Telehealth & Reimbursement for MNT

Telehealth & Reimbursement for MNT

UPDATED SEPTEMBER 30, 2021

MA Division of Insurance

MA DOI is the state regulatory agency which creates and enforces regulations for the insurance marketplace in Massachusetts. MA DOI solicits public comments when updating existing regulations, and when there is ambiguity in a law as written and the agency must provide further guidance to insurers, the insured and organizations involved in providing services. In addition, MA DOI takes complaints from consumers on all matters related to the insurance marketplace, insurance companies and policies and organizations providing services to insured individuals.

Specific to telehealth, MA DOI is responsible to consumers, health care institutions and providers (public, private, state) and health insurers (MassHealth, Group Insurance Plan, third party/private payers). MA DOI held five telehealth information sessions between February and April 2021 to solicit comments on the implementation of telehealth provisions within Chapter 260 of the Acts of 2020, the law which established permanent coverage of telehealth mental health services, set time and reimbursement parameters for primary care and chronic disease management and called for a study of the use and cost of telehealth services during the pandemic.

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

 

Telehealth FAQs

Can nutrition visits still be provided via telehealth?

Governor Baker announced the end of the emergency order initially put in place on March 10, 2020, which provided coverage + payment/rate parity for telehealth services via all types (modalities) of communication, including telephone, on June 15, 2021. Per the telehealth law which took effect on January 1, 2021, we have 90 days from June 15, 2021 for continued payment/rate parity for all types of telehealth services via all types of communication. As of September 13, 2021, there is no guarantee of rate parity for nutrition services provided by telehealth.

View MA DOI update on telehealth provisions here.

Is this decision final?

Yes and no. There is a clause that allows for payment/rate parity for "chronic disease management and primary care services" for two years from the date the law took effect (January 1, 2021 through January 1, 2023). Although the law as written does not mention MNT, nutrition services or RDNs/LDNs specifically, MNT providers work in chronic disease management, thus it should be safely assumed that MNT services provided by telehealth will be reimbursed through January 1, 2023. The main concern is the rate at which these services will be reimbursed. 

The September 7th announcement (see above link) to insurance carriers mandates coverage of all appropriate services provided via teleheath but includes the following language: "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 . . ."

What is MAND doing to help advocate for ongoing coverage of and payment/rate parity for nutrition services provided via telehealth?

MAND submitted written comments to MA DOI as part of the agency’s virtual information sessions for organizations and associations impacted by telehealth provisions in the telehealth law. In addition to submitting comments, MAND requested and was granted a meeting with MA DOI staff. 

For this meeting, MAND highlighted the following: (1) The academic and professional requirements to qualify for the ‘RDN’ credential; (2) continuing professional educational requirements of RDNs; (3) MAND’s work with the legislature to pass the law creating the voluntary practice license and Licensed Dietitian/ Nutritionist (LDN) designation; (4) medical nutrition therapy (MNT) and its use, effectiveness and cost-effectiveness in disease prevention, management, and treatment; (5) costs of chronic disease in the U.S. and in MA; and (6) how chronic conditions are contributing to poor COVID-19 outcomes, as evidenced by over a year of data. 

Regarding MNT, we described: (1) RDNs’ work in a variety of settings to prevent, manage and treat a variety of chronic conditions; (2) Medicare’s coverage of MNT for certain chronic conditions via secure video-conferencing services in the outpatient setting without copay since 2011; and (3) MassHealth’s and many third-party payers’ coverage of MNT, including in the private practice setting, most often with copay. 

We discussed barriers to the utilization of MNT services prior to the pandemic, including: (1) lack of awareness of the benefits of MNT; (2) lack of health insurers’ coverage of MNT; (3) the inability to locate or travel to and/ or costs associated with travel to the location of qualified dietitians; (4) patients’ and dietitians’ lack of appropriate secure videoconferencing tools; and (5) restrictive pre-COVID telehealth requirements. 

We next described the benefits to patients after the allowance for expanded means of providing MNT via telehealth since the declaration of the state of emergency in March 2020 (e.g., audio-only): (1) reduced mobility and transportation and related cost barriers faced by patients; (2) reduced “no-show” rates; and (3) increased access to MNT, especially among patients with limited or no broadband or without laptop, tablet or smart phone. We underscored that receiving MNT is especially important for reaching those most at-risk patients who suffered from chronic health disparities even prior to the pandemic.

View MAND’s written statement to MA DOI here.

What is the next step?

Further provisions may be issued by MA DOI, at which time there may be time for public comments. The September 7th announcement did not allow for public comments. MAND will continue to advocate for payment/rate parity for nutrition visits provided via all modalities of telehealth and will alert the membership when there are opportunities for members to provide comments to MA DOI. Members are also encouraged to visit MA DOI's website to stay informed on any new provisions: https://www.mass.gov/orgs/division-of-insurance

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?

