Beginning January 1, 2023, Medicare will cowl telehealth-based remedy providers delivered by federally-accredited opioid remedy packages (OTPs), generally known as “methadone clinics.” This new reimbursement is meant to additional the Facilities for Medicare and Medicaid Companies’ (CMS) aims in its 2022 Behavioral Well being Technique, with a selected concentrate on enhancing entry to substance use dysfunction (SUD) prevention, remedy, and restoration providers. To this finish, CMS added a number of growth alternatives for OTPs, together with telehealth protection. Nonetheless, these flexibilities don’t lengthen to SUD remedy offered outdoors an OTP, reminiscent of office-based opioid remedy (OBOT) providers.
Particulars of the brand new protection guidelines are contained within the 2023 Doctor Charge Schedule (PFS) Closing Rule (Closing Rule), and summarized under.
Background and Historical past of Medicare Telehealth Protection of SUD Remedy
Previous to the federal COVID-19 Public Well being Emergency (PHE), to provoke remedy with buprenorphine at an OTP, a practitioner wanted to carry out an entire in-person bodily analysis. The Drug Enforcement Administration (DEA) and the Substance Abuse and Psychological Well being Companies Administrating (SAMHSA) waived this requirement in the course of the PHE, permitting medication-assisted remedy (MAT) practitioners to provoke remedy with buprenorphine through audio-video telehealth and/or audio-only phone communications with out an preliminary in-person analysis (topic to state legislation restrictions). This short-term exemption solely applies to OTP sufferers handled with buprenorphine; it doesn’t apply to new sufferers handled with methadone.
CMS additionally prolonged protection for SUD remedy providers offered through telehealth. Whereas Medicare telehealth providers fall below Part 1834(m) of the Social Safety Act, which usually limits cost for telehealth providers to sufferers positioned in particular kinds of medical settings (originating websites) in largely rural areas, the SUPPORT Act amended Part 1834(m), by eradicating the originating website and geographic limitation for telehealth providers offered to people with a identified or co-occurring psychological well being dysfunction (together with a SUD) delivered on or after July 1, 2019.
In 2020, CMS established a brand new Half B profit class for opioid use dysfunction (OUD) remedy offered by OTPs. The coated profit contains MAT for sufferers with OUD, a number one remedy modality that mixes prescribing FDA-approved remedy (e.g., methadone and buprenorphine) with counseling and different behavioral remedy, to offer an entire particular person strategy.
Subsequently, the Consolidated Appropriations Act of 2021 (CAA) completely eliminated the geographic restrictions and added the affected person’s residence as a qualifying originating website for telehealth providers offered for the prognosis, analysis, or remedy of a psychological well being dysfunction. Below the CY 2022 PFS closing rule, CMS revised the definition of “interactive telecommunication system” to permit using audio-only communications know-how for telemental well being providers below sure circumstances when the beneficiary is positioned at their residence.
New Modifications to Medicare OTP Telehealth Companies
Below the Closing Rule, CMS made the next modifications regarding OTP telehealth providers:
- OTPs can use the OTP consumption add-on code to invoice for the initiation of buprenorphine remedy via two-way interactive audio-video communication know-how, as clinically applicable, and in compliance with all relevant necessities (offered such flexibilities are approved by DEA and SAMHSA on the time service is furnished).
- Audio-only phone calls can be utilized to provoke buprenorphine remedy at OTPs when two-way audio-video communications know-how will not be obtainable to the beneficiary, and all different necessities are met.
- CMS interprets “not obtainable to the beneficiary” to incorporate “circumstances during which the beneficiary will not be able to or has not consented to using units that allow a two-way, audio/video interplay as a result of in every of those situations audio/video communication know-how will not be in a position for use in furnishing providers to the beneficiary.”
- After the initiation of buprenorphine remedy, OTPs can proceed to make use of audio-only phone calls to carry out periodic affected person assessments when two-way audio-video will not be obtainable (offered such flexibilities are approved by DEA and SAMHSA on the time service is furnished). This flexibility might be in place till the tip of CY 2023.
CMS Acknowledged Broad Stakeholder Assist for Telehealth SUD Remedy
In feedback to the brand new guidelines, stakeholders lauded the advantages of two-way audio-video communications know-how used to provoke remedy with buprenorphine. CMS concurred, noting it’s “of crucial significance to people who’ve restricted skill to attend in-person appointments or who’re disincentivized to take action resulting from perceived stigma and worry.” CMS additionally acknowledged that audio-only flexibilities “additional promote fairness for people who’re economically deprived, dwell in rural areas, are racial and ethnic minorities, lack entry to dependable broadband or web entry, or don’t possess units with video capabilities.”
CMS declined to handle feedback regarding points outdoors the scope of the ultimate rule, together with: 1) feedback associated to permitting prescribers to provoke buprenorphine remedy for SUDs with out an in-person analysis in different settings (outdoors of OTPs); 2) coordinating with DEA to create a particular registration for telehealth suppliers below the Ryan Haight Act; and three) growing an add-on code for Contingency Administration.
Whereas the ultimate rule doesn’t lengthen protection to OBOT remedy – which has confirmed a profitable remedy possibility in the course of the COVID-19 PHE – it evidences CMS’s view of know-how as a viable manner to offer life-saving SUD remedy to susceptible beneficiaries.
Need to Study Extra?
For extra data on telemedicine, telehealth, digital care, distant affected person monitoring, digital well being, and different well being improvements, together with the crew, publications, and consultant expertise, go to Foley’s Telemedicine & Digital Well being.
