Vermont Telemedicine Laws: Licensure, Consent, Parity

Vermont requires Vermont authority for a clinician treating a patient located in the state, apart from narrow consultation exceptions. Under 26 V.S.A. chapter 56, out-of-state clinicians may hold a telehealth license (up to 20 unique patients per two-year term) or a telehealth registration (up to 10 patients over 120 days); for professions regulated by the Office of Professional Regulation, including nursing and osteopathic medicine, those credentials are not yet issued, and an Interim Telehealth Registration, with no patient caps or fees, applies until OPR's rules take effect. Providers must obtain and document informed consent, oral or written, before telemedicine or audio-only care. Commercial plans owe coverage parity and, with stated exceptions, payment parity. Vermont Medicaid covers audio-only care for a published code list.

Licensure: telehealth credentials with patient caps

Under 26 V.S.A. § 3053, a professional not otherwise credentialed in Vermont, but in good standing in every U.S. jurisdiction where they are or have been credentialed, "shall obtain a telehealth license or telehealth registration" to serve a patient or client located in Vermont. Providing telehealth without one, or beyond its limits, is unauthorized practice under 3 V.S.A. § 127 and 26 V.S.A. § 1314; section 1314 makes unlicensed practice of medicine a crime punishable by up to two years' imprisonment, a fine, or both. Neither credential permits an office or in-person care in Vermont.

Under § 3054, a telehealth license covers not more than 20 unique Vermont patients during its renewable two-year term. A telehealth registration lasts not more than 120 consecutive days, covers not more than 10 unique patients, cannot be renewed, and may be reactivated only once every three years. Applicants need an active, unencumbered out-of-state credential with the same or broader scope, and are barred if any credential has been revoked or faces pending disciplinary investigation or action.

The Board of Medical Practice issues these credentials to physicians, physician assistants and podiatrists under its rules effective May 1, 2024; a physician telehealth license requires meeting all requirements for full licensure. For the 23 professions regulated by the Office of Professional Regulation, including nursing, osteopathic medicine, psychology and the allied mental health professions, the permanent rules were proposed in 2026 with comments closing August 4, 2026. Until they take effect, those clinicians use an Interim Telehealth Registration kept alive by Act 4 of 2023, and OPR's filing states that patient caps are not yet in effect.

Section 3059 exempts consultation with another health care professional when it rests on a review of records "without in-person or remote contact" with the patient. For physicians, 26 V.S.A. § 1313(a)(3) exempts a nonresident physician "using telecommunications to consult with a duly licensed practitioner herein."

Vermont's Interstate Medical Licensure Compact statute took effect January 1, 2020, but Vermont issues licenses only and cannot serve as a physician's state of principal license. Multistate nursing licenses took effect February 1, 2022, and Vermont is a full Physical Therapy Compact member. PSYPACT legislation, H.282 (Act 37 of 2023), was signed June 1, 2023 with a July 1, 2024 effective date, yet PSYPACT still lists Vermont as enacted and not yet effective, so it is not participating. The Counseling Compact is enacted but not yet issuing privileges. See the cross-state licensing tracker.

Prescribing: an exam rule, a questionnaire ban and opioid limits

Under 18 V.S.A. § 9361(b), a provider licensed in Vermont may prescribe after an appropriate examination in person, through telemedicine (live interactive audio and video), or by instrumentation that transmits images and records, held to the same standards as in-person care. For physicians, 26 V.S.A. § 1354(a)(33) makes it unprofessional conduct to prescribe in response to electronic communication without a reasonable effort to verify the patient's identity, a diagnosis documented through accepted medical practices, and a current medical record, and deems a questionnaire "inadequate for the initial evaluation of the patient." Its six exceptions include covering-call prescribing, short-term continuation before a new patient's first appointment, emergencies where the patient's life or health is in imminent danger, and medication abortion by adaptive questionnaire.

The Department of Health's Rule Governing the Prescribing of Opioids for Pain, effective April 1, 2024, covers Schedule II–IV opioids. Before a first opioid prescription in a course of treatment, the prescriber must have "an in-person discussion" of risks, supply a patient education sheet and obtain signed informed consent. First prescriptions for acute pain in opioid-naive patients carry supply limits. Chronic-pain prescribing requires a documented medical evaluation and physical examination, a signed treatment agreement, and reevaluation of stable patients at least every 90 days. An average daily dose of 90 morphine milligram equivalents or more requires another in-person discussion. The prescriber must co-prescribe an opioid antagonist such as naloxone, or document that the patient has a valid prescription for one or says they have one, whenever opioid prescriptions total 90 MME a day or more or an opioid is prescribed for concurrent use with a benzodiazepine. Extended-release hydrocodone or oxycodone without an abuse-deterrent formulation also requires a documented medical evaluation and physical examination. Patients who are terminally ill, receiving hospice services or hospice-eligible are exempt from sections 4–7, but the prescriber must still cover safe storage and disposal and provide the patient education sheet; chronic pain associated with cancer or its treatment, and nursing home residents, are exempt from the chronic-pain section. The rule does not define "in-person," and we found no Department of Health guidance saying a video visit satisfies it. Because a telehealth license or registration does not authorize in-person care in Vermont (26 V.S.A. § 3053(b)), a telehealth-only prescriber should not assume a video discussion meets sections 4.3.1 or 6.4.2.7 and should confirm with the Department of Health before prescribing opioids for pain. The separate medications-for-opioid-use-disorder rule, effective May 15, 2024, lets eligible providers prescribe and conduct its evaluations by telehealth "in accordance with federal law and clinical need."

