Following up on our discussion this afternoon, below and at the link below please find the language from Vermont's recently enacted COVID-19 legislation which addresses telehealth. Please let me know if more information would be helpful. Thanks - Julie
https://legislature.vermont.gov/Documents/2020/Docs/ACTS/ACT091/ACT091%20As%20Enacted.pdf
These are the pertinent sections:
Sec. 23. TELEHEALTH EXPANSION; LEGISLATIVE INTENT
It is the intent of the General Assembly to increase Vermonters' access to
health care services through an expansion of telehealth services without
increasing social isolation or supplanting the role of local, community-based
health care providers throughout rural Vermont.
Sec. 24. 8 V.S.A. § 4100k is amended to read:
- 4100k. COVERAGE OF HEALTH CARE SERVICES DELIVERED
THROUGH TELEMEDICINE AND BY STORE-AND-
FORWARD MEANS
(a)(1) 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.
(2)(A) 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.
(B) The provisions of subdivision (A) of this subdivision (2) 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.
(b) A health insurance plan may charge a deductible, co-payment, or
coinsurance for a health care service or dental service provided through
telemedicine so as long as it does not exceed the deductible, co-payment, or
coinsurance applicable to an in-person consultation.
(c) A health insurance plan may limit coverage to health care providers in
the plan's network. A health insurance plan shall not impose limitations on the
number of telemedicine consultations a covered person may receive that
exceed limitations otherwise placed on in-person covered services.
(d) Nothing in this section shall be construed to prohibit a health insurance
plan from providing coverage for only those services that are medically
necessary and are clinically appropriate for delivery through telemedicine,
subject to the terms and conditions of the covered person's policy.
(e) A health insurance plan may reimburse for teleophthalmology or
teledermatology provided by store and forward means and may require the
distant site health care provider to document the reason the services are being
provided by store and forward means.
(1) A health insurance plan shall reimburse for health care services and
dental services delivered by store-and-forward means.
(2) 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.
(f) 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.
(g) Nothing in this section shall be construed to require a health insurance
plan to reimburse the distant site health care provider if the distant site health
care provider has insufficient information to render an opinion.
(g)(h) 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.
(h)(i) As used in this subchapter:
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Julie Tessler
Executive Director
Vermont Care Partners
Montpelier VT
(802)223-1773
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