Medicaid Telehealth Reimbursement
Summary
Vermont Medicaid reimburses for live video under certain circumstances. Home health monitoring is considered a Medicaid benefit and is available under certain conditions.
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.
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.
Eligible Services/Specialties
No reference found.
Eligible Providers
A distant site is the location of the health care provider delivering services through telemedicine at the time the services are provided.
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.
Geographic Limits
No reference found.
Facility/Transmission Fee
A facility fee is reimbursed, unless the facility site provider is employed by the same entity as the distant site provider.
Store-and-Forward
Policy
Statute permits health plans (including Medicaid) the option to reimburse for teleophthalmology and teledermatology services provided by store-and-forward. Iin the Medicaid Provider Manual dated Feb. 1, 2019, VT Medicaid states it does not reimburse for these services.
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.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
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.
Conditions
Individuals receiving Medicaid telemonitoring services must have Congestive Heart Failure (any diagnosis; 428.xx).
Provider Limitations
Qualified providers are home health agencies enrolled with Vermont Medicaid.
Other Restrictions
Click to view additional criteria for remote patient monitoring.
Email/Phone/Fax
No reimbursement for email. No reimbursement for telephone. No reimbursement for FAX.
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.
Out of State Providers
No reference found.
Miscellaneous
No reference found.
Private Payer Laws
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.”
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.
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.
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.”
Consent
A health care provider delivering health care services through telemedicine must obtain and document a patient’s oral or written informed consent.
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.
Cross State Licensing
Vermont enacted the Interstate Medical Licensure Compact.
Miscellaneous
No reference found.
Source: Center for Connected Health Policy
https://www.cchpca.org