VERMONT
Parity Law
Vermont’s parity law was enacted in 2012! Private payers (including state employee health plans) and Medicaid are required to cover live video telemedicine. The parity law limits telemedicine coverage to services provided in health care facilities only.
Type of Telemedicine Covered
Vermont is 1 of 3 states that only requires live video coverage as a condition of their parity law. The parity law allows, but doesn’t require, private payer reimbursement for some store-and-forward. Medicaid will cover live video and home health monitoring for chronically ill patients.
Covered Health Services
Live video is reimbursed regardless of service. Private payers may reimburse for store-and-forward if the service is tele-ophthalmology or tele-dermatology, but it is not required.
Billing Codes
The GT (Interactive Telecommunication) modifier must be used along with the appropriate HCPC code when billing for services provided via telemedicine.
Eligible Healthcare Providers
Here’s the list of the providers eligible to practice telemedicine in Vermont:
Physician
Nurse practitioner
Physician assistant
Nurse midwife
Clinical nurse specialist
Clinical psychologist
Clinical social worker
Registered dietitian or nutrition professional
Online Prescriptions
Prescriptions can be based off a live video telemedicine consult and must meet all the same criteria as in-person prescriptions.
Informed Patient Consent
Originating site providers must obtain consent for store and forward tele-ophthalmology or tele-dermatology. There is no patient consent requirement for live video telemedicine
Interstate Telemedicine Licensing
Legislation regarding the Interstate Medical Licensure Compact has been introduced in Vermont, but not enacted. As of now, telemedicine in Vermont requires a full state license, with an exemption for physician-to-physician consults.
Restrictions on Locations
A new bill (enacted in October 2015) removes some limitations for telemedicine and primary care services, allowing the patient home to be the originating site as opposed to a facility.
Documenting Barriers to In-Person Care
For Medicaid reimbursement, physicians must record why they are providing live video or store-and-forward services via telemedicine as opposed to in-person. This is not required for private payers.
Other Reimbursable Fees
Facility or transmission fees are allowed, but not required, for originating sites.
Reimbursement Rates
Reimbursement rates are equal for telemedicine and in-person services.
Helpful Resources
Center for Connected Health Policy – Vermont Page