Massachusetts 2023-2024 Regular Session

Massachusetts House Bill H3585 Compare Versions

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2	2	HOUSE DOCKET, NO. 1241 FILED ON: 1/18/2023
3	3	HOUSE . . . . . . . . . . . . . . . No. 3585
4	4	The Commonwealth of Massachusetts
5	5	_________________
6	6	PRESENTED BY:
7	7	Vanna Howard
8	8	_________________
9	9	To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
10	10	Court assembled:
11	11	The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
12	12	An Act relative to telehealth and digital equity for patients.
13	13	_______________
14	14	PETITION OF:
15	15	NAME:DISTRICT/ADDRESS :DATE ADDED:Vanna Howard17th Middlesex1/10/2023Colleen M. Garry36th Middlesex1/18/2023 1 of 13
16	16	HOUSE DOCKET, NO. 1241 FILED ON: 1/18/2023
17	17	HOUSE . . . . . . . . . . . . . . . No. 3585
18	18	By Representative Howard of Lowell, a petition (accompanied by bill, House, No. 3585) of
19	19	Vanna Howard and Colleen M. Garry relative to healthcare coverage for telehealth. Financial
20	20	Services.
21	21	The Commonwealth of Massachusetts
22	22	_______________
23	23	In the One Hundred and Ninety-Third General Court
24	24	(2023-2024)
25	25	_______________
26	26	An Act relative to telehealth and digital equity for patients.
27	27	Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
28	28	of the same, as follows:
29	29	1 SECTION 1. Section 30 of Chapter 32A of the General Laws, as appearing in the 2020
30	30	2Official Edition, is hereby amended by striking out subsection (c) and inserting in place thereof
31	31	3the following subsection:-
32	32	4 (c) Coverage for telehealth services may include utilization review to determine the
33	33	5appropriateness of telehealth as a means of delivering a health care service; provided, however,
34	34	6that the determination shall be made in the same manner as if the service was delivered in
35	35	7person. A carrier shall not be required to reimburse a health care provider for a health care
36	36	8service that is not a covered benefit under the plan or reimburse a health care provider not
37	37	9contracted under the plan except as provided for under subclause (i) of clause (4) of the second
38	38	10sentence of subsection (a) of section 6 of chapter 176O. Carriers shall not impose any prior
39	39	11authorization requirements to obtain medically necessary health services via telehealth that
40	40	12would not apply to the receipt of those same services on an in-person basis. 2 of 13
41	41	13 SECTION 2. Said section 30 of said chapter 32A of the General Laws, as so appearing, is
42	42	14hereby further amended by adding the following subsection:-
43	43	15 (i)Coverage for telehealth services shall include reimbursement for interpreter
44	44	16services for patients with limited English proficiency or those who are deaf or hard of hearing.
45	45	17 SECTION 3. Section 79 of Chapter 118E of the General Laws, as so appearing, is hereby
46	46	18amended by striking out subsection (c) and inserting in place thereof the following section:-
47	47	19 (c) The division may undertake utilization review to determine the appropriateness of
48	48	20telehealth as a means of delivering a health care service; provided, however, that the
49	49	21determination shall be made in the same manner as if service was delivered in-person. The
50	50	22division, a contracted health insurer, health plan, health maintenance organization, behavioral
51	51	23health management firm or third-party administrator under contract to a Medicaid managed care
52	52	24organization or primary care clinician plan shall not be required to reimburse a health care
53	53	25provider for a health care service that is not a covered benefit under the plan or reimburse a
54	54	26health care provider not contracted under the plan except as provided for under subclause (i) of
55	55	27clause (4) of the second sentence of subsection (a) of section 6 of chapter 176O. The division, a
56	56	28contracted health insurer, health plan, health maintenance organization, behavioral health
57	57	29management firm or third-party administrators under contract to a Medicaid managed care
58	58	30organization or primary care clinician plan shall not impose any prior authorization requirements
59	59	31to obtain medically necessary health services via telehealth that would not apply to the receipt of
60	60	32those same services on an in-person basis.
61	61	33 SECTION 4. Said section 79 of said chapter 118E of the General Laws, as so appearing,
62	62	34is hereby further amended by adding the following subsection:- 3 of 13
63	63	35 (i)The division and its contracted health insurers, health plans, health maintenance
64	64	36organizations, behavioral health management firms and third-party administrators under contract
65	65	37to a Medicaid managed care organization, accountable care organization or primary care
66	66	38clinician plan shall include in its coverage for reimbursement for interpreter services for patients
67	67	39with limited English proficiency or those who are deaf or hard of hearing in its coverage for
68	68	40telehealth services.
