Telehealth & Reimbursement for MNT
UPDATED June 24, 2024
MAND lobbyist update: MAND-Bulfinch Strategies partnership
Hello MAND Members,
As a reminder, MAND hired our lobbyists, Bulfinch Strategies Group, in November 2022 with the primary goal of helping ensure permanent access to and payment parity for telehealth MNT.
Here is a quick update on where we stand and where we aim to go from here:
The lobbyists have done a good job putting MAND in front of the legislative leadership and key stakeholders on Beacon Hill to help build strategic alliances with them.
MAND’s telehealth bills made some progress in the 2023-2024 legislative session. Our telehealth bills (S618 and H1073) were referred to the Joint Committee on Financial Services and then to the Joint Committee on Health Care Financing. However, our bills remain in committee, along with telehealth bills from other healthcare organizations, including the t-MED coalition. So, to date, no telehealth legislation has passed in Massachusetts.
Given the current legislative climate (e.g. prioritizing the Steward Health Care crisis), Bulfinch does not expect our telehealth bills to advance further during the 2023-2024 legislative session. This means that our bills will need to be reintroduced in the 2025-2026 legislative session with new sponsors with help from Bulfinch.
Please refer to this report from Sarah Conca, our Public Policy Director, for additional details on how Bulfinch can further assist MAND in achieving our legislative priorities in future legislative sessions. The primary goal of our partnership remains advocating for telehealth MNT reimbursement parity until all telehealth services provided by RDs in MA are paid on par with in-person visits.
In the meantime, at MAND’s June 13th Crossover meeting, the MAND Board of Directors approved the fiscal 2024-2025 budget which includes continued funding for our partnership with the Bulfinch lobbyists. The MAND Executive Committee will continue to work closely with the lobbyists for increased accountability and revise terms of the contract, if necessary, given these recent changes to ensure that member interests are fully represented.
Please contact Sarah Conca, MAND’s Public Policy Director, with any questions (email below). To submit comments on MAND’s relationship with Bulfinch, please contact the Executive Committee by emailing president@eatrightma.org.
Sincerely,
Sarah Conca, MPA, RDN, LDN
MAND Public Policy Director
sconca@live.com
Sangeeta Pradhan, MEd, RD, LDN, CDCES
MAND President, 2023-2024
president@eatrightma.org, spradhanrd@gmail.com
MAND's Executive Committee and Public Policy Panel are pleased to announce that, in conjunction with our partner organizations in the tMED Coalition, MAND was able to successfully advocate for a number of important changes to the long-awaited MA Division of Insurance (DOI) telehealth regulations, released on Friday, November 17. These changes clarify and expand upon definitions governing telehealth coverage and reimbursement as outlined in the "Patients First Act" (a.k.a., telehealth bill) signed into law on January 1, 2021.
The Bottom Line:
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MAND will continue to advocate for telehealth rate parity until all covered telehealth services provided by dietitians in Massachusetts are paid on par with in-person visits. We will advocate both as the voice of our profession and in coalition with other like-minded organizations. To that end, we continue to advocate for MAND’s MNT telehealth parity bills and the tMED Coalition’s broader telehealth parity bills.
- Until then, we will continue to maximize the application of the existing telehealth rate parity law to our services. With these changes to the DOI regulations, all covered services provided by dietitians via telehealth that fit the broadened definition of “behavioral health services” will be required by law to receive payment on par with an in-person visit.
- MAND can’t stand up to the insurers without your support: Please join MAND or talk with a colleague about joining MAND today. A strong MAND strengthens our ability to advocate for policies that impact you.
These regulations should take effect in approximately two weeks, once they have been published in the Massachusetts Register by the secretary of state. At that time, we will likely see health plans start to shift some of their policies to ensure compliance with the regulations.
We will be issuing more information and analysis of these changes in coming weeks, to be sent via similar e-blast and made available on www.eatrightma.org. In the meantime, please find additional information on some of the key regulatory changes below.
MAND Executive Committee & Public Policy Panel
Additional detail on the regulatory changes:
Behavioral Health Definition
- The telehealth bill requires insurers to reimburse Behavioral Health Services at parity with in-person services in perpetuity. However, the Legislature tasked DOI with defining in regulation what constitutes BH Services, essentially deciding which BH services are eligible for in-perpetuity telehealth rate parity.
- Along with our coalition partners, MAND was able to successfully advocate for a broad and inclusive definition of BH Services, requiring in-perpetuity telehealth rate parity for “Care and services for the evaluation, diagnosis, treatment, consultation, prescribing, monitoring or management of mental health, developmental, or substance use disorders. Such care and services may be provided by any Health Care Professional for whom such services are within the scope of licensure for such Health Care Professional. Behavioral Health Services shall also include but not be limited to Partial Hospital Programs and Intensive Outpatient Programs.”
Chronic Disease Management Definition
- While the legislative reimbursement parity requirement for chronic disease and primary care services expired on January 1, 2023, we were also able to successfully advocate for a significantly broadened definition of chronic disease management, which now goes well beyond the CMS definition to include congenital anomalies, hereditary conditions and other chronic conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.
