Most of you are probably aware that Congress plans on enacting legislation to address the opioid epidemic very soon. The House of Representatives alone is considering more than 55 bills. The Energy and Commerce Committee, which is spearheading those efforts, has repeatedly indicated they plan to have a package to the floor for a vote by Memorial Day. In contrast, the Senate HELP Committee has given a looser timeline of prior to the Congressional August recess.
Although each chamber’s bills are different, there is one area of common ground: They both agree that increasing the use of telehealth in substance use disorder (SUD) treatment is necessary. Telehealth has “[emerged] as a valuable weapon to confront the rising tide of opioid deaths” as we noted back in January.
This isn’t a surprise considering that Congress has already offered support for telehealth in other areas, such as chronic disease management, as indicated by the passing of the Bipartisan Budget Act of 2018 (BBA). If you need a refresher on telehealth provisions under the BBA, feel free to reference one of my earlier posts.
As they did with the Congressional budget deal, advocates of telehealth will likely claim its inclusion in the fight to address the ongoing opioid crisis as a victory, but keep in mind that the federal government is not yet completely committed to it as detailed here. Therefore, Congress is taking a multifaceted approach to curb the overprescribing of opioids and increase access to treatment for those with SUD that includes a limited role for telehealth.
The House Energy and Commerce Committee hasn’t finalized their package yet (which isn’t surprising considering they have more than 55 bills to sort through). Supporters of telehealth hope that one of the proposals they passed out of the health subcommittee, “Access to Telehealth Services for Opioid Use Disorders Act” is included in the final legislation. The bill is still in discussion draft form so the final language might change, but I think it’s safe to say that most of it, if not all, will remain intact. This bill would allow the Secretary of the Department of Health and Human Services (HHS) to waive certain Medicare telehealth restrictions allowing for payment when a practitioner is treating an opioid disorder or a concurrent mental health disorder. The requirements that can be waived include:
- criteria to qualify as an originating site,
- geographic limitations, and
- other limitations on the use of store-and-forward technologies
To be eligible to apply, one’s waiver must be budget neutral, improve the quality of care and increase access to treatment services for those with SUD. The bill also requires the HHS Secretary to issue an evaluation report within five years.
On the other side of the Capitol, the Senate’s Opioid Crisis Response Act of 2018, directs the Attorney General to issue regulations regarding specific instances in which special registration for telemedicine under the Controlled Substances Act may be granted. These regulations must be published within a year following the bill’s enactment. Issuing these regulations will provide more authority for the use of telemedicine by online pharmacies and clarify instances in which a practitioner working for or on behalf of the Indian Health Service can engage in the practice of telemedicine. Access to telemedicine for those working with indigenous populations is vital because they are often in acutely remote locations and have limited access to traditional care.
I’m optimistic that the final agreement that reaches the President’s desk will include telehealth provisions. If the House proposal is enacted, it has the potential to progress the argument for wider telehealth adoption and reimbursement by CMS. But, and this is a strong but, only if the evaluation report is a positive one.
The House proposal will be assessed based on its ability to reduce expenditures without sacrificing quality and ability to enhance access to behavioral health and SUD services for those addicted to opioids.
If the proposal proves to do all of that, the evidence base for telehealth in the treatment of behavioral health may be so compelling that broad reimbursement by CMS could follow.