Lawmakers review Vermont telehealth law: consent, recording ban and payment parity

Legislative counsel Jen Carby told the House Health Care Committee that Vermont law sets detailed rules for telehealth delivery and payment, including requirements for informed consent, limits on recordings, and recent changes requiring equal reimbursement for in-person, telemedicine and audio-only care.

Carby said the statutes define telemedicine as a live audio-video clinical encounter, and include other modalities such as audio-only telephone visits, store-and-forward transfers of images or data, and remote home monitoring. She noted that “the provider has to be licensed where the patient is physically located at the time the services are delivered,” a licensing rule that remains in place as telehealth expands.

The memorandum Carby reviewed requires clinicians to obtain and document patient informed consent (or document oral consent) before using telemedicine or store-and-forward, and to explain limitations, who else may be present, and privacy protections that comply with HIPAA. She also identified statutory exceptions to consent for medical emergencies and certain psychiatric examinations.

Carby told the committee that state law also bars recordings of telemedicine and audio-only consultations: “Under current law, neither the patient nor the provider can record their consultation,” she said, and she traced that prohibition to language added in 2017. At the same time, committee members and witnesses described how transcription and artificial-intelligence tools now can convert visits to text in real time and said the law may need updating to reflect current technology and patient needs.

Bob, a bill sponsor who addressed the committee about a bill on the committee’s wall, framed the proposed change as narrowly administrative: allowing a patient and provider to agree to record or transcribe an encounter so electronic systems can generate clinical notes. “Functionally, what it does is allows the electronic record system to more effectively record the notes and allows your physician to look at you while you're talking about what's wrong with you as opposed to typing,” Bob said.

Committee members raised privacy and equity concerns, noting patients sometimes want a family member present or a transcript for accessibility. Several members said they expect the committee to take public testimony before making statutory changes.

For now, the law treats clinical records (the provider’s chart) and audio/video recordings differently: providers must document visits in the medical record, but producing a separate audio or video file of the encounter is currently prohibited. Carby and multiple members recommended additional testimony to clarify whether modern transcription apps should be treated as recordings under the statute or as part of the medical record.

The committee did not take a vote; members said they will schedule testimony from technology vendors, clinicians and privacy advocates before deciding on any statutory changes.