69	69	41 SECTION 5. Section 47MM of chapter 175 of the General Laws, as so appearing, is
70	70	42hereby amended by striking out subsection (c) and inserting in place thereof the following
71	71	43subsection:-
72	72	44 (c) Coverage for telehealth services may include utilization review to determine the
73	73	45appropriateness of telehealth as a means of delivering a health care service; provided, however,
74	74	46that the determination shall be made in the same manner as if the service was delivered in-
75	75	47person. A policy, contract, agreement, plan or certificate of insurance issued, delivered or
76	76	48renewed within or without the commonwealth shall not be required to reimburse a health care
77	77	49provider for a health care service that is not a covered benefit under the plan or reimburse a
78	78	50health care provider not contracted under the plan except as provided for under subclause (i) of
79	79	51clause (4) of the second sentence of subsection (a) of section 6 of chapter 176O. A policy,
80	80	52contract, agreement, plan or certificate of insurance issued, delivered or renewed within the
81	81	53commonwealth shall not impose any prior authorization requirements to obtain medically
82	82	54necessary health services via telehealth that would not apply to the receipt of those same services
83	83	55on an in-person basis. 4 of 13
84	84	56 SECTION 6. Said section 47MM of said chapter 175 of the General Laws, as so
85	85	57appearing, is hereby further amended by adding the following subsection:-
86	86	58 (i)A policy, contract, agreement, plan or certificate of insurance issued, delivered or
87	87	59renewed within the commonwealth that provides coverage for telehealth services shall include
88	88	60reimbursement for interpreter services for patients with limited English proficiency or those who
89	89	61are deaf or hard of hearing.
90	90	62 SECTION 7. Section 38 of chapter 176A of the General Laws, as so appearing, is hereby
91	91	63amended by striking out subsection (c) and inserting in place thereof the following subsection:-
92	92	64 (c) Coverage for telehealth services may include utilization review to determine the
93	93	65appropriateness of telehealth as a means of delivering a health care service; provided, however,
94	94	66that the determination shall be made in the same manner as if the service was delivered in-
95	95	67person. A carrier shall not be required to reimburse a health care provider for a health care
96	96	68service that is not a covered benefit under the plan or reimburse a health care provider not
97	97	69contracted under the plan except as provided for under subclause (i) of clause (4) of the second
98	98	70sentence of subsection (a) of section 6 of chapter 176O. Carriers shall not impose any prior
99	99	71authorization requirements to obtain medically necessary health services via telehealth that
100	100	72would not apply to the receipt of those same services on an in-person basis.
101	101	73 SECTION 8. Said section 38 of said chapter 176A of the General Laws, as so appearing,
102	102	74is hereby further amended by adding the following subsection:-
103	103	75 (i)Coverage for telehealth services shall include reimbursement for interpreter
104	104	76services for patients with limited English proficiency or those who are deaf or hard of hearing. 5 of 13
105	105	77 SECTION 9. Section 25 of chapter 176B of the General Laws, as so appearing, is hereby
106	106	78amended by striking out subsection (c) and inserting in place thereof the following subsection:-
107	107	79 (c) Coverage may include utilization review to determine the appropriateness of
108	108	80telehealth as a means of delivering a health care service; provided, however, that the
109	109	81determination shall be made in the same manner as if the service was delivered in person. A
110	110	82carrier shall not be required to reimburse a health care provider for a health care service that is
111	111	83not a covered benefit under the plan or reimburse a health care provider not contracted under the
112	112	84plan except as provided for under subclause (i) of clause (4) of the second sentence of subsection
113	113	85(a) of section 6 of chapter 176O. Carriers shall not impose any prior authorization requirements
114	114	86to obtain medically necessary health services via telehealth that would not apply to the receipt of
115	115	87those same services on an in-person basis.
116	116	88 SECTION 10. Said section 25 of said chapter 176B of the General Laws, as so
117	117	89appearing, is hereby further amended by adding the following subsection:-
118	118	90 (i)A contract that provides coverage for telehealth services shall include
119	119	91reimbursement for interpreter services for patients with limited English proficiency or those who
120	120	92are deaf or hard of hearing who require interpreter services.
