Despite being an international hub for medical research and innovation, Massachusetts has attracted criticism for being, in the eyes of many advocates, not particularly friendly to telemedicine. Now, however, the state is working to change that, as highlighted in a recent National Law Review piece. Earlier this year, Massachusetts released an All Provider Bulletin addressing new policies for behavioral health services. These policies, which went into effect on January 1, specifically apply to patients covered by Massachusetts’ Medicaid program. While it is encouraging to see states addressing the use of telehealth in providing medical services, including psychiatry, Massachusetts’ bulletin elicited mixed responses from telehealth providers. Some see the new bulletin’s policies as too strict, requiring more heightened precautions than those at the federal level (i.e., the Ryan Haight Act). Others are excited about the expansion in ways to provide mental health services and reimbursement opportunities.
The highlight of the bulletin revolves around its enlargement
of health services for mental health to include telehealth. As a result,
residents in rural areas or those who are just unable
to access in-person care are now able to take advantage of needed mental
health services through telehealth. Secondly, the bulletin offered to “MassHealth-participating Community Health Centers, Community
Mental Health Centers, and Outpatient Substance Use Disorder providers…Medicaid
coverage and reimbursement of certain mental health and substance use disorder
services delivered via telehealth.” Beyond addressing expansion and
reimbursement, the bulletin also provides heightened guidelines for practicing
medicine while using telehealth. Only those professionals trained in telehealth
may provide mental health services that way. Those professionals must also have
training programs in place for staff delivering service via telehealth. The
telehealth modality must also “conform to industry-wide compressed audio-video
communication standards for real-time, two-way, interactive audio-video
transmission.” This means that providers may not use asynchronous
store-and-forward technology to provide eligible services under the bulletin. In
addition, there must be a face-to-face component to the interaction.
Lastly, the bulletin
addresses prescribing controlled substances—and it is here that many feel the
bulletin places too-strict requirements on professionals.
Prescribers are required to meet with patients in person initially, as well as
in person every three months through the duration of the prescription. Telehealth
providers, for their part, worry that the stringent conditions will prevent
patients from being able to receive the medication they need because they will
be required to meet in–person with their physician, which may not be feasible.
However, we are dealing with prescribing controlled substances, which are on
that list for a reason; thus, it’s understandable that Massachusetts wants to
ensure the right person is getting the correct medication needed by mandating
so many in-person visits. It is for the safety of the patient—and for the
physician as well.