THE ISSUE
The dramatic increase in telehealth utilization prompted by the COVID-19 pandemic has underscored the vital role virtual care delivery plays in providing continuity of and improved access to care for patients in the Commonwealth, as demonstrated in the
Health Policy Commission’s report on telehealth utilization.
In January 2021, the Massachusetts legislature passed Chapter 260 of the Acts of 2020, establishing a comprehensive framework for the coverage and reimbursement of health care services delivered via telemedicine for all state-regulated commercial plans
and public plans. Chapter 260 includes an expansive definition of telehealth, mandates coverage for all services that are covered in person and can appropriately be delivered via telehealth, and requires parity in reimbursement for behavioral health
services (delivered via both interactive audio-visual and audio-only technologies) in perpetuity; parity in reimbursement for primary care and chronic disease management services sunsets as of January 1, 2023. Carriers, including Blue Cross Blue Shield
of Massachusetts (BCBSMA), have opted to retain reimbursement parity indefinitely, while others have reverted to regressive, prepandemic-era telehealth payment policies. BCBSMA’s policy is consistent with recommendations contained in the Health Policy
Commission report to extend payment parity for primary care and chronic disease management services for at least two years and to reduce administrative complexities by standardizing telehealth billing policies.
OUR STANCE
Telemedicine has become an essential part of the core health care infrastructure in the Commonwealth. The Medical Society supports and continues to advocate for policies that promote the sustainability of access to virtual care for patients. Reimbursement
parity for services is foundational to the sustainability of providers’ ability to offer care via telehealth and to continue to invest in technology and innovate in the digital health space. Long-term, stable reimbursement policies across payors and
predictability for physicians and patients are essential, as a patchwork of varying payment policies across carriers leads to confusion and instability for physicians and decreased access to care for patients.
Additionally, the MMS continues to advocate for expanding telehealth policies to bridge the digital divide and promote equitable access to care via telehealth for all patients, including building upon the legislature’s funding initiatives to expand mobile
and broadband infrastructure and incorporating policies that support inclusivity, such as the integration of language translation services.
To learn more about MMS telehealth policies, click here.
OUR ADVOCACY
The Medical Society played a key role in advocating for the passage of telehealth coverage and payment policies as part of Chapter 260 of the Acts of 2020. In the spring of 2021, the Division of Insurance, jointly with MassHealth, held a five-part listening
session series seeking stakeholder input on issues to be addressed in regulation. The physician community provided a unified, leading voice with a clear foundational message: telehealth is an evolving modality for care delivery that should be treated
and compensated on par with in-person services. The MMS advocated for physician autonomy, payment parity, and patient access, with the physician voice playing a prominent role in shaping how the state will ultimately implement the recently enacted
telehealth law. Notably, the MMS advocated for:
- consistent policies across payors and flexibility in the use of telehealth technologies.
- limiting unnecessary regulation of telemedicine visits and expansive, inclusive definitions of behavioral health, primary care, and chronic disease management services.
- reimbursement frameworks that promote the sustainability of care via telehealth; and use of the full panoply of existing CPT, office-based E/M, and other codes used for health care services with a modifier to indicate delivery through telehealth.
- primacy of clinical decisions related to the appropriateness of telemedicine to deliver services, alongside critical safeguards to ensure that we do not create new barriers to accessing care through telemedicine through unfettered, unnecessary, or
burdensome utilization review and prior authorization requirements.
The MMS further submitted detailed comments to the Division in May 2022, when draft regulations were released. Final regulations were released in November 2023 (See 42 CMR 52.00, Managed Care Consumer Protections and Accreditation of Carriers). The MMS is reviewing the final regulations and will engage in continued advocacy efforts as opportunities arise to ensure
smooth implementation. To learn more about virtual care and public and private insurance policies, please visit our Telehealth and Virtual Care Practice Support page.
The MMS continues to work actively with key stakeholders, including playing a leading role in the statewide tMED Coalition, the Massachusetts Telemedicine Coalition, led by MHA with more than 35 health care provider organizations, consumer advocates,
and technology organizations. In the 2023–24 state legislative session, the MMS is supporting An Act relative to telehealth and digital equity for patients (H.986/S.655),
which builds upon the framework laid out in Chapter 260 to promote equitable access to care through telehealth for all patients.
