It is noteworthy that just one week prior to the official announcement of the Public Health Emergency caused by COVID-19 in march of 2020, the AMA released a statement that 75% of all healthcare could be delivered by telehealth. See COVID-19: Tipping Point in Telehealth Policy. The news was surprising for many, but the subsequent unveiling of telehealth legislation as a ready-made solution for the pandemic has now made it clear that the AMA statement was correct.
Today, we can see that the AMA predictions were not only accurate but visionary. Even in these politically difficult times, US legislators have been steadily bringing about the needed telemedicine and telehealth legislative change to continue the widespread deployment of telehealth to all communities, not only those in rural areas. As previously reported at TBHI in UPDATE: Telemedicine Across State Lines Post-Pandemic and Telehealth Reimbursement: Billing Medicare & Private Payers, US legislators are diligently crossing the aisle to create lasting telehealth legislation in areas that have previously been barriers to the expansion of telehealth.
This week’s telehealth legislative update includes current legislation to reintroduce CARA, the Tele-Mental Health Act, and the TREATS Act, as well as to eliminate the “X Waiver.”
The Comprehensive Addiction & Recovery Act (CARA) 3.0 bill, was introduced last week by Senators Rob Portman (R-OH), Sheldon Whitehouse (D-RI), Shelley Moore Caputo (R-WV), Amy Klobuchar (D-MN), and Jeanne Shaheen (D-NH). The bill was originally submitted Last December but failed. It is written to change funding authorization levels established in the 2016 CARA legislation in 2016 and include digital health measures to address the US Opioid Public Health Emergency. The bill is designed to provide access to both prevention and treatment services such as empowering state prescription drug monitoring programs.
The bill allows Medicare professionals to prescribe medications for substance abuse treatment services by telephone telehealth after a telephone telehealth session or in-person exam. The revised bill removes previous restrictions on the number of patients that can be treated with buprenorphine and methadone per provider. It allows the use of telehealth platforms, authorizes research into pain management alternatives and long-term treatment outcomes that can include mHealth and telehealth services. It also established a pilot program to study the use of mobile methadone clinics in rural and underserved areas. In total, it would set aside $785 million to fund a much more comprehensive range of treatment programs and resources.
Tele-Mental Health Improvement Act
Another resurrected bill that will be circulated is the Tele-Mental Health Improvement Act (HR 2264), submitted by US Representatives David Trone (D-MD) and Brian Fitzpatrick (R-PA). This bill would establish payment parity for private health plans covering telebehavioral health programs.
Trone explained in a press release, “During COVID, we’ve seen how effective and safe tele-mental health appointments are for folks who need access to mental health care from their own home…. This bill works to continue expanding access to tele-mental health and eliminate barriers to mental healthcare to ensure that every American can access high-quality care no matter where they live.”
Extending Telehealth Waivers Permanently
As part of other ongoing efforts to expand access to telehealth for mental health and substance abuse treatment, Senator Tina Smith (D-MN) and Lisa Murkowski (R- AK) introduced a new bill, S660. This bill requires private insurance health plans to cover telehealth as well as in-person services for mental health and substance abuse disorders. For more information on telehealth legislation and private payers, see Telehealth Coverage Rollbacks Are Increasing.
Reintroducing The TREATS Act
Another important Act, The Telehealth Response for E-prescribing Addiction Therapy Services Act (TREATS), was reintroduced in the House and Senate after having not been successfully passed last year. Waivers put in place eliminating the in-person exam requirement and permitting doctors to prescribe particular controlled substances via telehealth in medication-assisted treatment programs (MAT) have greatly enhanced addiction treatment. The TREATS Act would make these waivers permanent.
The TREATS Act would also expand coverage for mHealth services and audio-only treatment. Per US Rep. David Trone (D-MD), “The telehealth waivers implemented for COVID-19 are innovations long needed by people seeking treatment or in recovery. The TREATS ACT will allow us to make these life-saving addiction policies permanent.” This Act has many supporters, including the American Society for Addiction Medicine, National Safety Council, Community Catalyst, Boston Medical Center, National Association of Addiction Treatment Providers, Shatterproof, and The Kennedy Forum. For the 2020 TREATS Act details, see Telehealth Act HR 7992: Telehealth Legislation Combines Nine Separate Bills.
Eliminating the “X Waiver”
Additional telehealth legislation re-introduced recently by Senator Murkowski and Senator Maggie Hassan ( D-NH) involves the Mainstreaming Addiction Treatment Act (S 445), which would eliminate the ” X waiver,” a registration requirement for prescribing certain scheduled drugs in medication-assisted treatment. As mortality rates for substance abuse-related disorders continue to increase and the opioid crisis worsens, Murkowski stated, “It is critical that we ensure that Americans struggling with these issues have access to safe, effective, life-saving treatment. This legislation will expand access to medication-assisted treatment and eliminate barriers to important behavioral health and community-based therapies. Access to care is the key to solving any medical issue – the substance use epidemic is no different.”
For more information on medication-assisted treatment by telephone, see Telephonic Telehealth Opioid Treatment Found Effective.
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Have More Specific Questions about COVID-19 Telehealth Best Practices?
While we all know how important it is for our services to continue with COVID-19 telehealth best practices, many professionals are unsure of how to proceed with the multiple legal and ethical foundation issues of relevance to telehealth. PLUS, ongoing legal and regulatory changes must be integrated. To help practitioners and their administrators make sense of COVID-19 telehealth best practices as applicable to working from home and as a community service, TBHI is honored to be working with the California non-profit, Telehealth Institute to bring you this up-to-date, FREE informational course designed specifically for behavioral professionals.