Vermont § 4098a - Coverage of health care services delivered through telemedicine and by store-and-forward means

§ 4098a. Coverage of health care services delivered through telemedicine and by store-and-forward means

• (a) As used in this section: (1) “Distant site” means the location of the health care provider delivering services
  through telemedicine at the time the services are provided. (2) “Health insurance plan” has the same meaning as in section 4011 of this title and also includes a stand-alone dental plan or policy or other dental insurance plan
  offered by a dental insurer. (3) “Health care facility” has the same meaning as in 18 V.S.A. § 9402. (4) “Health care provider” means a person, partnership, or corporation, other than a facility
  or institution, that is licensed, certified, or otherwise authorized by law to provide
  professional health care services, including dental services, in this State to an
  individual during that individual’s medical care, treatment, or confinement. (5) “Originating site” means 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 the patient’s
  workplace. (6) “Store-and-forward” means an asynchronous transmission of medical information, such
  as one or more video clips, audio clips, still images, x-rays, magnetic resonance
  imaging scans, electrocardiograms, electroencephalograms, or laboratory results, sent
  over a secure connection that complies with the requirements of the Health Insurance
  Portability and Accountability Act of 1996, Pub. L. No. 104-191, to be reviewed at a later date by a health care provider at a distant site who is
  trained in the relevant specialty. In store-and-forward, the health care provider
  at the distant site reviews the medical information without the patient present in
  real time and communicates a care plan or treatment recommendation back to the patient
  or referring provider, or both. (7) “Telemedicine” means the delivery of health care services, including dental services,
  such as diagnosis, consultation, or treatment, 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, Pub. L. No. 104-191. (b)(1) A health insurance plan shall provide coverage for health care services and dental
  services delivered through telemedicine by a health care provider at a distant site
  to a covered individual 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: (i) to services provided pursuant to the health insurance plan’s contract with a third-party
  telemedicine vendor to provide health care or dental services; or (ii) in the event that a health insurer and health care provider enter into a value-based
  contract for health care services that include care delivered through telemedicine
  or by store-and-forward means. (c) A health insurance plan may charge a deductible, co-payment, or coinsurance for a
  health care service or dental service provided through telemedicine as long as it
  does not exceed the deductible, co-payment, or coinsurance applicable to an in-person
  consultation. (d) 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 individual may receive that exceed limitations otherwise placed
  on in-person covered services. (e) 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 individual’s policy. (f)(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 covered individual 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 covered individual’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. (g) A health insurance plan shall not construe a covered individual’s receipt of services
  delivered through telemedicine or by store-and-forward means as limiting in any way
  the covered individual’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. (h) 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. (i) 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. (j) This section shall apply to Medicaid and any other public health care assistance program
  offered or administered by the State or by any subdivision or instrumentality of the
  State. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)