions exists

  • After the first encounter, the member suffers illness or injury requiring additional diagnosis or treatment
  • The patient has a medical visit with a physician, physician assistant, nurse practitioner, nurse midwife, or a visiting nurse, and a visit with a clinical psychologist, clinical social worker, or other health professional for mental health services. Vermont Medicaid follows the same list of health professionals as Medicare.

If an FQHC/RHC provides one or more services on the same day to a Vermont Medicaid member with insurance other than Medicare, the visit should first be billed to the other insurer using the appropriate CPT code(s). The facility may bill Vermont Medicaid for the balance between the other insurance payment and the facility’s encounter rate using T1015 as the encounter code. (Refer to the instructions in Section 29 of CMS-1500 form.)

See supplement for examples of two separate encounters on the same day.

SOURCE: Vermont Medicaid Federally Qualified Health Centers (FQHC)/Rural Health Clinics (RHC) Supplement (Jan. 2022), (Accessed Feb. 2023).