Massachusetts

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

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

Last updated 08/29/2022

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

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: Active, expires Dec. 31, 2022

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 08/29/2022

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 08/29/2022

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

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 08/26/2022

Private Payer

Division of Insurance: Insurance FAQs During COVID-19

STATUS: May be expired as page no longer easily accessible from homepage.

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 08/29/2022

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

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 08/29/2022

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

Medicaid: MassHealth Coverage and Reimbursement Update

STATUS: Active, until end of the Public Health Emergency

Medicaid: Managed Care Requirements during COVID-19

STATUS: Active, expires Dec. 31, 2022

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.

Last updated 08/29/2022

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 Aug. 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 Aug. 2022).

Last updated 08/29/2022

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 Aug. 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 Aug. 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 Aug. 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 Aug. 2022).

Last updated 08/29/2022

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 Aug. 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 Mar. 2022).

Last updated 08/26/2022

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 Aug. 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 Aug. 2022).

Last updated 08/26/2022

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 Aug. 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/download 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 Lifeline program, a federal program that provides free or low-cost phone service to low-income households, and information on existing COVID-19 responses from broadband and telephone service providers.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 2022).

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

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.

Providers must include the place of service (POS) code 02 when submitting a professional claim and modifier GT when submitting a facility claim for services delivered via telehealth. Additionally, for any such professional claim, providers must include

  • modifier V3 to indicate services rendered via audio-only telehealth; and/or
  • modifier GQ to indicate services rendered via asynchronous telehealth.

MassHealth will initially implement modifiers 95, V3, and GQ through a six-month informational edit period. Thus, effective for dates of service between October 16, 2021, and April 15, 2022, MassHealth will not deny claims containing POS code 02 that are missing one of these modifiers. Effective for DOS on or after April 16, 2022, MassHealth will discontinue this informational edit, and will deny claims containing POS code 02 that are missing one of these modifiers.

*Note:  MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 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 Aug. 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 Aug. 2022).

Last updated 08/29/2022

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 Aug. 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 Aug. 2022).

Access to Health Services through Telehealth Options

Given the previously referenced trends, and recognizing the continuing impacts of COVID-19, MassHealth is updating its telehealth policy to ensure continued access to telehealth modalities for delivery of medically necessary MassHealth-covered services and to promote equity in access and high quality of care. This updated policy largely aligns with the telehealth policy described in All Provider Bulletin 324 (and its predecessor bulletins), with certain exceptions described in this bulletin. In sum, 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 December 31, 2022, 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 will be effective until MassHealth issues superseding guidance.

This bulletin, which is effective for DOS on or after October 16, 2021, provides that guidance, establishing MassHealth’s agency-wide rules for reimbursement of services provided via telehealth, applicable to all MassHealth programs. This bulletin applies to members enrolled in MassHealth fee-for-service, the Primary Care Clinician (PCC) plan, or a Primary Care Accountable Care Organization (ACO).

*Note:  MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 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 Aug. 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 Aug. 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 Mar. 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 Aug. 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-118, 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 does not anticipate introducing any such changes prior to January 1, 2023.

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 evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 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 Mar. 2022).

Consistent with All Provider Bulletin 324, and its predecessor bulletins, through December 31, 2022, MassHealth will reimburse providers delivering any telehealth-eligible covered service via any telehealth modality at parity with its in-person counterpart. Likewise, through December 31, 2022, 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 December 31, 2022, and may change those policies after that date.

Providers must include the place of service (POS) code 02 when submitting a professional claim and modifier GT when submitting a facility claim for services delivered via telehealth. Additionally, for any such professional claim, providers must include

  • modifier 95 to indicate services rendered via audio-video telehealth

MassHealth will initially implement modifiers 95, V3, and GQ through a six-month informational edit period. Thus, effective for dates of service between October 16, 2021, and April 15, 2022, MassHealth will not deny claims containing POS code 02 that are missing one of these modifiers. Effective for DOS on or after April 16, 2022, MassHealth will discontinue this informational edit, and will deny claims containing POS code 02 that are missing one of these modifiers.

*Note:  MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 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 Aug. 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 Aug. 2022).


FACILITY/TRANSMISSION FEE

Through December 31, 2022, 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 December 31, 2022, and may change those policies after that date.

*Note:  MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 2022).

Last updated 08/29/2022

Miscellaneous

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

Note:  MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 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 Aug. 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 Aug. 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 Aug. 2022).

Last updated 08/26/2022

Out of State Providers

No Reference Found

Last updated 08/26/2022

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 08/29/2022

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 evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 2022).


CONDITIONS

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

*Note:  MassHealth will continue to evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 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 Aug. 2022).


PROVIDER LIMITATIONS

No reference found.


OTHER RESTRICTIONS

No Reference Found

Last updated 08/29/2022

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 evaluate these telehealth rate parity and facility fee policies through December 31, 2022, and may change those policies after that date.  MassHealth does not anticipate introducing any such changes prior to January 1, 2023.

SOURCE: MassHealth All Provider Bulletin 327, Oct. 2021. (Accessed Aug. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Asynchronous teledentistry is covered.

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


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 08/29/2022

Cross State Licensing

No Reference Found

Last updated 08/28/2022

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 Aug. 2022).

Last updated 08/29/2022

Licensure Compacts

No Reference Found

Last updated 08/29/2022

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 Aug. 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 Aug. 2022).

Last updated 08/28/2022

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 Aug. 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 Aug. 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 Aug. 2022).

Last updated 08/29/2022

Professional Boards Standards

No Reference Found