Massachusetts

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes* (CMS RPM Codes)
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: None
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: No
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: MassHealth
  2. Administrator: Massachusetts Dept. of Health and Human Services
  3. Regional Telehealth Resource Center: Northeast Regional Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 11/17/2022

Audio Only Delivery

Medicaid: Access to Health Services Through Telehealth

STATUS: Permanent

Medicaid: Updated MassHealth Telehealth Policy

STATUS: Bulletins 314 and are now expired 324. See Medicaid section for bulletin 327 as amended by Bulletin 355

Medicaid: Coverage and Reimbursement Policy Updates for Services Related to COVID-19 After the Termination of the State of Emergency

STATUS: Active, through the end of the federal PHE

Medicaid: MassHealth Coverage and Reimbursement Update

STATUS: Active, describes flexibilities that will remain after end of MA State of Emergency.

Medicaid: Managed Care Requirements during COVID-19

STATUS: Bulletin requires policies maintained in line with 327 which was amended by Bulletin 355. Some flexibilities now scheduled to expire September 30, 2023.

Medicaid: Guidance for Home and Community-Based Services (HCBS) Waiver Providers Delivering Telehealth/Remote Services During the COVID-19 Public Health Emergency

STATUS: Active, until six months after the end of the federal PHE (extension consistent with Appendix K)

Medicaid: COVID-19 FAQs for Behavioral Health Providers

STATUS: Active

Medicaid: FAQs for Children’s Behavioral Health Initiative

STATUS: Active

Medicaid: FAQs for Applied Behavioral Analysis

STATUS: Active

Medicaid 1915(c) Waiver: Traumatic Brain Injury, Community Living, Residential Supports, Acquired Brain Injury with Residential Habilitation, Community Living, Intensive Supports, Adult Supports Waiver

STATUS: Expired February 28, 2021; extended through Addendum

Medicaid 1915(c) Waiver: Appendix K – Frail Elder Waiver; Traumatic Brain Injury Waiver; Community Living; Residential Supports; Acquired Brain Injury with Residential Habilitation; Acquired Brain Injury Non-residential Habilitation; Community Living Waiver; Intensive Supports; Adult Supports Waiver; Children’s Autism Spectrum Disorder

STATUS: Expired February 28, 2021; extended through Addendum

Medicaid: Frail Elder Waiver (FEW), Traumatic Brain Injury (TBI) Waiver, Community Living (MFP-CL) Waiver, Residential Supports (MFP-RS) Waiver, Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver Acquired Brain, Injury Non-residential Habilitation (ABI-N) Waiver Community Living Waiver (DDS-CL), Intensive Supports Waiver (DDS-IS), Adult Supports Waiver (DDS-AS), Children’s Autism Spectrum Disorder Waiver

STATUS: Active, until six months after the expirations of the COVID-19 PHE

Executive Office of Health and Human Services: Administrative bulletin 21-15 Health Safety Net Service and Reimbursement Policy Flexibilities Related to the 2019 Novel Coronavirus Disease 2019 (COVID-19)

STATUS: Active, expires 90 days after the Massachusetts Public Health Emergency ends

Last updated 11/18/2022

Cross State Licensing

Board of Registration in Medicine: Emergency Temporary License Application for Out-of-State Physicians

STATUS: Active until Dec. 31, 2022

Last updated 11/18/2022

Easing Prescribing Requirements

Medicaid: Access to Health Services Through Telehealth

STATUS: Permanent

Medicaid: Updated MassHealth Telehealth Policy

STATUS: Bulletins 314 and are now expired 324. See Medicaid section for bulletin 327 as amended by Bulletin 355

Medicaid: MassHealth Coverage and Reimbursement Policy

STATUS: Active, until federal public health emergency ends.

Medicaid: COVID-19 FAQs for Behavioral Health Providers

STATUS: Active

Emergency Rule: COVID-19 payment rates for certain community health care providers

STATUS: Active

Last updated 11/18/2022

Private Payer

Department of Insurance: Managed Care Practices and Continued Access to Telehealth Services

STATUS: Active

Department of Insurance: Continued Access to Telehealth Services

STATUS: Active

MA Legislature: Acts of 2020 Chapter 260

STATUS: Permanent

Office of the Governor: Order Expanding Telehealth

STATUS: Rescinded by Executive Order 61

Last updated 11/18/2022

Provider Type

Medicaid: Access to Health Services Through Telehealth

STATUS: Permanent

Medicaid: Updated MassHealth Telehealth Policy

STATUS: Bulletins 314 and are now expired 324. See Medicaid section for bulletin 327 as amended by Bulletin 355

