When the Massachusetts state of emergency ends next Tuesday, June 15, many of the regulatory flexibilities that were put in place to permit a quick response to the pandemic will also cease. One such set of flexibilities allowed for expanded access to telehealth services, which have been universally credited with providing cost-effective, safe, and convenient care to just about anyone with a phone or computer.
In addition to Governor Baker’s executive orders on telehealth, Chapter 260, which became law on January 1, 2021, advanced telemedicine in Massachusetts more than ever before. The law, An Act Promoting a Resilient Health Care System that Puts Patients First, ordered MassHealth, the Group Insurance Commission, and commercial health insurance companies to reimburse telehealth services at the same rates as in-person services until 90 days after the June 15 end of the state of emergency – which is September 13, 2021.
Since February, the Division of Insurance (DOI) and MassHealth held listening sessions to inform the regulations that will codify the telehealth provisions of Chapter 260. Those sessions recently ended in April. The administration’s forthcoming regulations will be subject to a subsequent public hearing process prior to the law’s implementation. As a result, there are many uncertainties around how telehealth services will be defined, reviewed, coded, billed, and reimbursed. Both providers and patients are currently left with many unanswered questions.
At the time Chapter 260 was written, lawmakers did not know when the state of emergency would end. Now, as the law’s September 13 deadline approaches, MHA and its membership are seeking a 90-day extension to keep the state’s current telehealth framework in place through mid-December. MHA argues that because the process of creating the regulations to implement the law is not yet underway, more time is needed to allow providers, insurers, and MassHealth to adjust billing systems and patient scheduling, and to agree on coding, billing, definitions, and other telehealth administrative complexities. Also of great concern are the patients whose existing telehealth-based care has been scheduled beyond September 13, potentially disrupting how those patients access, receive, and pay for care. One of the major unresolved issues DOI is deliberating involves identifying the services that qualify under the law’s definition of primary care and chronic disease management. Additionally, the state’s current telehealth flexibilities have protected access to healthcare for underserved populations, including those from communities of color, immigrants, and low-income communities. MHA has expressed concern about abruptly shifting from the existing telehealth framework without ensuring clarity to secure safe care access for all patients.
With or without the requested extension of current flexibilities, Chapter 260 mandates that behavioral healthcare provided by telehealth will be reimbursed on-par with in-person services in perpetuity. Health insurance companies will be required to reimburse primary care and chronic disease management services provided via telehealth at the same rates as in-person services – but only until January 1, 2023.
“Given that the state of emergency is now coming to an end, healthcare providers and patients need additional time to understand what the rules of the road will be,” said MHA’s Senior Director of Managed Care Karen Granoff. “Because we do not yet know how the state will define what a telehealth encounter is, or even how certain services will be reimbursed, the conclusion of the state of emergency and the uncertainty of the regulatory framework for telehealth demands that additional time be given to deliberate upon next steps. Providing an additional 90- day glide path will help address hospital, provider, and patient concerns and ensure that current treatment plans are not disrupted, especially as many continue to experience the long-lasting effects of COVID-19. Our state has made incredible strides in the area of telehealth recently, and we look forward to working with the legislature and administration on a solution that works best for patients and providers, who have embraced the benefits of virtual care.”