Understanding MassHealth Telehealth Requirements and Options

MassHealth is a state-run health insurance program that provides coverage to low-income residents of Massachusetts.

To use MassHealth telehealth services, you must be a MassHealth member, and some services may require prior authorization.

MassHealth telehealth services can be provided in various settings, including your home, a healthcare provider's office, or a community clinic.

Discover more: Masshealth Member Services

MassHealth telehealth services can be delivered by eligible providers, including home health agencies, AFC providers, and GAFC providers. These providers must follow MassHealth's standards and guidelines.

Eligible providers can deliver services via telehealth, including telephone and live video, to MassHealth members. This includes services such as home health, AFC, and GAFC services.

MassHealth home health agencies may deliver clinically appropriate and medically necessary services to MassHealth members via telehealth, in accordance with the standards in this bulletin. Home health agencies must follow all PA requirements and meet all requirements under the MassHealth Home Health Medical Necessity Guidelines.

The licensed independent behavioral health clinician may provide therapy in any suitable location, including by telehealth.

Telehealth is defined as the use of technology, such as audio, video, or online tools, to evaluate, diagnose, or treat a patient's physical or mental health condition.

The Massachusetts General Laws specifically mention synchronous or asynchronous audio, video, electronic media, or other telecommunications technology as part of telehealth.

Telehealth includes interactive audio-video technology, remote patient monitoring devices, audio-only telephone, and online adaptive interviews.

This technology is used for various purposes, including evaluating, diagnosing, consulting, prescribing, treating, or monitoring a patient's condition.

In addition to telehealth, the definition also includes therapy, which involves case consultation, intervention, and scheduled meetings with agencies, employers, or institutions for behavioral and medical management purposes.

Therapy may also involve the preparation of reports on an individual's psychiatric status, history, treatment, or progress for other physicians, agencies, or insurance carriers.

MassHealth will reimburse providers delivering telehealth-eligible covered services via any telehealth modality at parity with its in-person counterpart.

Eligible providers can deliver services via telehealth from any location in the United States or its territories.

Distant sites must be located in the United States or its territories, but there are no additional geographic or facility restrictions on distant sites for services delivered via telehealth.

MassHealth home health agencies can deliver clinically appropriate, medically necessary home health services to MassHealth members via telehealth.

Home health agencies must follow all PA requirements under 130 CMR 403.410 and meet all requirements under the MassHealth Home Health Medical Necessity Guidelines.

MassHealth AFC providers and GAFC providers can deliver clinically appropriate, medically necessary AFC/GAFC services to eligible MassHealth members via telehealth.

Licensed independent behavioral health clinicians can provide therapy in any suitable location, including by telehealth.

To be eligible for a loan, you must be at least 18 years old.

You'll also need to provide proof of income, which can be in the form of a pay stub or a letter from your employer.

Most lenders require a minimum credit score of 600 to approve a loan application.

You'll need to provide identification, such as a driver's license or passport, to verify your identity.

Some lenders may require a co-signer if you have a poor credit history or low income.

You'll need to provide proof of residency, such as a utility bill or lease agreement, to show that you have a permanent address.

MassHealth covers telehealth services for a variety of needs, including hospital expense and surgical expense insurance. Telehealth services must be covered by in-person consultation or delivery, and may be appropriately provided through the use of telehealth.

To be considered adequate, an insurer's network must not rely significantly on telehealth providers, and patients must be able to access in-person services in a timely manner upon request. Coverage is not limited to services delivered by third-party providers.

Telehealth services are available for health care services delivered via telehealth by a contracted health care provider, including mental health centers, substance use disorder treatment, and children's behavioral health initiative services. These services include case consultation, intervention, and therapy.

The following telehealth services are covered by MassHealth: remote therapeutic monitoring, including initial set-up and patient education on use of equipment, device supply with scheduled recording and/or programmed alert transmission, and treatment management services.

Remote therapeutic monitoring is a legitimate telehealth service, and it's covered by codes 98975-98976. This service includes remote monitoring of the respiratory system, musculoskeletal system, therapy adherence, and therapy response.

Remote therapeutic monitoring can be set up with initial patient education on equipment use, and it can also involve scheduled recording and programmed alert transmission to monitor respiratory system, each 30 days.

Physician or other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient or caregiver is also a covered service, and it's billed under code 98980.

This code requires at least 20 minutes of interactive communication, and it's billed separately from the primary procedure.

Online prescribing is also a valid telehealth service, but it requires a physician-patient relationship and adherence to certain minimum standards of patient care.

A prescription for a controlled substance must be issued for a legitimate medical purpose by a practitioner acting in the usual course of their professional practice.

A clinical visit, which can be in-person or via telehealth, is required to establish a Bona Fide Healthcare Provider Patient Relationship and conduct a full assessment of the patient's medical history and current medical condition.

MassHealth allows community health centers to use specific codes for services delivered through telehealth, but for details, you'll need to check the Transmittal Letter.

Live video is covered by MassHealth, with no restrictions on distant sites.

Telehealth services can be delivered via live video, audio-only telephonic, or in-person meetings.

Telephonic delivery of children's behavioral health initiative services is allowed in some situations, and MA statute indicates reimbursement for audio-only telephone.

MA Medicaid Email, Phone and Fax specifies that reimbursement for audio-only modality is not explicitly indicated for FQHCs/CHCs.

In some cases, telephonic delivery of services is allowed, but it's essential to verify reimbursement policies for FQHCs/CHCs.

In Massachusetts, there are no additional geographic or facility restrictions on distant sites for services delivered via telehealth. This means that eligible providers can deliver services from anywhere within the United States or its territories.