Medicaid: Behavioral Health and the Importance of Perinatal and Pediatric Behavioral Health Screening during the Pandemic

STATUS: Active

Medicaid: Extended COVID-19 Related Administrative Flexibilities for Independent Nurses Including Telehealth and New Telehealth Documentation Requirement

Status Active, through end of the Federal Public Health Emergency

Medicaid: COVID-19 FAQs for Behavioral Health Providers

STATUS: Active

Medicaid: FAQs for Children’s Behavioral Health Initiative

STATUS: Active

Medicaid: FAQs for Applied Behavioral Analysis

STATUS: Active

Medicaid: Guidance for Home and Community-Based Services (HCBS) Waiver Providers Delivering Telehealth/Remote Services During the COVID-19 Public Health Emergency

STATUS: Active, until six months after the end of the federal Public Health Emergency

Medicaid 1915(c) Waiver: Appendix K – Frail Elder Waiver; Traumatic Brain Injury Waiver; Community Living; Residential Supports; Acquired Brain Injury with Residential Habilitation; Acquired Brain Injury Non-residential Habilitation; Community Living Waiver; Intensive Supports; Adult Supports Waiver; Children’s Autism Spectrum Disorder

STATUS: Expired February 28, 2021; extended through Addendum

Medicaid: Frail Elder Waiver (FEW), Traumatic Brain Injury (TBI) Waiver, Community Living (MFP-CL) Waiver, Residential Supports (MFP-RS) Waiver, Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver Acquired Brain, Injury Non-residential Habilitation (ABI-N) Waiver Community Living Waiver (DDS-CL), Intensive Supports Waiver (DDS-IS), Adult Supports Waiver (DDS-AS), Children’s Autism Spectrum Disorder Waiver

STATUS: Active, until six months after the expirations of the COVID-19 PHE

Medicaid: Community Living (MFP-CL) Waiver, Residential Supports (MFP-RS) Waiver, Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver, Acquired Brain Injury Non-residential Habilitation (ABI-N) Waiver

STATUS: Active, until six months after the expirations of the COVID-19 PHE

Last updated 11/18/2022

Service Expansion

Medicaid: Access to Health Services Through Telehealth

STATUS: Permanent

Medicaid: Updated MassHealth Telehealth Policy

STATUS: Bulletins 314 and are now expired 324. See Medicaid section for bulletin 327 as amended by Bulletin 355

Medicaid: MassHealth Coverage and Reimbursement Update

STATUS: Active, until end of the Public Health Emergency

Medicaid: Managed Care Requirements during COVID-19

STATUS: Bulletin requires policies maintained in line with 327 which was amended by Bulletin 355. Some flexibilities now scheduled to expire September 30, 2023.

Medicaid: Comprehensive Needs Assessment Conducted Through Telehealth for Community Case Management Members

STATUS: Active

Medicaid: Behavioral Health and the Importance of Perinatal and Pediatric Behavioral Health Screening during the Pandemic

STATUS: Active

Medicaid: Continuous Skilled Nursing (CSN) Services via Telehealth

STATUS: Active, until the end of the Federal Public Health Emergency

Medicaid: Telehealth Policy for Home Health Services

STATUS: Active, until the end of the Federal Public Health Emergency

Medicaid: Guidance for Home and Community-Based Services (HCBS) Waiver Providers Delivering Telehealth/Remote Services During the COVID-19 Public Health Emergency

STATUS: Active, until February 28, 2021 (extension consistent with Appendix K)

Medicaid 1915(c) Waiver: Appendix K – Frail Elder Waiver; Traumatic Brain Injury Waiver; Community Living; Residential Supports; Acquired Brain Injury with Residential Habilitation; Acquired Brain Injury Non-residential Habilitation; Community Living Waiver; Intensive Supports; Adult Supports Waiver; Children’s Autism Spectrum Disorder

STATUS: Expired February 28, 2021; extended though Addendum

Medicaid: Frail Elder Waiver (FEW), Traumatic Brain Injury (TBI) Waiver, Community Living (MFP-CL) Waiver, Residential Supports (MFP-RS) Waiver, Acquired Brain Injury with Residential Habilitation (ABI-RH) Waiver Acquired Brain, Injury Non-residential Habilitation (ABI-N) Waiver Community Living Waiver (DDS-CL), Intensive Supports Waiver (DDS-IS), Adult Supports Waiver (DDS-AS), Children’s Autism Spectrum Disorder Waiver

STATUS: Active, until six months after the expirations of the COVID-19 PHE

Emergency Rule: COVID-19 payment rates for certain community health care providers

STATUS: Active

Medicaid: FAQs for Children’s Behavioral Health Initiative

STATUS: May have been replaced by Children’s Behavioral Health Initiative section in Bulletin 327 as amended by Bulletin 355

Last updated 11/18/2022

Definitions

“Telehealth”, the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Nov. 2022). 