121	121	93 SECTION 11. Section 33 of Chapter 176G of the General Laws, as so appearing, is
122	122	94hereby amended by striking out subsection (c) and inserting in place thereof the following
123	123	95subsection:-
124	124	96 (c) A carrier may undertake utilization review to determine the appropriateness of
125	125	97telehealth as a means of delivering a health care service; provided, however, that the
126	126	98determination shall be made in the same manner as if the service was delivered in person. A 6 of 13
127	127	99carrier shall not be required to reimburse a health care provider for a health care service that is
128	128	100not a covered benefit under the plan or reimburse a health care provider not contracted under the
129	129	101plan except as provided for under subclause (i) of clause (4) of the second sentence of subsection
130	130	102(a) of section 6 of chapter 176O. Carriers shall not impose any prior authorization requirements
131	131	103to obtain medically necessary health services via telehealth that would not apply to the receipt of
132	132	104those same services on an in-person basis.
133	133	105 SECTION 12. Said section 33 of said chapter 176G of the General Laws, as so appearing,
134	134	106is hereby further amended by adding the following subsection:-
135	135	107 (i) A contract that provides coverage for telehealth services shall include reimbursement
136	136	108for interpreter services for patients with limited English proficiency or those who are deaf or
137	137	109hard of hearing.
138	138	110 SECTION 13. Section 13 of chapter 176I of the General Laws, as so appearing, is hereby
139	139	111amended by striking out subsection (c) and inserting in place thereof the following subsection:-
140	140	112 (c) An organization may undertake utilization review to determine the appropriateness of
141	141	113telehealth as a means of delivering a health care service; provided, however, that the
142	142	114determination shall be made in the same manner as if the service was delivered in person. An
143	143	115organization shall not be required to reimburse a health care provider for a health care service
144	144	116that is not a covered benefit under the plan or reimburse a health care provider not contracted
145	145	117under the plan except as provided for under subclause (i) of clause (4) of the second sentence of
146	146	118subsection (a) of section 6 of chapter 176O. An organization shall not impose any prior
147	147	119authorization requirements to obtain medically necessary health services via telehealth that
148	148	120would not apply to the receipt of those same services on an in-person basis. 7 of 13
149	149	121 SECTION 14. Said section 13 of said chapter 176I of the General Laws, as so appearing,
150	150	122is hereby further amended by adding the following subsection:-
151	151	123 (i)A preferred provider contract that provides coverage for telehealth services shall
152	152	124include reimbursement for interpreter services for patients with limited English proficiency or
153	153	125those who are deaf or hard of hearing.
154	154	126 SECTION 15. Section 1 of chapter 176O of the General Laws, as so appearing, is hereby
155	155	127amended by striking out the definition of “Chronic disease management” and inserting in place
156	156	128thereof the following definition:-
157	157	129 “Chronic disease management”, care and services for the management of chronic
158	158	130conditions, as defined by the federal Centers for Medicare and Medicaid Services, that include,
159	159	131but are not limited to, diabetes, chronic obstructive pulmonary disease, asthma, congestive heart
160	160	132failure, hypertension, history of stroke, cancer, COVID-19 and its long-term symptoms, serious,
161	161	133long-term physical diseases including, but not limited to, cerebral palsy, cystic fibrosis,
162	162	134HIV/AIDS, blood diseases, such as anemia or sickle cell disease, muscular dystrophy, spina
163	163	135bifida, epilepsy and coronary heart disease.
164	164	136 SECTION 16. Chapter 176O of the General Laws is hereby amended by striking out
165	165	137section 26 and inserting in place thereof the following section:-
166	166	138 Section 26. The commissioner shall establish standardized processes and procedures
167	167	139applicable to all health care providers and payers for the determination of a patient's health
168	168	140benefit plan eligibility at or prior to the time of service, including telehealth services. As part of
169	169	141such processes and procedures, the commissioner shall (i) require payers to implement
170	170	142automated approval systems such as decision support software in place of telephone approvals 8 of 13
171	171	143for specific types of services specified by the commissioner and (ii) require establishment of an
172	172	144electronic data exchange to allow providers to determine eligibility at or prior to the point of care
173	173	145and determine the insured’s cost share for a proposed telehealth service, including any
174	174	146copayment, deductible, coinsurance or other out of pocket amount for any covered telehealth
175	175	147services.
