CurrentmasshealthPolicy N/A

MassHealth Telehealth Policy for Home Health Services - Coverage Criteria

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Guidance allowing MassHealth home health agencies to deliver medically necessary, clinically appropriate home health and continuous skilled nursing (CSN) services via telehealth (telephone or live video) for MassHealth members receiving fee-for-service home health. It defines permitted and prohibited uses, billing, consent, and documentation requirements.

Policy Summary

Payermasshealth

PolicyMassHealth Telehealth Policy for Home Health Services - Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain and document verbal member (and caregiver/guardian if applicable) consent and include telehealth rationale in the visit note.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

90 dayspolicy remains effective after State of Emergency end

Same ratespayment parity

GT modifiertelehealth modifier (home health)

Verbal consentconsent required

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CurrentmasshealthPolicy N/A

MassHealth Telehealth Policy for Home Health Services - Coverage Criteria

Customize your policy alerts

Sign up for all masshealth policy alerts

Know when masshealth releases new policies or updates existing guidance.

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Policy Summary

Payermasshealth

PolicyMassHealth Telehealth Policy for Home Health Services - Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain and document verbal member (and caregiver/guardian if applicable) consent and include telehealth rationale in the visit note.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

90 dayspolicy remains effective after State of Emergency end

Same ratespayment parity

GT modifiertelehealth modifier (home health)

Verbal consentconsent required

Telehealth Coverage Criteria for Home Health and CSN

Permitted telehealth home health and CSN services

Covered via telehealth when ALL of the following are met

Telehealth coverage criteria: Member has provided consent

Obtain and document verbal consent from the member (and caregiver/legal guardian if applicable).

Telehealth coverage criteria: Service does not require any hands-on care

Services that require hands-on care are not allowed via telehealth under this bulletin.

Telehealth coverage criteria: Service pertains to ongoing review of the member's assessment or to the discharge visit

Includes consultative CSN visits and recertification consultative visits when they meet the above conditions.

Telehealth coverage criteria: Service is clinically appropriate and medically necessary and complies with MassHealth Home Health Medical Necessity Guidelines and prior authorization requirements (130 CMR 403.410)

Home health agencies must follow all PA requirements under 130 CMR 403.410 for services delivered via telehealth.

Prohibited uses

Not covered via telehealth (explicit prohibitions)

Prohibited telehealth uses: Any service that requires hands-on care

These services may not be delivered via telehealth under this bulletin.

Prohibited telehealth uses: Any start of care (SOC) assessment visit

SOC assessments must be performed in person and are not allowed via telehealth.

Prohibited telehealth uses: Any resumption of care visit

Resumption of care visits must be performed in person and are not allowed via telehealth.

Prohibited telehealth uses: Any recertification visits when hands-on care is required

Recertification visits that would require hands-on care may not be delivered via telehealth; consultative recertification via telehealth is allowed when it meets permitted criteria.

Telehealth visits for home health may only be used when all bulletin conditions are met. Specifically, services delivered via telehealth must be ones for which the member has provided consent, must not require any hands-on care, and must pertain to an ongoing review of the member's assessment or to the discharge visit. Providers must also ensure services delivered via telehealth are clinically appropriate, medically necessary, and compliant with the MassHealth Home Health Medical Necessity Guidelines and applicable prior authorization requirements under 130 CMR 403.410.

Services that require hands-on care are explicitly excluded from telehealth delivery. Any service that requires the provider to perform physical, hands-on interventions cannot be provided via telephone or live video and therefore would not meet medical necessity under this telehealth guidance.

Billing, Modifiers, and Rate Guidance

Telehealth modifier instructionModifier

GT	Modifier to include when submitting claims for home health services delivered via telehealth (do not use GT for CSN services).

Rate regulations referencedmixed

101 CMR 350.00	Home Health Services rates referenced (payment parity with in-person).
101 CMR 361.00	Rates for Continuous Skilled Nursing Services referenced (payment parity with in-person).

Provider Requirements and Actions

Prior Authorization

Prior authorization required for telehealth home health services

Home health agencies must follow all prior authorization requirements under 130 CMR 403.410 for services delivered via telehealth and must meet all requirements under the MassHealth Home Health Medical Necessity Guidelines.

Note

Obtain and document informed verbal consent

Obtain and document member (and caregiver/guardian if applicable) verbal consent before initiating telehealth home health services; provide the member with information about what a telehealth visit entails, expectations for the member and provider, privacy considerations, and the right to revoke consent at any time.

Document verbal consent in the member’s record prior to starting telehealth services.
Inform the member about visit content, expectations, privacy considerations, and revocation rights.

Key Definitions

Telehealth visit for home health — definition

DefinitionA consultative or review visit delivered via telephone or live video for which the member has provided consent, does not require hands-on care, and pertains to ongoing assessment review or discharge (not start of care, resumption, or recertification visits that require hands-on care).

Included servicesConsultative CSN visits and recertification consultative visits when they meet the conditions above; billed using the same procedure codes as face-to-face visits with units reflecting visit length (e.g., 30 minutes = two units).

Consent requirementMember must provide consent for the telehealth visit; obtain and document verbal consent (member and caregiver/legal guardian if applicable).

Hands-on care exclusionTelehealth visits may not be used for any service that requires hands-on care, including start of care (SOC) assessment visits or resumption of care visits.

Discharge and ongoing reviewTelehealth may be used for visits that pertain to ongoing review of the member's assessment or for the discharge visit, provided all other criteria are met.

Policy Background and Scope

MassHealth introduced telehealth flexibilities to allow home health agencies to deliver clinically appropriate, medically necessary home health services via telephone or live video during the COVID-19 emergency. This bulletin clarifies that, notwithstanding other regulations (including physical presence requirements in 130 CMR 403.000), MassHealth will reimburse home health services delivered through telehealth when they meet the bulletin’s standards. Agencies must follow prior authorization requirements in 130 CMR 403.410, meet the MassHealth Home Health Medical Necessity Guidelines, document privacy considerations, and obtain member consent when using telehealth for ongoing assessment reviews or discharge visits.