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Department of Vermont Health Access Extends Telemedicine Reimbursement for Medicaid and Health Insurance Plans.

New legislation spells good news for patient care in Vermont. State Senate Bill S.50 expands insurance coverage for telemedicine services. This is especially helpful to patients who live in areas where specialists are rare or in short supply.

Currently, only telemedicine sessions that take place between two healthcare facilities are eligible for coverage. This act extends this coverage to encompass telemedicine sessions between a patient’s workplace or home and the providing healthcare facility.

Specific Provising in Vermont Senate Bill S.50

The new law directs the Vermont Department of Health Access (VHA) to ensure telemedicine services reimbursement for both the hosting facility and the treating medical provider. Exceptions apply if the clinicians at both ends of the session work for the same facility.

The bill also enacts the following provisions:

  • Insurance payers must treat these services the same as they do in-person medical visits between their insurance beneficiary and a medical care provider.
  • Insurers may require co-pays, deductibles, and coinsurance for telemedicine appointments, but they may not charge more for these services than they do for in-person medical visits.
  • Store-and-forward technology provided teledermatology and teleophthalmology is reimbursible.
  • Remote health care clinicians may be required to document the purposes for using store and forward options.
  • Payers may request explanations for the use of telemedicine from the provider.
  • Providers may not set maximums on telemedicine visits.
  • Telemedicine use is expanded to a larger base of licensed, certified, or otherwise legally authorized health professionals.

In addition to expanding access to specialty medical care, the law also has potential benefits for mental health treatment. It allows patients in hospital emergency departments who are combating a mental health crises to connect with psychiatric services from the hospital. This real-time care may facilitate a quicker return home and decrease the need for psychiatric hospitalizations.

Vermont Governor Phil Scott signed the bill on June 7. The new law is set to take effect on October 1, 2017. This legislation applies to all health insurance companies proving coverage in Vermont, including Medicaid. Many see this as a positive step forward in expanding healthcare coverage and access without substantially raising costs.