- MAND continues to collaborate with our coalition partners to advocate for the Legislature to extend parity for chronic disease management and primary care, in which case, this broadened definition will decide which services are eligible for telehealth rate parity.
Thank you to those who joined us on November 8th for the policy update and telehealth town hall. We will be posting answers to submitted questions here very soon.
Telehealth Town Hall
Please find the slides from the November town hall event here.
You can view the recording by copying and pasting this link into your browser: https://www.veed.io/view/3618e1de-ceb0-48e5-85aa-08aeda134691?panel=share
Telehealth Update
An Act Putting Patients First took effect in January 2021 as part of Chapter 260 of the Acts of 2020. It covered many areas of health care services provision in MA, including “no surprise billing” and COVID-related services.
- It also made permanent coverage of and reimbursement parity for behavioral health services provided via all modalities of telehealth, including audio-only.
- It called for coverage of and reimbursement parity for primary care services and chronic disease management through January 2023.
- As of September 2021, for all other services, insurers could reduce reimbursement rates with advance notification.
- Insurers have since announced reimbursement rate cuts for telehealth services: telehealth 80% the rate of in-person visits.
Telehealth advocacy in the 2023-2024 legislative session
MAND’s Board of Directors approved hiring lobbyists to help us advocate for MNT provided via telehealth and retained lobbyists ahead of the new two-year legislative session which began on January 4, 2023.
Since then, MAND’s lobbyists have been offering their expertise to guide MAND in its advocacy activities, which include:
- Filing new legislation to establish payment parity for MNT provided via all modalities of telehealth.
- Connecting with key members of the state legislature to help the bill move through the multi-step legislative process.
- Advocate for our services and make sure that MNT is included and reimbursed fairly in any new healthcare law.
- Work with Healey administration and state agencies, such as Division of Insurance and Executive Office of Health and Human Services, regarding possible regulatory changes.
MAND’s telehealth MNT bill
Our lobbyists worked with the MAND Executive Committee and Director of Public Policy to draft two versions of a bill to establish payment parity for MNT provided via all modalities of telehealth, including audio only.
The lobbyists then worked with two state legislators supportive of the work of dietitians to file these bills at the start of the new legislative session in February 2023:
- State Representative Meghan Kilcoyne (D-Clinton)
- State Senator Julian Cyr (D-Truro)
The bills were assigned bill numbers (H.1073/S.618) and were referred to the Joint Committee on Financial Services in March 2023.
On May 2 nd , 2023 the Financial Services Committee held a public hearing for organizations and individuals to present live testimony in support of bills referred to the committee. MAND’s President-elect and Director of Public Policy presented live testimony before the committee in support of “An Act relative to telehealth parity for nutrition counseling.”
As a follow-up to the live testimony, MAND submitted written testimony in the form of a longer document with links to MNT outcomes studies and a collection of patient testimonials. These documents will be reviewed by members of the Financial Services Committee as part of the process for determining whether they will advance the bill in the legislative process by reporting the bill favorably out of committee.
Where we stand and what might be next?
On May 2nd, 2023 the Financial Services Committee held a public hearing for organizations and individuals to present live testimony in support of bills referred to the committee. MAND’s President-elect and Director of Public Policy presented live testimony before the committee in support of “An Act relative to telehealth parity for nutrition counseling.”
As a follow-up to the live testimony, MAND submitted written testimony in the form of a longer document with links to MNT outcomes studies and a collection of patient testimonials. These documents will be reviewed by members of the Financial Services Committee as part of the process for determining whether they will advance the bill in the legislative process by reporting the bill favorably out of committee.
Need more information on telehealth reimbursement please email:
- Sarah Conca sconca@live.com
- Ellen Lowre elowre@yahoo.com
Telehealth FAQs
Yes, however, as of September 13, 2021, there is no guarantee of reimbursement rate parity for nutrition services provided via telehealth. Insurance carriers are acting within the law if they announce rate cuts. "Carriers may choose to continue paying all providers at existing telehealth rates of reimbursement. If Carriers wish to alter telehealth rates of reimbursement where allowed under the law, they are expected, as noted in Bulletin 2021-04, to file implementation plans with the Division that highlight the methods and timing that would apply to all affected providers . . ." (MA Division of Insurance update on telehealth issued September 7, 2021)
Per current MA DOI regulations, credentialed providers need to offer both in-person appointments and telehealth appointments to remain in compliance with many of the insurance providers’ contracts (i.e., should a patient request an in-person visit). Private insurers may have specific requirements related to in person vs remote appointments. You should review the updated telehealth information on insurance companies’ websites for credentialed providers.
Academy members can join the Reimbursement and Payment Online Discussion Community of Interest (COI) to dialogue with other members, learn from colleagues and receive reimbursement updates from Academy staff.
