Massachusetts

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

Massachusetts Medicaid (MassHealth) allows for the use of telehealth in Medicaid behavioral health services. Additionally, a 2014 budget bill that allocated funds for the reimbursement of remote patient monitoring mentioned telehealth. CCHP has found no further details regarding this.
It should be noted that Massachusetts is a managed care state and that some individual Medicaid managed care plans may reimburse for telehealth delivered services.

 

Definitions

Behavioral Health Services
Telehealth is the use of electronic communication and information technologies to provide or support clinical care at a distance. The delivery of services through telehealth involves the use of secure interactive audio and video telecommunications systems that permit two-way, real-time communication between a patient and a provider.

 

Source: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Apr. 2019).

Live Video

Policy

Behavioral Health Services
Telehealth is a modality of treatment, not a separate covered service. Providers are not required to deliver services via telehealth.

 

Source: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Apr. 2019).
Eligible Services / Specialties

Behavioral Health Services
The following sites may deliver behavioral health services via telehealth:
• All services specified in 101 CMR 306.00 et seq.;
• Opioid Treatment Counseling Services;
• Ambulatory Services: Outpatient Counseling;
• Clinical Case Management Ambulatory Services; and
• Outpatient Services for Pregnant/Postpartum Clients.

Source: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Apr. 2019).
Eligible Providers

Behavioral Health Services
The following sites and providers may deliver behavioral health services via telehealth:
• Community Health Centers
• Community Mental Health Centers
• Outpatient Substance Use Disorder Providers
• Psychologists
• Psychiatrists
• Psychoanalysts
• Clinical Social Workers
• Behavioral Health Nurses
• Nurse Practitioners
• Professional Counselors
• Any other qualified MassHealth provider

Source: MassHealth All Provider Bulletin 281, p. 1-2, Jan. 2019. (Accessed Apr. 2019).
Geographic Limits

Behavioral Health Services
There are no geographic or facility restrictions on distant or originating sites.

 

Source: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Apr. 2019).

Remote Patient Monitoring

Policy

In the FY 2014 State Budget, MA appropriates funds for the reimbursement of telehealth remote patient monitoring provided by home health agencies as a service to clients reimbursable through Medicaid, as long as it is for short term reimbursement.

 

Source: MMA EOHHS and MassHealth. 4000-300 (2014). (Accessed Apr. 2019).
Miscellaneous

Behavioral Health Services
A provider may prescribe Schedule II controlled substances via telehealth only after conducting an initial in-person examination of the patient. Ongoing in-person examinations are required every three months for the duration of the prescription.
Providers must follow consent and patient information protocol consistent with those followed during in-person visits.
Telehealth services may only be provided by behavioral health professionals who have been trained in the provision of services via telehealth.

 

Source: MassHealth All Provider Bulletin 281, p. 2-3, Jan. 2019. (Accessed Apr. 2019).

Private Payer Laws

Definitions

Telemedicine as it pertains to the delivery of health care services, shall mean the use of interactive audio, video or other electronic media for the purpose of diagnosis, consultation or treatment. ‘Telemedicine’ shall not include the use of audio-only telephone, facsimile machine or e-mail.

Source: Annotated Laws of MA. Part I, Titile XXII, Ch. 175, Sec. 47BB. (Accessed Apr. 2019).
Requirements

Private payers may provide coverage of telemedicine services and must be consistent with coverage for health care services provided through in-person consultations. However, coverage of telemedicine services may be limited to providers in a telemedicine network approved by the insurer.
Contracts may also require a deductible, copayment, or coinsurance for telemedicine services that does not exceed the deductible, copayment, or coinsurance which is applicable to an in-person consultation.

 

Source: Annotated Laws of MA. Part I, Titile XXII, Ch. 175, Sec. 47BB. (Accessed Apr. 2019).

Parity

Payment Parity

No explicit payment parity. Coverage shall be consistent with coverage for health care services provided through in-person consultation.

 

Source: Annotated Laws of MA. Part I, Titile XXII, Ch. 175, Sec. 47BB. (Accessed Apr. 2019).
Service Parity

No explicit payment parity. Coverage shall be consistent with coverage for health care services provided through in-person consultation.

 

Source: Annotated Laws of MA. Part I, Titile XXII, Ch. 175, Sec. 47BB. (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Online Prescribing

Prior to any e-prescribing, there must be a physician-patient relationship that conforms to certain minimum norms and standards of care, which includes taking a medical history, conducting an appropriate exam, and recording the results.

 

Source: “Internet Prescribing,” MA Board of Registration in Medicine. Dec. 17, 2003 & Prescribing Practices Policy and Guidelines. Policy 15-05, pg. iii (Sec. 4), Adopted Oct. 8, 2015. (Accessed Apr. 2019).

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