VERMONT

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Vermont Medicaid reimburses for live video under certain circumstances. Home health monitoring is considered a Medicaid benefit and is available under certain conditions.

 

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 110-111 (Feb. 2019). (Accessed Apr. 2019).
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Definitions

Telemedicine is defined in Act 64 as “…the delivery of health care services…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, 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. 106 (Feb. 2019). (Accessed Apr. 2019).

 

“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, Title 8 Sec. 4100k (2017). (Accessed Apr. 2019).

Live Video

Policy

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.

Source: VT Statutes Annotated, Title 8 Sec. 4100k & Title 18 Sec. 9361 (2017). (Accessed Apr. 2019).

 

Live video is reimbursed for clinically appropriate services delivered through telemedicine outside a health care facility or from facility to facility.
Facilities providing live telemedicine services are required to use the GT modifier.
02 place of service code must be on all claims.

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 106 (Feb. 2019). (Accessed Apr. 2019).
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 & Title 18 Sec. 9361(h(1)) (2017). (Accessed Apr. 2019).

 

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

Source: VT Agency of Human Services. Health Care Administrative Rules. 3.101.3 (Jan. 2019) & Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 106 (Feb. 2019). (Accessed Apr. 2019).
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 & Title 18 Sec. 9361 (2017). (Accessed Apr. 2019).
Facility/Transmission Fee

A facility fee is reimbursed, unless the facility site provider is employed by the same entity as the distant site provider.

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 106 (Feb. 2019). (Accessed Apr. 2019).

 

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(g) (2017) (Accessed Apr. 2019).

Store-and-Forward

Policy

Statute permits health plans (including Medicaid) the option to reimburse for teleophthalmology and teledermatology services provided by store-and-forward. In the Medicaid Provider Manual dated Feb. 1, 2019, VT Medicaid states it does not reimburse for these
services.

Source: VT Statutes Annotated, Title 8 Sec. 4100k. (2017). & Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 106 (Feb. 2019). (Accessed Apr. 2019).

 

Health Care Administrative Rules Dated Jan. 1, 2019, VT Agency of Human Services states that:
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 Agency of Human Services. Health Care Administrative Rules. 3.101.2(b) (Jan. 2019) (Accessed Apr. 2019).
Eligible Services / Specialties

No reimbursement for tele-ophthalmology or tele-dermatology by store-and-forward stated in the Provider Manual dated Feb 1, 2019. However, as noted above, The Administrative Rules for the VT Agency of Human Services (dated Jan. 1, 2019), states that store-and-forward teledermatology and teleopthalmology is covered. The two policies are close enough in date as to make it uncertain which may be the actual policy in place.

 

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 106 (Feb. 2019). (Accessed Apr. 2019) &VT Agency of Human Services. Health Care Administrative Rules. 3.101.2(b) (Jan. 2019) (Accessed Apr. 2019).

Remote Patient Monitoring

Policy

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. 1901(a). (Accessed Apr. 2019).

 

Home telemonitoring is a Medicaid benefit.

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 105 & 141-142 (Feb. 2019). (Accessed Apr.2019).
Conditions

Individuals receiving Medicaid telemonitoring services must have Congestive Heart Failure (any diagnosis; 428.xx).

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 141 (Feb. 2019). (Accessed Apr. 2019).
Provider Limitations

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: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 141-142 (Feb. 2019). (Accessed Apr. 2019).
Other Restrictions

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. 141-142 (Feb. 2019). (Accessed Apr. 2019).

 

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

Source: VT Agency of Human Services. Health Care Administrative Rules. 3.101.2(b) (Jan. 2019) & Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 141 (Feb. 2019). (Accessed Apr. 2019).

 

Qualified providers may bill once in every 30 days, including all necessary equipment; computer system, connections, and software; maintenance; patient education and support; per month. CPT 98969 may be billed once every 7 days for ongoing assessment and management of telemonitoring data.

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 142 (Feb. 2019). (Accessed Apr. 2019)
Email / Phone / Fax

No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.

 

Source: Dept. of VT Health Access, Green Mountain Care Provider Manual, p. 106 (Feb. 2019). (Accessed Apr. 2019).
Consent

Written or oral informed consent for telemedicine services shall be provided in accordance with Vermont and national policies and guidelines on the appropriate use of telemedicine within the provider’s profession prior to the use of telemedicine.

Source: VT Statutes Annotated, Title 18 Sec. 9361 (2017). (Accessed Apr. 2019).

Private Payer Laws

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

Source: VT Statutes Annotated, Title 8 Sec. 4100k & Title 18 Sec. 9361 (2017). (Accessed Apr. 2019).

 

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.

Source: VT Statutes Annotated, Title 8 Sec. 4100k (2017). (Accessed Apr. 2019).
Definitions

“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, Title 8 Sec. 4100k(7) (2017). (Accessed Apr. 2019).

Parity

Payment Parity

No explicit payment parity.

 

Service Parity

For live video, plans are required to cover services provided through telemedicine to the same extent the plan covers services provided in-person. For store-and-forward, plans are allowed but not required to reimburse for tele-ophthalmology and tele-dermatology.

 

Source: VT Statutes Annotated, Title 8 Sec. 4100k. (2017). (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Definitions

“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, Title 8 Sec. 4100k (2017). & Title 18 Sec. 9361 (2017). (Accessed Apr. 2019).
Consent

A health care provider delivering health care services through telemedicine must obtain and document a patient’s oral or written informed consent.

Source: VT Statutes Annotated, Title 18 Sec. 9361 (2017). (Accessed Apr. 2019).
Cross-State Licensing

A special purpose license allowing practitioners licensed in other states to practice across state lines
may be issued.

 

Source: Interstate Medical Licensure Compact. The IMLC. (Accessed Apr. 2019).
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, 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) (2017). (Accessed Apr. 2019).

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