Senate Passes Opioid Crisis Response Package With Changes for Telehealth

Original Source: Center for Connected Health Policy

Last week, the Senate voted on H.R. 6, the Opioid Crisis Response Act of 2018, which passed with a 99-1 vote on Monday, September 17th. The package of bills is an attempt to combat the opioid epidemic and includes over 70 bills providing for research, treatment, and prevention related to opioids and substance use disorder by making changes to state Medicaid programs and Medicare requirements. Included are several telehealth provisions for improving patient access and easing the exchange of critical data.

The major telehealth focused provisions include:

  • Sec. 1415 Regulations Relating to Special Registration for Telemedicine: Within one year, the Attorney General must promulgate final regulations specifying the limited circumstances in which a special registration to use telemedicine to treat substance use disorder may be issued and the procedure for obtaining a special registration.
  • Sec. 2102– Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder and Substance Use Disorders: Amends Medicare Part B by establishing the home of an individual as an eligible originating site for telehealth services to treat substance use disorders. Also removes all geographic requirements for telehealth eligible individuals with a substance use disorder for purposes of treatment of the disorder. All other Medicare telehealth restrictions would still apply, including provider type and service limitations.
  • Sec. 2203– Medicaid Substance Use Disorder Treatment Via Telehealth: Within one year, the Secretary of Health and Human Services must issue guidance on state options for the federal reimbursement of expenditures used to furnish services and treatment for substance use disorders using telehealth and to direct providers using the hub and spoke model. Also requires a report on reducing the barriers to using telehealth services and remote patient monitoring for pediatric populations under Medicaid.

Other provisions in H.R. 6 that include telehealth:

  • Sec. 1411 Career Act: Establishes a grant for evidence-based programs to help individuals in recovery from substance use disorders transition from treatment to independent living and the workforce. Use of the funds includes implementing or utilizing “innovative technologies” including telemedicine.
  • Sec. 1417– Loan Repayment for Substance Use Disorder Treatment Providers: Allows eligible health professionals providing substance use disorder treatment services to enter into contracts under the National Health Service Corps Loan Repayment Program. As part of the requirement for the contract, professionals must provide directly, or through telehealth, counseling to assess the psychological and sociological background of patients, to contribute to the appropriate treatment plan for the patient, and to monitor progress.
  • Sec. 1501– Study on Prescribing Limits: Within two years, The Secretary of Health and Human Services, along with the Attorney General, must submit a report on the impact of Federal and State laws and regulations that limit the length, quantity, or dosage of opioid prescriptions. The report should address, among other things, whether electronic prescribing or telemedicine mitigate any burden for prescribers of opioids or prescribers of treatments for opioid use disorders.
  • Sec. 1505– Preventing Overdoses of Controlled Substances: Requires the CDC Director to carry out, expand, and provide training, assistance, and grants to states for improving new or currently operating prescription drug monitoring programs. Such improvements include encouraging users to register in the program, improving access to data among states and providers, and establishing a notification system for misuse or abuse, among other things.
  • Sec. 1508– Jessie’s Law: Requires the Secretary to consult with stakeholders and establish best practices for determining circumstances when information provided by a patient to a health care provider regarding a history of opioid use disorder should, at the patient’s request, be prominently displayed in the patient’s medical records, including the electronic health record.
  • Sec. 2112 Testing of Incentive Payments for Behavioral Health Providers for Adoption and Use of Certified Electronic Health Record Technology: Provides incentive payments to behavioral health providers for the adoption and use of electronic health record technology.
  • Sec. 2210– Better Data Sharing to Combat the Opioid Crisis: Permits the State agency administering the state plan for Medicaid managed care organizations to have reasonable access to one or more prescription drug monitoring program databases that are administered or accessed by the state.

The bill package was passed by the House this June. After the House and Senate have reconciled their versions, the package will still require a vote from the President. More information on the bill package is available on the Congress website.
The Senate passage of H.R. 6 also coincides with the week President Trump has deemed to be Prescription Opioid and Heroin Epidemic Awareness week (Sept. 16-22) and prompted the release of several resources by the U.S. Department of Health and Human Services (HHS) on the opioid crisis, including a clarification of a DEA statement on the use of telemedicine for purposes of prescribing buprenorphine for medication assisted therapy (MAT).  The exception exempts “DATA 2000-waivered practitioners from the in-person medical evaluation requirement as a prerequisite to prescribing via the internet if the practitioner is engaged in the ‘practice of telemedicine’” as long as both the provider at the originating (patient) site and the provider at the distant site are DEA registered and licensed in the state the patient is located.  HHS provides a clinical scenario in an effort to provide a real world example when this exception would apply.
To learn more about HHS resources on combatting the opioid crisis,
visit the HHS website on the opioid epidemic.