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Shelley Starkey

Opioid Package Expands Telemedicine for Behavioral Health

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New provisions that would expand access to medication-assisted treatment (MAT) via telemedicine were included in the sweeping package of opioid legislation (H.R. 6) that has been passed by Congress and now awaits the President’s signature. The National Council for Behavioral Health applauds Congress for acting on this issue and taking up our recommendations, and remains committed to further expanding access to these evidence-based treatments through telemedicine.

ACCESS TO MAT, PSYCHIATRIC MEDICATIONS VIA TELEMEDICINE

Medication-assisted treatment (MAT), a treatment method that pairs cognitive/behavioral therapies with medication, is considered the gold standard of treatment for opioid addiction, yet many people with opioid dependence or addiction have no access to MAT. It is often more difficult for people living in rural and frontier communities to access MAT and critical psychiatric medications, despite higher rates of opioid addiction in these communities compared to the rest of the population. Additionally, individuals living with mental illness often require psychiatric medications that are categorized as controlled substances to support their mental health. Telemedicine, or the ability to provide health care services remotely with the help of technology, helps to bridge the gaps for these individuals by making treatment available to people in areas without regular access to physicians or other prescribers.

Current regulations prohibit the prescribing of controlled substances over the internet with narrow exceptions for telemedicine. In practice, meeting these exceptions typically requires that the patient be located in a facility registered through the Drug Enforcement Administration (DEA). These regulations stand as a barrier for many behavioral health clinics as they may not meet the narrow requirements for registration with the DEA in all states, leaving some clinics unable to offer patients access to much-needed medications to treat certain mental illnesses and addictions via telemedicine.

In an effort to increase access to MAT and other controlled substances via telemedicine, the Special Registration for Telemedicine Clarification Act, originally introduced by Representatives Earl L. “Buddy” Carter (R-GA) and Cheri Bustos (D-IL), was included in the final opioid package as a direct result of National Council advocacy efforts. The bill, once signed into law by the President, will require the Drug Enforcement Administration (DEA) to finalize a special registration pathway that would open the doors for additional providers to register with DEA in order to expand access to controlled substances prescribed via telemedicine, including MAT medications and certain psychiatric medications, per the terms of the Ryan Haight Act.

FURTHER ACTION NEEDED

While the bill is a step in the right direction for allowing more providers to administer MAT via telemedicine, the final decision of which provider types will be included falls to the DEA and is yet to be seen. The National Council urges Congress to bolster the actions already taken within H.R. 6 by passing the Improving Access to Remote Behavioral Health Treatment Act of 2018 (H.R. 5594). This bill, introduced by Representatives Gregg Harper (R-MS) and Doris Matsui (D-CA), would specifically name community mental health centers and addiction treatment centers as eligible sites to register with DEA to offer patients access to MAT via telemedicine. Although the DEA may choose to include these sites under the provisions included in the opioid package, H.R. 5594 would ensure their inclusion regardless of the DEA’s final regulations.

OTHER INCLUDED TELEMEDICINE PROVISIONS

Among the 70+ bills ultimately rolled into the opioid package are a number of other telemedicine-related measures, including a provision to eliminate requirements under Medicare that patients be at specific originating sites when initiating substance use disorder (SUD) treatment, a bill directing the Centers for Medicare and Medicaid services (CMS) to issue guidance on SUD treatment via telemedicine covered by Medicaid, and a measure to require the Government Accountability Office (GAO) to examine children’s access to Medicaid services and how telehealth may be used to increase such access. The National Council appreciates Congress’ moves to increase access to behavioral health treatment, especially for individuals who have difficulty traveling to providers’ offices due to geographic, medical, and various other barriers.