Section repeated in Civil Service, Retirement and Pensions section applying to active or retired employees of the commonwealth; Non-profit hospital service corporations; medical service corporation; health maintenance organizations; preferred provider arrangement

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Nov. 2022).

Last updated 11/18/2022

Parity

SERVICE PARITY

An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth shall provide coverage for health care services delivered via telehealth by a contracted health care provider if:

  • the health care services are covered by way of in-person consultation or delivery; and
  • the health care services may be appropriately provided through the use of telehealth

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Nov. 2022). 

Section repeated in Civil Service, Retirement and Pensions section applying to active or retired employees of the commonwealth; Non-profit hospital service corporations; medical service corporation; health maintenance organizations; preferred provider arrangement

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Nov. 2022).


PAYMENT PARITY

Coverage that reimburses a provider with a global payment, as defined in section 1 of chapter 6D, shall account for the provision of telehealth services to set the global payment amount.

Insurance companies organized under this chapter shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health service delivered via in-person methods; provided, that this subsection shall apply to providers of behavioral health services covered (see bill language for types of providers).

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Nov. 2022). 

Section repeated in Civil Service, Retirement and Pensions section applying to active or retired employees of the commonwealth; Non-profit hospital service corporations; medical service corporation; health maintenance organizations; preferred provider arrangement

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Nov. 2022).

Last updated 11/18/2022

Requirements

An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth  shall provide coverage for health care services delivered via telehealth by a contracted health care provider if:

  • the health care services are covered by way of in-person consultation or delivery; and
  • the health care services may be appropriately provided through the use of telehealth

An insurer shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered to have an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request. Coverage shall not be limited to services delivered by third-party providers.

A contract that provides coverage for services under this section may contain a provision for a deductible, copayment or coinsurance requirement for a health care service provided via telehealth as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation or in-person delivery of service.

Health care services provided via telehealth shall conform to the standards of care applicable to the telehealth provider’s profession and specialty. Such services shall also conform to applicable federal and state health information privacy and security standards as well as standards for informed consent.

Evidence of coverage provided to a household upon enrollment must include a summary description of the insured’s telehealth coverage and access to telehealth services, including, but not limited to behavioral health services, chronic disease management and primary care services via telehealth, as well as the telecommunications technology available to access telehealth services.

The executive office of health and human services and the division of insurance shall report on the use of telehealth services in the commonwealth and the effect of telehealth on health care access and system cost.

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM,  Ch. 176O, Sec. 6 & Ch. 260, Sec. 67  (Accessed Nov. 2022).

Section repeated in Civil Service, Retirement and Pensions section applying to active or retired employees of the commonwealth; Non-profit hospital service corporations; medical service corporation; health maintenance organizations; preferred provider arrangement

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Nov. 2022).

Last updated 11/18/2022

Definitions

“Telehealth”, the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

SOURCE: Massachusetts General Laws Part I, Title IV, Ch. 32A. Sec. 30 . (Accessed Nov. 2022). 

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 Nov. 2022).

Last updated 11/18/2022

Email, Phone & Fax

“Telehealth”, the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

The rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same service delivered by other telehealth modalities.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).

MassHealth reimburses the V3 modifier which is used when providers are rendering services via audio-only telehealth.

MassHealth Guidance Regarding Telephone and Internet Connectivity

MassHealth guidance available at www.mass.gov/doc/masshealth-provider-resource-telephone- and-internet-connectivity-for-telehealth aims to help providers guide members who want to receive services via telehealth, but have concerns about limited phone and internet access. This resource includes information about the federal Lifeline program, which provides free or low-cost phone service to low-income households, and information on the Affordable Connectivity Program (ACP), which is a federal benefit program that helps ensure that households can afford broadband internet.

SOURCE:  MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Telehealth and Children’s Behavioral Health Initiative (CBHI) Services

As under All Provider Bulletin 327 (corrected), existing performance specifications for Children’s Behavioral Health Initiative (CBHI) services allow for the telephonic delivery of services, other than for initial assessments. Notwithstanding any requirements that initial assessments be conducted in person, where appropriate, services for new clients may be initiated via telephonic means or other telehealth modality. CBHI providers must use the regular CBHI codes, as well as the POS code and modifiers described above, as appropriate, when billing for CBHI services delivered via approved telehealth modalities.