176	176	148 SECTION 17. Section 67 of chapter 260 of the acts of 2020 is hereby amended by
177	177	149striking out the last sentence and inserting in place thereof the following sentence:- The report,
178	178	150along with a suggested plan to implement its recommendations in order to maximize access,
179	179	151quality of care and cost savings, shall be submitted to the joint committee on health care
180	180	152financing and the house and senate committees on ways and means not later than 2 years from
181	181	153the effective date of this act; provided, however, that not later than 1 year from the effective date
182	182	154of this act, the commission shall present a report on: (i) the estimated impacts on costs and time
183	183	155spent by patients accessing healthcare services due to the use of telehealth; (ii) the estimated
184	184	156impacts to access to healthcare services due to the use of telehealth including employment
185	185	157productivity, transportation costs and school attendance; (iii) the estimated impacts on healthcare
186	186	158costs due to the impacts of telehealth on COVID-19 transmission and treatment; (iv) the
187	187	159estimated impact on the costs of personal protective equipment for providers and healthcare
188	188	160facilities due to the use of telehealth; (v) an estimate of the impact of health outcomes to those
189	189	161communities that have not been able to access telehealth services due to language or accessibility
190	190	162issues; and vi) an interim estimate of the fiscal impact of telehealth use in the commonwealth
191	191	163that shall include public health outcomes, increased access to services, reduction in
192	192	164transportation services and reduction in hospitalizations. The report shall additionally include
193	193	165data regarding the number of telehealth visits utilizing an interpreter for those who are deaf and 9 of 13
194	194	166hard of hearing and for languages other than English and shall quantify the number of telehealth
195	195	167visits in each language.
196	196	168 SECTION 18. Notwithstanding any general or special law to the contrary, the health
197	197	169policy commission shall establish a Digital Bridge Pilot Program to support telehealth services
198	198	170and devices and to provide funding for healthcare and human service providers and their patients
199	199	171and clients to support the purchase of telecommunications, information services and connected
200	200	172devices necessary to provide telehealth services to patients and clients. Communities that have
201	201	173had the highest prevalence of and been disproportionately affected by COVID-19 shall be
202	202	174prioritized for funding under this program in addition to communities that experience barriers in
203	203	175accessing telehealth services due to language constraints, socioeconomic constraints or other
204	204	176accessibility issues. Eligible programs may include but not be limited to public private
205	205	177partnerships with telecommunication providers, municipalities, healthcare providers and other
206	206	178organizations.
207	207	179 Eligible services may include, but not be limited to: telecommunications services;
208	208	180broadband and internet connectivity services including the purchase of broadband subscriptions
209	209	181and the establishment of wireless hotspots, so-called; voice services; remote patient monitoring
210	210	182platforms and services; patient reported outcome platforms; store and forward services, including
211	211	183the asynchronous transfer of patient images and data for interpretation by a physician; platforms
212	212	184and services to provide synchronous video consultation; tablets, smartphones, or connected
213	213	185devices to receive connected care services at home for patient or provider use; and telemedicine
214	214	186kiosks/carts for provider sites. Funding shall not be used for unconnected devices that patients
215	215	187utilize in the home and then manually report their results to providers. 10 of 13
216	216	188 SECTION 19. (a) Notwithstanding any general or special law to the contrary, the health
217	217	189policy commission shall establish a Digital Health Navigator Tech Literacy Pilot Program,
218	218	190herein referred to as the program, to complement and work in conjunction with the Digital
219	219	191Bridge Pilot Program. The program shall establish telehealth digital health navigators including
220	220	192community health workers, medical assistants and other healthcare professionals to assist
221	221	193patients with accessing telehealth services. The program and its funding shall prioritize
222	222	194populations who experience increased barriers in accessing healthcare and telehealth services,
223	223	195including those disproportionately affected by COVID-19, the elderly and those who may need
224	224	196assistance with telehealth services due to limited English proficiency or limited literacy with
225	225	197digital health tools. Entities receiving funding through this program will provide culturally and
226	226	198linguistically competent hands-on support to educate patients on how to access broadband and
227	227	199wireless services and subsequently utilize devices and online platforms to access telehealth
228	228	200services.
229	229	201 (b) The health policy commission shall publish a report, 1 year following the
230	230	202implementation of said Digital Bridge Health Navigator Tech Literacy Pilot Program, which
231	231	203shall include but not be limited to the following: (i) an identification of the program’s telehealth
232	232	204navigators disaggregated by healthcare profession; (ii) the resources required to provide literacy
233	233	205with digital health tools, including, but not limited to, the cost of operating said pilot program
234	234	206and additional workforce training for the program’s telehealth navigators; (iii) an identification
235	235	207of the populations served by the program disaggregated by demographics including, but not
236	236	208limited to, race, ethnicity, age, gender identity and primary language spoken; (iv) an
237	237	209identification of the regions served by the program across the commonwealth; and (v) an
238	238	210evaluation of the efficacy of the program in increasing the utilization of telehealth services 11 of 13
239	239	211disaggregated by patient demographics and including, but not limited to, the rate of attendance at
240	240	212telehealth visits.
