Massachusetts Medical Society: Telehealth and Virtual Care

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 starting 90 days after the close of the state of emergency, or September 13, 2021.

* MMS expects the promulgation of regulations by the Division of Insurance in the fall of 2021, which will provide detailed definitions of these and other terms used throughout chapter 260.

In the short term, the Medical Society is advocating to the legislature and the Division of Insurance to extend the glidepath for telehealth reimbursement parity for all other services (beyond behavioral health, primary care, and chronic disease management services) by an additional 90 days, for a total 180 days from the lifting of the state of emergency. 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. To learn more about out-of-state physicians’ ability to obtain temporary licensure in Massachusetts (accessible through September 15, 2021), please click here for the most up-to-date information from BORIM.

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 June 23, 2021) 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.

*The MMS has not reviewed this resource for accuracy, and due to the quickly-evolving nature of this issue, you should be mindful that the law may have changed since the last update to this resource.
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