Consistent with All Provider Bulletin 327 (corrected) and its predecessor bulletins, through September 30, 2023, MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart. Likewise, through September 30, 2023, an eligible distant-site provider delivering covered services via telehealth in accordance with this bulletin may bill MassHealth a facility fee if such a fee is permitted under the provider’s governing regulations or contracts. MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through September 30, 2023, and may change those policies after that date.

Providers must include the place of service (POS) code 02 when submitting a professional claim for telehealth provided in a setting other than in the patient’s home, and POS code 10 when submitting a professional claim for telehealth provided in the patient’s home. Additionally, for any such professional claim, providers must include:

  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

  • modifier 93 to indicate services rendered via audio-only telehealth;
  • modifier FQ to indicate counseling and therapy services provided using audio-only telecommunications;

MassHealth will implement modifiers 95, 93, GQ, GT, FQ, and FR through an informational edit period. Thus, effective for dates of service (DOS) between April 16, 2022, and March 30, 2023, MassHealth will not deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers. Effective for DOS on or after April 1, 2023, MassHealth will discontinue this informational edit, and will deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers.

*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE:  MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Psychiatric Services- After-Hours Telephone Service

The physician or psychiatric clinical nurse specialist (PCNS) must provide telephone coverage during the hours when the physician or PCNS is unavailable, for members who are in a crisis state.

SOURCE: MassHealth Provider Manual Series Physician Manual, Transmittal Letter PHY-154, pg. 4-22, (Accessed Nov. 2022).

Substance Use Disorder Treatment Code Revisions

Effective for dates of service beginning March 12, 2020, in accordance with All Provider Bulletins 289 and 291, this letter transmits revisions to behavioral health service codes in Subchapter 6 of the Substance Use Disorder Treatment Manual, allowing substance use disorder (SUD) treatment providers to bill for the following telephonic codes: (98966, 98967, 98968, 99441, 99442, 99443).

Please refer to All Provider Bulletins 289 and 291 for additional information and limitations on the uses of these codes.

SOURCE: Mass Health Substance Use Disorder Treatment Manual, Service Codes and Descriptions, Transmittal Letter SUD-22, page 6-9MassHealth Transmittal Letter SUD-22, Jun. 2022, (Accessed Nov. 2022).

Last updated 11/18/2022

Live Video

POLICY

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth.

The rate of payment for telehealth services provided via interactive audio-video technology and audio-only telephone may be greater than the rate of payment for the same service delivered by other telehealth modalities.

Coverage that reimburses a provider with a global payment shall account for the provision of telehealth services to set the global payment amount.  See services section below for behavioral health services specific requirements for payment.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).

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

The bulletin does not apply to services under the Children’s Behavioral Health Initiative (CBHI) program, which may continue to be delivered via all modalities currently authorized in applicable program specifications.

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Nov. 2022).

Access to Health Services through Telehealth Options

Through All Provider Bulletin 327 (corrected), MassHealth established rules for reimbursement of services rendered via telehealth. This bulletin amends and restates All Provider Bulletin 327 (corrected) to introduce the following changes: a new modifier for services delivered via audio-only telehealth; a new place of service (POS) code for delivery of telehealth services provided in a patient’s home; a clarification of requirements for telehealth encounters and documentation requirements; the extension of payment parity between services delivered via telehealth and their in-person counterparts through September 30, 2023; and the extension of the informational edit period for modifiers used on professional claims for services rendered via telehealth through March 30, 2023.

Pursuant to this policy, MassHealth will continue to allow MassHealth-enrolled providers to deliver a broad range of MassHealth-covered services via telehealth and, through September 30, 2023, will reimburse for such services at parity with their in-person counterparts. All providers delivering services via telehealth must comply with the policy detailed in this bulletin. This bulletin is effective until MassHealth issues superseding guidance. In addition, MassHealth may issue program-specific guidance with additional requirements and/or limitations that apply to the provision of services via telehealth by providers participating within those programs.

*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Health Care Services

The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization, accountable care organization or primary care clinician plan shall provide coverage for health care services delivered via telehealth by a contracted health care provider if: (i) the health care services are covered by way of in-person consultation or delivery; and (ii) the health care services may be appropriately provided through the use of telehealth.

SOURCE:  Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).

Behavioral Health Services

The division shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health services delivered via in-person methods; provided, that this subsection apply to providers of behavioral health services covered as required (see text for applicable behavioral health providers).

SOURCE:Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).

The division of medical assistance shall ensure that rates of payment for in-network providers for telehealth services provided in pursuant to MA law (see text) are not less than the rate of payment for the same service delivered via in-person methods.

Source: Massachusetts General Laws, Ch. 32A Sec. 30, Ch. 118E Sec. 79, Ch. 175 47MM, Ch. 176A Sec. 38, Ch. 176B Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Nov. 2022).

