The White House Office on National Drug Policy (ONDCP) supports permanent telehealth prescribing for people with Substance Use Disorders (SUD), according to the issued guidance “Telehealth and Substance Use Disorder Services in the Era of Covid-19: Review and Recommendations” published on June 22, 2022. The report acknowledges that access to telehealth-controlled substances is essential to ensure that people with SUD continue to access care. It points out that people with this disorder are less likely to access healthcare through conventional avenues. The ONDCP concludes that healthcare providers must continue prescribing controlled substances via telemedicine, especially for the vulnerable group of people with SUD.
Telehealth Prescribing Expansion
During the Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) expanded reimbursement for telehealth access as a temporary measure. Simultaneously, the United States Department of Health and Human Services (HHS) introduced healthcare license waivers that allowed healthcare providers to claim reimbursement for services offered across state borders without a license.
The Drug Enforcement Agency (DEA) also made changes to improve access to health care services using telehealth during the PHE. They dropped the requirement for an in-person consultation before prescribing controlled substances via telemedicine. The DEA and the Substance Abuse and Mental Health Administration (SAMHSA) also lowered requirements for the prescription of online SUD. These SUD waivers allowed qualified practitioners to prescribe telehealth-controlled substances without an in-person evaluation. These online SUD waivers will cease when the PHE expires unless they are extended or made permanent.
ONDCP Recommendations for Telehealth Controlled Substances
The ONCDP Guidance highlight four guidelines to permanently expand telehealth services for people suffering from SUD. These recommendations are written for consideration by Congress, federal agencies, and healthcare providers alike:
- Federal Support for Continued Cross Border License Portability. The guidance recognizes the inefficiency of state-by-state changes to practitioners licensing laws and the difficulty some healthcare workers will face if the practicing over state lines licenses falls away. ONCDP guidance suggests that the federal government should encourage licensure reciprocity through Medicare and other federal program beneficiaries to increase opportunities for license portability.
- Make Current Telehealth Prescribing Laws Permanent. ONCDP recommends making the current telehealth prescribing laws permanent, including the waiver of the originating site requirement so that prescribing controlled substances via telemedicine is easily accessible. Before the pandemic, the originating site requirement meant that Medicare patients could not receive telehealth services from a “qualified originating site,” such as a healthcare provider’s office. The ONDCP also suggests that DEA expand and make permanent the SUD waivers to allow for the ongoing prescription of controlled substances via telehealth.
- Increase Funding for Telehealth Technologies. The guidance suggests increasing funding for telehealth platforms, which should be upgraded so that vulnerable populations like those people with SUD, with limited financial means, and with developmental disorders have easier access to telehealth services. Thus, the guidance articulates the importance of equipping platforms with adaptive technology, mobile applications, and public Wi-Fi access to ensure equitable access to telehealth. Therefore, the guidance emphasizes the importance of equipping platforms with adaptive technology, mobile applications, and public Wi-Fi access for equitable access to telehealth. The guidance recommends that providers hire a telehealth coordinator to promote digital literacy training and education among these populations to ensure equitable access to telehealth.
- Continued Use of Telehealth via Social Media Apps. During the PHE, the HHS allowed healthcare workers to use applications like FaceTime and unpaid versions of Skype and Zoom, even though they did not fully comply with the Health Insurance Portability and Accountability Act (HIPAA). Those advocating for the continuance of telehealth-controlled substances for SUD clients and patients want these HIPAA waivers to continue as they point out that access to more options will encourage people to seek help when needed. Appropriately, ONCDP has concerns about healthcare privacy but recommends that all stakeholders must take heed of patient consent, accessibility, data use, and protection when providing telehealth services.
The Bottom Line
For telehealth providers, government recognition of telehealth benefits is good news. However, the fact that the recommendations are specific to online SUD suggests that there may be policy resistance to making the waivers for prescribing controlled substances via telemedicine permanent. If telehealth prescribing waivers lapse when the PHE runs its course, the improvements made to increase access to behavioral health and telehealth services could be significantly slowed.
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