Annual Meeting
We are VERY excited that ANCE will be in person this year. Please join us on Friday, March 31st at the Four Points Sheraton in Norwood for what is sure to be a great day.
If you are an exhibitor wishing to register, please go HERE:
Telehealth & Reimbursement for MNT
UPDATED January 20, 2023
Telehealth Town Hall
Please find the slides from the January town hall event here.
Please find the link to the recording here. Passcode is V1*f6Y6t
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.
MAND’s Board of Directors approved hiring lobbyists to help us advocate for MNT provided via telehealth and retained Smith, Costello & Crawford in November 2022, ahead of the new two-year legislative session which began on January 4, 2023.
Lobbyists' role is to offer expertise and guide MAND’s 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.
Lobbyists’ work to date
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.
- Version #1 – Coverage and reimbursement parity for MNT as part of behavioral health
- Version #2 – Coverage and reimbursement parity similar to that of behavioral health but separate, such as for primary care services
They then worked with two members of the state legislature to file these bills:
- State Representative Meghan Kilcoyne (D-Clinton)
- State Senator Julian Cyr (D-Truro)
Next steps are to connect MAND with key members of the legislature as bills get assigned to committees. They will also continue to monitor regulatory avenues for telehealth reimbursement parity.
For more information on telehealth reimbursement in MA please email:
Sarah Conca sconca@live.com
Ellen Lowre elowre@yahoo.com
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).
No, as coverage of telehealth was assumed but not spelled out in legislation prior to the pandemic. The Putting Patients First Act ("telehealth bill" of 2020) specified that telehealth is to be covered for all services by all insurers, but only with payment parity in perpetuity for behavioral health.
Similar primary care, chronic disease management and other related services (e.g., OT, PT, SLP, MNT) are to be covered if covered in-person. This is per the Minimum Creditable Coverage requirements per the Affordable Care Act.
This will be dependent upon the coverage of the policy purchased. According to the telehealth FAQ section of their website, Proliability’s plans do “not exclude telehealth/telemedicine services.” For practitioners electing to provide professional services via telehealth/telemedicine, it is the responsibility of each practitioner to ensure that they are lawfully providing professional services and meeting the requirements outlined by their professional state or federal licensing or regulatory boards and practicing within the profession’s scope and standards of practice.
For more information visit https://www.proliability.com/customer-service/faqs.html and read the April 2021 MNT Provider.
At the federal level, CMS/Medicare has covered telehealth provided by credentialed dietitian nutritionists since 2006, thus telehealth will not go away at the federal level. At the state level, Medicaid plans are governed by CMS/Medicaid and state laws and regulations, as are private insurers. Please note that MA has telehealth coverage parity, if not reimbursement parity, thus telehealth will always be covered.
From the Academy’s payment and reimbursement team: Private payers do not “sell” one policy. Each payer offers a variety of policies and products to individuals or employers and may customize them to suit client needs. Telehealth coverage varies from company to company and policy to policy, therefore it would be nearly impossible to track every payer.
Many larger payers will post their national coverage policies, which may provide helpful insight into what a company may include in their menu of services. However, national coverage policies do not determine what is covered in individual policies. In all cases, a customer’s benefits package for their individual plan always supersedes information in the national policy (i.e,. does the individual plan allow for MNT, for what conditions, and do they allow that service to be delivered via telehealth?).
No. MNT has been an approved telehealth service for Medicare beneficiaries for some time and once the PHE ends, MNT will continue to be an approved telehealth service and RDNs will remain approved providers for telehealth services within the Medicare program. The PHE brought about flexibilities that relate to how dietitians (and several other providers) deliver services via telehealth and how beneficiaries can receive services. This includes the relaxation around the location of both the provider and beneficiary during the service and the ability to provide telehealth as audio-only. With the recent passage of the 2023 Consolidated Appropriations Act, Congress extended telehealth flexibilities through December 24, 2024. https://www.eatrightpro.org/news-center/public-policy-news/consolidated-appropriations-act-of-2023-telehealth-and-medicare
According to the Academy’s payment and reimbursement team, they are not considering creating a RSO or similar structure, as it is unclear if this would be feasible. Please note that the Academy does not collect fee information from RDN members due to antitrust laws. The Academy’s Setting Fees page goes into more detail about this: www.eatrightpro.org
Want to Learn More?
For more information on the 2023-2024 session of the Massachusetts General Court: https://malegislature.gov/ClerksOffice/Senate/Deadlines
For more information on the MA Division of Insurance:
https://www.mass.gov/orgs/division-of-insurance
For more information on Chapter 260 of the Acts of 2020:
https://malegislature.gov/Laws/SessionLaws/Acts/2020/Chapter260
View all comments submitted to MA DOI regarding telehealth provisions here:
https://www.mass.gov/service-details/telehealth-information-sessions
Join the Academy's telehealth discussion board: https://www.eatrightpro.org/practice/practice-resources/telehealth/telehealth-discussion-board
View the Academy's Telehealth Policy Stance here.
View the Academy's letter to CMS regarding telehealth here.
