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News & Press: Health Plans

Changes to Payment Methodologies for Psychologists in Tufts Health Plan Network

Tuesday, October 18, 2016   (0 Comments)
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Professional Affairs News  
 
Changes to Payment Methodologies for Psychologists in 
Tufts Health Plan Network

MPA holds regular meetings with health plans to advocate for positive changes, voice members' concerns, educate the insurers about research and innovative evidence-based assessments, treatments, and standards of care, and to learn about initiatives and issues the health plans are working on. We also work to ensure compliance with state and federal laws and regulations.
Over the past two years, MPA has communicated our concerns over the processes used by Tufts Health Plan to set rates for psychological services. As a result of these ongoing efforts, we are pleased that Tufts recently informed us of positive upcoming policy changes, and that they agreed we could share these encouraging developments with MPA members.
In the course of a recent meeting with Tufts Health Plan, we learned that they will be making significant changes to the payment methodologies for psychologists. Specifically, Tufts Health Plan will be moving to a relative value based scale. One effect of this conversion is the elimination of payment differentiation between codes. For example, reimbursements for 60-minute psychotherapy sessions (CPT 90837) will now be higher than those for 45-minute psychotherapy sessions (CPT 90834). It has long been an MPA advocacy priority to convince Tufts Health Plan to change the process for setting their rates, especially for those sessions, so we are pleased to announce this incremental policy improvement. Tufts Health Plan will send more information to contracted providers to clarify this and other changes in the coming months. We also will keep you updated as we learn more. It is our understanding that Tufts Health Plan expects to make these changes effective January 1st for all Commercial Products and Senior Products plans.
We expect that these changes will be very positive for Massachusetts psychologists and we hope that it will help you in providing the best possible care for your patients.

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