18 V.S.A. § 4289 requires prescribers of Schedule II–IV drugs to register with the Vermont Prescription Monitoring System and, except during electronic or technological failure, to query it in four listed circumstances, including annually for ongoing opioid therapy. The Department's VPMS rule adds triggers, including a first benzodiazepine prescription and a first buprenorphine prescription. For buprenorphine, the rule also requires queries at least twice a year and before any replacement prescription, and prescribing above the Vermont Medicaid Drug Utilization Review Board's dosage threshold requires prior approval from the Department of Vermont Health Access. We found no Vermont mandate for electronic prescribing of controlled substances; Medicare Part D separately requires at least 70 percent of Part D Schedule II–V prescriptions to be electronic under 42 CFR 423.160, subject to exceptions and waivers. We found no separate Vermont controlled-substance registration. Instead, 18 V.S.A. § 4206(a) bars anyone from prescribing a regulated drug without "a license from the respective professional board," and the chapter defines a prescription as one written by a prescriber "licensed under this chapter." Vermont law does not say whether a telehealth license, a telehealth registration or an Interim Telehealth Registration satisfies § 4206, and we found no Board of Medical Practice, Office of Professional Regulation or Department of Health guidance on the point. Out-of-state clinicians who plan to prescribe controlled substances to Vermont patients should confirm with their Vermont regulator first.

Federal law adds a separate layer for controlled substances. Under the temporary rule DEA and HHS published December 31, 2025 (90 FR 61301), which runs through December 31, 2026, a DEA-registered practitioner may prescribe Schedule II–V controlled substances after a real-time audio-video telemedicine encounter without a prior in-person evaluation, when the rule's other conditions are met; audio-only encounters qualify only for Schedule III–V narcotic medications approved by the FDA to treat opioid use disorder. See our guide to federal telehealth laws.

Consent: oral or written, before care

Section 9361(c) requires a provider to "obtain and document a patient's oral or written informed consent" before telemedicine. The consent must explain the opportunities and limitations of telemedicine, disclose anyone else participating or observing and obtain permission, and assure a HIPAA-compliant connection. It is needed only at the first episode of ongoing care, and is excused in a medical emergency and for two specified mental health examinations: a second certification under 18 V.S.A. § 7508 and a psychiatrist's examination under 13 V.S.A. § 4815(g)(3). A provider working through a third-party vendor that requires the vendor's own consent terms complies by following them. Store-and-forward patients must be told they may refuse and request real-time or in-person care.

Section 9362 adds audio-only rules: consent before or at the start of the appointment but before any billable service, disclosures about billing and cost-sharing, an offer of a written copy after oral consent, and a documented reason audio-only was clinically appropriate. A provider may not require a patient to accept audio-only care, and audio-only may not be used for the two mental health examinations above. One form may cover every modality. Vermont Medicaid's rule adds required consent content, including the provider's credentials, security measures and the risk of information lost to technical failure. Act 80 of 2026, which took effect on passage (signed April 20, 2026), replaced a flat ban and allows recording a telehealth or telephone visit when both patient and provider consent.

Medicaid: parity by statute, a code list for audio-only

Section 4098a(j) extends the telemedicine coverage statute to Medicaid, and § 4098b(e) does the same for audio-only "to the extent permitted by" CMS. Health Care Administrative Rule 3.101, effective May 1, 2023, covers telemedicine, store-and-forward, audio-only and remote patient monitoring when clinically appropriate and medically necessary. As conditions of coverage, providers must be Medicaid-enrolled, establish an emergency protocol, address continuity of care, and follow traditional standards when prescribing without a physical examination. Remote patient monitoring runs through home health agencies and is limited to congestive heart failure, hypertension and diabetes. DVHA pays audio-only at the same rate with modifier 93 for codes on its list, which is mostly behavioral health codes, with speech therapy, nutrition, case management and audio-only evaluation codes.

Private insurance: coverage and payment parity

Section 4098a(b)(1) requires coverage "to the same extent" as in-person care. Subsection (b)(2)(A) requires "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." Rate parity does not apply to services under a plan's third-party telemedicine vendor contract or under a value-based contract. Cost-sharing may not exceed in-person amounts, and plans may limit coverage to in-network providers and to medically necessary, clinically appropriate services. Store-and-forward carries one cost-share. These mandates bind health insurers and state employee plans; they reach self-funded employer plans only "to the extent permitted under federal law" (8 V.S.A. § 4011), which generally leaves ERISA self-funded plans outside them. Section 4098b applies coverage and rate parity to audio-only care, with a value-based contract exception, and bars requiring an existing relationship. Both were recodified from §§ 4100k and 4100l effective September 1, 2025, and carry no sunset. See our reimbursement guide.

What to watch

First, OPR's telehealth rules: once effective, caps and fees start for OPR-regulated clinicians, interim registrants get at least 90 days to transition, and the draft excludes Vermont residents. Second, Act 133 of 2026 requires certain facilities and management services organizations to report private equity and hedge fund ownership, but exempts entities serving Vermont exclusively through telehealth. Third, H.848, on facility fees for outpatient and telehealth services, shows no committee action in the 2025–2026 session. See how state telemedicine laws work.