More than a year after the passage of a state law that broadened access to telehealth and mandated higher insurance reimbursements for several types of telephonic and virtual visits, the Division of Insurance has issued draft regulations that give insurers and providers more clarity on how to put the law into practice.
The regulations, issued Tuesday, came after the state’s largest insurer, Blue Cross Blue Shield of Massachusetts, put into effect its own state-approved policy interpreting the law. On Monday, the Boston Globe reported that the absence of regulations had created uncertainty among providers and threatened to undo gains the health care industry had made in adopting telehealth over the course of the pandemic.
The Division of Insurance is taking public comment and will hold a virtual hearing on the draft regulations on May 11. It was unclear when final regulations would be issued.
Providers have been especially concerned about reimbursements for behavioral health visits done over telehealth. The law required behavioral health virtual visits to be reimbursed at in-person rates in perpetuity. But Blue Cross Blue Shield’s policy had restricted the full reimbursement largely to behavioral health clinicians.
Those who fell outside of the policy’s “payment parity” requirements would receive only 80 percent of the in-person visit fee.
The new regulations would broaden Blue Cross Blue Shield’s policy, allowing any clinician delivering behavioral telehealth to be reimbursed at in-person rates, as long as the behavioral health visit falls within the scope of their licensure.
The insurer said it would amend its policy as soon as final regulations were put in place.
“While we continue to review the DOI regulations and look forward to engagement during the regulatory hearing, these regulations set forth a solid foundation for telehealth services being appropriately delivered in the commonwealth,” said Mike Caljouw, vice president of government and regulatory affairs at Blue Cross Blue Shield of Massachusetts.
In some cases, the new regulations may be more restrictive than the insurer’s policy. The law called for primary care services to be reimbursed at in-person rates until Dec. 31. The regulations spell out that primary care services will only qualify for in-person rates when delivered by a primary care provider, though it is unclear if that includes clinicians who are not doctors. Blue Cross’s policy allows other types of providers to receive the in-person reimbursement for primary care, such as nurse practitioners.
Blue Cross said it would keep its current definition of the provider even if not required to under the final regulations.
The Massachusetts Health & Hospital Association, which represents hospitals, expressed concern that the new regulations would not go far enough in covering telehealth visits for chronic conditions and improving health equity. The regulations, like the original law, specify that primary care and chronic care visits only have full reimbursement through December.
“Clinicians need clarity, reliability, and predictability as they utilize virtual care in the long-term. And patients need to know that telehealth will be a fully accessible tool for the care they need,” said Adam Delmolino, director of virtual care & clinical affairs with the Massachusetts Health & Hospital Association. “As we take a deeper look and gather feedback from our coalition partners, we will continue to flag concerns about where these regulations need to be improved.”
Blue Cross said its policy was in line with the regulations around chronic conditions. Both the insurer and the regulations specify that chronic conditions would primarily be defined by the federal Centers for Medicare and Medicaid Services.