Community Health Centers, Community Mental Health Centers, and Outpatient Substance Use Disorder providers (provider types 20, 26 and 28) may deliver the following covered services via telehealth:

  • All services specified in 101 CMR 306.00 et seq.; and
  • The outpatient services specified in the following categories:
  • Opioid Treatment Services: Counseling;
  • Ambulatory Services: Outpatient Counseling; Clinical Case Management; and
  • Services for Pregnant/Postpartum Clients: Outpatient Services

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Nov. 2022). 

MassHealth lists specific codes that may be used by community health centers for services delivered through telehealth. See Transmittal Letter for details.

SOURCE: MassHealth Transmittal Letter CHC-118 Community Health Center Manual (Addition of Codes) &  MassHealth Transmittal Letter CHC-119, p. 6-12 & 6-13, Jan. 1, 2022. (Accessed Aug. 2022).

Section B of this bulletin identifies specific categories of service that MassHealth has deemed inappropriate for delivery via any telehealth modality. Except for those services identified in Section B in this bulletin, and notwithstanding any regulation to the contrary, including the physical presence requirement at 130 CMR 433.403(A)(2), any MassHealth-enrolled provider may deliver any medically necessary MassHealth-covered service to a MassHealth member via any telehealth modality, if:

  • the provider has determined that it is clinically appropriate to deliver such service via telehealth, including the telehealth modality and technology employed, including obtaining member consent;
  • such service is payable under that provider type;
  • the provider satisfies all requirements set forth in this bulletin, including Appendix A to this bulletin, and any applicable program-specific bulletin;
  • the provider delivers those services in accordance with all applicable laws and regulations(including M.G.L. c. 118E, § 79 and MassHealth program regulations); and
  • the provider is appropriately licensed or credentialed to deliver those services.

MassHealth will continue to monitor telehealth’s impacts on quality of care, cost of care, patient and provider experience, and health equity to inform the continued development of its telehealth policy. Based on the results of this monitoring, and its analysis of relevant data and information, MassHealth may adjust this coverage policy, including by imposing limitations on the use of certain telehealth modalities for various covered services.

MassHealth has deemed these following categories of service ineligible for delivery via any telehealth modality:

  • Ambulance Services
  • Ambulatory Surgery Services
  • Anesthesia Services
  • Certified Registered Nurse Anesthetist Services
  • Chiropractic Services
  • Hearing Aid Services
  • Inpatient Hospital Services
  • Laboratory Services
  • Nursing Facility Services
  • Orthotic Services
  • Personal Care Services
  • Prosthetic Services
  • Renal Dialysis Clinic Services
  • Surgery Services
  • Transportation Services
  • X-Ray/Radiology Services

As described above, except for these categories of services, any provider may deliver any MassHealth-covered service via any telehealth modality in accordance with the standards set forth in this bulletin, provided that such services are payable under that provider type.

*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).


ELIGIBLE PROVIDERS

Coverage shall not be limited to services delivered by third-party providers.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).

Consistent with All Provider Bulletin 327 (corrected) and its predecessor bulletins, through September 30, 2023, MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart. Likewise, through September 30, 2023, an eligible distant-site provider delivering covered services via telehealth in accordance with this bulletin may bill MassHealth a facility fee if such a fee is permitted under the provider’s governing regulations or contracts. MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through September 30, 2023, and may change those policies after that date.

Providers must include the place of service (POS) code 02 when submitting a professional claim for telehealth provided in a setting other than in the patient’s home, and POS code 10 when submitting a professional claim for telehealth provided in the patient’s home. Additionally, for any such professional claim, providers must include:

  • modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
  • modifier FR to indicate a supervising practitioner was present through a real-time two- way, audio and video communication technology

Additionally, for any institutional claim, providers are allowed to use the following modifiers:

  •  modifier 95 to indicate counseling and therapy services rendered via audio-video telecommunications;
  • modifier GT to indicate services rendered via interactive audio and video telecommunications systems
  • modifier FR to indicate that a supervising practitioner was present through a real-time two-way, audio and video communication technology; and/or

MassHealth will implement modifiers 95, 93, GQ, GT, FQ, and FR through an informational edit period. Thus, effective for dates of service (DOS) between April 16, 2022, and March 30, 2023, MassHealth will not deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers. Effective for DOS on or after April 1, 2023, MassHealth will discontinue this informational edit, and will deny claims containing POS code 02 or POS code 10 that are missing one of these modifiers.

*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Synchronous teledentistry is covered.


ELIGIBLE SITES

A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth; provided, however, that a patient may decline receiving services via telehealth in order to receive in-person services.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).