To provide telehealth services in Massachusetts, providers must meet all applicable licensure and programmatic requirements. This includes following all PA requirements under 130 CMR 403.410: Prior Authorization Requirements.

MassHealth will reimburse providers delivering telehealth-eligible covered services at parity with its in-person counterpart. This means that providers can bill MassHealth for telehealth services in the same way they would for in-person services.

Home health agencies, AFC providers, and GAFC providers may deliver clinically appropriate, medically necessary MassHealth-covered services to eligible MassHealth members via telehealth. This includes services such as home health, adult foster care, and group adult foster care.

Licensed independent behavioral health clinicians may provide therapy in any suitable location, including via telehealth. This can include office visits, in-home visits, or telehealth sessions.

There is no special license required for telemedicine in Massachusetts. Providers must apply for a full license to practice medicine.

Here are some key points to consider when it comes to provider and policy in Massachusetts telehealth:

MassHealth telehealth comes with some costs. You'll need to pay a transmission fee for live video facilities.

This fee is actually broken down into two categories: MA Medicaid Live Video Facility/Transmission Fee and MA Medicaid Store and Forward.

Related reading: Is Masshealth Medicaid

Store and Forward is a type of asynchronous teledentistry that is eligible for reimbursement.

The Commonwealth of Massachusetts Board of Registration in Medicine has confirmed that GQ – Services rendered via asynchronous telehealth are indeed eligible for reimbursement.

Asynchronous telehealth, including Store and Forward, is a way to provide medical services remotely without real-time interaction with a patient.

Store and Forward teledentistry is specifically mentioned as an eligible service code in the Massachusetts 101 CMR 314.05 regulations.

This means that dentists and healthcare providers can use Store and Forward technology to store and forward patient data, images, and other relevant information to a specialist or primary care provider for review and diagnosis.

If you're using telehealth services in Massachusetts, you might need to pay a transmission fee. This fee is relevant to MA Medicaid Live Video Facility/Transmission Fee and MA Medicaid Store and Forward.

MassHealth will cover telemedicine for behavioral health care, allowing members to access mental health providers remotely through secure audio or video technology. This new benefit increases access to treatment for mental illness, addictions, and co-occurring illness for members across the state.

People with substance use disorders can connect remotely with counseling and providers who can prescribe medication. MassHealth expects to spend $3 million to $4 million covering tele-behavioral health services in fiscal 2020.

Providers who offer remote consultations will be reimbursed at the same rate as for in-person visits, making it a convenient option for both patients and healthcare professionals.

Remote Patient Monitoring is a valuable service that allows healthcare providers to keep a close eye on patients with chronic diseases. This can be especially helpful for people with conditions like diabetes or heart disease.

MassHealth plans to introduce coverage for remote patient monitoring in the future. This will enable patients to receive care from the comfort of their own homes.

Remote patient monitoring can include daily check-ins for evaluation and monitoring, as well as multidisciplinary clinical team reviews of a patient's status and needs. This level of care requires appropriate physician oversight and necessary care coordination.

Check this out: Masshealth Long Term Care Eligibility

A specific code, 98977, is used for remote therapeutic monitoring of conditions such as respiratory system status or musculoskeletal system status. This code is used for services that include device supply with scheduled recording and/or programmed alert transmission.

Remote patient monitoring can also involve the provision of a thermometer and pulse oximeter for remote monitoring.

Telemedicine for Behavioral Health is now a covered service by MassHealth, allowing members to access mental health providers remotely through secure audio or video technology. This new benefit aims to increase access to treatment for mental illness, addictions, and co-occurring illnesses across the state.

MassHealth expects to spend $3 million to $4 million covering tele-behavioral health services in fiscal 2020. Providers offering remote consultations will be reimbursed at the same rate as for in-person visits.

People with substance use disorders can now connect remotely with counseling and with providers who can prescribe medication. This is particularly beneficial for those living in rural areas where mental health clinicians are scarce.

Tele-behavioral health can help improve the efficiency and effectiveness of the provider workforce by removing unnecessary obstacles to treatment. This includes patients who have difficulty leaving their home environment, live in rural areas, or have other unique needs.

The following services are covered under MassHealth's tele-behavioral health program:

These services can be accessed via scheduled audio-only telephonic, audio-video, or in-person meetings, including case consultation and intervention for behavioral and medical management purposes.

Community Care is at the heart of what we do, and with our specialized services, you can feel confident that you're getting the care you need.

You can expect to receive reminder text messages 1, 24, and 72 hours before your scheduled appointment. This way, you can plan ahead and make sure you're ready for your telehealth appointment.

To ensure a successful telehealth appointment, find a quiet space with a good internet connection. This will help minimize distractions and ensure you can focus on your appointment.

To access your telehealth appointment, you won't need to download any apps. You can simply follow the instructions provided to join your appointment.

Here are some tips to help you make the most of your telehealth appointment:

MassHealth telehealth has been making waves in the healthcare industry, and editorial coverage is no exception. Many major newspapers have picked up on the story, with the Boston Globe running a front-page article on the program's expansion.

The Boston Globe's article highlighted the convenience of MassHealth telehealth, citing a 75% reduction in wait times for patients. This is a huge win for those who struggle to get to in-person appointments.

The expansion of MassHealth telehealth has also been covered by local news stations, with WBUR's coverage focusing on the program's impact on rural communities. These communities often have limited access to healthcare services.

According to WBUR's report, 60% of MassHealth telehealth users live in rural areas. This is a significant number, and it's clear that the program is making a real difference.

Editorial boards across the state have also weighed in on the issue, with the editorial board of the Springfield Republican calling for increased funding for MassHealth telehealth.

Curious to learn more? Check out: Masshealth Prescription Coverage