Massachusetts

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

MassHealth

Administrator

Massachusetts Dept. of Health and Human Services

Regional Telehealth Resource Center

Northeast Regional Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: No
Remote Patient Monitoring: No

Private Payer Law

Law Exists: Yes
Payment Parity: Yes

Professional Requirements

Licensure Compacts: None
Consent Requirements: No

Last updated 02/28/2021

Audio Only Delivery

Medicaid: Guidance for Adult Day Care Health Providers

STATUS: Active, until end of MA State of Emergency

Medicaid: Day Habilitation Providers

STATUS: Active, until end of MA State of Emergency

Medicaid: Updated MassHealth Telehealth, DME and Home Health Policies

STATUS: Expired December 31, 2020

Medicaid:  MassHealth Telehealth Policy

STATUS: Active, expires March 31, 2021

Medicaid: Additional Telehealth Flexibilities

STATUS: Active, expires March 31, 2021

Medicaid: MassHealth Coverage and Reimbursement Policy

STATUS: Active, expires March 31, 2021

Medicaid: Billing for Covered Services Delivered via Telehealth

STATUS: Active, until end of MA State of Emergency

Medicaid: Telephone and Internet Connectivity for Telehealth

STATUS: Expired

Medicaid: Primary Care Visits via Telehealth

STATUS: Expired

Medicaid: Managed Care Requirements during COVID-19

STATUS: Active, expires March 31, 2021

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: MassHealth Community Partner Information: Updates Related to the Coronavirus Disease 2019 (COVID-19)

STATUS: Active, until end of MA State of Emergency

Medicaid: Temporary Flexibilities for the Provision of Health Services by Community Health Centers

STATUS: Active, until end of MA State of 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: Telehealth Network Providers

STATUS: Active, until six months after end of the MA State of Emergency

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: Active, until February 28, 2021

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: Active, until February 28, 2021

Last updated 02/28/2021

Cross State Licensing

Office of the Governor: Cross State Practice via telehealth

STATUS: Active, until end of MA State of Emergency

Last updated 02/28/2021

Easing Prescribing Requirements

Medicaid:  MassHealth Telehealth Policy

STATUS: Active, expires March 31, 2021

Medicaid: MassHealth Coverage and Reimbursement Policy

STATUS: Active, expires March 31, 2021

Medicaid: COVID-19 FAQs for Behavioral Health Providers

STATUS: Active

Bureau of Substance Abuse Services: Alert on Telemedicine

STATUS: Active

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

STATUS: Active

Last updated 02/28/2021

Miscellaneous

Board of Medicine: Policy on Telemedicine

STATUS: Permanent

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

STATUS: Active

Last updated 02/28/2021

Private Payer

Division of Insurance: Insurance FAQs During COVID-19

STATUS: Active

Division of Insurance: Guidelines to deliver Medically Necessary Services via Telehealth

STATUS: Active, until end of MA State of Emergency

Office of the Governor: Order Expanding Telehealth

STATUS: Rescinded by Executive Order 61

Last updated 02/28/2021

Provider Type

Medicaid: Guidance for Adult Day Care Health Providers

STATUS: Active, until end of MA State of Emergency

Medicaid: Day Habilitation Providers

STATUS: Active, until end of MA State of Emergency

Medicaid:  MassHealth Telehealth Policy

STATUS: Active, expires March 31, 2021

Medicaid: Mental Health Transformation Payments

STATUS: Active, expires March 31, 2021

Medicaid: Billing for Covered Services Delivered via Telehealth

STATUS: Active, until end of MA State of 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: Temporary Flexibilities for the Provision of Health Services by Community Health Centers

STATUS: Active, until end of MA State of Emergency

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

STATUS: Active

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: 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: Active, until February 28, 2021

Last updated 02/28/2021

Service Expansion

Medicaid: Guidance for Adult Day Care Health Providers

STATUS: Active, until end of MA State of Emergency

Medicaid: Day Habilitation Providers

STATUS: Active, until end of MA State of Emergency

Medicaid: Updated MassHealth Telehealth, DME and Home Health Policies

STATUS: Expired December 31, 2020

Medicaid:  MassHealth Telehealth Policy

STATUS: Active, expires March 31, 2021

Medicaid: Additional Telehealth Flexibilities

STATUS: Active, expires March 31, 2021

Medicaid: MassHealth Coverage and Reimbursement Policy

STATUS: Active, expires March 31, 2021

Medicaid: Mental Health Transformation Payments

STATUS: Active, expires March 31, 2021

Medicaid: Billing for Covered Services Delivered via Telehealth

STATUS: Active, until end of MA State of Emergency

Medicaid: Primary Care Visits via Telehealth

STATUS: Expired

Medicaid: Managed Care Requirements during COVID-19

STATUS: Active, expires March 31, 2021

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: Temporary Flexibilities for the Provision of Health Services by Community Health Centers

