Legislature passes telehealth compromise
Bill also addresses COVID testing and community hospital payments
THE MASSACHUSETTS LEGISLATURE on Wednesday sent Gov. Charlie Baker a bill that could permanently change how health care providers use telehealth, a consequence of the rapid shift that occurred due to the COVID-19 pandemic.
Senate Health Care Financing Committee chair Cindy Friedman said on the Senate floor that by passing the bill, “We ensure greater access to telehealth services, offer safe care options for patients, incentivize the continued expansion of services, and provide a financial lifeline to doctors, hospitals, and community health centers that shifted largely to telehealth services.”
Friedman led the conference committee along with House Majority Leader Ron Mariano, who is the leading candidate for House speaker, should Speaker Robert DeLeo, who is in job negotiations with Northeastern University, step down.
The conference committee report passed both bodies unanimously, 40-0 in the Senate and 157-0 in the House. No members spoke on the bill in the House.
The bill would require insurers to permanently cover behavioral health services conducted via videoconference or phone at the same rate as they cover in-person visits. It would require insurers to pay the same rate for telehealth and in-person visits for primary care services and chronic disease management for two years. Pay parity for all other services would apply for 90 days after the end of the COVID-19 emergency.
During the pandemic, as doctors’ offices temporarily cancelled non-urgent procedures and many people feared going into a doctor’s office, telehealth burgeoned in popularity. Massachusetts’ largest health insurer, Blue Cross Blue Shield, had been processing 200 telehealth claims daily pre-pandemic and by May was processing 38,000 claims per day. Clinicians at the large Mass General Brigham health care system conducted 1 million telehealth visits between March and July – compared to an average of 1,200 or 1,500 a month pre-pandemic.
The growth was made possible because emergency orders issued by Baker required insurers to cover telehealth at the same rate as in-person visits during the state of emergency.
But the shift raised many long-term questions regarding how telehealth should best be used and paid for. In theory, telehealth could lower health care costs, if doctors can perform basic services over a computer without support staff. But it could also raise costs, if someone has a telehealth visit, then is told to make a physical appointment.
The Senate and House took different approaches in their initial bills, but both versions aimed to provide temporary clarity about the future of telehealth while giving state health policy agencies time to do more comprehensive studies.
The final version of the bill includes permanent pay parity for behavioral health because that is where telehealth has been most successful. Doctors report that patients are less likely to miss behavioral appointments when they are conducted remotely. Data from the Health Policy Commission showed that behavioral health visits rebounded to pre-pandemic levels by this summer, faster than other medical specialties, primarily because more than 85 percent of those visits took place remotely.
Conference committee member Sen. Julian Cyr, a Truro Democrat, said he has received outpatient mental health services through telehealth during the pandemic and “it has made all the difference.” Cyr stressed the importance of allowing virtual visits for mental health care to give patients more flexibility with work, travel, and childcare; to expand access for patients in rural areas; and to increase access to clinicians who speak a language other than English.
Lora Pellegrini, president and CEO of the Massachusetts Association for Health Plans, said she is happy some rates could be negotiated after the emergency ends, though she worries about the two-year pay parity for some specialties. “In order for telehealth to truly deliver on its promise of increased access to high-quality care at lower costs, it is imperative that market-based negotiations set the reimbursement rate and any extension of mandated rates of payment be time-limited,” Pellegrini said.
Amy Rosenthal, executive director of the consumer advocacy group Health Care for All, said by permanently covering behavioral health services over telephone and video, “this provision helps support a behavioral health system that has been historically underfunded and ensures that consumers who do not have sufficient technology or internet connectivity can get the care they need.”
The bill also includes provisions expanding the scope of what some medical professionals can do. It lets optometrists treat glaucoma, resolving a years-long fight between optometrists and ophthalmologists over who has authority to prescribe medication. It lets nurse practitioners, nurse anesthetists, and certain psychiatric nurses practice more independently. It gives pharmacists more authority to review medications with patients.
The bill does not allow for dental therapists, a potential new job for mid-level dental practitioners, which has been the subject of a dispute for years between dentists and advocacy groups trying to expand access to dental care in underserved areas.
The bill does not take permanent steps to address the financial woes plaguing many community hospitals, but it does provide two years of enhanced monthly Medicaid reimbursement payments – up to $30 million each year – for community hospitals that serve large numbers of low-income patients.
It requires insurers to cover medically necessary COVID-19 testing and treatment without co-pays. The bill would result in broader coverage than what is currently included in Baker’s emergency orders by requiring insurers to cover COVID testing for some asymptomatic people who work in high-risk fields like health care, restaurants, retail, and hospitality.
Congress is on the verge of eliminating “surprise” billing, where people face unexpected out-of-network insurance charges for emergency or inpatient care – for example, when someone gets a bill for an out-of-network anesthesiologist during surgery at an in-network hospital. The state bill requires transparency in charges for non-urgent care, while directing state health officials to develop recommendations for future out-of-network rates, in accordance with any new federal law.The bill includes several other provisions: making it easier for MassHealth members to get care at urgent care centers, creating a new rare disease advisory council, requiring an analysis be done of COVID-19’s impact on the health care system, and requiring insurers to cover pediatric neuropsychiatric syndromes referred to as PANDAS or PANS.