Although the specifics of the reimbursement of nutrition visits provided via telehealth are still unclear at this point, per MA DOI credentialed providers need to offer both in-person appointments and telehealth appointments in order 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.


Interested in the Academy's Telehealth Policy Stance?

Academy Telehealth Policy Stance
1. Nutrition care serices are critical to comprehensive health care delivery systems and should be covered when provided via telehealth under the same coverage and payment policies as in-person care.
2. Patients should have coverage for telehealth delivered via audio-only if they cannot effectively access or utilize audio-visual technologies.
3. In declared emergency situations when access to qualified providers is otherwise severely impacted, the modification of certain consumer protection policies such as licensure and HIPAA requirements may be appropriate.
4. Public funding and support for broadband internet, technolog, digital literacy education and language services are necessary to address racial, economic, and geographical health disparities and to address disabilities.
5. Publicly funded research on teleheath should be nationally representative and include a wide variety of services and providers, including nutrition care services provided by registered dietitian nutritionists and nutrition and dietetics technicians, registered.

View the Academy's Telehealth Policy Stance here

Interested in what the Academy submitted to CMS related to MNT provided via telehealth?

View the Academy's letter to CMS here.

Here is an excerpt from the 18-page letter:

"Telehealth and Other Services Involving Communications Technology (Section II.D)
The Acacemy recognizes the value of reducing barriers to adequate mental health services. In similar vein, the Academy encourages CMS to continue beneficiary access to Medical Nutrition Therapy (MNT) services via audio-only communication. We believe that CMS’s rationale for continuing audio- only access to mental health services squarely aligns with the rationale for audio-only MNT services. MNT services, like mental health services, “primarily involve verbal conversation where visualization between the patient and furnishing physician or practitioner may be less critical to provision of the service.” 3

The U.S. has been and continues to pay a high price for overlooking the importance of nutrition in both preventing and treating costly and chronic conditions such as diabetes, cardiovascular disease, chronic kidney disease, obesity, and hypertension. The CDC estimates that six out of 10 Americans has at least one chronic disease4 and according to the CMS Chronic Conditions Dashboard, nearly 70% of Medicare Beneficiaries currently have one or more chronic conditions, accounting for nearly 90% of Medicare spending.5 MNT provided by the RDN is a widely recognized component of medical guidelines for the prevention and treatment of many chronic diseases and conditions. It is critical that beneficiaries have access to timely, safe, and effective nutrition services that can improve their health and better manage their chronic diseases.


The Academy urges CMS to extend audio-only coverage to RDNs providing MNT services when audio-only telehealth services are appropriate, based on individual patient needs. We support CMS’s belief that two-way, audio/video communications technology is the appropriate, general standard for telehealth services. There are, however, situations where the availability of telehealth services for nutrition care via audio-only communications would increase access to care. Beneficiaries located in areas with poor broadband infrastructure and those who either do not wish to use, do not have access to, and/or are unable to utilize devices that permit a two-way, audio/video interaction, are unable to fully access their MNT benefit or will often go without the service to which they are entitled. And much like services for mental health, the need for coverage of audio-only telehealth visits by RDNs is unlikely to disappear once the PHE has ended. Lastly, we acknowledge and agree with CMS that there are guardrails and parameters that should be put in place to guide audio-only encounters.


The Academy believes the continuation of coverage for synchronous audio-only telenutrition visits based on patient limitations, technical challenges, and patient needs post-PHE will create a more connected model of nutrition service delivery that will improve access for those individuals who may not otherwise be able to receive care.”

_______________________________
3 https://www.federalregister.gov/documents/2021/07/23/2021-14973/medicare-program-cy-2022-payment-policies-underthe-physician-fee-schedule-and-other-changes-to-part | Accessed August 19, 2021.
4 CDC: National Center for Chronic Disease and Health Promotion Center, Chronic Disease Interactive Data Applications. https://www.cdc.gov/chronicdisease/pdf/infographics/chronic-disease-H.pdf | Accessed August 16, 2021.
5 Medicare Chronic Conditions Dashboard https://portal.cms.gov/wps/portal/unauthportal/unauthmicrostrategyreportslinkevt=2048001&src=mstrWeb.2048001&doc umentID=FE7B7B934CB8184F214E39982EB1F435&visMode=0&currentViewMedia=1&Server=E48 V126P&Project=OIPDABI_Prod&Port=0&connmode=8&ru=1&share=1&hiddensections=header,path,dockTop,dockLeft,footer | Accessed August 16, 2021.


 

Annual Meeting

Annual Meeting

2022 ANCE will be virtual. Thursday and Friday, March 24th & 25th. 

Public Policy

Public Policy

Do You Want to Make a Difference for Your Profession and Your Community?  Visit our Public Policy Section.