Telehealth and Virtual Care

Telehealth: Coverage & Reimbursement

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. The COVID-19 State of Emergency was lifted on June 15th, 2021, triggering the sunset of certain requirements for telehealth reimbursement parity.

While all services that can be appropriately delivered via telehealth will continue to be covered permanently, requirements for parity in reimbursement are scheduled to sunset at various times, depending on the type of care. Specifically:

• Behavioral health services, including those delivered through interactive audio-visual and audio-only technologies, will continue to be reimbursed on par with in-person services in perpetuity.
• Primary care and chronic disease management services* will be reimbursed at parity for 2 years from the effective date of C.260, through the calendar year 2022.
• The requirement to reimburse all other services delivered via telehealth at parity will no longer be statutorily mandated as of September 13, 2021.

* MMS expects the promulgation of regulations by the Division of Insurance, which will provide detailed definitions of these and other terms used throughout chapter 260.

In the interim, the DOI has issued guidance via Bulletin 2021-10 outlining requirements that carriers amending their telehealth reimbursement policies submit an implementation plan for review by the DOI. Massachusetts law requires carriers to give physicians and patients 60 days-notice of material changes in telehealth reimbursement. Once implementation plans are submitted to the Division and proper notice is effectuated, plans may implement changes consistent with Chapter 260 subject to updating consistent with regulations when finalized by the Division. Separately, MassHealth issued All Provider Bulletin 327, announcing updated telehealth policies which took effect October 16th, 2021. MassHealth continues to provide robust, comprehensive coverage for all medically necessary health care services that the provider has determined is clinically appropriate to deliver and that meet additional program requirements. This covers delivery through any telehealth modality, including telephone and asynchronous services. MassHealth will continue to reimburse for all telehealth services on par with in-person services for eligible services through December 31, 2022, after which MassHealth may evaluate and choose to amend these policies.

To learn more about this and MMS’ telehealth-related advocacy, please click here. For practice support for telehealth services and virtual care, please click here for more resources.

Practicing Telehealth Across State Lines

The prevailing state regulatory approach maintains that the location of the patient dictates the state laws that govern the practice of medicine. In other words, a physician must be compliant with all laws, including physician licensure laws, of the state in which the patient is located when they receive care.

With the close of the state of emergency in the Commonwealth, many of the emergency licensure provisions have expired. On January 27th, the Massachusetts Department of Public Health, pursuant to the current Public Health Emergency (PHE) declared on May 28, 2021, issued PHE Order No. 2022-09 authorizing physicians licensed in good standing in another state to apply for an Emergency Temporary License in Massachusetts that shall remain valid through June 30, 2022. Physicians may apply for an Emergency Temporary Licenses pursuant to Public Health Emergency Order 2022-09 until June 30, 2022. Emergency Temporary Licenses issued will be valid until December 31, 2022 unless extended or rescinded by the Commissioner prior to that date, or the public health emergency is terminated by the Governor, whichever shall happen first. Per the Board of Registration in Medicine (BORIM), “To qualify for an Emergency Temporary License, a physician must hold an active, full, unlimited and unrestricted license in good standing in another U.S. state/territory/district and provide services in Massachusetts within a facility licensed or operated by the Department or another state agency, or in another location if approved by the Commissioner.” For more information, please see BORIM Policy 2020-05, amended June 16, 2022, to be extended through December 31, 2022. An application for an Emergency Temporary License is available here.

Additionally, on January 14, 2022, the Commissioner of Public Health issued PHE Order No. 2022-04, providing that all graduates of International Medical Schools who have satisfactorily completed at least two years of postgraduate medical training in a program approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association or in an accredited Canadian program shall be eligible for licensure. The Order also directs the Board of Registration in Medicine to review and approve such applications by expedited process and shall remain in effect until rescinded by the Commissioner or the public health emergency is terminated by the Governor, whichever shall happen first.

Please click here for the most up-to-date information from BORIM on physician licensure and the practice of medicine.

For Massachusetts physicians looking to continue to provide care via telehealth for your patients who may be out-of-state, you should look to the current regulations for the state in which your patient is located. The Federation of State Medical Boards has put together a resource* (last updated January 19, 2022) with information about the extent to which each state has modified licensure requirements for telehealth in response to COVID-19.

Should you have any questions or concerns, please reach out to Leda Anderson, Legislative Counsel, at landerson@mms.org or Bissan Biary, Senior Practice Solutions Specialist, at bbiary@mms.org.