GEOGRAPHIC LIMITS

A health care provider shall not be required to document a barrier to an in-person visit nor shall the type of setting where telehealth services are provided be limited for health care services provided via telehealth.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).


FACILITY/TRANSMISSION FEE

Consistent with All Provider Bulletin 327 (corrected) and its predecessor bulletins, through September 30, 2023, MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart. Likewise, through September 30, 2023, an eligible distant-site provider delivering covered services via telehealth in accordance with this bulletin may bill MassHealth a facility fee if such a fee is permitted under the provider’s governing regulations or contracts. MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through September 30, 2023, and may change those policies after that date.

*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Last updated 11/18/2022

Miscellaneous

See bulletin for specific requirements around prescribing, telehealth encounters, documentation and recordkeeping.

Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE:MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Medicaid contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract to a Medicaid managed care organization or primary care clinician shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).

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.

SOURCE: MassHealth All Provider Bulletin 281, p. 2, Jan. 2019. (Accessed Nov. 2022).

Recently Passed Legislation

The department of public health shall utilize money in the fund to:

  • Provide a grant to each health center to pay for the cost of direct and indirect medication abortion readiness; provided, however, that, the department shall prioritize applications from the University of Massachusetts and state university segments and create a simple application process for community colleges to apply for funding; and provided further, that allowable expenses under these grants shall include, but not be limited to:
    • costs associated with enabling the health center to deliver telehealth services

SOURCE: MA Acts (2022) Chapter 127. (Accessed Nov. 2022).

Last updated 11/18/2022

Out of State Providers

No Reference Found

Last updated 11/18/2022

Overview

Massachusetts passed major revisions to the state’s Medicaid telehealth policy that took effect in January 2021 and established coverage for health care services, and parity for behavioral health services.  MassHealth recently issued a bulletin largely aligning the state’s telehealth policy with the COVID era policies with certain exceptions through Dec. 31, 2022.  The update provides for reimbursement of live video with certain limitations, and modifiers for billing asynchronous and audio-only services.  It is indicated that RPM will be addressed in an upcoming bulletin.

 

 

Last updated 11/18/2022

Remote Patient Monitoring

POLICY

MassHealth anticipates introducing coverage for remote patient monitoring for chronic disease management and e-consult services in the near future. Subject to the availability of federal financial participation, MassHealth plans to publish transmittal letters that will include applicable service limitations and add appropriate codes to the relevant provider manuals.

*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).


CONDITIONS

MassHealth anticipates introducing coverage for remote patient monitoring for chronic disease management and e-consult services in the future.

*Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Medicine Coding Updates

Remote therapeutic monitoring

98975- Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of  equipment

98976- Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days

98977- Remote therapeutic monitoring (eg, respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days

98980- Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least one interactive communication with the patient or caregiver during the calendar month; each additional 20 minutes (List separately in addition to code for primary procedure)

SOURCE: The Commonwealth of Massachusetts Executive Office of Health and Human Services Administrative Bulletin 22-09, (Jan. 2022), (Accessed Nov. 2022).


PROVIDER LIMITATIONS

No reference found.


OTHER RESTRICTIONS

No Reference Found

Last updated 11/18/2022

Store and Forward

POLICY

MassHealth reimburses the GQ modifier which is used when providers are rendering services via asynchronous telehealth.

Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Asynchronous teledentistry is covered.

SOURCE: MA 101 CMR 314. 05. (Accessed Nov. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 11/18/2022

Cross State Licensing

“The Board deems a physician to be practicing medicine in Massachusetts when the patient is physically located in Massachusetts. A physician licensed by the Board whose license does not restrict practice to a particular location may engage in the practice of medicine with respect to patients in Massachusetts irrespective of whether the physician is physically located in Massachusetts. A physician licensed by the board whose license does restrict practice to a particular location may engage in the practice of medicine with respect to patients in Massachusetts only from the location identified on his or her license.”

SOURCE: Commonwealth of Massachusetts Board of Registration in Medicine, (Oct. 6, 2022). (Accessed Nov. 2022).

Last updated 11/18/2022

Definitions

“Telehealth” shall mean the use of synchronous or asynchronous audio, video, electronic media or other telecommunications technology, including, but not limited to: (i) interactive audio-video technology; (ii) remote patient monitoring devices; (iii) audio-only telephone; and (iv) online adaptive interviews, for the purpose of evaluating, diagnosing, consulting, prescribing, treating or monitoring of a patient’s physical health, oral health, mental health or substance use disorder condition.

SOURCE: MA General Laws, Part 1, Title XVI, Ch. 112, Sec. 5O . (Accessed Nov. 2022).

