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Analysis

Pending Opioid Legislation Opens Doors to Telehealth Innovation

By Mandy Roth  
   October 05, 2018

Provisions in the law, which President Trump is expected to sign, would remove certain barriers to telehealth treatment that currently limit the technology's use.

Earlier this week the U.S. Senate passed a bipartisan bill with a 98-1 vote to fight the opioid crisis. With new legislation on the cusp of approval by President Donald J. Trump, it appears significant barriers to treating opioid addicts via telehealth will be removed.

"This legislation delivers multiple wins for telehealth treatment," says telehealth consultant Matthew Rumbaugh, executive director of Telehealth Suite. Rumbaugh has been closely following the legislation and is actively involved in legislative initiatives in Pennsylvania related to telehealth.

Among the changes that will impact telehealth: "geographic restrictions are gone," says Rumbaugh. In addition, "They are no longer going to deny Medicaid coverage for students who are at risk. This also allows the MCOs [managed care organizations] for Medicaid plans know that they're going to have access to funding to support these programs, which then trickles down to allowing the plans and the health systems and these groups to start expanding their services and their reach as pertains to the opioid epidemic."

Treating Opioid Addiction as a Chronic Disease
 

Another important aspect of the new legislation is a provision enabling remote patient monitoring for pediatric populations receiving Medicaid coverage.

"Remote monitoring is one of the strongholds of telehealth," says Thompson H. Boyd, III, MD, FACHE, CHCQM, CPHIMS, CPHM, an internal medicine physician and medical informatics expert who serves as acting medical director of Telehealth Suite.

One of the benefits of remote monitoring, he explains, is that it enables opioid addiction to be treated as a chronic disease. It opens the possibility of deploying many of the same approaches and resources currently used in population health programs to treat opioid patients.

Compared to traditional treatment approaches for opioid addiction, Rumbaugh says that some of the advantages virtual care could offer opioid patients include:

  • Eliminating transportation issues and enhancing access for patients in urban and rural locations
     
  • Providing the insulation of a safe virtual environment
     
  • Providing an opportunity for intervention and contact with the care team 24/7 before a catastrophic event occurs
     
  • Reducing the stigma associated with visiting a rehab facility
     
  • Using an application that employs existing smartphone technology

An appropriate platform could contain video access to healthcare professionals, connections to peers, secure texting with patients and family members involved in care, education, and monitoring capabilities, among other features, Rumbaugh suggests. An article published by mHealthIntelligence.com details the advantages of using telehealth services to treat substance abuse patients via smart phones.

An Area Ripe for Innovation
 

While some entities may be testing the waters with such programs, a large-scale telehealth program for opioid treatment has yet to be deployed, Rumbaugh says.

"It's an area that is ripe for innovation," he says.

The opioid crisis has already had a huge impact on hospitals and healthcare systems. The new legislation opens doors to try new approaches to better manage the problem.

"Existing telehealth technology and [resources] can be adapted and scaled to increase access," says Rumbaugh. "Hospitals will be able to work with groups that can provide additional help and assistance through a telehealth platform working in concert with a MAP or MAT program. That's the beauty of what this bill can do for a health system that wants to expand those services."

Further Information About How New Legislation Impacts Telehealth
 

According to a summary document prepared for Senate staff members, provisions impacting telehealth include:

  • Medicaid substance use disorder treatment via telehealth: This provision directs CMS to issue guidance to states on options for providing services via telehealth that address substance use disorders under Medicaid. It requires guidance to cover state options for federal reimbursement for substance use disorder services and treatment using telehealth including, services addressing high-risk individuals, provider education through a hub-and-spoke model, and options for providing telehealth services to students in school-based health centers.  This section also directs GAO to evaluate children’s access to Medicaid services to treat substance use disorders, including options to improve access through telehealth. Additionally, it directs CMS to issue a report to Congress identifying best practices and potential solutions to barriers to furnishing services to children via telehealth to compare services delivered via telehealth to in-person.
     
  • Beginning July 1, 2019, the bill expands the use of telehealth services for the treatment of opioid use disorder and other substance use disorders. It does so by eliminating certain statutory originating site requirements for telehealth services furnished to Medicare beneficiaries for the treatment of substance use disorders and co-occurring mental health disorders. It would allow payment for those services furnished via telehealth at originating sites, including a beneficiary’s home, regardless of geographic location. A separate facility fee would not be provided if the originating site is the beneficiary’s home.

 

Mandy Roth is the innovations editor at HealthLeaders.


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