State and Federal Approaches to Decreasing the National Opioid Epidemic

Original Source: Center for Connected Health Policy

The Center for Medicare and Medicaid Services recently released a State Medicaid Director letter addressing findings within the President’s Commission on Combating Drug Addiction and the Opioid Crisis’ final report issued November 1, 2017. The letter identifies many of the strategies supported and emphasized within the President’s Commission report along with some of the potential benefits associated with implementing such strategies. State Medicaid programs are encouraged to consider adopting some of the strategies which are presented as potential approaches to decrease the national opioid epidemic.

According to the letter, the President’s Commission is supportive of many telehealth-related approaches aimed at containing and reducing the nation’s opioid epidemic. Examples of these include:

  • Integrating connections between prescription drug monitoring programs (PDMPs) and electronic health records (EHRs) or the health information exchange (HIE) to reduce the provider burden
  • Linking opioid use risk assessment screening data into EHRs or HIEs to support data-driven approaches to treatment and prevention
  • Coordinate care using telemedicine and telepsychiatry

The letter emphasizes that States can use existing authority over funding to support health information technology efforts aimed at expanding health record connectivity and interoperability as a means to decrease the national opioid epidemic. The President’s Commission also reminded States that they are not required to submit a state plan amendment to begin delivering covered Medicaid services via telehealth, so long as those services are not reimbursed at a rate different than in-person.

While States incorporate these strategies into their Medicaid programs, Congress continues the decision-making process for proposed Federal responses to the opioid epidemic. Last month, 59 Federal bills related to the national opioid epidemic were analyzed for cost estimates by the Congressional Budget Office. Fifty-eight bills would increase net spending no more than $2.5 billion or on-budget deficits by no more than $5 billion over 10-year periods. Among these, bills incorporating telehealth approaches were particularly cost competitive. HR 5603, the Access to Telehealth Services for Opioid Use Disorders Act, would increase direct spending by $11 million between 2019-2028 while HR 5483, the Special Registration for Telemedicine Clarification Act of 2018, would increase spending by less than $500,000 between 2019-2023.
To review the documents mentioned, use the following links to the full State Medicaid Director letter and the Congressional Budget Office’s cost estimate of proposed opioid legislation.

Opioid Bills Currently in Congress

HR 6 – The SUPPORT for Patients and Communities Act
Congressman Walden (R-OR)
HR 6 makes several changes to state Medicaid programs to address opioid and substance use disorder, as well as alters Medicare requirements to address opioid use.  Among the changes, it would authorize Medicare beginning in 2020 to waive through rulemaking any of the geographic and originating site reimbursement restrictions for the treatment of an opioid use disorder or a mental health disorder that is co-occurring with an opioid use disorder under certain circumstances.  Eligible services will be identified by the Secretary.  Newly eligible facilities under this section would not qualify for the facility fee.  The bill also requires the Secretary to submit a report to Congress within five years on the impact of any non-application of Medicare’s telehealth requirements.  The bill transfers $3,000,000 of CMS funds to remain available for purposes of carrying out the paragraph. (Passed House)

HR 5594 – Improving Access to Remote Behavioral Health Treatment Act of 2018
Congressman Harper (R-MS) & Congresswoman Matsui (D-CA)
HR 5594 amends the definition of telemedicine to allow DEA registered community mental health centers to qualify as an eligible site where a patient could receive an initial prescription for a controlled substance via telemedicine, if other conditions are met.  Currently, only DEA registered clinics or hospitals are allowed to serve as originating sites for the prescription of a controlled substance over telemedicine.  The legislation also outlines certain circumstances where the Attorney General could determine that registration of qualified community mental health centers to administer controlled substances would be inconsistent with public interest. (5/22/18: Referred to the Subcommittee on Crime, Terrorism, Homeland Security, and Investigations.)

HR 5603 – Access to Telehealth Services for Opioid Use Disorders Act
Congresswoman Matsui (D-CA)
HR 5603 authorizes Medicare beginning in 2020 to waive through rulemaking any of the geographic and originating site reimbursement restrictions for the treatment of an opioid use disorder or a mental health disorder that is co-occurring with an opioid use disorder under certain circumstances.  Eligible services will be identified by the Secretary.  Newly eligible facilities under this section would not qualify for the facility fee.  The bill also requires the Secretary to submit a report to Congress within five years on the impact of any non-application of Medicare’s telehealth requirements.  The bill transfers $3,000,000 of CMS funds to remain available for purposes of carrying out the paragraph.  (6/12/18: House – Placed on Union Calendar)

HR 5483 – Special Registration for Telemedicine Clarification Act of 2018
Congressman Carter (R-GA)
HR 5483 Requires the Attorney General to promulgate an interim final regulation within 1 year after the enactment of the bill that would specify the limited circumstances in which a telemedicine special registration may be issued and the procedure for obtaining such registration.  The Attorney General is currently required to promulgate regulations related to the telemedicine special registration process, but has no time limit as to when a final rule must be issued.  (6/13/18: Passed House; In Senate Committee on Health, Education, Labor and Pensions)

S 2680 – The Opioid Response Act of 2018
Senator Alexander (R-TN)
S. 2680 Requires the Attorney General to promulgate final regulations within one year after the enactment of the bill that would specify the limited circumstances in which a special telemedicine registration may be issued and the procedure for obtaining such registration.  It also outlines a specific timeline for the proposal and comment period for the regulation. (5/7/18: Placed on Senate Legislative Calendar)

S. 2901 – Expanding Telehealth Response to Ensure Addiction Treatment Act (eTREAT Act)
Senator Thune (R-SD)
S. 2901 exempts Medicare’s telehealth originating site and geographic restriction from services provided for purposes of the treatment of substance use disorder.  New sites would not qualify for a facility fee.  The bill would become effective Jan. 1, 2019. (5/22/18: Introduced & referred to Sen. Committee on Finance)

S. 2904 – Medicaid Substance Use Disorder Treatment via Telehealth Act
Senator Carper (D-DE)
S. 2904 requires the Centers for Medicaid and Medicare (CMS) to issue guidance to States on federal reimbursement for furnishing services and treatment for substance use disorders under Medicaid using telehealth services on a general scale, but they would also be required to specifically address school-based health centers as well as other high risk populations. (5/22/18: Introduced & referred to Sen. Committee on Finance)

S. 2910 – Telehealth for Children’s Access to Services and Treatment Act (TeleCAST Act)
Senator Roberts (R-KS)
S. 2910 requires the Comptroller General to evaluate children’s access to services and treatment for substance use disorders, including State Medicaid options for expanding providers using school-based telehealth services. The Secretary would also be required to issue a report to Congress identifying best practices and potential solutions for reducing barriers to using telehealth services to treat substance use disorders. (5/22/18: Introduced & referred to Sen. Committee on Finance)

S. 3042 – Agriculture Improvement Act of 2018
Senator Roberts (R-KS)
S. 3042 would specify that 20% of the amount of money allocated to distance learning and telemedicine grants be set aside for substance use disorder treatment services, unless there is not sufficient qualified applicants.  (In Senate Committee on Agriculture)