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Massachusetts Drops Parity from Telemedicine Reimbursement Bill

Facing stiff resistance from insurers, lawmakers rework a telemedicine bill to give payers the power to negotiate coverage. And even that may not be enough.

By Eric Wicklund

- Massachusetts legislators are debating telemedicine legislation that would, among other things, give insurers leeway to negotiate reimbursement rates - or not reimburse at all.

A reworked bill recently issued by the commonwealth’s Joint Committee on Health Care Financing would enable insurers to determine whether telemedicine is appropriate and negotiate reimbursement rates with providers, with the provision that it be no higher than a reimbursement for an office visit.

An earlier version of House Bill 267 that established payment parity met resistance. The Massachusetts Association of Health Plans had argued that the bill “would undermine the premise that telemedicine will ultimately lead to savings for providers and consumers.”

"Clearly, the costs are lower when it's telemedicine, so the reimbursements should be lower," Jon Hurst, president of the Retailers Association of Massachusetts, told Mass Live.

"It's mostly a vehicle for making sure that people who want to do telemedicine on whatever terms they make up and charge what they want will get away with it," added Jim Kessler, general counsel for Health New England, based in Springfield. "If you mandate certain services and reimbursements, you're taking away the whole negotiating ability of health insurers to benefit consumers."

The proposed legislation, which now faces reviews in both the House and Senate by July 31, would also direct the commonwealth’s Board of Registration in Medicine to craft telemedicine guidelines and align them with national standards on quality of care. It would also create a framework for licensing doctors who want to use the technology.

Supporters noted that Massachusetts is behind the curve in developing telemedicine legislation – particularly in a region that boasts some of the best healthcare and educational systems in the nation, many of them already actively involved in telemedicine and digital health programs.

"This is an important step for us as a commonwealth to move forward in terms of providing and enhancing telemedicine in Massachusetts," state Sen. Jim Welch, who chairs the Joint Committee on Health Care Financing, said. "I don't think it's a fad. It's something we're going to have to utilize more and more going forward."

Not everyone agrees with the new bill. The Massachusetts Medical Society has signaled its opposition, drawing upon a familiar argument in other states that have been slow to adopt telemedicine: The concern that a virtual visit would replace the in-person visit and negatively affect the doctor-patient relationship.

"While telemedicine is an important development worthy of reimbursement, it represents a different modality of care than traditional face-to-face care," MMS spokesman Rick Gulla told Mass Live. "The (society) has concerns that the proposed legislation lacks an appreciation of these differences — differences that could disrupt existing physician-patient relationships carefully developed over time in face-to-face settings."

The commonwealth’s reluctance to advocate for telemedicine coverage and reimbursement isn’t sitting well with the American Telemedicine Association. In its latest state-by-state report cards, the ATA gave Massachusetts a grade of ‘F’ for insurance parity in state employee health plans and private insurers, and a ‘B’ for its Medicaid coverage.

Dig Deeper;

Telemedicine Report Cards Offer Good, Bad News for States

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