In addition to the COI, the Academy convenes the monthly Reimbursement and Payment Affinity Group the fourth Tuesday of each month at 2:00 pm Eastern. This forum-based event brings together staff, policy leaders and members to discuss Academy reimbursement advocacy priorities and strategies, share their experience and determine how they can become involved in advocating. Use this link to join the COI and register for the monthly affinity group.
Telehealth Q&As
The MA legislature has a two-year legislative cycle, the current one beginning on January 4, 2023 and running through December 31, 2024. It could take until December 2024 for MAND’s telehealth bills to be passed. However, an annual state budget bill is passed each July, and telehealth parity could be included as part of the FY24 state budget. A third means of getting parity is a change to insurance regulations overseen by the Division of Insurance, which is another track of MAND’s telehealth advocacy. MAND filed bills in the MA House and Senate and will provide updates as the legislative session gets underway.
Inflation and COL increases impact all sectors, all employers and employees. To date, this has not been a prominent aspect of MAND’s general telehealth advocacy; however, in meetings with legislators this will be part of the argument against rate cuts. With insurers, this will be part of the argument against rate cuts and, moreover, for rate increases.
MAND thanks all RDNs for their advocacy and will provide sample language (e.g., emails, letters, social media posts) to be used in correspondence with legislators, agencies and insurers. We will receive input from our lobbyists and Academy payment and reimbursement staff as appropriate and hope we can speak with one voice. We will also reach out to RDNs across the state when there are opportunities to present at public hearings of relevant committees of the state legislature and agencies. In addition, we will put out “action alerts” at key steps in the legislative process, when constituents’ communication is key to having them move a bill along to the next committee, etc. These public hearings (in person or via Zoom) give interested parties the opportunity to speak in favor or in opposition of a bill through the submission of verbal or written testimony.
The language of MAND’s telehealth bills specify reimbursement at parity for nutrition counseling provided by dietitian nutritionists licensed in MA.
You must be licensed to practice in the state of residence of each client IF the state has practice exclusivity, meaning only a licensed dietitian/nutritionist is allowed to provide MNT. (This includes Maine and Rhode Island.) If the state does not have practice exclusivity, but only title protection, then you are able to provide services to clients in that state, as long as you do not identify yourself as a “licensed dietitian/nutritionist,” or that state’s particular protected title. (This includes Connecticut, Massachusetts and Vermont). Please note: if you are billing insurance companies in MA, and are credentialed by MA insurance companies, then you very likely need to have a current MA LDN in order to be reimbursed by the insurance company.
You can use the Academy’s licensure map to check licensure laws in each state: https://www.eatrightpro.org/advocacy/licensure/licensure-map-and-statutes-by-state
This is not specifically addressed in MAND’s telehealth bills for telehealth parity. However, we will discuss with our lobbyists and see in which current and proposed bills and regulations (e.g., MassHealth patient/provider requirements) this is addressed and/or can be included in the language.
For now, there is no national licensure reciprocity for RDNs/LDNs. The Academy received a grant from the Department of Defense to work with the current Congress to find opportunities for this to happen (related to military spouses needing to get licensed with each transfer of their spouses). RDNs need to review the licensure laws of each state to see if they offer reciprocity and what is required to get licensure reciprocity. You generally still need to apply for a license in the other state(s), but the process might be expedited.
This is a related but separate issue to telehealth reimbursement parity. The Academy is focusing its advocacy this year on increasing access to MNT by expanding services covered under Medicare Part B. We will be organizing advocacy efforts on this as the Nutrition and Dietetics Advocacy Summit approaches (March 28-30, 2023).
This is a great question! And this is why MAND hired lobbyists and hopes all RDNs will contribute to our efforts to let legislators and insurers know why our work is so important – a question of health equity, improving health outcomes and reducing health care spending – and why we are hoping you will be involved in MAND’s advocacy for telehealth parity. We will need written testimony from RDNs, data from your practices showing decreased no-show rates or outcomes of care (e.g., change in A1c or BMI), as well as patient testimonials about using telehealth compared to in-person visits.
That’s what lobbying is about, so we can get our voices heard through the legislative and regulatory processes. MAND hopes RDNs across MA can work together, now with the guidance of our lobbyists.
MAND believes strongly that we can all work together at the state and national level to increase access to MNT and increase reimbursement for our services. This is why we are working with lobbyists, holding town halls such as this, and asking for your involvement in our advocacy efforts.
Please review the slides and watch the recording. MAND is working with new lobbyists who have a multi-pronged approach (i.e., legislation, regulation, working with governor’s office and state agencies). Also see Q1.
MAND’s telehealth bill language covers MNT provided via dietitian nutritionists licensed in MA, on par with behavioral health. We feel this less-specific language will cover all billable conditions, regardless of HHS/Medicare definitions.
It is hard to say how the language for each state's telehealth bill was created, but it is safe to say that someone familiar with the work of dietitians and MNT was involved in bill creation and/or that the state affiliate hired a lobbyist (which we know was the case in RI, whose telehealth bill was not passed until July 2021, giving RIAND an opportunity to hire a lobbyist and compare other states’ telehealth laws).
