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