Telehealth & Reimbursement for MNT

Updated February 10, 2025

Where we stand - New legislative session

MAND hired Bulfinch Strategies Group in November 2022 with the primary goal of establishing permanent payment parity for telehealth MNT.

In the 2023-2024 legislative session, MAND’s lobbyists filed telehealth MNT bills in the senate and House (S618/H1073). The bills were referred to the Joint Committee on Financial Services then referred to the Joint Committee on Health Care Financing. Despite this good progress, the bills did not move beyond the HCF committee, thereby “dying” at the end of the session.

In the new 2025-2026 legislative session, which began on January 1^st, MAND’s lobbyists worked to re-file the bills. See more information on the bills at:

“An Act relative to telehealth parity for nutrition counseling”

https://malegislature.gov/Bills/194/HD2620

https://malegislature.gov/Bills/194/HD2618

In the next few weeks, the bills will be assigned to a committee of jurisdiction. Once in a committee, they will receive new bill numbers and will be considered for public hearing, providing an opportunity for MAND to provide testimony in support of the bills.

MAND’s Executive Committee and Director of Public Policy continue to work with the lobbyists to follow through on the primary goal of our partnership: advocating for telehealth MNT reimbursement parity until telehealth services provided by RDNs in MA are paid on par with in-person visits.

To learn more about advocating for telehealth MNT, please contact MAND Director of Public Policy Sarah Conca, MPA, RDN, LDN at sconca@live.com.

For questions regarding MAND’s ongoing public policy work and partnership with Bulfinch Strategies, please contact MAND President Sarah Andrus, MS, RD, LDN at president@eatrightma.org.

Where we stand - Regulations governing telehealth

In conjunction with our partner organizations in the tMED Coalition, MAND successfully advocated for a number of important changes to the MA Division of Insurance (DOI) telehealth regulations. The 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.

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 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.

Additional Information - Regulations governing telehealth

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 licensurefor 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.

Telehealth in MA – The history

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 FAQs

Can nutrition visits still be provided via telehealth?

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)

I am a dietitian in private practice and I have relinquished my office space during the pandemic and now practice by telehealth exclusively. How should I proceed?

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.

Does the Academy have an online reimbursement discussion forum?

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

When will be the next opportunity to get the telehealth parity bill changed? More MA insurers are reducing payment for telehealth by 20% starting March 1, 2023. What is the likelihood of the bill passing and our getting rate parity? What is the timeline when we may expect some concrete change?

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.

The rent on my office is likely to increase at the end of my lease cycle (December 2023). Are COL/inflation numbers included in the argument for rate parity?

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.

Who should we be contacting (e.g., legislators, Division of Insurance, other) to report on the way providers are treated by insurance?

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.

We seem to often get lumped into other groups of healthcare providers where what we do may or may not fit and/or have legislators not understand our niche concerns on reimbursement. Is it possible to get us specifically listed in legislation by our profession or are we likely to continue to get listed under "prevention" or some other vague term?

The language of MAND’s telehealth bills specify reimbursement at parity for nutrition counseling provided by dietitian nutritionists licensed in MA.

I am still licensed in MA, take a few insurances, but now live in Texas. Does this still impact me?

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

Updates on current or proposed legislation pertaining to the distant site requirements for providers.

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.

How does telehealth interface with licensure and reciprocity?

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.

What is the work being done around increasing nutrition coverage in general (i.e., beyond three visits per year, for diagnoses other than DM, CVD, etc.)? Are only medical issues (diabetes, etc.) covered or will weight management and surveillance still be covered by telehealth in the future?

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).

Why do the insurers think telehealth should be reimbursed at lower rates than in-person visits?

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.

We need representation to insurance companies. Tufts has not increased our reimbursement rates for 20 years!

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.

We need political representation. Based on cost-of-living changes, we are living 60% less than our original contract. A 20% reduction in telehealth benefits is unfair, biased and discriminatory.

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.

After the failed attempts to this point, what will you be doing differently?

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.

My understanding is that some health plans, including BCBSMA, will reimburse MNT provided via telehealth at parity during the COVID pandemic (as defined by HHS) as long as the patient has a chronic disease as defined by Medicare. If the patient has obesity as the only diagnosis, for example, then reimbursement is not at parity, as Medicare does not consider obesity a chronic disease. In the legislation proposed, will MNT provided via telehealth beyond the COVID pandemic will be reimbursed at parity not only for chronic diseases as defined by Medicare, but also for other conditions, such as obesity, IBD, IBS, etc. for which currently MNT is considered a cornerstone of treatment?

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.

What can you learn from RI, who has managed to secure parity for telehealth for MNT? And possibly NH and CT? What did NH and CT do to gain parity that MA did not do? Have you looked into the rationale/arguments by other states with rate parity?

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).

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