Massachusetts Seeks Insurance Coverage for Mobile Integrated Health Programs

Massachusetts is considering legislation requiring insurance coverage for mobile integrated health (MIH) programs, which expand emergency medical services (EMS) to include community-based care. MIH programs combine telemedicine and preventive healthcare to provide medical, behavioral, and chronic disease management outside traditional hospital settings, potentially reducing unnecessary emergency visits and improving patient outcomes. A financial analysis by the Center for Health Information and Analysis (CHIA) supports the cost-effectiveness and health equity benefits of these programs, estimating a moderate premium increase over five years if mandated coverage is enacted.

The Massachusetts Health and Hospital Association (MHA) backs the legislation as a way to enhance community care access, while the Massachusetts Association of Health Plans (MAHP) raises concerns over mandated reimbursement parity with facility-based care, warning it may lead to higher healthcare spending and premiums. The legislation stipulates that coverage must include services provided through state-approved MIH programs, with payment rates and out-of-pocket costs comparable to those for similar services delivered in healthcare facilities. Currently, 11 MIH programs operate statewide, supported by grants and hospital funds, which MHA terms unsustainable without insurance reimbursement. The proposed bills aim to formalize insurance coverage, but MAHP highlights potential underestimations in cost and utilization impacts, emphasizing the need for data-driven reimbursement models that reflect service setting and intensity.