Policy News

Massachusetts Again Mulls Telehealth Guidelines, Including Parity

Governor Charles Baker has introduced a massive healthcare bill that would, among other things, establish a regulatory framework for telehealth, mandate coverage parity and regulate retail clinics and urgent care centers.

Source: ThinkStock

By Eric Wicklund

- Massachusetts is once again looking to improve its telehealth landscape, with a bill sponsored by Governor Charles Baker that establishes a regulatory framework for telehealth services and requires payers to cover telehealth services as they would in-person care.

The proposals are part of “An Act to Improve Health Care by Investing in Value” (H. 4134), filed in Oct. 18, 2019 by the governor. The massive 179-page bill targets a wide range of issues, including mental health services, practice standards for mid-level practitioners, healthcare costs and prescription drug costs.

Tucked into that tome is a bid by the governor to push telehealth adoption forward, a challenge that has eluded the commonwealth in recent years.

“Telemedicine supports efforts to significantly improve the quality of health care by increasing accessibility and efficiency through reducing the need to travel,” Baker said in a press release. “However, patient use of telemedicine remains low. There is currently no definition of the medical services that can be provided via telehealth services. In addition, insurance coverage of telehealth services varies by insurer which has stalled widespread adoption.”

Baker’s bill would define telehealth as many other states have done – namely, by including synchronous and asynchronous telemedicine technology but not audio-only phones calls, e-mail messages or faxes.

It would also establish that payers cover telehealth services as they would in-person services, provided those services can be appropriately provided through connected health channels. The bill allows for a deductible, copayment or coinsurance requirement, as well as preauthorizion to ensure that telehealth is an appropriate means of care, and it wouldn’t require a payer to cover a telehealth service that isn’t a covered benefit and that health plan.

The governor’s bill comes roughly one year after Massachusetts lawmakers failed to approve telehealth legislation that would have set guidelines for insurance coverage. That effort died after lawmakers could not agree on compromises to combine the House bill, which had been passed, and the Senate version, which had been rejected.

Massachusetts has rates near the bottom in surveys assessing each state’s adoption of telehealth and telemedicine. It’s one of only a handful that hasn’t established some sort of parity for telehealth, and received an ‘F’ from the American Telemedicine Association for telehealth parity in 2018 – the last time the ATA issued state-by-state report cards. The commonwealth was also one of a handful to be rated as restrictive in telemedicine policies in a 2018 report by the Manatt legal and consulting firm.

Baker’s bill also tackles a growing mobile health trend: retail clinics and urgent care centers.

“The growth of retail clinics and urgent care centers, both in Massachusetts and around the nation, represents an effort to provide alternative, convenient points of access to health care beyond the traditional hours and sites of physician offices, community health centers, and hospitals,” he said in his press release. “Research has shown that greater access to these sites holds the potential to reduce avoidable and costlier emergency department visits, and utilization continues to grow.”

To address that trend, Baker’s bill would define urgent care services “as those that are episodic in nature, generally provided on a walk-in basis, and available to the general public.” It would also require retail clinics and urgent care centers to be licensed as such by the commonwealth, and require them to accept MassHealth members, provide mental health services and meet certain primary care standards.

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