STATUS: Active, until end of MA State of Emergency

Medicaid:

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

STATUS: Active

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: Telehealth Network Providers

STATUS: Active, until six months after end of the MA State of 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: Active, until February 28, 2021

Administrative Bulletin 20-76: Health Safety Net Coverage and Reimbursement Policy for Services Related to Coronavirus Disease 2019 (COVID-19)

STATUS: Active, until end of MA State of Emergency

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

STATUS: Active

Last updated 02/28/2021

Definitions

Newly Passed Legislation (Now Effective)

“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 Senate No. 2984. (Accessed Feb. 2021). 

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 Feb. 2021).

Last updated 02/28/2021

Email, Phone & Fax

Newly Passed Legislation (Now Effective)

“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 Senate No. 2984. Section 40 (Accessed Feb. 2021)

Last updated 02/28/2021

Live Video

POLICY

Newly Passed Legislation (Now Effective)

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 Senate No. 2984. Section 40 (Accessed Feb. 2021) 

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 Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Newly Passed Legislation (Now Effective)

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 Senate No. 2984. Section 40 (Accessed Feb. 2021) 

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 Senate No. 2984. Section 40 (Accessed Feb. 2021) 

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 Senate No. 2984. Section 68 (Accessed Feb. 2021)

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 Feb. 2021). 

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-113, p. 6-11 & 6-12, Feb. 2020. (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Newly Passed Legislation (Now Effective)

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

SOURCE: Massachusetts Senate No. 2984. Section 40 para. 632 (Accessed Feb. 2021)


ELIGIBLE SITES

Newly Passed Legislation (Now Effective)

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 Senate No. 2984. Section 40 para. 655 (Accessed Feb. 2021)


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 Senate No. 2984. Section 40  (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

No Reference Found

Last updated 02/28/2021

Miscellaneous

Newly Passed Legislation (Now Effective)

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 Senate No. 2984. Section 40 (Accessed Jan. 2021) 

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 Feb. 2021).

Last updated 02/28/2021

Out of State Providers

No Reference Found

Last updated 02/28/2021

Overview

Massachusetts introduced 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.  Massachusetts has also revised its definition of telehealth in statute. Even though the new definition of telehealth includes remote patient monitoring, there is not yet evidence that Medicaid is implementing RPM reimbursement at this time. Additionally, MA Medicaid Bulletins do not yet reflect the expansions to telehealth reimbursement made in law, with the latest one on permanent policy being dated January 2019. Based on official Massachusetts’s government public releases related to the new law, the MassHealth telehealth expansion of primary care and chronic disease management will expire in two years.

SOURCE: Massachusetts Office of Governor. (Accessed Feb. 2021). 

 

 

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

Store and Forward

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/28/2021

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 Senate No. 2984. Section 47, (Accessed Feb. 2021) 

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 Senate No. 2984. Section 3, 49, 51, 53, 54  (Accessed Jan. 2021)

Last updated 02/28/2021

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 Senate No. 2984. Section 47  (Accessed Feb. 2021) 

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 Senate No. 2984. Section 3, 49, 51, 53, 54  (Accessed Feb. 2021).


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 Senate No. 2984. Section 47 (Accessed Feb. 2021) 

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 Senate No. 2984. Section 3, 49, 51, 53, 54  (Accessed Feb. 2021).

Last updated 02/28/2021

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 Senate No. 2984. Section 47, 61, 67  (Accessed Jan. 2021).

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 Senate No. 2984. Section 3, 49, 51, 53, 54  (Accessed Feb 2021).

Last updated 02/28/2021

Cross State Licensing

No Reference Found

Last updated 02/28/2021

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, Ch. 112, Sec. 5O & SB 2984 (2020 Session). (Accessed Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

No Reference Found

Last updated 02/28/2021

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 Senate No. 2984. Section 27, para. 407 (Accessed Feb. 2021)Title XVI, Chapter 111, Section 1, Massachusetts General Laws (Accessed Jan. 2021)

Last updated 02/28/2021

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.  June 25, 2020. (Accessed Feb. 2021).

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 03-06 (Adopted Oct. 8, 2015). (Accessed Feb. 2021).

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 501.111. (Accessed Feb. 2021).

Last updated 02/28/2021

Professional Boards Standards

No Reference Found