Vermont State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Vermont Medicaid

Medicaid Program Administrator: State Dept. of Vermont Health Access, under the Agency of Human Services.

Regional Telehealth Resource Center: Northeast Telehealth Resource Center 11 Parkwood Drive
Augusta, ME 04330
(800) 379-2021
www.netrc.org

STATE LAW/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“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 meets Health Insurance Portability and Accountability Act (HIPAA) requirements. Telemedicine does not include the use of audio-only telephone, e-mail, or facsimile.”

Source: VT Statutes Annotated, rrtle 8 Sec. 4100k (2012). Telemedicine is defined in Act 107 as “.. .the delivery of health care services… through the use of live interactive audio and video over a secure connection that complies with the requirementsthe Health Insurance Portability and Accountability Act of 1996, Public Law 104-191.
Telemedicine does not include the use of audio-only telephone, e-mail, or facsimile.”

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 103 (Feb. 10, 2017). (Accessed Mar. 2017).
Live Video Reimbursement
Private payers must reimburse for live video.

Source: VT Statutes Annotated, rrtle 8 Sec. 4100k (2012).

In order to facilitate the use of telemedicine in treating substance use disorder, health insurers and the Department of Vermont Health Access shall ensure that both the treating clinician and the hosting facility are reimbursed for the services rendered, unless the health care providers at both the host and service sites are employed by the same entity.

Source: VT Statutes Annotated, rrtle 8 Sec. 4100k No. 173 (2016).

(See “Private Payers” section) Live video is reimbursed.

Originating site providers are required to document the reason the service is being provided by telemedicine rather than in person.

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 103 (Feb. 10, 2017). (Accessed Mar. 2017).

Live video for the provision of primary care services outside of a health care facility will be reimbursed. Coverage shall comply with federal requirements imposed by the Center for Medicare and Medicaid Services which limits certain services and providers for reimbursement.

Source: VT Bill S. 139 (2015).
Store and Forward Reimbursement
Allows, but doesn ‘t require, reimbursement for tele­ ophthalmology and tele-derma tology.

Allows payers to require the distant site provider to document the reason the services are being provided by storean d forwar d. No reimbursement for tele-ophthalmology or tele­ derm atology; no reference to other store and forward technologies.

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 103 (Feb. 10, 2017). (Accessed Mar. 2017)

STATE LAW/REGULATtONS MEDICAID PROGRAM
Source : VT Statutes Annotated, Title 8 Sec. 4100k (2012).
Remote Patient Monitoring Reimbursement
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.

Source: VT Statutes Annotated Title 33 Sec. 19011c). Home telemonitoring is a Medicaid benefit.

Qualified providers are home health agencies enrolled with Vermont Medicaid.

The following healthcare professionals can review data:
⦁ Registered nurse
⦁ Nurse practitioner
⦁ Clinical nurse specialist
⦁ Licensed practice nurse under supervision of
RN
⦁ Physician assistant

Source: Code of VT Rules Sec. 13-170-770 & Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 138-139 (Feb. 10, 2017). (Accessed Mar. 2017)

Individuals receiving Medicaid telemonitoring must:
⦁ Have Medicaid as primary insurance or be dually eligible with non-home bound status; and
⦁ Have congestive heart failure; and
⦁ Be clinically eligible for home health services; and
⦁ Have a physician’s plan of care with an order for telemonitoring services
Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 137 (Feb. 10, 2017). (Accessed Mar. 2017).
Email/Phone/FAX
No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012). No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 103 (Feb. 10, 2017). (Accessed Mar. 2017)
Online Prescribing
Providers may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations if they first examine the patient in person or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.

Treatmentrecommendations 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 (2012). No reference found.

STATE LAW/REGULATtONS MEDICAID PROGRAM
Consent
Originating site providers must obtain consent for store and forward tele-ophthalmology or tele-dermatology.

Patients will be informed of the right to receive a consult with the distant-site provider, and will receive one, upon request, either at the time of the consult, or within a reasonable time after notification of the results of the initial consult.

Receiving tele-dermatology or tele-ophthalmology services by store and forward shall not preclude a patient from receiving real-time telemedicine, or face-to- face services with the distant site provider at a future date.

Source: VT Statutes Annotated, Title 18 Sec. 9361 (2012). No reference found.
Location
No reference found. Certain primary care services may be provided outside of a health care facility.
Source: VT Bill S. 139 (2015).

For primary care services billed outside of a health care facility, certain requirements must be met
⦁ Must complete a telemedicine application
⦁ To be eligible a provider must be:
0 Medicaid-enrolled provider
0 Licensed physician, naturopathic physician, advanced practice registered nurse, or physician assistant
0 Physicians must be Board certified
0 Physician assistants must have supervision who is board certified
0 APRNs must have their advanced degree in a primary care specialty.

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 103 (Feb. 10, 2017). (Accessed Mar. 2017).
Cross-State Licensing
No reference found. No reference found.
Private Payers
Requires coverage of telemedicine services, subject to contract terms and conditions.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012). No reference found.
Site/Transmission Fee
No reference found. Originating site providers are required to document the reason the service is being provided by telemedicine rather than in person and may be reimbursed a facility fee.

STATE LAW/REGULATtONS MEDICAID PROGRAM

Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 103 (Feb. 10, 2017). (Accessed Mar. 2017).
Miscellaneous
The Department of Vermont Health Access is required to reimburse the hosting facility for services rendered.

Source: VT Statutes Annotated, Title 8 Sec. 4100k No. 173 (2016) http://legistature.vermont.gov/statutes/section/081107104100k The Department of Vermont Health Access and the Green Mountain Care Board is tasked with considering the implementation of pilot projects using telemedicine. Among other things, the pilot project should consider the scope of services that should be provided using telemedicine outside of a health care facility including possibly equipping home health agency nurses with tools needed to provide telemedicine during home health visits.

Source: VT Act. No. 40 (S. 88).

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