Telemedicine means the provision of services to a patient by a physician from a distance by electronic communication in order to improve patient care, treatment or services.

SOURCE: 243 CMR 2.01. (Accessed Nov. 2022). 

Last updated 11/18/2022

Licensure Compacts

No Reference Found

Last updated 11/18/2022

Miscellaneous

The board shall allow a physician licensed by the board to obtain proxy credentialing and privileging for telehealth services with other health care providers, as defined in Section 1 of chapter 111, or facilities that comply with the federal Centers for Medicare and Medicaid Services’ conditions of participation for telehealth services.  Applicable providers include:

  • any doctor of medicine, osteopathy, or dental science
  • registered nurse
  • social worker
  • doctor of chiropractic
  • psychologist

SOURCE: Massachusetts General Laws Part I, Title  XVI, Ch. 112, Sec. 5O & Title XVI, Chapter 111, Section 1, Massachusetts General Laws (Accessed Nov. 2022).

Involuntary Commitment

The requirement for examination may be satisfied through utilization of telemedicine or other technology pursuant to protocols approved by the Department that assure verbal and visual observation and communication between the patient and an off-premises authorized clinician and adequate on-premises clinical staff only in cases where restraint or seclusion episode has ended, the patient has been permanently released from restraint or seclusion in accordance with 104 CMR 27.12(8)(h)8., and there are no apparent medical or physical conditions, including injury, related to the mechanical restraint or seclusion restraint that require an in-person examination.

SOURCE: 104 Code of Massachusetts Regulations (CMR) 27.12, (Accessed Nov. 2022).

Last updated 11/18/2022

Online Prescribing

The practice of medicine shall not require a face-to-face encounter between the physician and the patient prior to health care delivery via telemedicine.  The standard of care applicable to the physician is the same whether the patient is seen in-person or through telemedicine.

SOURCE: “Policy on Telemedicine,” Board of Registration in Medicine.  Feb. 3, 2022. (Accessed Nov. 2022).

To be valid, a prescription must be issued in the usual course of the physician’s professional practice, and within a physician-patient relationship that is for the purpose of maintaining the patient’s well-being. In addition, the physician must conform to certain minimum standards of patient care, such as taking an adequate medical history, doing a physical and/or mental status examination and document the findings. This rule applies to any prescription, issued by any means, including the Internet or other electronic process.

SOURCE: “Internet Prescribing,” MA Board of Registration in Medicine.  Dec. 17, 2003 & Prescribing Practices Policy and Guidelines Policy 15-05 (Adopted Oct. 8, 2015), (Amended January 14, 2021). (Accessed Nov. 2022).

Cannabis Control Commission

Clinical Visit means an in-person or telehealth visit during which a Certifying Healthcare Provider establishes a Bona Fide Healthcare Provider Patient Relationship and conducts a full assessment of the Patient’s medical history and current medical condition, including the Debilitating Medical Condition, and explains the potential benefits and risks of Marijuana use. A Clinical Visit for an initial Certificate of Registration shall be performed in-person.

SOURCE: MA Regulations, Cannabis Control Commission, Ch. 935 CMR 501.002. (Accessed Nov. 2022).

Last updated 11/18/2022

Professional Boards Standards

Board of Medicine

SOURCE: 243 CMR 2.01. (Accessed Nov. 2022). 

Last updated 11/18/2022

Definition of Visit

Home Visit — a face-to-face meeting between a member and a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, or registered nurse in the member’s residence for examination, diagnosis, or treatment.

Hospital Visit — a face-to-face meeting between a member and a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, or registered nurse when the member has been admitted to a hospital by a physician on the CHC’s staff.

Individual Medical Visit — a face-to-face meeting at the CHC between a member and a physician, physician assistant, certified nurse practitioner, clinical nurse specialist, or registered nurse for medical examination, diagnosis, or treatment.

Individual Mental Health Visit —a face-to-face meeting at the CHC between a patient and either a psychiatrist or an advanced practice registered nurse (APRN) with a graduate degree and advanced training in psychiatric care (a psychiatric clinical nurse specialist or a psychiatric mental health nurse practitioner) within the community health center setting, for purposes of examination, diagnosis, or treatment.

SOURCE: MA 130 CMR 405.402, (Accessed Nov. 2022).

Last updated 11/18/2022

Eligible Distant Site

MassHealth lists specific codes that may be used by community health centers for services delivered through telehealth. See Transmittal Letter for details.

SOURCE: MassHealth Transmittal Letter CHC-119, p. 6-12 & 6-13, Oct. 2022. (Accessed Nov. 2022).

See: MA Medicaid Live Video Distant Site

Last updated 11/17/2022

Eligible Originating Site

No reference found.