241	241	213 SECTION 20. (a) Notwithstanding any general or special law to the contrary, the
242	242	214executive office of health and human services shall establish a task force on an interstate medical
243	243	215licensure compact and licensure reciprocity. The task force shall consist of: the secretary of the
244	244	216executive office of health and human services or a designee who shall serve as chair; the
245	245	217commissioner of the department of public health or a designee; the commissioner of the
246	246	218department of mental health or a designee; the executive director of the board of registration in
247	247	219medicine or a designee; the undersecretary of the office of consumer affairs and business
248	248	220regulation or a designee; a representative from the health policy commission; a representative
249	249	221from the Massachusetts Medical Society; a representative from the Massachusetts Health and
250	250	222Hospital Association; and a representative from the Massachusetts League of Community Health
251	251	223Centers.
252	252	224 (b) The task force shall conduct an analysis and issue a report evaluating the
253	253	225commonwealth’s options to facilitate appropriate interstate medical practice and the practice of
254	254	226telemedicine including the potential entry into an interstate medical licensure compact or other
255	255	227reciprocity agreement. The analysis and report shall include but not be limited to: (i) an analysis
256	256	228of physician job vacancies in the commonwealth broken down by practice specialization and
257	257	229projected vacancies based on the demographics of the commonwealth’s physician workforce and
258	258	230medical school graduate retention rates; (ii) an analysis of other states’ entry into the interstate
259	259	231medical licensure compact and any impact on quality of care resulting from entry; (iii) an
260	260	232analysis of the ability of physicians to provide follow-up care across state lines, including via
261	261	233telehealth; (iv) an analysis of registration models for providers who may provide care for patients 12 of 13
262	262	234via telehealth with the provider located in one state and the patient located in another state,
263	263	235provided that said analysis would include delineation of provider responsibilities for registration
264	264	236and reporting to state professional licensure boards; (v) an analysis of impacts to health care
265	265	237quality, cost and access resulting from other states’ entry into a medical licensure compact, as
266	266	238well as anticipated impacts to health care quality, cost and access associated with entry into an
267	267	239interstate medical licensure compact; (vi) evaluations of barriers and solutions regarding
268	268	240prescribing across state lines; (vii) evaluations of the feasibility of a regional reciprocity
269	269	241agreement allowing telemedicine across state lines both for existing patient provider
270	270	242relationships and the establishment of new relationships; (viii) evaluations of the feasibility of
271	271	243the establishment of interstate proxy credentialing; and (ix) recommendations regarding the
272	272	244commonwealth’s entry into an interstate physician licensure compact or other licensure
273	273	245reciprocity agreements.
274	274	246 (c) The task force shall submit its recommendations to the governor and the clerks of the
275	275	247house of representatives and the senate not later than October 1, 2023.
276	276	248 SECTION 21. (a) Notwithstanding any general or special law to the contrary, the
277	277	249executive office of health and human services shall establish a task force on interstate licensure
278	278	250reciprocity for advanced practice registered nurses, physician assistants, behavioral and allied
279	279	251health professions. The task force shall consist of: the secretary of the executive office of health
280	280	252and human services or a designee who shall serve as chair; the commissioner of the department
281	281	253of public health or a designee; the commissioner of the department of mental health or a
282	282	254designee; the executive director of the board of registration in medicine or a designee; the
283	283	255Undersecretary of the office of consumer affairs and business regulation or a designee; and 12
284	284	256persons to be appointed by the secretary of the executive office of health and human services 13 of 13
285	285	257representing organizations that represent advanced practice registered nurses, physician
286	286	258assistants, hospitals, patients, behavioral health professions, allied health professions, telehealth
287	287	259and other professional groups.
288	288	260 (b) The task force shall: (i) investigate interstate license reciprocity models with other
289	289	261nearby states for advanced practice registered nurses, physician assistants, behavioral health,
290	290	262allied health and other professions and specialties to ensure that there is sufficient access for
291	291	263professionals throughout the region and ensure that continuity of care for patients is achieved for
292	292	264patients that access services in state’s throughout the region; and (ii) examine registration models
293	293	265for providers who may provide care for patients via telehealth with the provider located in one
294	294	266state and the patient located in another state. Such examination would include delineation of
295	295	267provider responsibilities for registration and reporting to state professional licensure boards.
296	296	268 (c) The task force shall submit its recommendations to the governor and the clerks of the
297	297	269house of representatives and the senate not later than February 1, 2024.
298	298	270 SECTION 22. Chapter 260 of the acts of 2020 is hereby amended by striking out section
299	299	27176 and inserting in place thereof the following section:
300	300	272 Section 76. Section 63 is hereby repealed.
301	301	273 SECTION 23. Sections 77 and 79 of chapter 260 of the acts of 2020 are hereby repealed.