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Reimbursement & Policy

Updated June 16, 2021

Maturity Model

The Maturity Model provides high-level guidance for advancing telehealth capabilities. It’s the “what” we hope to achieve. This is the model for Reimbursement & Policy; view the full Maturity Model.

Sustainability Curve 1:
Covid-19 Response
Sustainability Curve 2:
CARE INTEGRATION
Sustainability Curve 3:
EXPANSION & SUSTAINABILITY
Liberal to support COVID-19 delivery of careFFS reimbursement supports phone and video; partial patient enablement support; HRSA, FTCA, other regulatory flexibilitiesSustainable reimbursement HRSA modernization

Drivers of Success

The Drivers of Success represent “how” to improve performance. These are the drivers for Reimbursement & Policy; view the full Driver Diagram.

  1. Expanded reimbursement guidelines at state and federal levels
  2. Advocacy for HRSA and other regulatory agencies to support sustainability

Expanded Reimbursement Guidelines

The COVID-19 crisis led to a rapid expansion of telehealth reimbursement. Reimbursement policies continue to evolve, and differ across state lines.

  • Resource

    MassHealth Provider Bulletins

    MassHealth issues provider bulletins as needed to communicate procedures, reminders, and other information to MassHealth providers.

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Advocacy to Support Sustainability

For health centers to be positioned well for sustained reimbursement and support for telehealth, leaders will need to focus on the following tactics, in partnership with their state’s Primary Care Association:

  • Monitor closely the developments in industry, policy, and reimbursement that will or may impact telehealth goals
  • Measure visit access, patient satisfaction, and equity with telehealth to support advocacy
  • Capitalize on expanded reimbursement guidelines and build sustainable billing processes for all appropriate care team members
  • Resource

    MassHealth COVID-19 Resources for Providers

    A resource for providers to find up-to-date COVID-19 publications and other guidance

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  • Resource

    MassHealth Telephone & Internet Connectivity for Telehealth

    A resource from MassHealth to help providers guide members who have questions about engaging in services through telehealth

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  • Resource

    CMS Telehealth Information

    Information about telehealth from the Centers for Medicare and Medicaid Services

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