Vermont

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Vermont Medicaid

Administrator

State Dept. of Vermont Health Access, under the Agency of Human Services

Regional Telehealth Resource Center

Northeast Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: Yes, with limitations
Remote Patient Monitoring: Yes

Private Payer Law

Law Exists: Yes
Payment Parity: Yes

Professional Requirements

Licensure Compacts: IMLC, NLC
Consent Requirements: Yes

Last updated 11/01/2021

Audio-Only Delivery

Medicaid: Continuing Telemedicine Coverage for Dental Services & Telephonic Coverage

STATUS: Active

Medicaid:  Telephonic Services FAQ* – No longer accessible on VT website.

STATUS: Expired, Statewide Emergency Declaration expired June 15, 2021

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: Telephonic Services Reference Chart

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

Last updated 11/01/2021

Cross State Licensing

No Reference Found

Last updated 11/01/2021

Easing Prescribing Requirements

No Reference Found

Last updated 11/01/2021

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

Last updated 11/01/2021

Originating Site

Medicaid:  Telephonic Services FAQ* – No longer accessible on VT website.

STATUS: Expired, Statewide Emergency Declaration expired June 15, 2021

Last updated 11/01/2021

Private Payer

Dep. Of Financial Regulation: Coverage for Telehealth, Telephone or Store and Forward

STATUS: Withdrawn, October 23, 2020

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

STATUS: Active

Emergency Rule: Access to Health Care Services During the COVID-19 Pandemic

STATUS: Expires July 1, 2021

H 742: Insurance Reimbursement

STATUS: Enacted

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

STATUS: Enacted

Last updated 11/01/2021

Provider Type

Medicaid: Continuing Telemedicine Coverage for Dental Services & Telephonic Coverage

STATUS: Active

Medicaid:  Telephonic Services FAQ* – No longer accessible on VT website.

STATUS: Expired, Statewide Emergency Declaration expired June 15, 2021

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

STATUS: Active, extended to March 31, 2022

Last updated 11/01/2021

Service Expansion

Medicaid: Continuing Telemedicine Coverage for Dental Services & Telephonic Coverage

STATUS: Active

Medicaid:  Telephonic Services FAQ* – No longer accessible on VT website.

STATUS: Expired, Statewide Emergency Declaration expired June 15, 2021

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: Telephonic Services Reference Chart

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)

Senate Bill 117: Waiver of Certain Telehealth Requirements for a Certain Time

STATUS: Enacted, Temporary section on telehealth expires Mar. 31, 2022

Last updated 11/01/2021

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 Nov. 2021).

“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 Nov. 2021).

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 Nov. 2021).

Last updated 11/01/2021

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 Nov. 2021).

Audio-Only Telephone

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.

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

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

Last updated 11/01/2021

Live Video

POLICY

Health insurance plans (includes Medicaid) 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.

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 Nov. 2021).

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 Nov. 2021).

Providers should refer to Health Care Administrative Rule 3.101 on Telehealth for requirements.  Information contained in rule will not be repeated in the provider manual.  Billing rules for telemedicine:

  1. 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.
  2. All professional claims (CMS-1500 form) with services billed for telemedicine must have POS 02. Modifier GT should not be used on professional services.
  3. All facility claims (UB-04 form) must include modifier GT on any telemedicine services delivered via interactive audio and/or video.
  4. Originating facility site providers (patient site) may be reimbursed a facility fee (Q3014)
    1. Facility fees will not be reimbursed if the provider is employed by the same entity as the originating site.
    2. 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. 85 & 94 (Sept. 15, 2021). (Accessed Nov. 2021).


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 Nov. 2021).

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. 85, (Sept. 15, 2021). (Accessed Nov. 2021).


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 Nov. 2021).

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 Nov. 2021).

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. 7, 2021), & Letter on Vermont Medicaid Continuing Telemedicine Coverage for Dental Services, Apr. 10, 2020, (Accessed Nov. 2021)


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 Nov. 2021).

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 Nov. 2021).


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. 85, (Sept. 15, 2021). (Accessed Nov. 2021).

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 Nov. 2021).

Last updated 11/01/2021

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 Nov. 2021).

 

Last updated 11/01/2021

Out of State Providers

No Reference Found

Last updated 11/01/2021

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 11/01/2021

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 (Oct. 21, 2021), (Accessed Nov. 2021).

“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 Nov. 2021).

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 Nov. 2021).

 


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 Nov. 2021).

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 Nov. 2021).


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 Nov. 2021).

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 Nov. 2021).

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 (Oct. 21, 2021). (Accessed Nov. 2021).


OTHER RESTRICTIONS

No Reference Found

Last updated 11/01/2021

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.

SOURCE:  VT Health Care Administrative Rules 13.174.003 (3.101.1), Telehealth, (Accessed Nov. 2021).

“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 Nov. 2021).


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. 85, (Sept. 15, 2021). (Accessed Nov. 2021).

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 Nov. 2021).

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 Nov. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 11/01/2021

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 Nov. 2021).

Last updated 11/01/2021

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 Nov. 2021).

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.

SOURCE: VT Statutes Annotated, Title 8 Sec. 41001, as amended by S. 117. (Accessed Nov. 2021).

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 Nov. 2021).


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 Nov. 2021).

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 Nov. 2021).

Last updated 11/01/2021

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 Nov. 2021).

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 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, as amended by S. 117. (Accessed Nov. 2021).

Last updated 11/01/2021

Cross State Licensing

Legislation created the Facilitation of Interstate Practice Using Telehealth Working Group to compile and evaluate methods for facilitating
the practice of health care professionals throughout the United States using telehealth modalities.

The Working Group shall compile and evaluate methods for facilitating the interstate practice of health care professionals using telehealth modalities, including through the creation of telehealth licenses, waiver of licensure, national licensure compacts, and regional reciprocity agreements.  See enacted legislation for details on key considerations the group must make.  The working group must present its findings by December 15, 2021.

SOURCE: House Bill 104 (2021 Session), (Accessed Nov. 2021).

Last updated 11/01/2021

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 Nov. 2021).

Last updated 11/01/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (Accessed May 2021).

Member of the Nurse Licensure Compact (NLC).

SOURCE: Nurse Licensure Compact Map & VT S. 48 (2021 Session). (Accessed Nov. 2021).

Last updated 11/01/2021

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, & Senate Bill 117 (2021 Session), (Accessed Nov. 2021).

Last updated 11/01/2021

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 Nov. 2021).

Last updated 11/01/2021

Professional Board Standards

No Reference Found