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                                                                                 Center for Connected Health Policy

           Vermont


             Medicaid Program:  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
           (207) 622-7566 / (800) 379-2021
           www.netrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM
            Definition of telemedicine/telehealth
            "Telemedicine means the delivery of health care    Telemedicine is defined in Act 107 as “…the delivery of
            services such as diagnosis, consultation, or treatment   health care services…through the use of live interactive
            through the use of live interactive audio and video over a  audio and video over a secure connection that complies
            secure connection that meets Health Insurance      with the requirements the Health Insurance Portability
            Portability and Accountability Act (HIPAA) requirements.  and Accountability Act of 1996, Public Law 104-191.
            Telemedicine does not include the use of audio-only   Telemedicine does not include the use of audio-only
            telephone, e-mail, or facsimile.”                  telephone, e-mail, or facsimile.”

            Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).   Source: Dept. of VT Health Access, Provider Manual, p. 116 (Jan.
                                                               1, 2015).
            Live Video Reimbursement

            Private payers must reimburse for live video.      Live video is reimbursed.

            Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).   Originating site providers are required to document the
                                                               reason the service is being provided by telemedicine
            (See “Private Payers” section)                     rather than in person.

                                                               Source: Dept. of VT Health Access, Provider Manual, p. 118 (Jan.
                                                               1, 2015).
            Store and Forward Reimbursement

            Allows, but doesn’t require, reimbursement for tele-  No reimbursement for tele-ophthalmology or tele-
            ophthalmology and tele-dermatology.                dermatology; no reference to other store and forward
                                                               technologies.
            Allows payers to require the distant site provider to
            document the reason the services are being provided by   Source: Dept. of VT Health Access, Provider Manual, p. 118 (Jan.
            store and forward.                                 1, 2015).

            Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).
            Remote Patient Monitoring Reimbursement
            VT Medicaid is required to cover home telemonitoring   Home telemonitoring is a Medicaid benefit.
            services performed by home health agencies or other
            qualified providers for beneficiaries who have serious or  Qualified providers are home health agencies enrolled
            chronic medical conditions.                        with Vermont Medicaid.

            Source: VT Statutes Annotated, Title 33 Sec. 1901k).    The following healthcare professionals can review data:
                                                                   •   Registered nurse

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   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, Provider Manual, p. 152 (Jan. 1, 2015).

                                                               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, Provider Manual, p. 152 (Jan.
                                                               1, 2015).
            Email/Phone/FAX

            No reimbursement for email.                        No reimbursement for email.
            No reimbursement for telephone.                    No reimbursement for telephone.
            No reimbursement for FAX.                          No reimbursement for FAX.

                                                               Source: Dept. of VT Health Access, Provider Manual, p. 116 (Jan.
            Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).   1, 2015).
            Online Prescribing

            Providers may prescribe, dispense, or administer drugs   No reference found.
            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.

            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 (2012).
            Consent

            Originating site providers must obtain consent for store   No reference found.
            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

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            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).
            Location

            No reference found.                                No reference found.
            Cross-State Licensing
            No reference found.                                No reference found.

            Private Payers
            Requires coverage of telemedicine services, subject to   No reference found.
            contract terms and conditions.

            Source: VT Statutes Annotated, Title 8 Sec. 4100k (2012).

            Site/Transmission Fee
            No reference found.                                Allowed, but not required, for originating site providers.

                                                               Dept. of VT Health Access, Provider Manual, p. 119 (Jan. 1, 2015).
            Miscellaneous
                                                               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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