See: MA Medicaid Live Video Eligible Sites.

Last updated 11/18/2022

Facility Fee

No reference found.

See: MA Medicaid Live Video Facility/Transmission Fee

Last updated 11/17/2022

Home Eligible

A home visit must be used to deliver episodic care in the member’s home when a health practitioner has determined that it is not advisable for the member to visit the CHC. The medical record must document the reasons for a home visit. A house-bound member with chronic medical and nursing care needs must be referred to a Medicare-certified home health agency.

SOURCE: MA 130 CMR 405.421, (Accessed Nov. 2022).

A CHC must provide on site the medical services specified in 130 CMR 405.408. It is not necessary that all of these services be available during all hours of the CHC’s operation, but all must be available to members on a regularly scheduled basis with sufficient frequency to ensure access to care and continuity of care. If the CHC does not serve patients of a particular age group, upon the prior written approval of the MassHealth agency, the CHC will not be required to provide pediatric or obstetrical/gynecological services or both (see 130 CMR 405.408(A) and (C)).

All of the services listed in 130 CMR 405.409 must be provided on site or, alternatively, through a referral network. For the purpose of 130 CMR 405.409, a service furnished by a practitioner other than an employee or contractor of the CHC for which the practitioner, rather than the CHC, claims payment is not considered to be “on site,” even if the service is provided on CHC premises. With the exception of audiology, electrocardiogram, laboratory, and radiology services, the CHC must notify the MassHealth agency, in writing, of each service listed in 130 CMR 405.409(A) through (N) that the CHC will provide on site. All services provided on site must be furnished by practitioners qualified to provide the service that are employees or contractors of the CHC. With the exceptions of audiology, electrocardiogram, laboratory, and radiology services provided on site (for which such services must be furnished and payment claimed by the CHC in accordance with applicable provisions set forth in 130 CMR 405.000 and Subchapter 6 of the Community Health Center Manual), all services set forth below that are provided on site must be furnished, and associated payment claimed by the CHC, in compliance with the applicable MassHealth regulations and subchapter 6 for each such service, including applicable fee schedules. See regulations for referral requirements.

SOURCE: MA 130 CMR 405.408 & 405.409, (Accessed Nov. 2022).

Last updated 11/18/2022

Modalities Allowed

Live Video

Community Health Centers, Community Mental Health Centers, and Outpatient Substance Use Disorder providers (provider types 20, 26 and 28) may deliver the following covered services via telehealth:

  • All services specified in 101 CMR 306.00 et seq.; and
  • The outpatient services specified in the following categories:
  • Opioid Treatment Services: Counseling;
  • Ambulatory Services: Outpatient Counseling; Clinical Case Management; and
  • Services for Pregnant/Postpartum Clients: Outpatient Services

SOURCE: MassHealth All Provider Bulletin 281, p. 1, Jan. 2019. (Accessed Nov. 2022). 

MassHealth lists specific codes that may be used by community health centers for services delivered through telehealth. See Transmittal Letter for details.

SOURCE: MassHealth Transmittal Letter CHC-119, p. 6-12 & 6-13, Oct. 2022. (Accessed Nov. 2022).

According to statute, there is no restrictions on distant sites, and live video is covered.

See: MA Medicaid Live Video.


Store and Forward

According to teledentistry and the GQ modifier are covered for store-and-forward. However, CCHP has not found an explicit reference to whether or not FQHCs/CHCs are eligible for reimbursement for store-and-forward

See:  MA Medicaid Store and Forward.


Remote Patient Monitoring

Although MassHealth reimburses some select RTM codes, there is no explicit indications to whether or not FQHCs are eligible to be reimbursed those codes.

See: MA Medicaid Remote Patient Monitoring.


Audio-Only

While telephonic delivery of children’s behavioral health initiative services is allowed in some situations, and MA statute indicates reimbursement for audio-only telephone, CCHP has not found an explicit indication that FQHCs/CHCs can be reimbursed for the audio-only modality.

See:  MA Medicaid Email, Phone and Fax.

Last updated 11/17/2022

Patient-Provider Relationship

No reference found

Last updated 11/17/2022

PPS Rate

No reference found

Last updated 11/18/2022

Same Day Encounters

The CHC may bill for a visit, a treatment, or a procedure, but may not bill for more than one of these services provided to the same member on the same date when the services are performed in the same location. This limitation does not apply to tobacco cessation counseling services provided by a physician or other qualified staff member under the supervision of a physician on the same day as a visit. See regulations for additional instructions for specific types of services (such as obstetrics, acupuncture, audiology, etc.)

SOURCE: MA 130 CMR 405.421, (Accessed Nov. 2022).